What is the degree of variability in formal training for pediatric orthopedic surgeons performing scoliosis surgery? / ¿Cuál es el grado de variabilidad en la educación formal de los cirujanos ortopédicos pediátricos que realizan intervenciones quirúrgicas de escoliosis?

Abstract: Introduction: although pediatric orthopedic surgeons worldwide perform scoliosis surgery, the training received is variable and poorly understood. By surveying the European Pediatric Orthopedic Society (EPOS) and the Sociedad Latinoamericana de Ortopedia (SLAOTI), we aim to characterize this variability. Material and methods: in 2021, we distributed an anonymous online questionnaire to EPOS and SLAOTI. Results: 43% EPOS and 22% SLAOTI perform scoliosis procedures (p < 0.05). 18% EPOS and 2% SLAOTI performed > 35 procedures annually (p < 0.05). 70% EPOS and 27% SLAOTI received formal training in spinal deformity surgery (p < 0.005). Conclusions: results show significant differences in training and performance of scoliosis procedures between societies.

Resumen: Introducción: aunque muchos cirujanos ortopédicos pediátricos alrededor del mundo realizan cirugías para la escoliosis, el entrenamiento es variable y poco conocido. A través de encuestar a la Sociedad Europea de Ortopedia Pediátrica (EPOS) y a la Sociedad Latinoamericana de Ortopedia (SLAOTI) queremos caracterizar esta variabilidad. Material y métodos: distribuimos un cuestionario anónimo en 2021 a los miembros de EPOS y SLAOTI. Resultados: realizan las cirugías de escoliosis 43% de EPOS, en comparación con 22% de SLAOTI (p < 0.05); 18% de EPOS realizó > 35 cirugías al año, en comparación con 2% de SLAOTI (p < 0.05); 70% de EPOS y 27% de SLAOTI recibieron capacitación formal en cirugía de deformidades de la columna (p < 0.005). Conclusiones: los resultados de este estudio subrayan las diferencias en el entrenamiento de las cirugías de escoliosis entre diferentes sociedades.

What is the degree of variability in formal training for pediatric orthopedic surgeons performing scoliosis surgery?

INTRODUCTION: although pediatric orthopedic surgeons worldwide perform scoliosis surgery, the training received is variable and poorly understood. By surveying the European Pediatric Orthopedic Society (EPOS) and the Sociedad Latinoamericana de Ortopedia (SLAOTI), we aim to characterize this variability. MATERIAL AND METHODS: in 2021, we distributed an anonymous online questionnaire to EPOS and SLAOTI. RESULTS: 43% EPOS and 22% SLAOTI perform scoliosis procedures (p < 0.05). 18% EPOS and 2% SLAOTI performed > 35 procedures annually (p < 0.05). 70% EPOS and 27% SLAOTI received formal training in spinal deformity surgery (p < 0.005). CONCLUSIONS: results show significant differences in training and performance of scoliosis procedures between societies.

INTRODUCCIÓN: aunque muchos cirujanos ortopédicos pediátricos alrededor del mundo realizan cirugías para la escoliosis, el entrenamiento es variable y poco conocido. A través de encuestar a la Sociedad Europea de Ortopedia Pediátrica (EPOS) y a la Sociedad Latinoamericana de Ortopedia (SLAOTI) queremos caracterizar esta variabilidad. MATERIAL Y MÉTODOS: distribuimos un cuestionario anónimo en 2021 a los miembros de EPOS y SLAOTI. RESULTADOS: realizan las cirugías de escoliosis 43% de EPOS, en comparación con 22% de SLAOTI (p < 0.05); 18% de EPOS realizó > 35 cirugías al año, en comparación con 2% de SLAOTI (p < 0.05); 70% de EPOS y 27% de SLAOTI recibieron capacitación formal en cirugía de deformidades de la columna (p < 0.005). CONCLUSIONES: los resultados de este estudio subrayan las diferencias en el entrenamiento de las cirugías de escoliosis entre diferentes sociedades.

The effect of femoral shortening in the treatment of developmental dysplasia of the hip after walking age.

PURPOSE: The optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is controversial. High tension forces after hip reduction increase the pressure on the femoral head, potentially causing avascular necrosis. Femoral shortening (FS) is commonly used as a means to decrease the pressure on the femoral head. We examined the effect of FS on the outcomes of patients with late-presenting DDH. METHODS: A total of 645 hips of a late-presenting DDH cohort treated with open reduction and iliac osteotomies were retrospectively reviewed; 328 hips had a FS performed (FS+) and 317 (FS-) had not. The mean age was 3.9 years (sd 1.55). We classified the hips with the Tönnis and International Hip Dysplasia Institute (IHDI) methods; and the Pediatric Outcomes Data Collection Instrument (PODCI), Iowa Hip Score (IHS) and Severin classification as outcome measurements. RESULTS: The FS- group had higher scores in PODCI (median 95 points; interquartile range (IQR) 78 to 91) and IHS (median 91 points; IQR 64 to 88) than the FS+ group (PODCI: median 94 points; IQR 69 to 89 points; IHS: median 89 points; IQR 62 to 87). The mean Severin scores were similar (FS- 2.65; FS+ 2.5; p = 0.93) but the FS- group had higher rates of good and excellent outcomes (FS- 56%; FS+ 41%; p < 0.00001) and lesser dislocation rates (FS- 6%; FS+ 14%; p = 0.16). CONCLUSION: Although FS should be used when a hip cannot be reduced without undue tension, our results indicate that this procedure is not necessarily related to a better outcome. LEVEL OF EVIDENCE: Therapeutic, Level III.

Outcomes following open reduction for late-presenting developmental dysplasia of the hip.

PURPOSE: Patients with late-presenting developmental dysplasia of the hip (DDH) are more likely to require an open reduction. Since many developing countries do not have mandated screening, there continues to be a relatively high incidence of late-presenting DDH. We report the clinical and radiographic outcomes of open reduction in a series of patients who presented late. PATIENTS AND METHODS: This was a retrospective review of 712 hips in 645 patients that underwent open reduction, alone or in combination with a pelvic osteotomy. In all, 91 hips had open reduction alone and 621 had open reduction and pelvic osteotomy. Femoral shortening was performed in 221 hips. The mean age at the time of surgery was 2.1 years (1 to 6.5) and the mean follow-up time was 9.3 years (6 to 14). We used the Children's Hospital Oakland Hip Evaluation Score (CHOHES) to determine functional outcomes and the Severin classification was used to evaluate radiographic outcomes. The rate of avascular necrosis (AVN) and the need for a reoperation were also recorded and analyzed. RESULTS: In all 80% (570 hips) had good radiographic outcomes (Severin type I or II) and 87% had a CHOHES score of > 90 at final follow up. There was a 14% rate of AVN and only a 2% rate of redislocation. Better radiographic outcomes and lower reoperation rates were seen with patients who underwent both an open reduction and pelvic osteotomy. A trend was observed towards worse outcomes in older patients. CONCLUSIONS: There was a high rate of good clinical and radiographic outcomes at a minimum six-year follow-up in patients with late-presenting DDH who underwent open reduction. Those who underwent open reduction in combination with a pelvic osteotomy had a higher rate of good radiographic outcomes and a lower rate of complications, particularly reoperation.

Outcome and toxicity of intensity modulated radiotherapy with simultaneous integrated boost in locally advanced non-small cell lung cancer patients.

PURPOSE: The aim of this study was to assess the feasibility and treatment outcome of intensity modulated radiation therapy with simultaneous integrated boost (SIB-IMRT) in locally advanced non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS: A total of 64 NSCLC patients with stage IIB (3%), IIIA (36%), and IIIB (61%) were treated with concomitant (N = 47; 73%) or sequential (N = 9; 14%) chemotherapy between February 2009 and January 2014. Eight patients (13%) received RT alone. All patients received the same irradiation scheme using IMRT: prophylactic dose for mediastinum was 56 Gy at 1.65 Gy/fraction and SIB to macroscopic disease up to 68 Gy at 2 Gy/fraction. RESULTS: The median follow-up was 16 months (range, 1-70 months). The overall survival rate for all patients was 79% after 1 year and 46% after 2 years. Disease-free survival (DFS) was 81 and 45% after 1 and 2 years, respectively, resulting in a median DFS of 16 months. Multivariate analysis showed a statistically significant association between stage IIIB patients and a higher risk of mortality (HR 2.11; P = 0.019). In addition, T4 stage associated with higher risk of recurrence (HR 2.23; P = 0.024) while concomitant chemoradiation was associated with lower risk of any recurrence (HR 0.34; P = 0.004) No patient experienced grade ≥3 esophagitis and only 6 cases (9%) had grade 3 pneumonitis. Only having a higher lung volume was associated with higher risk of pneumonitis in the multivariate analysis (HR 16.21; P = 0.022). CONCLUSION: This study in advanced NSCLC patients shows that SIB-IMRT is an effective technique with acceptable toxicity, also when combined with chemotherapy.

A Scheduled Program of Molecular Screening for Epstein-Barr Virus Decreases the Incidence of Post-transplantation Lymphoproliferative Disease in Pediatric Liver Transplantation.

This is a cohort, retrospective, comparative study of all liver transplant recipients from a single center, from May 1998 to July 2015. Patients were divided into two groups according to the type of Epstein-Barr viral load monitoring. For group I (1998-2007), polymerase chain reaction (PCR) was not available or it was only qualitative with limited access. For group II (2008-2015), we used periodically scheduled quantitative PCR in plasma and leukocytes, with aggressive tapering of immunosuppression as soon as viral replication was detected. Ninety-eight recipients were included, 41 (41.8%) were Epstein-Barr virus (EBV) - seronegative before liver transplantation (LT). EBV replication was confirmed in 74 patients (75.5%), being more frequent in seronegative (87.8%) than seropositive patients (66.6%). Eight recipients (8.1%) developed post-transplantation lymphoproliferative disorder (PTLD) on average at 14.3 months post-LT, seven of eight were <3 years at LT, four of eight were D+/R- for EBV, and all had post-LT EBV replication confirmed by PCR. PTLD was classified as lymphoma (n = 4), polymorphic polyclonal (n = 3), and lymphoid hyperplasia (n = 1). Five patients died, and three cleared PTLD after immunosuppression tapering or interruption. There were no significant differences in the etiology, age at LT (5.6 vs. 7.3 years, P = .069), patients <4 years (53.2% vs. 35.3%, P = .103), or EBV seronegative recipients (44.7% vs. 37.3%, P = .54); however, the incidence of PTLD decreased from 14.9% to 1.9% (P = .026), and graft rejection from 51.1% to 29.4% (P = .039). One- and 5-year patient survival rates were 94.7% and 85%, respectively, with no differences between groups. This strategy dramatically decreased the incidence of PTLD (14.9% vs. 1.9%), without increasing the incidence of rejection; therefore, we recommend that it should be used in the follow-up of all pediatric LT recipients.

Evidencia de cambios clínicos y radiográficos en implantes oseointegrados de superficie maquinada y modificada, 3-12 meses de seguimiento / Evidence of clinical and radiographic changes in machined and modified surface osseointegrated implants. 3 to 12 months follow up

En este estudio se realizó una evaluación clínica y radiográfica entre un grupo de pacientes con implantes de superficie maquinada y otro grupo con superficie modificada para determinar si existe alguna diferencia significativa que justifique la utilización de una u otra superficie; para ello se trabajó con dos tipos de implantes de la casa comercial Lifecore®, un grupo con 30 implantes de superficie maquinada o lisa (SuperCAT®) y 30 implantes de superficie modificada o rugosa (RBM®), de conexión externa, tipo tornillo, para la restauración de diente único. El procedimiento quirúrgico se realizó de acuerdo con las recomendaciones del fabricante y a los seis meses se realizó la cirugía de destape y se colocó una restauración temporal. Se siguieron los parámetros de Roos y colaboradores (1997) para la evaluación clínica y radiográfica. Se obtuvo el 100% de oseointegración de los implantes para ambos grupos. La pérdida ósea promedio fue de 0,78 mm. No se encontraron diferencias estadísticamente significativas en la evaluación clínica y radiográfica entre los dos grupos de implantes de superficie maquinada o modificada para la restauración de diente único.

The aim of this study is to undertake a clinical and radiographic evaluation between two different patient groups: machined versus modified surface, to find out if there is statistically significant difference that support the use of implants with different surface properties. Sixty screw, external hex connection implants were examined: one group with 30 machined surface implants (SuperCAT®), and a second group with 30 implants with modified surface (RBM®), for restoring a single tooth. The surgical procedure was performed according with the manufacturer’s protocol. After six months the second phase surgery was performed and the temporary restoration was placed. At this point, the first radiographic evaluation was made. The Roos et al (1997) parameters were followed for the clinical and radiographic evaluation. A 100% of osseointegration was accomplished in both groups. The average marginal bone loss was 0.78 mm, without significant differences between the groups. All implants were reported as success grade 1, with no complications. There are not significant differences between the two groups of machined and modified implant surfaces for single tooth restoration.

Laparoscopic diagnosis and treatment of an acute epiploic appendagitis with torsion and necrosis causing an acute abdomen.

Acute epiploic appendagitis is not as rare as previously thought; but, since the presenting signs and symptoms are not specific, preoperative diagnosis has been rarely made. At the present time, a laparoscopic exploration of the peritoneal cavity will establish the correct diagnosis, and the treatment can be provided during the same procedure. Herein, a case of a 63-year-old female patient with acute abdominal syndrome caused by a necrotic epiploic appendix that was successfully diagnosed and treated laparoscopically is described. A review of the literature is made, as well.

Phytogrowth-inhibitory and antifungal constituents of Helianthella quinquenervis.

Investigation on the roots of Helianthella quinquenervis (Hook.) A. Gray (Asteraceae), led to the isolation of one new benzofuran (6-methoxy-tremetone (1)) and a new prenylacetophenone (4-beta-D-(glucopyranosyloxy)-3-[3-methoxy-trans-isopenten-1 -yl] acetophenone (3)). In addition, 6-hydroxy-3-methoxytremetone (2), encecalin (6), euparin (5), demethylencecalin (4), and angelic acid were obtained. Structural assignments of the isolated compounds were based on spectroscopic and spectrometric analysis. Natural products 1-4 showed marginal cytotoxicity against three human tumor cell lines [MCF-7, A-549, and HT-29]. Compounds 4 and 6 inhibited the radicle growth of Amaranthus hypochondriacus and Echinochloa crusgalli. Furthermore, substances 4-6 exhibited antifungal activity against Trichophyton mentagrophytes.