Hemodynamic response function description in patients with glioma.

INTRODUCTION: Functional magnetic resonance imaging is a powerful tool that has provided many insights into cognitive sciences. Yet, as its analysis is mostly based on the knowledge of an a priori canonical hemodynamic response function (HRF), its reliability in patients' applications has been questioned. There have been reports of neurovascular uncoupling in patients with glioma, but no specific description of the Hemodynamic Response Function (HRF) in glioma has been reported so far. The aim of this work is to describe the HRF in patients with glioma. METHODS: Forty patients were included. MR images were acquired on a 1.5T scanner. Activated clusters were identified using a fuzzy general linear model; HRFs were adjusted with a double-gamma function. Analyses were undertaken considering the tumor grade, age, sex, tumor location, and activated location. RESULTS: Differences are found in the occipital, limbic, insular, and sub-lobar areas, but not in the frontal, temporal, and parietal lobes. The presence of a glioma slows the time-to-peak and onset times by 5.2 and 3.8 % respectively; high-grade gliomas present 8.1 % smaller HRF widths than low-grade gliomas. DISCUSSION AND CONCLUSION: There is significant HRF variation due to the presence of glioma, but the magnitudes of the observed differences are small. Most processing pipelines should be robust enough for this magnitude of variation and little if any impact should be visible on functional maps. The differences that have been observed in the literature between functional mapping obtained with magnetic resonance vs. that obtained with direct electrostimulation during awake surgery are more probably due to the intrinsic difference in the mapping process: fMRI mapping detects all recruited areas while intra-surgical mapping indicates only the areas indispensable for the realization of a certain task. Surgical mapping might not be the gold standard to use when trying to validate the fMRI mapping process.

The impact after 20 years of an early detection program for severe retinopathy of prematurity in a Latin American city.

Purpose: To evaluate the effects of long-standing early detection program in the incidence and trends of severe retinopathy of prematurity (ROP) in Cali, Colombia. Methods: This was a retrospective cohort study of infants included in an ROP prevention, early detection, and prompt treatment program, from January 01, 2002, to December 31, 2021 (20 years). Infants with gestational age (GA) <37 weeks or birth weight (BW) <2000 g and those with known ROP risk factors were screened. The incidence of severe ROP was calculated, and the average annual percent change (AAPC) was estimated through a joinpoint model. Results: 16,580 infants were screened, with an average GA and BW of 31.4 ± 2.8 weeks and 1526.5 ± 56.7 g, respectively. The incidence of severe ROP was 2.69% (446 cases, 95% confidence interval [95%CI]: 2.45%; 2.95%), with an average annual decrease of - 14% (AAPC, 95%CI: -16.3%; -11.6%) from 13.6% in 2002 to 0.7% in 2021. In infants with GA <32 weeks, the incidence was 5.21%. A significant reduction in the risk of ROP was observed with increasing GA and BW (P < 0.05). Among the cases with severe ROP, 6.5% (29/446) had a GA ≥32 weeks with a maximum of 37 weeks; only 0.4% (2/446) of the detected infants had a BW >2000 g. Conclusion: Awareness and screening as part of the early detection program to prevent ROP has shown a significant decline in the incidence of severe ROP over time. Screening infants with GA <32 weeks or BW <2000 g and preterm infants (<37 weeks) with risk factors may be a feasible decision for resource optimization.

Carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-haematopoietic stem cell transplant: a retrospective cohort study.

BACKGROUND: Risk factors for carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-HSCT have not been thoroughly explored. METHODS: All children with cancer or post-HSCT who developed Enterobacterales bloodstream infections in two cancer referral centres in major Colombian cities between 2012 and 2021 were retrospectively examined. When the infection episode occurred, carbapenem resistance mechanisms were evaluated according to the available methods. Data were divided in a training set (80%) and a test set (20%). Three internally validated carbapenem-resistant Enterobacterales (CRE) prediction models were created: a multivariate logistic regression model, and two data mining techniques. Model performances were evaluated by calculating the average of the AUC, sensitivity, specificity and predictive values. RESULTS: A total of 285 Enterobacterales bloodstream infection episodes (229 carbapenem susceptible and 56 carbapenem resistant) occurred [median (IQR) age, 9 (3.5-14) years; 57% male]. The risk of CRE was 2.1 times higher when the infection was caused by Klebsiella spp. and 5.8 times higher when a carbapenem had been used for ≥3 days in the previous month. A model including these two predictive variables had a discriminatory performance of 77% in predicting carbapenem resistance. The model had a specificity of 97% and a negative predictive value of 81%, with low sensitivity and positive predictive value. CONCLUSIONS: Even in settings with high CRE prevalence, these two variables can help early identification of patients in whom CRE-active agents are unnecessary and highlight the importance of strengthening antibiotic stewardship strategies directed at preventing carbapenem overuse.

Relationship between Spinopelvic Parameters and Hip Function in Patients with Femoroacetabular Impingement at Diagnosis: A Cross-Sectional Study.

Purpose: The aim of this study was to determine correlation between the spinopelvic parameters in sitting and standing positions (sacral slope [SS], lumbar lordosis [LL], spinopelvic tilt [SPT], pelvic incidence [PI], and pelvic femoral angle [PFA]), with hip function assessed using the modified Harris hip scores (mHHs) in patients with symptomatic femoroacetabular impingement (FAI) at diagnosis. Materials and Methods: A retrospective study of 52 patients diagnosed with symptomatic FAI was conducted. Evaluation of the spinopelvic complex in terms of SS, LL, SPT, PI and PFA was performed using lateral radiographs of the pelvis and lumbosacral spine in standing and sitting positions. Assessment of hip function at diagnosis was performed using the mHHs. Calculation of spinopelvic mobility was based on the difference (Δ) between measurements performed in standing and sitting position. Results: The median time of pain evolution was 11 months (interquartile range [IQR], 5-24 months) with a median mHHs of 66.0 points (IQR, 46.0-73.0) at diagnosis. The mean change of LL, SS, SPT, and PFA was 20.9±11.2°, 14.2±8.6°, 15.5±9.0°, and 70.7±9.5°, respectively. No statistically significant correlation was observed between spinopelvic parameters and the mHHs (P>0.05). Conclusion: Radiological parameters of the spinopelvic complex did not show correlation with hip function at the time of diagnosis in patients with symptomatic FAI. Conduct of further studies will be required in the effort to understand the effect of the spinopelvic complex and its compensatory mechanics, primarily between the hip and spine, in patients with FAI before and after hip arthroscopy.

Groin pain of neurological origin as a differential diagnosis of femoroacetabular impingement.

BACKGROUND: To describe the experience in the diagnostic process and treatment of patients with groin pain (GP) of neurological origin due to entrapment of the iliohypogastric (IH), ilioinguinal (IL) and genitofemoral (GF) nerves in a hip preservation clinic. METHODS: Retrospective study of patients with GP of neurological origin confirmed with ultrasound-guided nerve block. Clinical outcomes were reported in 21 cases (age, 53.3 ± 15.9 years) treated with conservative treatment from January to December 2019, and in 9 patients (age 43.7 ± 14.6 years) who underwent neurectomy from January 2015 to December 2019. Pain intensity was assessed with a numerical rating scale (NRS) before starting the diagnostic process (Day 0) and at the end of follow-up. RESULTS: All cases reported pain on groin palpation. Half of these cases also reported a positive FADIR test (flexion, adduction, internal rotation) (15/30). On day 0, the intensity of pain in cases treated with conservative treatment was severe in 19 patients (NRS 7-10) and moderate in 2 (NRS 4-6), with a median improvement of 7 points (interquartile range [IQR] 5.5-8.0) at the end of follow-up (p < 0.001). In neurectomy group, a similar improvement in pain severity was (Day 0: 9 points [IQR 8.0-9.0]; end of follow-up: 0 points [IQR: 0-2.0]; p = 0.002). At the end of the study, 17/21 patients with conservative treatment and 7/9 with neurectomy were pain free or with mild pain (NRS < 3). CONCLUSIONS: In cases with PG of neurological origin, there is a high frequency of false positives in the FADIR test. Our findings suggest that neurectomy is a treatment option for patients in whom conservative treatment fails, providing significant pain relief.

Use of polymyxins for carbapenem-resistant infections in children and adolescents.

Background: Polymyxins are still used in children in some regions due to limited availability of newer antibiotics. Objectives: To describe our experience in a cohort of children who received polymyxins for suspected or confirmed carbapenem-resistant bacterial infections (CRI), and explore potential factors associated with therapeutic success. Methods: Retrospective, observational study in children and adolescents <18 years who received IV polymyxin B or colistin therapy for suspected or culture-documented CRI and were admitted to a high complexity clinic in Cali, Colombia between 1 September 2016 and 22 June 2020. Patients' demographic, clinical and microbiological characteristics were collected and analysed; associations with therapeutic success were explored using univariate and multivariate models. Results: There were 40 episodes of polymyxin use (polymyxin B, n = 34; colistin, n = 6) in 34 patients with a median age of 10 years (IQR 7-15); 65% were male. There were 17 adverse events: 3 (17.6%) neurotoxic and 14 (82.4%) nephrotoxic. Therapeutic success was achieved in 28 episodes (70%), of which 32% (9/28) had adverse events. Therapeutic success decreased by 35% with each additional year of age (OR 0.65; 95% CI 0.49-0.80) and by 7% for every hour that elapsed between the onset of fever and the start of appropriate antibiotic therapy (OR 0.93; 95% CI 0.8-0.97) and increased with concomitant non-carbapenem treatment (OR 6.87; 95% CI 1.04-71.01) and the use of adequate empirical therapy (OR 121.36; 95% CI 2.90-1147.95). Conclusions: Several factors were associated with the therapeutic success of polymyxins, however, more than half of episodes had therapeutic failure or adverse events. Antibiotics with greater efficacy and safety are needed in regions with high rates of CRI.

Etiology and Risk Factors for Admission to the Pediatric Intensive Care Unit in Children With Encephalitis in a Developing Country.

OBJECTIVE: To describe a cohort of pediatric patients with encephalitis and their risk factors for admission to the pediatric intensive care unit (PICU). STUDY DESIGN: Children (<18 years old), with encephalitis evaluated by conventional microbiology and syndromic, multiplex test in cerebrospinal fluid (CSF) between July 2017 and July 2020, were recruited from 14 hospitals that comprise the Colombian Network of Encephalitis in Pediatrics. Multivariate analyses were used to evaluate risk factors associated with the need for PICU admission. RESULTS: Two hundred two children were included, of which 134 (66.3%) were male. The median age was 23 months (IQR 5.7-73.2). The main etiologies were bacteria (n = 55, 27%), unspecified viral encephalitis (n = 44, 22%) and enteroviruses (n = 27, 13%), with variations according to age group. Seventy-eight patients (38.6%) required management in the PICU. In multivariate analysis, factors associated with admission to the PICU were the presence of generalized seizures (OR 2.73; 95% CI: 1.82-4.11), status epilepticus (OR 3.28; 95% CI: 2.32-4.62) and low leukocyte counts in the CSF (OR 2.86; 95% CI: 1.47-5.57). Compared with enterovirus, bacterial etiology (OR 7.50; 95% CI: 1.0-56.72), herpes simplex encephalitis (OR 11.81; 95% CI: 1.44-96.64), autoimmune encephalitis (OR 22.55; 95% CI: 3.68-138.16) and other viral infections (OR 5.83; 95% CI: 1.09-31.20) increased the risk of PICU admission. CONCLUSIONS: Data from this national collaborative network of pediatric patients with encephalitis allow early identification of children at risk of needing advanced care and can guide the risk stratification of admission to the PICU.

Femicide and Attempted Femicide before and during the COVID-19 Pandemic in Chile.

Experts and international organizations hypothesize that the number of cases of fatal intimate partner violence against women increased during the COVID-19 pandemic, primarily due to social distancing strategies and the implementation of lockdowns to reduce the spread of the virus. We described cases of attempted femicide and femicide in Chile before (January 2014 to February 2020) and during (March 2020 to June 2021) the pandemic. The attempted-femicide rate increased during the pandemic (incidence rate ratio: 1.22 [95% confidence interval: 1.04 to 1.43], p value: 0.016), while the rate of femicide cases remained unchanged. When a comparison between attempted-femicide and femicide cases was performed, being a foreigner, having an intimate partner relationship with a perpetrator aged 40 years or more, and the use of firearms during the assault were identified as factors associated independently with a higher probability of being a fatal victim in Chile. In conclusion, this study emphasizes that attempted femicide and femicide continued to occur frequently in family contexts both before and during the COVID-19 pandemic.

Factors Associated With Hospitalization or Intensive Care Admission in Children With COVID-19 in Latin America.

Background: Limited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19. Objective: To describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America. Method: Multicenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children <18 years of age with COVID-19 confirmed by polymerase chain reaction or antigen detection from the nasopharynx were included. Children with multisystem inflammatory syndrome in children (MIS-C) were excluded. Associations were assessed using univariate and multivariable logistic regression models. Results: A total of 1063 children with COVID-19 were included; 500 (47%) hospitalized, with 419 (84%) to the pediatric wards and 81 (16%) to the ICU. In multivariable analyses, age <1 year (Odds Ratio [OR] 1.78; 95% CI 1.08-2.94), native race (OR 5.40; 95% CI 2.13-13.69) and having a co-morbid condition (OR 5.3; 95% CI 3.10-9.15), were associated with hospitalization. Children with metabolic or endocrine disorders (OR 4.22; 95% CI 1.76-10.11), immune deficiency (1.91; 95% CI 1.05-3.49), preterm birth (OR 2.52; 95% CI 1.41-4.49), anemia at presentation (OR 2.34; 95% CI 1.28-4.27), radiological peribronchial wall thickening (OR 2.59; 95% CI 1.15-5.84) and hypoxia, altered mental status, seizures, or shock were more likely to require PICU admission. The presence of pharyngitis (OR 0.34; 95% CI 0.25-0.48); myalgia (OR 0.47; 95% CI 0.28-0.79) or diarrhea (OR 0.38; 95% CI 0.21-0.67) were inversely associated with hospital admission. Conclusions: In this data analysis reported to the SLIPE research network in Latin America, infants, social inequalities, comorbidities, anemia, bronchial wall thickening and specific clinical findings on presentation were associated with higher rates of hospitalization or PICU admission. This evidence provides data for prioritization prevention and treatment strategies for children suffering from COVID-19.

Incidence and risk factors for acute kidney injury associated to surgery for congenital heart disease / Incidencia y factores de riesgo de falla renal aguda asociados a la corrección quirúrgica de cardiopatías congénitas

Abstract Background: Acute kidney injury (AKI) occurs frequently after cardiac surgery for congenital heart disease and it has a great impact on patient´s prognosis. Objective: The aims of this study were to determine the incidence and risk factors for AKI in children undergoing cardiac surgery and its impact on mortality, duration of mechanical ventilation, ICU and total hospital length of stay. Methods: This was a historical cohort study of children 0 - 18 years of age who underwent cardiac surgery between 2012 and 2014. We used the Risk Adjustment for Congenital Heart Surgery-1 (RACHS) scale to evaluate risk of the surgery. AKI was defined in accordance to the Acute Kidney Injury Network (AKIN) criteria. Results: A total of 485 patients were included. AKI occurred in 89 (18.3%) patients during the study period. Risk factors for AKI were age < 2 years, cardiopulmonary bypass (CPB) time > 120 min and RACHS score > 3. AKI increased the mortality risk (OR: 5.82, 95% CI: 2.24-15.10) and the time in mechanical ventilation and ICU stay from 1 to 5 days and 6 to 12 days, respectively. Conclusions: Risk factors for AKI are younger age, higher RACHS score, and time of CPB greater than 120 minutes. AKI increases mortality, days on MV and ICU stay. In the present study AKIN scale allowed us to classify the severity of AKI and it correlated with prognosis after cardiac surgery.

Resumen Introducción: La insuficiencia renal aguda (IRA) ocurre frecuentemente después de las cirugías de cardiopatías congénitas e impacta el pronóstico del paciente. Objetivo: Determinar incidencia y factores de riesgo para IRA en niños sometidos a cirugía de cardiopatía congénita y su impacto en mortalidad, duración de ventilación mecánica, tiempo de hospitalización total y en Cuidados Intensivos (UCI). Métodos: Cohorte histórica de niños entre cero y 18 años sometidos a cirugía cardiaca entre 2012 y 2014. El riesgo de la cirugía fue calculado mediante la escala Risk Adjustment for Congenital Heart Surgery-1 (RACHS). La falla renal fue establecida de acuerdo a la escala de Acute Kidney Injury Network (AKIN). Resultados: Se incluyeron 485 pacientes. 89 pacientes (18.3%) desarrollaron IRA durante el postquirúrgico. Los factores de riesgo para IRA fueron edad < 2 años, tiempo de bypass cardiopulmonar > 120 minutos y escala de RACHS > 3. La ocurrencia de IRA aumento el tiempo de ventilación mecánica de 1 a 5 días, la estancia en UCI de 6 a 12 días y el riesgo de mortalidad (OR: 5.82, 95% IC: 2.24-15.10). Conclusiones: Los factores de riesgo para IRA fueron menor edad, mayor escala de RACHS y de tiempo de bypass. La ocurrencia de IRA aumentó la mortalidad, días en ventilación mecánica y estancia en UCI. En el presente estudio la escala de AKIN permitió clasificar la severidad de AKI y se correlaciono con el pronóstico después de cirugía de cardiopatía congénita.

Lower adherence to a prudent dietary pattern is associated with earlier age at menarche in adolescents from the Growth and Obesity Chilean Cohort Study.

Introduction: Early menarche is associated with obesity, and metabolic and mental health risks, among other diseases. Thus, it is relevant to identify modifiable risk factors of early menarche. Some nutrients and foods have been linked to pubertal timing, but how menarche relates to overall dietary patterns is unclear. Methods: The aim of this study was to analyze the association between dietary patterns and age at menarche in a prospective cohort of Chilean girls from low and middle-income families. We conducted a survival analysis of 215 girls (median = 12.7 years, IQR = 12.2-13.2) from the Growth and Obesity Cohort Study (GOCS) who had been followed prospectively since 4 years of age (2006). Age at menarche and anthropometric measurements were recorded every 6 months since 7 years of age while diet (24-hour dietary recall) was collected for 11 years. Dietary patterns were obtained from exploratory factor analysis. Accelerated Failure Time models adjusted for potential confounding variables were used to study the association between dietary patterns and age at menarche. Results: Girls' median age at menarche was 12.7 years. Three dietary patterns were identified: "Breakfast/Light Dinner," "Prudent" and "Snacking" which explained 19.5% of the diet variation. Girls in the lowest tertile of the "Prudent" pattern had menarche 3 months earlier than girls in the highest tertile (ß: 0.022; 95% CI: 0.003; 0.041). "Breakfast/Light Dinner" and "Snacking" patterns were not associated with age at menarche. Conclusion: Our results suggest that healthier dietary patterns during puberty might be associated with menarche timing. Nevertheless, further studies are required to confirm this result and to clarify the association between diet and puberty.

Validación al español del instrumento Self-Administered Patient Satisfaction Scale (SAPS) para reemplazo total de cadera o de rodilla / Validation of the spanish version of the self-administered patient satisfaction scale (sAPs) for total hip and knee arthroplasty

Introducción: La satisfacción del paciente es un indicador importante al evaluar los resultados clínicos de un reemplazo total de cadera o rodilla. El objetivo de este estudio fue validar al idioma español el instrumento Self-Administered Patient Satisfaction Scale (SAPS) para reemplazo total de cadera o rodilla, y estudiar sus propiedades psicométricas. materiales y métodos: Se realizó un estudio de validación de corte transversal para evaluar el contenido, la consistencia interna y la validez de criterio de la SAPS. Se incluyó a 105 pacientes con reemplazo total de cadera o rodilla. La validez de criterio fue valorada con las escalas WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) y SF-36 (36-Item Short Form Survey). Resultados: Se analizó a 50 pacientes con reemplazo total de cadera y 55 con reemplazo total de rodilla y una mediana de seguimiento de 14 meses (rango intercuartílico, 11-19), con una edad de 71.3 ± 11.6 años; 73,3% (77) eran mujeres. El coeficiente alfa de Cronbach fue de 0,797 indicando una consistencia interna aceptable. La correlación entre las escalas SAPS y WOMAC fue moderada (coeficiente de Spearman 0,488; p <0,05), al igual que con el componente físico de la SF-36 (coeficiente de Spearman 0,525; p <0,05). Conclusión: La versión en español de la SAPS es una herramienta válida y confiable para medir el grado de satisfacción de los pacientes sometidos a reemplazo total de cadera o rodilla, tiene propiedades psicométricas similares a las de la escala original. Nivel de Evidencia: II

Introduction: Patient satisfaction is an important parameter when evaluating clinical outcomes after total hip (THA) or knee (TKA) arthroplasty. The objective of this work was to validate the Spanish version of the Self-Administered Patient Satisfaction scale (SAPS) for THA or TKA, as well as to study its psychometric properties. materials and methods: A cross-sectional validation study was carried out to evaluate the content, internal consistency, and criterion validity of the SAPS scale. A total of 105 subjects who were treated with THA or TKA were included. Criterion validity was assessed with the WOMAC scale (Western Ontario and McMaster Universities Osteoarthritis Index) and SF-36 (Short Form 36 Health Survey). Results: Fifty patients undergoing THA and 55 undergoing TKA were analyzed at a median follow-up of 14 months (Interquartile range, 11-19) after surgery, with a mean age of 71.3 ± 11.6 years; 73.3% (77) were women. Cronbach's alpha was 0.797, indicating an acceptable internal consistency. A moderate correlation was found between the SAPS scale and the WOMAC scale (Spearman's coefficient: 0.488, p <0.05), as well as with the physical component of the SF-36 (Spearman's coefficient: 0.525, p <0.05). Conclusion: The Spanish version of the SAPS scale is a valid and reliable tool to measure patient satisfaction after THA or TKA, with psychometric properties similar to those of the original scale. Level of Evidence: II

Resuperficialización de la rótula en el reemplazo primario total de rodilla: estudio comparativo a dos años de seguimiento / Patellar resurfacing in primary total knee replacement: A comparative study at two years of follow-up

Objetivo: Comparar los resultados funcionales del reemplazo total de rodilla con resuperficialización de rótula o sin resuperficialización, a los dos años de seguimiento. materiales y métodos: Estudio observacional retrospectivo de grupos comparativos de pacientes con osteoartritis sometidos a un reemplazo total de rodilla primario con resuperficialización de rótula o sin este procedimiento, entre enero de 2014 y diciembre de 2016, en dos centros de Colombia. A todos se les colocó una prótesis cementada Optetrak®. La función se evaluó antes de la cirugía y a los dos años mediante las escalas Knee Society Score (KSS), Hospital for Special Surgery (HSS) y Oxford Knee Score (OKS). Resultados:Se incluyeron 206 reemplazos totales de rodilla: 94 (grupo con resuperficialización) y 112 (grupo sin resuperficialización). La media de la edad en la cohorte de estudio era de 66.9 ± 9.7 años y el 76,7% (n = 155) eran mujeres. El tiempo quirúrgico fue más prolongado en el grupo con resuperficialización (mediana 100 min, RIC 90-110) que en el otro grupo (mediana 85 min, RIC 70-90; p <0,001). Aunque se observó una mejoría funcional antes del reemplazo total de rodilla y después, en ambos grupos, el cambio en el KSS clínico, el KSS funcional y el OKS fue mejor en el grupo con resuperficialización (p <0,05). Conclusiones: La resuperficialización de rótula durante el reemplazo total de rodilla se asoció a mejores resultados funcionales a los dos años. No obstante, los pacientes sin resuperficialización también refirieron una mejoría funcional después del reemplazo total de rodilla. Nivel de Evidencia: III

Objective: To compare the functional outcomes of total knee replacement (TKR) with and without patellar resurfacing at two years of follow-up. materials and methods: We carried out a retrospective observational study of patients with osteoarthritis who had undergone TKR with or without patellar resurfacing between January 2014 and December 2016 in two hospitals in Colombia. All patients received a cemented Exactech Optetrak prosthesis. Function was evaluated before surgery and after two years of follow-up with the Knee Society Score (KSS), Hospital for Special Surgery (HSS) and Oxford Knee Score (OKS). Results: A total of 206 TKRs were included, 94 in the group with resurfacing and 112 in the group without resurfacing. The mean age was 66.9 ± 9.7 years and 76.7% (n = 155) were female. Surgical time was longer in the group with resurfacing with a median of 100 minutes (Interquartile range-IQR: 90-110) compared to 85 minutes in the group without resurfacing (IQR: 70-90), p <0.001). Although functional improvement was observed before and after TKR in both groups, the change in clinical KSS, functional KSS, and OKS scores before and after TKR was better in the resurfacing group (p <0.05). Conclusion: Patellar resurfacing during TKR was associated with better functional outcomes at two years of follow-up. However, patients without resurfacing also reported functional improvement after TKR. Level of Evidence: III

Prevalence and risk factors for primary angle-closure disease spectrum: The Colombian glaucoma study.

PURPOSE: To estimate the prevalence and risk factors associated with the primary angle-closure disease spectrum in participants of the Colombian Glaucoma Study. METHODS: A cross-sectional study in subjects older than 50 years with a diagnosis of diabetes mellitus or/and systemic hypertension was conducted in Colombia to estimate glaucoma prevalence. This study included 1749 patients and classified them using gonioscopy into either open-angle or primary angle-closure disease spectrum groups. The patients in the primary angle-closure disease spectrum group were then subdivided into the following categories: primary angle-closure suspect, primary angle-closure, and primary angle-closure glaucoma. A logistic regression model was carried out to identify factors related to the primary angle-closure disease spectrum, including age, sex, height, and refraction. RESULTS: The prevalence of primary angle-closure disease spectrum was 19.3% (338) (95% CI: 17.5-21.2). The prevalence of primary angle-closure suspect, primary angle-closure, and primary angle-closure glaucoma was 8.0% (140) (95% CI: 6.8-9.4), 10.1% (176) (95% CI: 8.7-11.6), and 1.2% (22) (95% CI: 0.8-1.9), respectively. In the multivariate analysis, advanced age (+80 years), female sex, and high hyperopia (p = 0.000, 0.021, and 0.001, respectively) were identified as independent factors related to the primary angle-closure disease spectrum. CONCLUSION: A high prevalence of primary angle-closure disease spectrum was found in Colombian patients with a diagnosis of diabetes mellitus or/and systemic hypertension, especially primary angle-closure and primary angle-closure glaucoma. Age, female sex, and high hyperopia were identified as risk factors for the primary angle-closure disease spectrum.

Biological knowledge-slanted random forest approach for the classification of calcified aortic valve stenosis.

BACKGROUND: Calcific aortic valve stenosis (CAVS) is a fatal disease and there is no pharmacological treatment to prevent the progression of CAVS. This study aims to identify genes potentially implicated with CAVS in patients with congenital bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in comparison with patients having normal valves, using a knowledge-slanted random forest (RF). RESULTS: This study implemented a knowledge-slanted random forest (RF) using information extracted from a protein-protein interactions network to rank genes in order to modify their selection probability to draw the candidate split-variables. A total of 15,191 genes were assessed in 19 valves with CAVS (BAV, n = 10; TAV, n = 9) and 8 normal valves. The performance of the model was evaluated using accuracy, sensitivity, and specificity to discriminate cases with CAVS. A comparison with conventional RF was also performed. The performance of this proposed approach reported improved accuracy in comparison with conventional RF to classify cases separately with BAV and TAV (Slanted RF: 59.3% versus 40.7%). When patients with BAV and TAV were grouped against patients with normal valves, the addition of prior biological information was not relevant with an accuracy of 92.6%. CONCLUSION: The knowledge-slanted RF approach reflected prior biological knowledge, leading to better precision in distinguishing between cases with BAV, TAV, and normal valves. The results of this study suggest that the integration of biological knowledge can be useful during difficult classification tasks.

Complications of Hip Endoscopy in the Treatment of Subgluteal Space Pathologies.

PURPOSE: To assess complications of hip endoscopy in patients with subgluteal space pathologies. METHODS: This was a retrospective study of patients diagnosed with sciatic nerve entrapment (SNE), ischiofemoral impingement (IFI), and rupture of the proximal origin of the hamstring muscles (RHM) who underwent a hip endoscopy from January 2012 to December 2018, after a minimum of 3 months of conservative management without satisfactory results. Complications were documented and graded using the adapted system of Clavien-Dindo. Revision surgeries were classified as treatment failures. Function was evaluated by the Western Ontario McMaster Universities Osteoarthritis Index before and 12 months after the surgical procedure. RESULTS: A total of 97 hips with subgluteal space pathologies were treated with hip endoscopy. This total consisted of 77 hips with SNE, 5 with IFI, 12 with SNE + IFI, and 3 hips with RHM. Minor (Clavien-Dindo I-II) and major (Clavien-Dindo III-V) complications occurred in 7.22% (7) (95% confidence interval 3.54%-14.15%) and 12.37% (12) (95% confidence interval 7.22%-20.39%). Grade II, III, and IV complications were reported in 7.22% (7), 7.22%, and 5.15% (5) hips, respectively. Temporary nerve injury of the sciatic nerve, hematoma, and permanent nerve injury of the posterior femoral cutaneous nerve were the most common grade II, grade III, and grade IV complications, respectively. The revision rate was 6.19% (6) and entrapment of the sciatic nerve was the main cause of reoperation. No statistically significant differences were found between cases with and without complications in the Western Ontario McMaster Universities Osteoarthritis Index scores evaluated before and after surgery (P > .05). CONCLUSIONS: A high rate of complications associated with hip endoscopy were observed in patients with SNE, IFI, and RHM. Sciatic nerve and posterior femoral cutaneous nerve injury were the most frequent events. LEVEL OF EVIDENCE: IV, case series type.

Endoscopic Flexor Hallucis Longus Transfer for Achilles Noninsertional Tendinopathy: Description of Surgical Technique and Functional Outcomes.

Background. The transfer of the flexor hallucis longus (FHL) tendon is an established treatment for replacing a dysfunctional Achilles tendon. Objectives. (1) Describe a new technique for endoscopic FHL transfer for noninsertional Achilles tendinopathy and (2) describe the functional outcomes and complications after endoscopic and open FHL transfer. Materials and Method. Retrospective study of patients who underwent open or endoscopic FHL transfer between 2014 and 2016. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale was used preoperatively and postoperatively to measure the functional results. Results. We included 18 endoscopic FHL transfers and 24 open FHL transfers. The mean age of endoscopic and open procedures was 47.5 years (range 25-77 years) and 61.2 years (range 43-72 years), respectively. An improvement on the average AOFAS of 52.8% (31.9 points) was observed in the endoscopy group during the follow-up from the baseline. The mean improvement in AOFAS score for the open group was 41.4% (24.5 points). Four and 7 cases reported complications in the endoscopy and open FHL transfer groups, respectively. Conclusion. While both procedures were effective in treating noninsertional Achilles tendinopathy, the described arthroscopic treatment led to a greater improvement in the AOFAS score and is slightly less prone to lasting complications.Level of Evidence: Level IV: Case series.

Pain relief and good functional outcomes after hip endoscopy via posterior approach in patients with ischiofemoral impingement.

PURPOSE: Ischiofemoral impingement is considered to be an uncommon and difficult pathology to diagnose with respect to hip pain etiology. The objective was to describe the clinical results of endoscopic lesser trochanter resection via a posterior approach in patients with Ischiofemoral impingement. METHODS: This was a retrospective observational study of consecutive patients with Ischiofemoral impingement, who underwent endoscopic resection of the lesser trochanter via a posterior approach, between 2015 and 2018. Clinical results were evaluated using the ischiofemoral impingement test, long-stride walking test, modified Harris Hip Score (mHHS) and the Oxford scale to assess the strength of the iliopsoas muscle as well as the presence of complications. Preoperative and postoperative ischiofemoral space was measured to assess whether the resection of the lesser trochanter was adequate. RESULTS: 16 hips in 13 patients (mean age: 34.4 ± 12.1 years, 11 women) with a follow-up period between 24 and 59 months were included. Preoperative ischiofemoral space ranged from 6.4 to 22.4 mm, a measure > 17.0 mm was achieved in 15 hips without the presence of pain in IFI test and long-strides walking test. Function improved postoperatively, as reflected by a higher mean mHHS (preoperative: 44.6 ± 21.5, postoperative: 81.2 ± 15.1, p < 0.05). After surgery, the strength of the iliopsoas muscle was not decreased compared to the preoperative measure. Three complications were reported, including two cases that required revision surgery. CONCLUSIONS: Endoscopic resection of the lesser trochanter via posterior approach provides satisfactory outcomes with symptom relief and good functional results in patients with Ischiofemoral impingement. It is important to discuss the benefits and risks when offering this treatment choice. LEVEL OF EVIDENCE: Level IV.