How will digitalisation affect patient treatment in arthroplasty? Part I: Intraoperative aspects

BackgroundAfter the coronavirus disease 2019 (COVID-19) became a pandemic, the World Health Organization declared it to be a public health emergency. The population aged >of 18 years in Bingol province is 72766 and constitutes 25.8% of the entire population. This study aimed to examine the epidemiological characteristics of < 18-year-old patients with COVID-19 in Bingol Province.MethodsIn this study 1431 people aged <18 who tested positive on reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 in Bingol province between March and December 2020 were studied.The necessary institutional permission and ethics committee approval were obtained to conduct the study. The independent variables of the study were age, gender and place of residence, whereas the dependent variable was the development of pneumonia. Descriptive data were expressed as numbers and percentages, and Chi-Square test was used for statistical analysis. P < 0.05 was considered statistically significant.ResultsThe median age of the study patients was 14 (0-17) years. Of the patients, 99.8% did not have any comorbidity and 96% presented with a good clinical condition. Of the patients, 91.1% were home-isolated and 6.9% developed pneumonia. Pneumonia developed at significantly higher rate in the age groups of 0-4 and 5-9 years compared with other age groups (p = 0.004). There was no significant difference in the development of pneumonia according to gender and comorbidity (p > 0.05).ConclusionsThe rate of pneumonia development was low in the study group. The clinical condition of most of the patients was good, and they isolated at home. Pneumonia developed at a higher rate in younger patients.Key messages COVID-19 has a milder prognosis in patients aged<18 years.Among the patients aged <18 years, pneumonia develops at a higher rate in younger patients.

The combined technique (simultaneous use of a stent retriever and contact aspiration) is widely used for mechanical thrombectomy to treat acute large-vessel occlusions, but its clinical benefits remain unclear. We compared the efficacy and safety of different vessel-recanalization strategies on clinical outcomes across age groups. We analyzed 301 consecutive patients with internal carotid or middle cerebral artery occlusions. Between January 2017 and March 2021, 145 patients underwent single-device mechanical thrombectomy (stent retriever or contact aspiration) as the first-line strategy. Between April 2021 and December 2023, the combined technique was used as the first-line strategy in 96 patients. The modified first-pass effect (Thrombolysis in Cerebral Infarction grade ≥2b), final reperfusion outcomes, and functional outcomes were compared between strategy groups in patients <75 years and ≥75 years. In patients aged <75 years, the modified first-pass effect rate was significantly higher in the first-line combined-technique group than in the first-line single-device group (68.1% vs. 38.1%, p = 0.033), but favorable functional outcomes were similar. In patients ≥75 years, the first-line combined-technique group showed higher modified first-pass effect rates (61.3% vs. 42.7%, p = 0.03) and more frequent favorable functional outcomes than the first-line single-device group (31.3% vs. 13.4%, p = 0.0079). Thus, when performing mechanical thrombectomy for acute large-vessel occlusions, the combined technique should be used as a first-line strategy in older patients, as it is associated with more favorable functional outcomes than a first-line single-device strategy. In contrast, the favorable outcome rate in younger patients does not appear to differ by strategy.

P-57: Young women and assisted reproduction outcome: A conundrum

Higher Rate of Early Revision Following Primary Total Knee Arthroplasty in Patients Under Age 55: A Cautionary Tale

Background: Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) have shown good clinical outcomes in primary avascular necrosis of the humeral head (PANHH) both in short and long terms. The purpose of this study was to assess the complications, the clinical and radiological outcomes of shoulder arthroplasty in young patients with PANHH. Methods: One hundred and twenty-seven patients aged under 60 years old and suffering from PANHH were operated with arthroplasty. Patients were assessed clinically and radiographically before surgery with a minimum of 2 years of follow up (FU). Results: HA was performed on 108 patients (85%). Two patients were revised for painful glenoid wear after 2 and 4 years. TSA was performed on 19 patients (15%). Five TSA had to be revised for glenoid loosening (n = 4) or instability (n = 1). Revision rate was 26% with TSA and 2% with HA. There were no significant differences between HA and TSA in terms of clinical outcomes. Conclusions: With a mean FU of 8 years, HA and TSA improved clinical outcomes of patients with PANHH. HA revisions for painful glenoid wear were rare (2%). The revision rate was excessively high with TSA (26%).

This was a retrospective study of all patients with a diagnosis of lentigo maligna or lentigo maligna melanoma at 50 years of age or younger at the time of their first diagnosis in two Australian tertiary centres. The low recurrence rate in younger patients in this study warrants further investigation. Early diagnosis in young patients is crucial to allow early treatment and lifestyle changes to reduce actinic damage and subsequent development of further melanomas.

ObjectivesThe purpose of this study was to compare the efficacy of femoral neck system (FNS) and cannulated screws with a medial plate (CSMP) for Pauwels type III femoral neck fractures in young adults.MethodsIn this retrospective analysis, 70 patients aged 18–65 with Pauwels type III femoral neck fractures were divided into two groups according to internal fixation: 37 in the FNS group and 33 in the CSMP group. Postoperative complications and functional outcomes were mainly studied.ResultsThe mean follow-up was 25.3 ± 3.7 months. The FNS group exhibited significantly shorter fluoroscopy time, less blood loss, and shorter surgical time than the CSMP group (all P < 0.001). The CSMP group had a shorter fracture union time than the FNS group (P = 0.032). The length of femoral neck shortening at 6-, 12-, and 18-months was significantly lower in the CSMP group (all P < 0.05). Harris Hip Score (HHS) at 6 months was higher in the CSMP group (P = 0.042). However, no significant differences were observed between the two groups regarding the length of femoral neck shortening at 3 months or Harris Hip Score (HHS) at 3-, 12-, and 18 months (all P > 0.05). The VAS scores at 18 months showed no significant difference between the two groups (P = 0.247). Additionally, no significant differences were noted in other complications. There is a significant difference in the Harris Hip Score at 18 months between the femoral neck shortening and the non-shortening groups (P < 0.001). Logistic regression analysis identified fracture comminution (OR = 7.764, 95% CI 1.928–31.258) as a risk factor for developing femoral neck shortening.ConclusionFNS and CSMP demonstrated similar long-term functional outcomes and complication rates in young patients with Pauwels type III femoral neck fractures. CSMP was superior in promoting bone healing and minimizing femoral neck shortening. More significant femoral neck shortening was correlated with inferior hip functional outcomes. Fracture comminution posed a risk for the development of femoral neck shortening in these cases.

Patients Receiving a Primary Unicompartmental Knee Replacement Have a Higher Risk of Revision but a Lower Risk of Mortality Than Predicted Had They Received a Total Knee Replacement: Data From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man

Although little improvement has been made in the survival rate among young cancer patients over recent decades, whether they have achieved a good death has never been systematically explored. We aimed to clarify whether young cancer patients (aged 20-39years) have achieved a good death, and compare their achievement with that of middle-aged patients (aged 40-64years). We analyzed combined data of three nationwide, cross-sectional surveys of families of cancer patients who died at inpatient hospices in Japan (2007-2014). We measured 10 core items of the Good Death Inventory (GDI) short-version on a 7-point scale, and calculated rates of "agree/absolutely agree" and the mean scores. We analyzed 245 and 5140 responses of families of young and middle-aged patients, respectively. Less than 60% of families of young patients reported "agree/absolutely agree" regarding 9 items, which included "feeling that one's life was completed" in 44 (18%; 95% confidence interval (CI) = 14-23%), "being independent in daily life" in 48 (20%; 95% CI = 15-25%), and "being free from physical distress" in 103 (42%; 95% CI = 36-48%) young patients. Young patients were significantly less likely to feel "one's life was completed" (mean = 3.3 (standard deviation = 2.0) vs. 3.8 (1.9), respectively; effect size (ES) = 0.29; adjusted p value = 0.000) and "not being a burden to others" (3.1 (1.5) vs. 3.5 (1.6), respectively; ES = 0.24; adjusted p value = 0.010) than the middle-aged. Overall, young cancer patients did not achieve a good death. Future efforts are needed to improve the quality of palliative care for young patients, focusing on psychosocial/spiritual suffering.

Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults in Western countries. Fludarabine-based regimens demonstrate higher response rates in younger patients but have a significant risk of infection and are thus poorly tolerated by older, frail patients. Anti-CD20 monoclonal antibodies have added to the efficacy of chemotherapy in CLL. Obinutuzumab is a potent Type II anti-CD20 monoclonal antibody with enhanced antibody-dependent cellular toxicity and direct cell death compared with rituximab. In Phase I studies, infusion reactions and neutropenia were the predominant toxicities. Phase II studies demonstrated efficacy both as a single agent and in combination with chemotherapy in patients with CLL. The CLL11 trial was a Phase III randomized trial of chlorambucil alone or with either obinutuzumab or rituximab in elderly, unfit patients. Progression-free survival (the primary end point) was 26.7 months for patients receiving obinutuzumab plus chlorambucil versus 16.3 months for those receiving rituximab plus chlorambucil and 11.1 months for those receiving chlorambucil alone (P<0.001). Overall survival was improved for patients receiving obinutuzumab plus chlorambucil versus chlorambucil alone (P=0.002). This trial led to the US Food and Drug Administration (FDA) approval of obinutuzumab in this patient population.

This study reports on the demographic features, clinico-pathological results and prognoses of patients aged less than 36 years diagnosed with non-small cell lung cancer (NSCLC). This is an observational study of patients with primary NSCLC who had a surgical procedure at a tertiary thoracic surgery centre in Turkey. Data collected were age, gender, history of smoking, symptoms, postoperative histopathological diagnosis, stage, surgical procedure and survival. Of the 31 patients in the study, 27 were male (87%) and the median age was 32 years (10-35 years). Nineteen patients were smokers (61.2%). The most common presenting symptom was cough (n = 23, 67.7%). Histopathological diagnosis was squamous cell carcinoma (SCC, n = 17), adenocarcinoma (n = 12), lymphoepithelioma-like carcinoma (n = 1) and undifferentiated carcinoma (n = 1). Staging of the 17 patients with SCC (58.8%) was stage I and II (n = 10, 58%), and stage III (n = 7, 41%). Staging of the 13 patients with adenocarcinoma was stage IV (n = 2, 16%) and stage III patients (n = 8, 66%). Follow-up data were available on 22 patients (71%) and showed a median survival of 17.2 months. Two and 5-year survival rates were 54.5% and 45.5%, respectively. SCC comprised a relatively high proportion of NSCLC in these younger patients. Aggressive multimodality treatment may achieve satisfactory 2- and 5-year survival rates in young patients with NSCLC who usually present with advanced disease.

Uncertainty persists on the best treatment for patients with obstructive hydrocephalus: endoscopic third ventriculostomy (ETV) or shunt, particularly in the younger age groups. We performed decision analysis for quality of life (QOL) outcomes comparing these two procedures. Frequency of outcome events for ETV was obtained from the Canadian Pediatric Neurosurgery Study Group (368 patients) and for shunts from two prospective randomized trials, the Shunt Design Trial and the Endoscopic Shunt Insertion Trial (647 patients combined). Quality-adjusted life year (QALY) estimates for various outcomes were obtained from the literature. Decision analysis was performed at 1 year of follow-up for specific age groups, e.g., <1 month, 1-6 months, etc. Failure from cerebrospinal fluid (CSF) diversion from either procedure was a function of age with higher failures rates in younger patients. Expected QALY at 1 year were marginally higher for ETV for all age groups, but the outcomes were similar enough to be regarded as equivalent. The results, however, were highly sensitive to the assigned health utility value estimates for patients who are well with a functioning ETV or shunt and the severe complication rate from ETV. Age is a major determinant of outcome from CSF diversion with worse outcomes in young patients. QALY estimates for either ETV or shunt are similar at 1 year.

Background: Tonsillectomy remains one of the most frequently performed ENT procedures, yet postoperative complications continue to influence recovery, patient safety, and resource utilization. Understanding the pattern of early and delayed complications helps refine perioperative practices and improve outcomes. Aim: To evaluate the early and delayed postoperative complications following tonsillectomy and determine their association with demographic and clinical variables. Methods: A prospective observational study was conducted among 50 patients aged 8–30 years undergoing tonsillectomy by the dissection and snare method. Baseline data, preoperative symptoms, tonsillar hypertrophy grade, early complications (≤24 hours), and delayed complications (up to 6 months) were recorded. Statistical analysis was performed using the Chi-square test, with p < 0.05 considered significant. Results: Most participants belonged to the 11–20-year group (74%), and females constituted 56%. Odynophagia (88%) and throat pain (84%) were the most common preoperative symptoms. Grade III tonsillar hypertrophy predominated (46%). Early complications were frequent, with oropharyngeal pain (82%), uvular edema (24%), and referred otalgia (22%) being the most common. Reactive hemorrhage occurred in 6%. Delayed complications included secondary hemorrhage (8%) and infection (6%), while no cases of tonsillar remnants or postoperative voice change were observed. Age showed a significant association with both early and delayed complications (p = 0.04), with higher rates in younger patients. Gender and tonsillar grade showed no statistically significant correlation. Conclusion: Oropharyngeal pain and uvular edema were the predominant early postoperative events, while secondary hemorrhage represented the most frequent delayed complication. Younger age groups exhibited higher susceptibility to postoperative morbidity. Recommendations: Strengthening preoperative counselling for younger patients, standardising analgesic protocols, ensuring meticulous surgical technique, and implementing structured postoperative monitoring may reduce complication rates. Regular auditing of outcomes is recommended to enhance patient safety and refine clinical practice.

Mitral Annular Calcium Causing Mitral Stenosis

Evaluate the outcome of induction and postremission therapy in adults younger than 60 years with normal cytogenetics acute myeloid leukemia (AML). In 490 patients, induction included cytarabine and daunorubicin (AD) or cytarabine and escalated doses of daunorubicin and etoposide +/- PSC-833 (ADE/ADEP). Intensification included one cycle of high-dose cytarabine (HDAC) followed by etoposide/cyclophosphamide and mitoxantrone/diaziquone (group I), three HDAC cycles (group II), four intermediate-dose cytarabine (IDAC) or HDAC cycles (group III), or one HDAC/etoposide cycle and autologous stem-cell transplantation (ASCT; group IV). Of 350 patients receiving AD, 73% achieved complete remission (CR), compared with 82% of 140 receiving ADE/ADEP (P = .04). Splenomegaly was associated with a lower CR rate (P < .001), and ADE/ADEP, with a higher CR rate in younger patients (P = .005). The 5-year disease-free survival (DFS) rate was 28% each for intensification groups I and II, compared with 41% and 45% for groups III and IV, respectively (P = .02). The 5-year cumulative incidence of relapse (CIR) was 62% and 67% for groups I and II, respectively, compared with 54% and 44% for groups III and IV, respectively (P = .049). The type of postremission intensification remained significant for DFS and CIR in multivariable analysis. In younger adults with normal cytogenetics AML, splenomegaly predicts a lower CR rate, and the postremission strategies of either four cycles of I/HDAC or one cycle of HDAC/etoposide followed by ASCT are associated with improved DFS and reduced relapse compared with therapies that include fewer cycles of cytarabine or no transplantation.