The aim of this study was to determine whether the use of analgesia and sedation (AS) as opposed to general anesthesia (GA) for closed reduction and spica casting of children with severe developmental dysplasia of the hip (DDH) influenced the long-term incidence of avascular necrosis (AVN). In a prospective, randomized, single-blinded clinical trial we investigated 100 pediatric patients with DDH type IIIa, IIIb, and IV (according to Graf classification), who were randomly assigned into the group receiving AS, and the group receiving GA. Baseline demographics, splint duration, and type of DDH were carefully assessed. The presence of AVN was assessed at the follow-up visits at 1 and 7 years after the end of treatment. The AS-group consisted of 50 patients (46 girls) with 76 hips affected ( = 11/Type-IIIa, = 32/Type-IIIb, and = 33/Type-IV). The GA-group consisted also of 50 patients (44 girls) with 78 hips involved ( = 15/Type-IIIa, = 34/Type-IIIb, and = 29/Type-IV). At 7-years follow-up, AVN was diagnosed in 9 of 154 hips (5.8%), 5 hips in the AS-group and 4 hips in the GA group. The logistic regression model showed no significant difference in AVN incidence between the AS and GA groups at 7-years follow-up ( = 0.27). The multivariate regression analysis showed that neither the type of DDH nor the age at diagnosis influenced the incidence of AVN ( = 0.48 and = 0.28, respectively). Splint duration was identified as the only significant factor for the long-term incidence of AVN in the treatment of severe DDH. For every month of longer splint duration, the odds of AVN at 7-years follow-up increased by a factor of 3.81 (95%: 1.35-13.73, = 0.02). Closed reduction and spica casting of children with severe DDH under AS can be considered a feasible alternative to management under GA. All efforts must be made to diagnose patients with DDH as early as possible and shorten the duration of splint treatment to prevent the development of AVN. Level of Evidence. Level II-1.
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http://dx.doi.org/10.3389/fped.2022.850605 | DOI Listing |
Eur Respir J
December 2024
Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.
Rationale: Adherence to Continuous Positive Airway Pressure (CPAP) for Obstructive Sleep Apnoea (OSA) continues to be low with high termination rates. Alternative therapies to CPAP are needed.
Objectives: To compare objective adherence to CPAP and Mandibular Advancement Splints (MAS) and to evaluate their effectiveness.
Front Microbiol
November 2024
Jiangsu Academy of Agricultural Sciences, Nanjing, China.
Introduction: Aerobic composting is an effective method for utilizing chicken manure. However, its low carbon to nitrogen (C/N) ratio leads to slow heating and short high-temperature phases, which reduce composting efficiency and product quality.
Methods: To address this issue, splinted mushroom cultivation residues were added to adjust the C/N ratio, and exogenous thermophilic composting strains were introduced to increase composting temperature.
J Biomed Mater Res B Appl Biomater
December 2024
J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Luskin Orthopaedic Institute for Children in Alliance With UCLA, Los Angeles, California, USA.
Severe infantile tracheobronchomalacia (TBM) is often treated with invasive surgery and fixed-size implants to support the trachea during respiration. A novel 3D-printed extra-luminal splint has been developed as a flexible and bioresorbable alternative. Therefore, the goal of the present study was to use an in vitro breathing simulator model to comprehensively evaluate the structural stiffness and failure modes of two sizes of a novel bioresorbable 3D-printed splint design under a range of physiological degradation conditions.
View Article and Find Full Text PDFJ Emerg Trauma Shock
August 2024
Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India.
Introduction: Prehospital capabilities are inadequately developed to meet the growing needs for emergency care in most low- and middle-income countries. This study aims to describe the prehospital care received by the road traffic injury (RTI) victims presenting to a level I Trauma Care Center in Central Kerala, India.
Methods: This was a hospital-based prospective observational study, which included consecutive victims of RTI attending the emergency department within 24-h of the event.
Saudi Dent J
October 2024
Department of Prosthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil.
Objective: Temporomandibular joint disorder (TMD) comprises several musculoskeletal conditions in the orofacial region, with chronic pain and/or dysfunction involving the temporomandibular joint (TMJ) and masticatory muscles. This study assessed the clinical characteristics of patients with TMD treated at a public tertiary care facility in Brazil.
Methods: In this retrospective study, we assessed data from adult patients attending the Center for Occlusion, TMD, and Orofacial Pain at a Brazilian school of dentistry, from 2000 to 2020.
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