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A new ordered, multivariate meta-analysis approach to synthesising world-wide alter experiments.
With no consensus on the optimal management strategy for asymptomatic retained bullet fragments (RBF), the emerging data on RBF lead toxicity have become an increasingly important issue. There are, however, a paucity of data on the magnitude of this problem. The aim of this study was to address this by characterizing the incidence and distribution of RBF.

A trauma registry was used to identify all patients sustaining a gunshot wound (GSW) from July 1, 2015, to June 31, 2016. After excluding deaths during the index admission, clinical demographics, injury characteristics, presence and location of RBF, management, and outcomes, were analyzed.

Overall, 344 patients were admitted for a GSW; of which 298 (86.6%) of these were nonfatal. Of these, 225 (75.5%) had an RBF. During the index admission, 23 (10.2%) had complete RBF removal, 35 (15.6%) had partial, and 167 (74.2%) had no removal. Overall, 202 (89.8%) patients with nonfatal GSW were discharged with an RBF. The primary indication for RBF removal was im.
Prospective multicenter study.

The purpose of this study was to characterize a population of patients with degenerative cervical myelopathy (DCM) combined with a history of falling, and to identify the predictors associated with those falls.

Falls among patients with DCM are common and can lead to the worsening of neurological symptoms. However, there are no prospective studies that have investigated the risk factors for falls in these patients.

We prospectively enrolled patients scheduled for surgery for DCM and evaluated the significance of various preoperative measures for predicting falls. We then examined the correlation between the number of falls and the preoperative factors. Lastly, we performed stepwise logistic regression analysis to assess the concurrent effects of various factors on the occurrence of falls.

Among the 135 patients analyzed, 64 experienced one or more falls from the time of enrollment to 1 year postoperatively. Univariate analysis showed that the preoperative potassium and serum potassium level and weaker handgrip strength as significant predictors of falls in patients with DCM. Therefore, DCM patients with these risk factors should be cautious about falls and might be candidates for immediate surgical intervention.Level of Evidence N/A.
A systematic review.

To summarise evidence on measurement properties of outcome measures (OM) used to assess physical functioning in Adolescents with Idiopathic Scoliosis (AIS).

The AIS is a common spine deformity in those aged 10 to 18 years old. Associated health problems (e.g., back pain) significantly impact the quality of life (QoL). One important domain in QoL is physical functioning, which can be measured with Patient-Reported Outcome Measures (PROM), Performance-Based Outcome Measures (PBOM), and body structure and function OM. Adequate measurement properties of outcome measures (OM) are important for precision in research and practice.

A two-search strategy performed on electronic databases up to December 2019. Search one revealed list of OM were used for physical functioning assessment in AIS. Search two identified studies that evaluated measurement property in AIS; using list identified in search one. Two independent reviewers determined study eligibility, risk of bias assessment (COSMIN chasures in AIS. Majority of measurement properties studies were evaluating PROM with paucity of information on measurement properties of PBOM and body structure and function OM. Based on COSMIN methodology, none of OM identified in this review can be recommended for use in individuals with AIS.Level of Evidence 2.
Retrospective single-institution study.

To determine the relationship between patients' insurance status and the likelihood for them to be recommended various spine interventions upon evaluation in our neurosurgical clinics.

Socioeconomically disadvantaged populations have worse outcomes after spine surgery. No studies have looked at the differential rates of recommendation for surgery for patients presenting to spine surgeons based on socioeconomic status.

We studied patients initially seeking spine care from spine-fellowship trained neurosurgeons at our institution from July 1, 2018 to June 30, 2019. Multivariable logistic regression was used to assess the association between insurance status and the recommended patient treatment.

Overall, 663 consecutive outpatients met inclusion criteria. selleckchem Univariate analysis revealed a statistically significant association between insurance status and treatment recommendations for surgery (p < 0.001). Multivariate logistic regression demonstrated that compare access to care, and differences in shared decision making between surgeons and patients.Level of Evidence 3.
A retrospective comparative study.

To examine the changes in cervical sagittal alignment (CSA) following surgical correction in a patient with Lenke type 5 adolescent idiopathic scoliosis (AIS) and evaluate any possible factors influencing postoperative CSA.

Few studies have assessed the association between CSA and thoracic or lumbar sagittal alignment in AIS patients with major thoracolumbar/lumbar curve who underwent posterior correction and fusion surgery.

66 patients with Lenke type 5 AIS (2 males and 64 females, the mean age at surgery of 16.2 years) were included in this study. They were followed up for minimum 5 years after surgery. Multiple linear regression analysis was used to evaluate possible factors influencing the postoperative CSA. To determine the influence of upper end vertebra (UEV) level on postoperative CSA, the subjects were divided into two groups according to UEV level of ≥ T9 or ≤ T10. The outcome variables were compared between the two groups and analyzed for changes in variou located at T9 or higher levels, CSA was influenced through the changes in thoracic kyphosis following posterior correction surgery.Level of Evidence 4.
Retrospective review.

This study sought to determine how baseline motor weakness (MW) affects elective spine surgery in patients with degenerative lumbar spinal stenosis (LSS).

Favourable clinical outcomes have been described for elective spine surgery in patients with LSS. However, the way pre-operative MW affects the patient's health-related quality of life (HRQoL) after surgery is not well understood.

A retrospective review of prospectively collected data from 305 surgically treated patients with LSS who had 2-year follow-up was performed (age 71 ± 9 years, male 62%). Demographic, radiographic, and clinical outcomes were analysed at baseline and at 1-year, 2-year, and 3-year post-operation. the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used to assess the HRQoLs. The HRQoLs were compared between those with or without pre-op MW. Adjusted multivariate logistic regression analyses (MRAs) were performed to determine whether MW affected HRQoLs.

116 patients (38%) were categorized as MW+.
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