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Pain catastrophizing is an exaggerated focus on pain sensations. It may be an independent factor influencing pain and functional outcomes of knee arthroplasty. We aimed to evaluate the association between pre-operative pain catastrophizing with pain and function outcomes up to one year after knee arthroplasty. We used data from a cohort study of patients undergoing primary knee arthroplasty (either total or unicompartmental arthroplasty) for knee osteoarthritis. Pain catastrophizing was assessed pre-operatively using the Pain Catastrophizing scale (PCS). Other baseline variables included demographics, body mass index, radiographic severity, anxiety, depression, and knee pain and function assessed using the Western Ontario and McMaster University Index (WOMAC). Patients completed the WOMAC at 6- and 12-months after arthroplasty. WOMAC pain and function scores were converted to interval scale and the association of PCS and changes of WOMAC pain and function were evaluated in generalized linear regression models with adjustment with confounding variables. Of the 1136 patients who underwent arthroplasty (70% female, 84% Chinese, 92% total knee arthroplasty), 1102 and 1089 provided data at 6- and 12-months post-operatively. Mean (± SD) age of patients was 65.9 (± 7.0) years. PCS was associated with a change in WOMAC pain at both 6-months and 12-months (β = − 0.04, 95% confidence interval: − 0.06, − 0.02; P < 0.001) post-operatively after adjustment in multivariable models; as well as change in WOMAC function at 6-months and 12-months. In this large cohort study, pre-operative pain catastrophizing was associated with lower improvements in pain and function at 6-months and 12-months after arthroplasty. [ABSTRACT FROM AUTHOR]

The size and axial alignment of prostheses, when planned during total knee replacement (TKA) are critical for recovery of knee function and improvement of knee pain symptoms. This research aims to study the effect of artificial intelligence (AI)-based preoperative three dimensional (3D) planning technology on prosthesis size and axial alignment planning in TKA, and to compare its advantages with two dimensional (2D) X-ray template measurement technology. A total of 60 patients with knee osteoarthritis (KOA) who underwent TKA for the first time were included in the AI (n = 30) and 2D (n = 30) groups. The preoperative and postoperative prosthesis size, femoral valgus correction angle (VCA) and hip-knee-ankle angle (HKA) were recorded and compared between the two groups. The results of the University of Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the American Knee Association Score (AKS) were evaluated before surgery, 3 months, 6 months, and 12 months after surgery. The accuracy of prosthesis size, VCA and HKA prediction in AI group was significantly higher than that in 2D group (P < 0.05). The WOMAC and AKS scores in AI group at 3 months, 6 months and 12 months after surgery were better than those in 2D group (P < 0.05). Both groups showed significant improvement in WOMAC and AKS scores at 12 months follow-up. AI-based preoperative 3D planning technique has more reliable planning effect for prosthesis size and axial alignment in TKA. [ABSTRACT FROM AUTHOR]

Purpose: Condylar constrained knee prostheses (CCK) are increasingly used in revision total knee arthroplasty (rTKA), but the clinical effectiveness and long-term survival remain a debate. The purpose of this study is to report the long-term clinical and radiographic outcome, implant survival rate, and surgical safety of revision total knee arthroplasty with condylar constrained knee prosthesis. Methods: A retrospective cohort study was performed on patients undergoing rTKA with CCK. The cases who received rTKA with CCK from January 2005 to January 2022 were selected. The duration of operation, the estimated perioperative blood loss, and the intraoperative blood transfusion rate were recorded to evaluate surgical safety. The pain visual analog scale (VAS), range of motion (ROM), the Hospital for Special Surgery (HSS) score, the Knee Society Score (KSS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Oxford knee score (OKS) was recorded to assess clinical outcome. Standard anteroposterior, lateral, skyline and long-standing AP radiographs of the lower limbs were conducted to assess radiographic outcome. Implant survival was analyzed by Kaplan–Meier survival estimates. Results: Fifty-five cases were followed up for an average of 9.6 years (1–18 years), including 16 males and 38 females, with an average age of 66 and an average BMI of 26.9 kg/m2. The main reasons for revision were periprosthetic infection (32 knees, 58.2%) and aseptic loosening (13 knees, 23.6%). The duration of operation was 149 ± 56.2 min. The perioperative blood loss was 973.6 ± 421.6 ml. At the last follow-up, VAS (8.0 ± 1.1 to 1.3 ± 1.4), ROM (82.7° ± 26.1° to 108.4° ± 11.8°), HSS (45.0 ± 10.4 to 85.3 ± 8.6), KSKS (38.4 ± 12.1 to 88.5 ± 12.0), KSFS (19.6 ± 12.9 to 68.8 ± 15.1), WOMAC (67.9 ± 12.5 to 14.4 ± 9.5), and OKS (9.9 ± 4.2 to 41.6 ± 7.7) were significantly improved (P < 0.001). A total of five complications were observed, all of which were periprosthetic infection. Non-progressive radiolucent lines were observed in 26 knees (47.3%). The 10-year survival rate for no operation was 96.0%. The ten year survival rate for no revision was 98.0%. Conclusion: The use of CCK prosthesis for rTKA can achieve good long-term efficacy and prosthesis survival. [ABSTRACT FROM AUTHOR]

The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities. [ABSTRACT FROM AUTHOR]

Purpose: The tipping point (TP) of the knee joint is the centre of rotation of the joint in the coronal plane. This study aimed to define the TP in medial opening wedge high tibial osteotomy (MOWHTO). Methods: Data from 154 consecutive patients with varus knee malalignment, who underwent MOWHTO between 2017 and 2021, was retrospectively reviewed. The degree of preoperative osteoarthritis (OA), using the Kellgren–Lawrence (KL) grading system, was recorded. Long‐leg standing radiographs were used to record the alignment parameters, including the hip–knee–ankle angle (HKA), the mechanical lateral distal femoral angle (mLDFA), the medial proximal tibial angle (MPTA), the joint line convergence angle (JLCA) and the joint line obliquity (JLO) angle. Postoperative Tegner activity scores, Western Ontario and McMaster University Scores and patients' satisfaction were recorded. To define the TP, the relationship of all variables to Δ JLCA (absolute difference between preoperative to postoperative JLCA values) was analysed. Linear regression was employed for Δ JLCA to preoperative JLCA and postoperative and Δ MPTA (absolute difference between preoperative and postoperative values). K‐means clustering was used to partition observations into clusters, in which each observation belongs to the cluster with the nearest mean serving as a prototype of the cluster, and analysed if there was any specific threshold influencing Δ JLCA. After defining the TP, further subanalysis of the TP based on the preoperative KL OA grade and analysis of variance of this TP to the KL OA grade was performed. Results: A total of 154 patients (77.9% males and 22.1% females) were included. The mean age was 48.2 ± 11 years, and the mean body mass index was 27.1 ± 4 kg/m2. Preoperatively, 26 (16.9%) patients had KL grade IV OA. The mean preoperative and postoperative JLCA and the significance of their relation to Δ JLCA were 2.6° ± 1.8° (p < 0.0001) and 1.9° ± 1.8° (p = 0.6), respectively. The mean Δ JLCA was 1.4° ± 1.5°. The mean pre‐ and postoperative MPTA and the significance of their relation to Δ JLCA were 84.6 ± 2.2 (p = 0.005) and 91.8 ± 2.5 (p < 0.0007), respectively. The mean Δ MPTA was 7.2 ± 2.3 (p = 0.3). The mean preoperative and postoperative HKA and the significance of their relation to Δ JLCA were 174.6 ± 2.5 (p = 0.2) and 181.9 ± 2.4 (p = 0.7), respectively. The overall linear regression for Δ JLCA was statistically significant for preoperative JLCA (R2 = 0.3, p < 0.0001) and postoperative MPTA (R2 = 0.09, p = 0.0001) and statistically insignificant for Δ MPTA (R2 = 0.01, p = 0.2) and postoperative HKA (R2 = 0.04, p = 0.7). MPTA > 91.5° was the optimal threshold dividing this series data set between substantial and nonsignificant Δ JLCA. Conclusion: In this study, the main predictive factors for intra‐articular correction (Δ JLCA) after MOWHTO were the preoperative value of JLCA and the postoperative value of MPTA. A value of 92° for postoperative MPTA is potentially the optimal threshold to predict intra‐articular correction. Level of Evidence: Level IV, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to report the early to midterm results of medial opening wedge high tibial osteotomy (MOWHTO) from the largest single‐centre osteotomy database. The primary outcomes were reporting the radiological corrections and the functional outcomes represented by multiple patient‐reported outcome measures (PROMs). The secondary outcomes were to report the complications, revisions and survivorship up to 10 years postoperatively. Methods: A prospectively maintained single‐centre database of 1138 knee osteotomies was retrospectively reviewed. Patients who underwent MOWHTO and met the inclusion criteria were included. Those inclusion criteria were moderate to severe knee pain that failed conservative management; varus knee malalignment; and isolated medial osteoarthritis of the knee. A total of 651 cases, with a mean age of 46.7 ± 9 years and a mean body mass index of 29.6 ± 5.2 kg/m2, were included. This comprised 71% males (n = 462) and 29% females (n = 189). The mean follow‐up was 158.1 ± 45.4 months. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the Knee injury and Osteoarthritis Outcome Scores, the Oxford Knee Score, the Oxford Knee Score‐Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ‐5D, which is a standardised measure of health‐related quality of life. All lower limb alignment measurements were recorded pre‐ and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 5‐ and 10‐year survivorship were recorded. Results: A total of 651 cases were followed up to a mean of 158.1 ± 45.4 months. The mean planned correction angle was 7.6° ± 2.9°. The mean planned opening wedge distance was 8.1 ± 3.1 mm. The mean intraoperative anterior and posterior osteotomy gaps opening were 7.7 ± 3.4 and 8.9 ± 3.8 mm, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from −5.7° ± 2.9° varus to 1.3° ± 2.5° valgus, the mean medial proximal tibial angle improved from preoperative 85.5° ± 2.3° to postoperative 91.6° ± 2.7° and the mean Mikulicz point improved from 21.7 ± 12.6% to 54.8 ± 11% (all p values < 0.001). All PROMs significantly improved at 24 months follow‐up (all p values < 0.001). The rate of osteotomy revision was 1.1% at a mean of 2 ± 2.5 years postoperatively. The overall rate of arthroplasty conversion was 9.1%. This comprised 5.8% total knee arthroplasty conversion at a mean of 6.9 ± 3.5 years postoperatively and 3.2% unicompartmental knee arthroplasty conversion at a mean of 5.7 ± 2.5 years postoperatively. An overall 10.3% complication rate was recorded. The 5 and 10‐year survivorship was 97.2% and 91.9%, respectively. Conclusion: MOWHTO is a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands. MOWHTO should be considered in patients presenting with medial unicompartmental knee pain with an evidence of overload and a varus mechanical coronal plane axis. Level of Evidence: Level IV, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Purpose: To quantify the clinical relevance of intra‐articular corticosteroid effects compared to placebo for the injective treatment of knee osteoarthritis (OA). Methods: The PubMed, Cochrane Library and Web of Science databases were searched on May 3, 2023. This study was conducted in accordance with the PRISMA guidelines. The inclusion criteria were randomized controlled trials (RCTs), published in English, with no time limitation regarding publication date, comparing intra‐articular corticosteroids and placebo injections for knee OA. The effects were quantified at short‐ (≤6 weeks), mid‐ (>6 weeks and ≤3 months), and long‐term (≥6 months) follow‐ups. The minimal clinically important difference (MCID) for the outcomes (visual analogue scale for pain ‐ VAS: 1.4, Western Ontario and McMaster University Osteoarthritis Index ‐ WOMAC: 9) was used to interpret the clinical improvement provided by intra‐articular corticosteroid injections compared to placebo. The quality of each article was assessed using the Cochrane RoB 2 tool and the GRADE guidelines. Results: Among the 1030 articles retrieved, 11 RCTs (842 patients) were included. A comparison of the two groups revealed statistically significant differences in the improvement of VAS and WOMAC scores in terms of the mean difference (MD); this difference was in favour of corticosteroids at short‐term (p < 0.001, MD = −1.6 and p < 0.001, MD = −9.9, respectively) and mid‐term follow‐ups (p = 0.001, mean MD = −1.3 and p = 0.005, MD = −4.9, respectively). No difference was observed at the long‐term follow‐up. The MDs between the improvements in the two groups reached the MCID values for the VAS and WOMAC only at the short‐term follow‐up. The RoB 2 tool and the GRADE evaluations showed the presence of risk of bias and limited quality of evidence. Conclusion: This systematic review and meta‐analysis demonstrated that intra‐articular corticosteroid injections offer clinically perceivable pain relief and functional improvement higher than the placebo effect only at short‐term follow‐up in patients affected by knee OA, with benefits losing clinical relevance already after 6 weeks. These results, together with the low number and the limited quality of the RCTs comparing this treatment with placebo, question the indication for the use of corticosteroid injections in clinical practice for the treatment of knee OA. Level of Evidence: Level I. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare long‐term clinical and radiographic outcomes and survival rates between navigation‐assisted (NAV) total knee arthroplasty (TKA) and conventional (CON) TKA using a mobile‐bearing insert. Methods: From May 2008 to December 2009, 45 and 63 mobile‐bearing TKA patients were enroled in the CON‐ and NAV‐TKA groups with 146.8 months follow‐up, respectively. Clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index and Knee Society Scores), radiographic outcomes (hip‐knee‐ankle [HKA], lateral distal femoral, medial proximal tibial, γ, and δ angles), and survivorship were compared between both groups. Results: The number of HKA angle outliers (more than 3 degrees or less than −3 degree) was significantly lower in the NAV‐TKA group (24.4% vs. 9.5%, p = 0.036) than in the CON‐TKA group. However, long‐term clinical outcomes were similar between both groups. The cumulative survival rate (best‐case scenario) was 98.3% in the CON‐TKA group and 97.5% in the NAV‐TKA group, with no significant difference between the groups (p = 0.883). Conclusion: Long‐term clinical outcomes and survival rates were similar between the two groups despite fewer outliers of postoperative lower‐limb alignment in the NAV‐TKA group. Excellent survival rates were observed in both groups using mobile‐bearing inserts. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the safety and efficacy of intra-knee stromal vascular fraction (SVF) injection in patients with symptomatic knee osteoarthritis at the midterm (3-year) follow-up. Methods: SVF injection was applied to 25 knees of 20 patients. Eighteen patients (90%) were female, and the means ± standard deviations of age was 61.9 ± 7.8 (range, 50–76) years. Patients who received conservative treatment for at least 6 months and had radiographic Kellgren–Lawrence (K–L) grades 2 and 3 varus gonarthrosis were included in the study. SVF was obtained from the umbilical region by liposuction using local anaesthesia. Patients were followed-up for 36 months. Their visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lysholm scores were evaluated before and at 6, 12, 24 and 36 months post-SVF injection. Results: A statistically significant improvement (p < 0.05) was observed in VAS, WOMAC and Lysholm scores at the first 2-year follow-up compared to baseline. However, no statistically significant difference (n.s.) was observed in VAS, WOMAC and Lysholm scores at the 3-year follow-up compared with baseline. Conclusion: Intra-articular SVF injection decreased pain and significantly improved the functional outcomes in the first 2 years in knees with grade 2–3 osteoarthritis; however, these positive effects of the injection disappeared in the 3rd year. Although short-term successful results of SVF have been reported in the literature, prospective studies are needed for medium- and long-term results. [ABSTRACT FROM AUTHOR]

Purpose: This study was aimed to compare the clinical, functional, and radiographic outcomes between symmetric and asymmetric extension and mediolateral gap balance after navigation-assisted (NA) total knee arthroplasty (TKA) using ultracongruent (UC) insets and the medial stabilising technique (MST). Methods: In all, 363 knees of 275 patients who underwent mechanical alignment-target NA TKA with MST between January 2015 and December 2017 were analysed. Patients were divided into balanced (extension mediolateral gap difference ≤ 2 mm) and tight medial (difference ≥ 3 mm) groups. Pre- and postoperative clinical, functional (range of motion, Western Ontario and McMaster University Osteoarthritis [WOMAC] index, Knee Society Knee Score [KSKS], and Knee Society Function Score [KSFS]) and radiographic (hip–knee–ankle [HKA] angle, femoral condylar offset, extension angle [a minus indicates hyperextension], and joint line distance) outcomes were compared between the groups. Student's t- or Chi-squared test was used to compare the outcomes. Results: Among the 363 knees analysed, 279 (77%) were assigned to the balanced group and 84 (23%) to the tight medial group. The preoperative HKA angle was significantly greater in the tight medial group than in the balanced group (9.7° ± 4.1° vs 14.3° ± 4.7°, P < 0.001). The postoperative WOMAC index, KSKS, and KSFS were similar between the groups. The change in the joint line distance was not significantly different (1.5 ± 3.7 vs 2.0 ± 3.3; n.s). Conclusion: The clinical, functional, and radiographic outcomes, including joint line distance, were comparable between the tight medial and balanced group after mechanical alignment-targeted UC TKA with MST. Level of evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Study design: Systematic review. Objectives: The objectives were to systematically review the literature since the most recent systematic reviews for both adult and pediatric spinal cord injuries without radiologic abnormality (SCIWORA) in order to provide an update on the condition's epidemiology and characteristics and investigate the relationship between SCIWORA and concurrent concussion. Methods: A review was conducted according to the 2020 guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The databases PubMed and OvidSP were searched on February 27, 2022. Inclusion criteria were individuals of any age, diagnosis of SCIWORA with or without abnormalities on MRI, and articles published from 2013 to 2014 (adults only) and 2014–present (all ages). Exclusion criteria were any spinal fracture or dislocation, studies that were narrative reviews, letters, book chapters, or editorials. Risk of bias was assessed using tools from the Clinical Advances Through Research and Information Translation Group at McMaster University and the Joanna Briggs Institute. Collected data were synthesized using Microsoft Excel. Results: Since the most recent systematic reviews, a total of 61 studies were identified, resulting in 2788 patients with SCIWORA. 69.55% of patients were pediatric, 30.45% adult. The most prevalent reported mechanism of injury was sports-related (39.56%) followed by fall-related (30.01%) and vehicle-related (27.23%). The vast majority of injuries occurred at the level of the cervical spine (82.59%). Of the 61 included studies, only 5 reported cases of concurrent concussion and/or TBI. Discussion: Since the most recent previous systematic reviews, there has been a 64% increase in reported cases of SCIWORA, likely as the result of advances in imaging technology and better awareness of SCIWORA. Still, SCIWORA remains a diagnosis most prevalent in children and young adults, the most common cause being sports-related injury. With the pathogenesis of SCIWORA sharing a predisposition to concussion, the significant lack of reporting of SCIWORA with concurrent concussion suggests that there have been missed diagnoses of either SCIWORA with concurrent concussion or vice versa, leading to longer recovery times, unrecognized and/or untreated underlying pathology, and possibly additional unnecessary morbidity. When the diagnosis of either SCIWORA or concussion is suspected, the other should additionally be considered in order to minimize the possible extended recovery time and related comorbidities. Limitations included the prevalence of lower quality studies such as case reports/series, insufficient reporting of study characteristics, and variability among neurologic impairment scales used and how SCIWORA was defined. [ABSTRACT FROM AUTHOR]

Although the use of intra-articular polynucleotide (IA PN) injection as a viscosupplement for knee osteoarthritis (OA) treatment has been proposed, its efficacy and safety compared to high molecular weight hyaluronic acid (HMWHA) injection has not yet been established. The present double-blind, multicenter, randomized controlled trial aimed to investigate the efficacy and safety of IA PN injection compared to IA HMWHA injection. A total of 60 patients (15 men, 45 women, 64.5 ± 7.5 years) with knee OA (Kellgren–Lawrence grade 1–4) were randomly allocated to each group. All patients were given three IA injections of PN (n = 30) or HMWHA (n = 30) at intervals of 1 week. The primary endpoint was the change rate in weight-bearing pain (WBP) 16 weeks from the baseline. The secondary endpoint included multiple measurements: the change rate in WBP rate at 8 weeks; the change rate in pain level at rest and during walking at 8 and 16 weeks; the Korean-Western Ontario and McMaster University Osteoarthritis index; the Euro-Quality of Life-5 Dimension; Clinical Global Impression, Patient Global Impression at 8 and16 weeks, and total consumption of rescue medicine. The mean change rate in the WBP at 16 weeks from the baseline was − 54.0 ± 38.1% in the IA PN group and − 42.8 (± 35.8%) in the IA HMWHA group, and there was no significant difference between the two groups (p = 0.296). All secondary endpoints related with pain and functional outcome also showed no significant difference between the two groups. Pain at the injection site and swelling were reported as adverse events, and the incidence was similar between the two groups. IA PN showed comparable efficacy and safety to IA HMWHA at 3 times injection with an interval of 1 week. IA PN can be useful alternative to IA HMWHA for the treatment of knee OA. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to analyse the effect of BMI on clinical outcomes of cemented fixed-bearing lateral unicompartmental knee arthroplasty (UKA) on a 2- to 12-year follow-up. Methods: Between January 2010 and January 2020, a total of 103 lateral UKAs were implanted. The Oxford Knee Score (OKS) and the Western Ontario and McMaster University Osteoarthritis Index for pain, stiffness, function, and total score were administered to estimate patients' overall health status pre- and post-operatively. Results were considered good or excellent for WOMAC values > 85 points and OKS > 40 points. Survivorship, described with Kaplan–Meier method, was defined as the lack of revision at the latest follow-up. Complications or further operations were recorded. p values of < 0.05 were considered significant. Results: One hundred one lateral UKAs were assessed at a mean follow-up of 77.8 months. No patients underwent revision, but 2 patients (2, 0%) developed aseptic loosening of the implant 2 and 5 years after surgery but for clinical reasons neither undergo revision (5-year survivor 97.2%). Overall satisfaction was generally high, with excellent scores in all WOMAC subscales and OKS for all BMI groups. Considering the pain subscale (WOMAC pain), patients with normal weight and overweight achieve excellent results more frequently [10 (25.64%) vs 10 (23.81%) p = 0.026] than obese patients (n = 0); on the other hand, considering the quality of life (WOMAC QoL), obese patients most frequently reach excellent values, even statistically significant [n = 15 (75.00%) p = 0.040]. Conclusion: Although obesity has historically been described as a contraindication to UKA, improved outcomes with modern UKA implant designs have challenged this perception. Therefore, the classic contraindication of UKAs in patients with BMI > 30 kg/m2 may not be justified. According to the present study, lateral UKA patients with BMI > 30 kg/m2 had satisfactory patient-reported outcome measures compared to non-obese patients on a long term with survival rates comparable to medial UKA. Obese patients should not be excluded from the benefit of lateral UKA surgery. [ABSTRACT FROM AUTHOR]

Design: A systematic appraisal and statistical aggregation of primary studies. Data sources: Scopus/ELSEVIER, PubMed/MEDLINE, Clarivate Analytics' Web of Science (i.e., Web of Science Core Collection—WoS, Korean Journal Database—KJD, Russian Science Citation Index—RSCI, SciELO Citation Index—SCIELO), and Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library.The complementary searches consisted of OpenGrey, Google Scholar (first 100 returns), Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, DART-Europe E-theses Portal—DEEP, Opening access to UK theses—EThOS. Study selection: Human clinical trials studies in English language with at least 10 patients with mature or immature permanent teeth with pulpitis characterized by spontaneous pain in each arm (i.e., root canal treatment [RCT] and pulpotomy) at the end of the study, comparing the patient- (Primary: survival, pain, tenderness, swelling assessed by clinical history, clinical examination, and pain scales; Secondary: tooth function, need for further intervention, adverse effects; OHRQoL using a validated questionnaire) and clinical-reported outcomes (Primary: emerging apical radiolucency as per intraoral periapical radiograph or limited FOV CBCT scan; Secondary: radiological evidence of continued root formation and presence of sinus tract). Data extraction and synthesis: Two independent review authors conducted study selection, data extraction and risk of bias (RoB) assessment and a third reviewer was consulted for solving disagreements. When insufficient or absent information, the corresponding author was reached out to for further explanation. The Cochrane RoB tool for randomized trials (RoB 2.0) was evaluated the quality of studies.The meta-analysis was performed on a fixed-effect model to estimate pooled effect size such as odds ratio (OR) and 95% confidence intervals (CIs) were performed using the R software. The quality of evidence assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach (GRADEpro GDT: GRADEpro Guideline Development Tool [software], McMaster University, 2015). Results: Five primary studies were included. Four studies referred to a multicentre trial assessing postoperative pain and long-term success rate after pulpotomy compared with one-visit RCT in 407 mature molars. The other study was a multicentre trial assessing postoperative pain in 550 mature molars treated with pulpotomy and pulp capping with the calcium-enriched mixture (CEM), pulpotomy and pulp capping with mineral trioxide aggregate (MTA) and one-visit RCT. Both trials primarily reported first molars from young adults. When looking at the results of postoperative pain, all the trials included had a low RoB. However, when evaluating the clinical and radiographic outcomes of the included reports, it was determined that there was a high RoB. The meta-analysis found that the likelihood of experiencing pain (i.e., mild, moderate, or severe) at the 7th postoperative day was not affected by the type of intervention (OR = 0.99, 95% CI 0.63–1.55, I2 = 0%).The study design, risk of bias, inconsistency, indirectness, imprecision, and publication bias domains were used to grade the quality of evidence for postoperative pain between RCT and full pulpotomy, resulting in a 'High' grade. In the first year, clinical success was high for both interventions, with a rate of 98%. However, the success rate declined over time, with pulpotomy showing a 78.1% success rate and RCT showing a 75.3% success rate at the 5-year follow up. Conclusions: This systematic review was limited by the inclusion of only two trials, indicating a lack of sufficient evidence to draw definitive conclusions. Nonetheless, the available clinical data suggests that patient-reported pain outcomes do not differ significantly between RCT and pulpotomy at Day 7 postoperatively, and that the long-term clinical success rate of both treatments is comparable, as demonstrated by a single randomized control trial. However, to establish a more robust evidence base, additional high-quality randomized clinical trials, conducted by diverse research groups, are needed in this field. In conclusion, this review underscores the insufficiency of current evidence to draw solid recommendations. [ABSTRACT FROM AUTHOR]

CAG-expanded ATXN7 has been previously defined in the pathogenesis of spinocerebellar ataxia type 7 (SCA7), a polyglutamine expansion autosomal dominant cerebellar ataxia. Pathology in SCA7 occurs as a result of a CAG triplet repeat expansion in excess of 37 in the first exon of ATXN7, which encodes ataxin-7. SCA7 presents clinically with spinocerebellar ataxia and cone-rod dystrophy. Here, we present a novel spinocerebellar ataxia variant occurring in a patient with mutations in both ATXN7 and TOP1MT, which encodes mitochondrial topoisomerase I (top1mt). Using machine-guided, unbiased microscopy image analysis, we demonstrate alterations in ataxin-7 subcellular localization, and through high-fidelity measurements of cellular respiration, bioenergetic defects in association with top1mt mutations. We identify ataxin-7 Q35P and top1mt R111W as deleterious mutations, potentially contributing to disease states. We recapitulate our mutations through Drosophila genetic models. Our work provides important insight into the cellular biology of ataxin-7 and top1mt and offers insight into the pathogenesis of spinocerebellar ataxia applicable to multiple subtypes of the illness. Moreover, our study demonstrates an effective pipeline for the characterization of previously unreported genetic variants at the level of cell biology. Neurodegenerative disease: Finding new mutations associated with ataxia Two genetic mutations combine to cause a novel variant of spinocerebellar ataxia (SCA), a rare neurodegenerative disease. SCA affects the cerebellum, a brain region that controls movement, causing progressive coordination problems. Presented with a patient with an atypical form of SCA, Ray Truant at McMaster University in Hamilton, Canada, and co-workers used whole-genome sequencing to identify mutations in two genes: ATXN7, involved in cytoskeleton maintenance, and TOP1MT, in mitochondria, the cellular powerhouses. Unable to see differences in the affected tissues using routine microscopy, the researchers used computer-guided microscopy image analysis to determine that the altered ATXN7 protein was mis-located in cells. High-fidelity measurements of cell metabolism showed that mitochondria with altered TOP1MT produced insufficient energy. These results clarify the genetics of ataxia, and offer new ways to identify the effects of rare mutations. [ABSTRACT FROM AUTHOR]

Purpose: Unicompartmental Knee Arthroplasty (UKA) recorded an increased incidence of around 30% per year in the United States. Patient's experience and satisfaction after surgery were traditionally assessed by pre, and post-surgical scores and Patient-Reported Outcome Measures (PROMs) scales. Traditional scales as Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS) reported high ceiling effect. Patients treated by UKA usually perform well; therefore, it is necessary to have a PROMs' scale with a low ceiling effect as the Forgotten Joint Score-12 (FJS-12). PROMs have to be validated in the local language to be used. This study aims to perform a psychometric validation of the Italian version of FJS-12 for UKA for the first time. Methods: Between January 2019 and October 2019, 44 patients were included. Each patient completed both the FJS-12 Italian version and the WOMAC Italian version in preoperative follow-up, after 2-week and 1-month, 3-month, and 6-month postoperative follow-up. Cronbach's α, intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated to evaluate the reliability. The Pearson coefficient was used to assess validity. The Effect Size (ES) was used to test the responsiveness. Results: A range of Cronbach's α between 0.90 and 0.95 indicated good internal consistency for the FJS-12. The test–retest reliability was acceptable (i.e., the ICC was higher than 0.7) at each follow-up. The Pearson correlation coefficient between the FJS-12 and WOMAC was − 0.11 (n.s.) at preoperative follow-up, r = 0.47 (P = 0.001) at 1 month, r = 0.57 (P < 0.001) at 3 months, and r = 0.57 (P < 0.001) at 6 months. Therefore, except for the preoperative period, the validity of the FJS-12 score was assessed. Conclusion: The FJS-12 represents a valid and reliable tool with a low ceiling effect to assess the outcomes improvement in UKA patients. Therefore, validating and translating this score in different languages could help perform more accurate studies on outcomes after UKA. Level of evidence: Level III, diagnostic study. [ABSTRACT FROM AUTHOR]

The interactions between Ronald J. Gillespie (1924–2021), the initiator of the VSEPR model of molecular geometry, and the author started in the early 1970s and culminated in a joint book about the model in 1991, republished in 2012. In 1998, they recorded a conversation about Gillespie's life and career, which he augmented by his thoughts about the similarities between his demeanor as a scientist and that of Charles Darwin. [ABSTRACT FROM AUTHOR]

Background: High tibial osteotomy (HTO) provides reliable and good long-term results, if performed with correct indications, but different techniques and types of fixation have been described. The purpose of this study is to present a novel modified biplanar medial opening-wedge (MOW) HTO technique where the osteotomies are performed in a Z-shaped fashion, and to present the medium-term clinical and radiographic results.Materials and Methods: We present a case series of 75 patients (80 knees) with mean age of 45.8 years, affected by isolated medial knee osteoarthritis and symptomatic varus knee malalignment, who underwent novel biplanar Z-shaped MOWHTO. Clinical and radiological outcomes were collected, retrospectively before surgery and at median follow-up of 7.2 years (95% CI 5.6-9.2 months) after surgery. Clinical results and satisfaction were assessed by visual analog scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Likert scale. Radiological assessment involved the evaluation of the medial proximal tibial angle (MPTA), tibial slope (TS), Caton-Deschamps index, and knee osteoarthritis grade according to Ahlbäck classification. Pre- and postoperative results were compared using the two-tailed t-test or Wilcoxon's test of independent samples for paired data or nonparametric analog. P < 0.05 was considered significant.Results: At medium-term follow-up, Z-shaped MOWHTO showed a survival rate of 95 ± 1.7% with failure occurring in four knees due to symptom recurrence and osteoarthritis progression. No perioperative complications were observed (intraarticular fracture, delayed union or nonunion, and neurological injury). Mean bone healing time was 12 weeks. Clinical scores showed significant improvement at last follow-up and a good grade of satisfaction. MPTA increased significantly, while Caton-Deschamps index decreased significantly. No significant TS increase was found.Conclusions: Modified biplanar Z-shaped MOWHTO is a safe and reliable technique that offers satisfactory clinical and radiological medium-term outcomes with low knee arthroplasty conversion rate. The unique three-dimensional geometrical conformation potentially provides a favorable environment for bone healing, increased anteroposterior and rotational stability, and safer opening-wedge loading force application with low lateral hinge fracture risk.Level Of Evidence: Level IV, retrospective observational case series study. Trial registration The study protocol was approved by the Internal Review Board of our Institution (authorization number 54/2019, 20 November 2019). [ABSTRACT FROM AUTHOR]

Purpose: The Coronavirus disease 2019 (COVID-19) has led to an unparalleled influx of patients. Prognostic scores could help optimizing healthcare delivery, but most of them have not been comprehensively validated. We aim to externally validate existing prognostic scores for COVID-19. Methods: We used "COVID-19 Evidence Alerts" (McMaster University) to retrieve high-quality prognostic scores predicting death or intensive care unit (ICU) transfer from routinely collected data. We studied their accuracy in a retrospective multicenter cohort of adult patients hospitalized for COVID-19 from January 2020 to April 2021 in the Greater Paris University Hospitals. Areas under the receiver operating characteristic curves (AUC) were computed for the prediction of the original outcome, 30-day in-hospital mortality and the composite of 30-day in-hospital mortality or ICU transfer. Results: We included 14,343 consecutive patients, 2583 (18%) died and 5067 (35%) died or were transferred to the ICU. We examined 274 studies and found 32 scores meeting the inclusion criteria: 19 had a significantly lower AUC in our cohort than in previously published validation studies for the original outcome; 25 performed better to predict in-hospital mortality than the composite of in-hospital mortality or ICU transfer; 7 had an AUC > 0.75 to predict in-hospital mortality; 2 had an AUC > 0.70 to predict the composite outcome. Conclusion: Seven prognostic scores were fairly accurate to predict death in hospitalized COVID-19 patients. The 4C Mortality Score and the ABCS stand out because they performed as well in our cohort and their initial validation cohort, during the first epidemic wave and subsequent waves, and in younger and older patients. [ABSTRACT FROM AUTHOR]

Multiparametric magnetic resonance imaging (mpMRI) of the prostate is increasingly used for the preoperative detection and staging of prostate cancer. Image quality of prostate mpMRI can be significantly degraded by motion related artefact due to bowel peristalsis and susceptibility related artefact, which reduces cancer detection sensitivity. The use of several different methods including anstispasmodic medications and rectal enemas were proposed as potential methods to reduce mpMRI artefacts, but current recommendations in the scientific literature are conflicting and inconsistent. This article seeks to identify the best available evidence to determine which patient preparation method is most effective in improving prostate mpMRI, and provides recommendations for further areas of research. We used the five-step 'Evidence-Based Practice' systematic approach of 'Ask, Search, Appraise, Apply and Evaluate' described by the McMaster University and National Health Service for critical appraisal of topics. We developed a focused clinical question using a PICO format, and performed a primary and secondary literature search through Ovid Medline, Ovid Embase and Cochrane CENTRAL (Wiley). All identified articles were appraised for strength and validity. Seven articles were retrieved which demonstrated conflicting sensitivities and specificities for intravenous hyoscine butylbromide and rectal enema in improving image susceptibility artefact, motion artefact, and anatomic distortion on the T2 or diffusion weighted imaging sequences. Intravenous hysoscine butylbromide is the optimum patient preparation method for improving T2W and DWI image quality in prostate mpMRI. The use of a preparatory rectal enema is not currently recommended, but better quality studies are required. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Many observational studies have suggested the existence of a link between urinary incontinence (UI) and lumbopelvic pain. The aim of our study is to evaluate the association between UI and back pain (BP) or pelvic girdle pain (PGP) in the adult population. Methods: This systematic review with meta-analysis was registered in PROSPERO under the number 2019:CRD42019120047. Literature was sought in the Medline, Embase, and PEDro databases. The search was limited to English, Spanish, and French records, and was conducted from inception until November 2019. Observational studies evaluating the association between UI and BP/PGP were selected by two independent reviewers. Quality assessment was performed using the "Critical Review Form for quantitative studies" (McMaster University). Results: From the 2,055 retrieved articles, 18 were selected. Both qualitative (n = 18) and quantitative analysis (n = 7) were performed. Fifteen out of 18 studies (83%) found a positive association between UI and BP or PGP for at least one type of incontinence. Pooled estimates were OR 1.61, 1.53, and 1.51 for stress, urgency, and mixed urinary incontinence respectively. A similar degree of association between women and men was found. Subjects with stress and mixed incontinence showed greater likelihoods of mild pain compared with severe pain, although severe pain was more frequently associated with urgency incontinence than mild pain. Conclusions: Our results support the association between UI and BP/PGP, which seems to be independent of gender-based differences. The strength of this association depends on pain or incontinence subtypes. Clinicians should be aware of the relationship in their clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the clinical and functional outcome scores following total knee arthroplasty (TKA) with two different systems. The hypothesis was that there is a difference between patients receiving the newer design than those receiving the predecessor. Methods: Two hundred patients who underwent TKA were randomized into two groups: patients received either Attune TKA or PFC Sigma (both DePuy Synthes, Warsaw, IN). Clinically, the Knee Society Knee and Function Scores (KS and FS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Range of Motion (ROM) and Visual Analogue Scale (VAS) were evaluated and compared between the groups 2 years after surgery. 158 patients (80 in the Attune group and 78 in the PFC Sigma group) were available for follow-up. Results: Through bivariate analysis using parametric and non-parametric statistical tests, no significant differences in postoperative KS, FS, WOMAC, ROM or VAS between the two groups were detected. Both groups significantly improved regarding all evaluated endpoints 2 years after surgery. Conclusions: In the current study population, no difference in clinical outcome between the two systems was found. The expected benefits of design modifications could not be observed in clinical outcome scores 2 years postoperatively. Both designs are effective options for improving pain and function in end-stage osteoarthritis. Level of evidence: I. [ABSTRACT FROM AUTHOR]

Background: Cartilage repair performed as a single-stage procedure is an important advancement in the treatment of full-thickness cartilage injury and has potential for widespread clinical use. Purpose: To investigate the short-term outcomes and cartilage regeneration after implantation of allogeneic human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) in patients who received high tibial osteotomy (HTO) for symptomatic medial knee osteoarthritis. Methods: Patients underwent treatment of full-thickness chondral injury in the osteoarthritic knee with HTO and implantation of hUCB-MSCs and were followed prospectively for a minimum of one year. Ninety-three patients were followed for a mean 1.7 years (range, 1.0–3.5). Median cartilage lesion size was 6.5 cm2 (range, 2.0–12.8). Clinical outcomes were examined with patient-reported scoring instruments that consisted of the International Knee Documentation Committee (IKDC) subjective score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), and Hospital for Special Surgery (HSS) score. Cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) cartilage repair assessment grading (CRA) system and the Koshino regeneration staging system in 49 patients who underwent second look arthroscopic assessment when their HTO plates were removed. Results: At final follow-up, the median IKDC subjective score had significantly improved from 39.0 to 71.3; the WOMAC score from 44.5 to 11.0; the KSS pain and function scores from 29.8 to 43.2 and 61.0 to 81.2, respectively; and the HSS from 61.6 to 82.7 (p < 0.05). Pre-operative examination showed ICRS grade IV cartilage injury in all knees, and cartilage regeneration at 2nd look arthroscopy showed improvements (8.2% of patients improved to ICRS grade I, 69.3% to grade II, and 22.5% to grade III). Moreover, Koshino stage was B in 24.5% and C in 75.5% of patients (p < 0.05). Conclusion: Allogeneic hUCB-MSC implantation combined with HTO for medial knee osteoarthritis was safe and showed signs of cartilage status improvement. Furthermore, randomized controlled studies with a control group are necessary to determine the real effectiveness and indications of this new combined procedure for patients with osteoarthritis. [ABSTRACT FROM AUTHOR]

There is an increasing awareness of high burnout found among physicians. Resident physicians particularly face heightened stress due to inherent pressures of training in addition to systemic challenges common to healthcare. It is crucial that medical training programs and organizations create a culture which promotes physician well-being. We conducted an evaluation of a quality assurance pilot program aimed at creating a safe space for increasing burnout awareness and well-being among resident physicians. The program was voluntary, offered to psychiatry residents enrolled at McMaster University, and comprised an online resilience curriculum, peer groups, and wellness newsletters. Data analysis took place between December 15, 2018 and July 15, 2019. The educational goals were evaluated by outcome measures obtained over time in aggregated response data through residents' anonymous survey feedback. All aspects of the triad received positive feedback, with peer groups being perceived as most helpful. Of all residents, 31% (n = 22) engaged in all three aspects of the program; the majority were female (83%) and senior residents (63%). While 48% reported burnout upon enrollment, there was an average 50% stress reduction perceived post-attendance. This project has shown that peer groups can make a difference in the daily experience of psychiatry residents at our institution. [ABSTRACT FROM AUTHOR]

That idea that problem-based learning (PBL) is more motivating that traditional education has been prevalent since the inception of PBL at McMaster University in the late 1960s. Evidencing this through empirical research, however, has proven to be a lot more problematic. This paper retraces how the discourse on motivation started from a laymen's conception in the early days of PBL, and slowly evolved into a field of scientific inquiry in the 1980s and 1990s. However, looking at the evolution of motivation theory over the same period, we show that motivation discourse in the burgeoning literature on motivation and PBL remained largely wedded to the laymen's approach, and failed to catch up with the new achievement-goal theory and self-determination theory approaches. This paper proceeds to analyse the explosion of studies on PBL and motivation after 2000, acknowledging efforts to move away from anecdotal accounts and provide theoretical grounding to the research. However, once again, we show that the majority of the research employed outdated motivational measures that do not fully grasp the complexity of contemporary motivation theory. The paper concludes on the observation that single-course and curriculum-wide research interventions have yielded no conclusive results on the effect of PBL on intrinsic motivation, and that future research should therefore seek to use up-to-date motivational constructs in more targeted interventions. [ABSTRACT FROM AUTHOR]

Background: To enhance the acute care delivery system, a comprehensive understanding of the patient's perspectives for seeking care in the emergency department (ED) versus primary care (PC) is necessary.Methods: We conducted a qualitative metasynthesis on reasons patients seek care in the ED instead of PC. A comprehensive literature search in PubMed, CINAHL, Psych Info, and Web of Science was completed to identify qualitative studies relevant to the research question. Articles were critically appraised using the McMaster University Critical Review Form for Qualitative Studies. We excluded pediatric articles and nonqualitative and mixed-methods studies. The metasynthesis was completed with an interpretive approach using reciprocal translation analyses.Results: Nine articles met criteria for inclusion. Eleven themes under four domains were identified. The first domain was acuity of condition that led to the ED visit. In this domain, themes included pain: "it's urgent because it hurts," and concern for severe illness. The second domain was barriers associated with PC, which included difficulty accessing PC when ill: "my doctor said he was booked up and he instructed me to go to the ED." The third domain was related to multiple advantages associated with ED care: "my doctor cannot do X-rays and laboratory tests, while the ED has all the technical support." In this domain, patients also identified 24/7 accessibility of the ED and no need for an immediate copay at the ED as advantageous. The fourth domain included fulfillment of medical needs. Themes in this domain included the alleviation of pain and the perceived expertise of the ED healthcare providers.Conclusions: In this qualitative metasynthesis, reasons patients visit the ED over primary care included (1) urgency of the medical condition, (2) barriers to accessing primary care, (3) advantages of the ED, and (4) fulfillment of medical needs and quality of care in the ED. [ABSTRACT FROM AUTHOR]

Competency-based education requires that programs increase the breadth of direct observation and assessment to improve resident training. To achieve these goals, the authors developed and executed a multiple-trainee, multiple-level, multiple-competency (Multi-TLC) obstetrical emergencies simulation curriculum. Depending upon their training level (PGY1–PGY5), obstetrics and gynaecology residents participated in various roles (i.e., first responder, second responder, confederates, and evaluators) within four simulation scenarios designed to provide opportunities for education, direct observation, and assessment across a number of competencies (i.e., medical expert, communicator, collaborator, leader, advocate, and scholar). The curriculum was carried out over 8 h spread evenly across 2 days (i.e., 4 h/day) and involved periods of pre-briefing, live simulation, and debriefing. An evaluation of the Multi-TLC was operationalised via a context-input-process-product model. This report presents the outcomes of that evaluation derived from quasi-experimental comparisons of the new and previous curricula across four priorities for simulation-based education identified by the Department of Obstetrics and Gynecology at McMaster University (Hamilton, ON, Canada): increasing learning opportunities, maintaining or improving resident learning, maintaining or reducing program costs, and improving resident satisfaction. The evaluation revealed that the Multi-TLC curriculum permitted a greater breadth of direct observation and assessment across competencies, maintained the previous learning objectives while also addressing additional ones, and was done so in a way that reduced the overall financial and human resource costs associated with the department's obstetrical emergency simulation curriculum. A Multi-TLC organisation of simulation curricula can facilitate efficient application of competency-based education principles. [ABSTRACT FROM AUTHOR]

Purpose: To examine the responsiveness of the EQ-5D-3L and EQ-5D-5L among total hip/knee replacement (THR/TKR) patients.Methods: The EQ-5D (3L or 5L) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) have been routinely administered to all THR/TKR patients before and at 3 months after surgery in Alberta, Canada, since 2010. Patients were included in this analysis if they completed the WOMAC and the same version of EQ-5D at baseline and 3-month follow-up. The WOMAC was used as an anchor to categorize patients into 9 subgroups according to the relative change from baseline, i.e., no change, and 4 categories each for the amount of deterioration or improvement: large (≥ 70%), moderate (50% ≤ change < 70%), small but important (20% ≤ change < 50%), and very mild (0 < change ≤ 20%). The responsiveness of the EQ-5D-3L and EQ-5D-5L for each subgroup was assessed using effect size, standardized response mean, and Guyatt's Responsiveness Index.Results: A total of 1594 patients completed the EQ-5D-3L and WOMAC (60% females, mean age 66 years, N = 646 [41%] THR), and 3180 completed the EQ-5D-5L and WOMAC (60% females, mean age 66 years, N = 1352 [43.2%] THR) at baseline and 3-month follow-up. For both THR and TKR patients with "small but important" improvement, the EQ-5D-5L was consistently more responsive than the EQ-5D-3L.Conclusion: Our study demonstrated that the EQ-5D-5L is more responsive than the EQ-5D-3L in identifying health-related quality of life changes in THR/TKR patients. We recommend using the EQ-5D-5L in longitudinal studies in this patient population. [ABSTRACT FROM AUTHOR]

Purpose: The primary aim of this study was to define a classification in the WOMAC score after total knee arthroplasty (TKA) according to patient satisfaction. The secondary aims were to describe patient demographics for each level of satisfaction.Methods: A retrospective cohort consisting of 2589 patients undergoing a primary TKA were identified from an established arthroplasty database. Patient demographics, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and short form (SF) 12 scores were collected pre-operatively and 1 year post-operatively. In addition, patient satisfaction was assessed at 1 year with four responses: very satisfied, satisfied, dissatisfied or very dissatisfied. Receiver operating characteristic (ROC) curves were used to identify values in the components and total WOMAC scores that were predictive of each level of satisfaction, which were used to define the categories of excellent, good, fair and poor.Results: At 1 year, there were 1740 (67.5%) very satisfied, 572 (22.2%) satisfied, 190 (7.4%) dissatisfied and 76 (2.9%) very dissatisfied patients. ROC curve analysis identified excellent, good, fair and poor categories for the pain (> 78, 59-78, 44-58, < 44), function (> 72, 54-72, 41-53, < 41), stiffness (> 69, 56-69, 43-55, < 43) and total (> 75, 56-75, 43-55, < 43) WOMAC scores, respectively. Patients with lung disease, diabetes, gastric ulcer, kidney disease, liver disease, depression, back pain, with worse pre-operative functional scores (WOMAC and SF-12) and those with less of an improvement in the scores, had a significantly lower level of satisfaction.Conclusion: This study has defined a post-operative classification of excellent, good, fair and poor for the components and total WOMAC scores after TKA. The predictors of level of satisfaction should be recognised in clinical practice and patients at risk of a lower level of satisfaction should be made aware in the pre-operative consent process.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes, and complication rates, after a minimum of five years of follow-up after medial open wedge high tibial osteotomy (MOWHTO) using an Anthony-K plate.Methods: MOWHTO was performed on 35 knees of 34 consecutive patients. A visual analogue scale (VAS), and Western Ontario and McMaster University Osteoarthritis (WOMAC) and Lysholm scores, were used in clinical evaluation. Upon radiographic assessment, alignment was expressed as the femorotibial angle (FTA). The posterior tibial slope (PTS) and the Insall-Salvati Index (ISI) were also measured.Results: VAS, WOMAC, and Lysholm scores improved significantly upon follow-up (p < 0.001 for all). The overall mean FTA was 4.68 ± 4.39° varus pre-operatively; at the last post-operative follow-up, the value was 8.43 ± 2.02° valgus. The mean correction angle was 13.1 ± 2.7°. A significant increase in PTS was evident (p < 0.01), as was a significant decrease in the ISI (p < 0.01). The overall complication rate was 8.6 %.Conclusions: The Anthony-K plate affords accurate correction, initially stabilises the osteotomy after surgery, and maintains such stability until the osteotomy gap is completely healed, without correction loss. The plate survival rate was 97.2 % after a minimum of five years of follow-up. The plate increased the PTS, as do other medial osteotomy fixation plates. [ABSTRACT FROM AUTHOR]

The objective of the present longitudinal study was to clarify whether osteophytosis and joint space narrowing predict quality of life (QOL) decline using a longitudinal population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study. The present study analyzed 1,525 participants who completed the radiographic examination at baseline and questionnaires regarding QOL at a 3-year follow-up (546 men and 979 women; mean age, 67.0 ± 11.0 years). This study examined the associations of osteophyte area (OPA) and minimum joint space width (mJSW) in the medial compartment of the knee at baseline with pain and physical functional disability measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). OPA and mJSW in the medial compartment of the knee were measured using a knee osteoarthritis (OA) computer-aided diagnosis system. Overall, OPA independently predicted physical functional disability after 3 years of follow-up. When analyzed in men and women separately, OPA, rather than mJSW, was an independent predictor for pain and physical functional disability after 3 years of follow-up in men. OPA, rather than mJSW, also predicted worsening of pain in men during the 3-year follow-up, whereas in women, mJSW, rather than OPA, predicted worsening of pain. In conclusion, the present longitudinal study using a large-scale population from the ROAD study found gender differences in the association of osteophytosis and joint space narrowing with pain and physical functional disability. [ABSTRACT FROM AUTHOR]

Professor Fruehan has been a pioneer in the fundamental understanding of slag foaming in ironmaking and steelmaking processes. Although considerable progress has been made in our understanding of the phenomena, there are still unanswered questions regarding the mechanisms in industrial processes and how to control them. At McMaster University, we have been working on conditions that are relevant to foaming in electric arc furnaces (EAFs) where these phenomena are central to modern EAF practices. This work will be reviewed and put in the context of what is known from a fundamental standpoint. [ABSTRACT FROM AUTHOR]

The aim of this study was to prospectively evaluate the efficacy and tolerability of hyaluronic acid (HA) and meloxicam for the treatment of knee pain due to Kashin-Beck disease (KBD). A total of 162 patients with KBD-based knee pain were randomly assigned to treatment with a 3-week course of HA ( n = 80) and a 12-week course of meloxicam ( n = 82). Clinical assessments for each patient were made at 0 (baseline), 1, 2, 4, 8, and 12 weeks. The primary efficacy measure was visual analog scale (VAS) pain score. Second efficacy measures comprised the Western Ontario and McMaster Universities (WOMAC) A (pain), B (stiffness), and C (function) scores as well as patients' and physicians' global assessments. Tolerability was evaluated based on adverse events (AEs) and physician reporting. The VAS rapidly decreased in both groups over 12 weeks. The VAS improvement observed in HA group was lower at week 1 ( p = 0.001) but better at weeks 8 and 12 ( p < 0.001) than the meloxicam group, which were supported by the secondary variables of WOMAC A ( p = 0.001) and WOMAC C ( p < 0.001) scores and the global assessments of the patients and their physicians ( p = 0.020 and 0.003, respectively). No serious AEs were reported, and the overall incidence of AEs among patients treated with meloxicam was higher than in patients treated with HA ( p = 0.012). This study suggests that intra-articular injection of HA and administration of oral meloxicam should be efficacious and well tolerated in the treatment of knee pain due to KBD; the onset of action of meloxicam was faster than that of HA, whereas HA therapy resulted in a more prolonged increasing improvement of symptoms than meloxicam. In addition, HA treatment was likely superior to meloxicam with respect to tolerability. Other randomized double-blind studies are needed to confirm the findings of our open-label study. [ABSTRACT FROM AUTHOR]

Maljkovic and Nakayama () demonstrated memory influences in singleton search from one trial to the next, an effect they termed priming of pop-out (PoP). This effect was described as resulting from the persistence of an implicit memory trace, the influence of which could be observed for around five to eight subsequent trials. The seemingly short-lived nature of this priming effect has been attributed to decay of the underlying memory representation that occurs when attention is directed to intervening search items, even when such items are perceptually dissimilar from the search trials upon which PoP is measured (Maljkovic & Nakayama, ). The present study reexamines the role of perceptual similarity as a mechanism of interference by examining the influence on PoP of rare search trials that were perceptually distinct with respect to the other, common trials. Long-lasting ( n − 16) PoP was observed for rare trials that were composed of distinct target/distractor colors, suggesting that PoP can be observed across at least twice as many trials as has previously been reported. Thus, the time span across which PoP can be measured depends heavily on the nature of the intervening search displays, a result that must be accommodated by current theoretical accounts of PoP. [ABSTRACT FROM AUTHOR]

Study Design:Cross-sectional.Objectives:To examine patterns of participation in activities of daily living (ADL) and fitness-related factors associated with these patterns among individuals with spinal cord injury (SCI).Setting:Centre for Health Promotion and Rehabilitation at McMaster University, School of Kinesiology and Health Studies at Queen's University.Methods:Forty-eight participants completed the Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) and a fitness test assessing cardiovascular fitness (VO2max and peak power output (Po)). The most commonly reported ADL were extracted from the PARA-SCI data for analysis.Results:Women tended to spend more time participating in domestic and personal care ADL than men. Compared to individuals with tetraplegia, individuals with paraplegia tended to spend more time transferring, cleaning and preparing food and less time wheeling, toileting and dressing. Fitness and participation in leisure time physical activity (LTPA) were associated with certain ADL. Participants with higher levels of fitness spent more time partaking in ADL wheeling and cleaning. Moreover, greater time spent participating in moderate- and heavy-intensity LTPA was positively correlated with time spent engaged in certain ADL.Conclusion:By identifying common ADL performed by individuals with SCI, the study findings begin to provide direction for developing strategies to optimize ADL participation. Future research should examine fitness as a way to help individuals with SCI optimize their ADL participation.Spinal Cord (2009) 47, 550–554; doi:10.1038/sc.2008.160; published online 23 December 2008 [ABSTRACT FROM AUTHOR]

Objectives: To use methods from the field of marketing research to involve students in the redesign of McMaster University’s small group, problem-based undergraduate medical education program. Methods: We used themes from a focus group conducted in an electronic decision support lab to compose 14 four-level educational attributes. Undergraduate medical students completed a discrete choice experiment composed of 15 web-administered, partial-profile, conjoint-choice tasks. Results: Latent class analysis revealed two segments with different preferences. Segment 1, (86% of students), preferred a problem-based approach with more small group tutorial sessions led by expert tutors who facilitated the tutorial process without teaching didactically. Segment 2, (14% of students), preferred more large group lectures, explicit learning objectives, expert tutors who taught didactically, and streaming options based on learning preferences. Although Segment 1 preferred smaller tutorial groups, simulations predicted these students would trade increases in tutorial group size for a conceptually integrated program that included tutorial problems based on core curriculum concepts, greater integration of the content of clinical skills training sessions and the tutorial curriculum, and a link between clerkship patient selection and the program’s curriculum. A majority of both segments would accept a more conceptually integrated program if the savings associated with increases in tutorial group size was reinvested in web-enhanced tutorial processes and computer-simulated health care problems. Conclusions: Most students preferred a small group, web-supported, problem-based learning approach led by content experts who facilitated group process. Students favored a program in which tutorial group problems, clinical skills training sessions and the patients selected for clerkship activities were more closely linked to core curriculum concepts. [ABSTRACT FROM AUTHOR]

Vezetéknév [ABSTRACT FROM AUTHOR]

The article emphasizes the importance of infusing creativity and curiosity into medical education at McMaster University, which the author believes would be best in enhancing a competence-driven curriculum. As one of those who developed the COMPASS Curriculum for medical education at McMaster, he asserts that medical graduates needs to operationalize creativity and curiosity at the course level while maintaining competence. He suggests that students should take courses based on interest.

The article focuses on misconduct ruling for psychologist Marc Hauser who resigned from Harvard University after the university found him guilty of misconduct. It cites the findings of the U.S. Office of Research Integrity (ORI) that Hauser "engaged in research misconduct." It also mentions that Bennett Galef of McMaster University in Hamilton, Ontario reviewed evidence used in the Harvard investigation and questions the ORI's use of the word "fabricated."

The article presents the use of human embryonic stem cells. A recent observation that they contain an immunogenic nonhuman sialic acid indicates that there may be limitations to their use. Sialic acid is found on the surface of most nonhuman mammalian cells. These cells are targeted by circulating antibodies found in human sera. The process results in complement-mediated death of cells bearing this molecule. Serum-induced killing of the cells does not correlate with sialic acid content.

The article reports on the opening of the Light Metal Casting Research Centre which aims to develop lighter, stronger and fuel-efficient cars at McMaster University in Hamilton, Ontario. The research center is part of the McMaster Manufacturing Research Institute. It is working with the automobile industry and the government to advance automotive casting research for engines and body panels. Partners of the project include Orlick Industries, General Motors, Burlington Technologies, Alcan International and Magna Powertrain.

The article is a biography of Stephen Lewis, UN's special envoy for HIV/AIDS in Africa, who has served in many capacities some of them being Canada's ambassador to the UN and the deputy executive director of UNICEF. Stephen who has 24 honorary doctorates, has dedicated his life for social justice and has gained international acclaim. Stephen has been nominated as one of the most influential persons in the world and may be nominated for the Nobel in spite of he differing with various leaders.