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Purpose: The purpose of this study was to compare the efficacy, and ocular pharmacokinetics of a new 0.04% w/v bis in die means twice a day (BID) ophthalmic solution and marketed 0.05% w/v quater in die means four times a day (QID) ophthalmic emulsion of difluprednate in New Zealand white (NZW) rabbits. Methods: The preclinical proof of concept was established in paracentesis-induced acute inflammation, endotoxin-induced acute uveitis, and bovine serum albumin-induced chronic uveitis in NZW rabbit animal models. A comparison of clinical score, total cell count, and total protein was performed to determine efficacy. An ocular pharmacokinetic study was conducted to study the influence of the vehicle on the ocular absorption of the drug. Results: In both uveitis models, the new solution formulation and marketed emulsion formulation inhibited total clinical score, total cell count, PGE2, and total protein significantly more than the placebo and lipopolysaccharide (disease control) groups and were comparable. In an ocular pharmacokinetic study, the Cmax and AUC0–t of difluoroprednisolone 17-butyrate in humor were ∼2-fold higher after 14 days' instillation of new solution formulation (0.04% w/v, BID) compared with 14 days' instillation of marketed emulsion (0.05% w/v, QID). Conclusions: The study demonstrated that the efficacy of the solution formulation at a lower dose and reduced dosing regimen were comparable to that of the emulsion formulation. The reduction in strength and regimen may result in improved patient adherence and outcomes. [ABSTRACT FROM AUTHOR]

Background: Early medical and surgical intervention in acute spinal cord injuries can improve long‐term functional outcomes. This study aims to observe the effects of the New Zealand (NZ) Spinal Cord Impairment Action Plan on timing to acute decompression and comparing this to the period prior to the policy change. Method: Data were collected in the form a retrospective audit from medical records of 12 patients admitted to Middlemore Hospital from 2010 to 2013 prior to the NZ Spinal Cord Impairment Action Plan, and 11 patients from 2014 to 2015 following the policy change. Time of decompression is defined as either closed reduction or open reduction plus decompression. Patients were transferred from an initial regional hospital to Middlemore Hospital or directly to Middlemore Hospital following injury. Important time points were compared before and after the NZ Spinal Cord Impairment Action Plan. Results: Cox regression modelling was used to compare statistical data. Following the regional policy change, patients had a shorter time of transfer between hospitals, pre‐surgical work up, and hence shorter time to decompression. The mean time of injury to decompression before the policy change is 57.8 and 24.9 h after. Conclusion: Since implementing the NZ Spinal Cord Impairment Action Plan, time to decompression has been significantly reduced compared with the same group prior. [ABSTRACT FROM AUTHOR]

Background: The rate of Achilles tendon ruptures is increasing, but there is a lack of consensus on treatment of acute injuries. The purpose of this trial was to compare outcomes of weight-bearing casts with those of traditional casts in the treatment of acute Achilles tendon ruptures.Methods: Eighty-four patients with an acute Achilles tendon rupture were recruited over a two-year period. Patients were randomized to be treated with either a weight-bearing cast with a Böhler iron or a non-weight-bearing cast for eight weeks. Patients underwent muscle dynamometry testing at six months, with additional follow-up at one and two years. The primary outcomes that were assessed were the rerupture rate and the time taken to return to work. Secondary outcomes included return to sports, ankle pain and stiffness, footwear restrictions, and patient satisfaction.Results: There were no significant differences between groups with regard to patient demographics or activity levels prior to treatment. At the time of follow-up at two years, one (3%) of the thirty-seven patients in the weight-bearing group and two (5%) of the thirty-seven in the non-weight-bearing group had sustained a rerupture (p = 0.62). The patients in the weight-bearing group experienced less subjective stiffness at one year. There were no significant differences in time taken to return to work, Leppilahti scores, patient satisfaction, pain, or return to sports between the groups.Conclusions: Use of weight-bearing casts for the nonoperative treatment of Achilles tendon ruptures appears to offer outcomes that are at least equivalent to those of non-weight-bearing casts. The overall rerupture rate in this study was low, supporting the continued use of initial nonoperative management for the treatment of acute Achilles tendon ruptures.Levels Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Aim: To investigate the epidemiology of traumatic spinal cord injury (TSCI) in New Zealand over a 10-year period., Methods: Ambispective data of all new patients admitted to New Zealand's two spinal rehabilitation units between January 2007 and December 2016 (n=929) were collated. Variables assessed included age at injury, gender, ethnicity, date of injury, aetiology, length of hospital stay, injury level, neurological status on discharge and discharge destination., Results: The incidence of TSCI averaged 22 (95% CI 21-24) per million, increasing 6% a year. The average incidence for Māori (29 per million people (95% CI 25-34)) was 1.8 times higher than New Zealand European (16 per million people (95% CI 15-18)), and show an increase of 14% a year. The median age of TSCI increased from 43 to 48 years. Overall, falls (32%), transport (32%) and sports (22%) were the most common causes of TSCI. Cervical TSCI (54%) were most common, particularly in older adults (70% over 75 years) and Māori (61%) and Pacific Island (72%) patients. Surgical rates remained stable (77%) but length of stay in hospital decreased over the study period., Conclusions: The demographic of TSCI is changing in New Zealand. The median age of patients is increasing, as is the incidence, particularly for women, older adults and Māori patients., Competing Interests: Mrs Croot is one of two NZ Spinal Cord Injury Registry (NZSCIR) Coordinators. She is involved with consenting participants, data collection, data entry, registry oversight and maintenance, as well as data access requests for the NZSCIR. She was not involved in the data extraction for this paper. Dr Nunnerley reports funding from Canterbury Orthopaedic Services during the conduct of the study.

Early decompression may improve neurological outcome after spinal cord injury (SCI), but is often difficult to achieve because of logistical issues. The aims of this study were to 1) determine the time to decompression in cases of isolated cervical SCI in Australia and New Zealand and 2) determine where substantial delays occur as patients move from the accident scene to surgery. Data were extracted from medical records of patients aged 15-70 years with C3-T1 traumatic SCI between 2010 and 2013. A total of 192 patients were included. The median time from accident scene to decompression was 21 h, with the fastest times associated with closed reduction (6 h). A significant decrease in the time to decompression occurred from 2010 (31 h) to 2013 (19 h, p = 0.008). Patients undergoing direct surgical hospital admission had a significantly lower time to decompression, compared with patients undergoing pre-surgical hospital admission (12 h vs. 26 h, p < 0.0001). Medical stabilization and radiological investigation appeared not to influence the timing of surgery. The time taken to organize the operating theater following surgical hospital admission was a further factor delaying decompression (12.5 h). There was a relationship between the timing of decompression and the proportion of patients demonstrating substantial recovery (2-3 American Spinal Injury Association Impairment Scale grades). In conclusion, the time of cervical spine decompression markedly improved over the study period. Neurological recovery appeared to be promoted by rapid decompression. Direct surgical hospital admission, rapid organization of theater, and where possible, use of closed reduction, are likely to be effective strategies to reduce the time to decompression.