Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: maxillary growth at eight years of age.
Scandicle单侧唇腭裂初次手术的随机试验: 8 岁时上颌骨生长。
- 作者列表："Küseler A","Mølsted K","Marcusson A","Heliövaara A","Karsten A","Bellardie H","Sæle P","Brinck E","Skaare P","Rizell S","Chalien MN","Mooney J","Eyres P","Shaw W","Semb G
OBJECTIVES:To assess differences in craniofacial growth at 8 years of age according to the different protocols for primary cleft surgery in the Scandcleft project. DESIGN AND SETTING:Prospective, randomized, controlled clinical trial (RCT) involving 10 centres, including non-syndromic Caucasians with unilateral cleft lip and palate (UCLP). In Trial 1, a common surgical method (1a) with soft palate closure at 3-4 months of age and hard palate closure at 12 months of age was tested against similar surgery but with hard palate repair at 36 months (delayed hard palate closure) (1b). In Trial 2, the common method (2a) was tested against simultaneous closure of both hard and soft palate at 1 year (2c). In Trial 3, the common method (3a) was tested against hard palate closure together with lip closure at 3 months of age and soft palate closure at 1 year of age (3d). Participants were randomly allocated by use of a dice. Operator blinding was not possible but all raters of all outcomes were blinded. SUBJECTS AND METHODS:The total number of participating patients at 8 years of age was 429. Lateral cephalograms (n = 408) were analysed. The cephalometric angles SNA and ANB were chosen for assessing maxillary growth for this part of the presentation. RESULTS:Within each trial (Trial 1a/1b, Trial 2a/2c, and Trial 3a/3d), there was no difference in cephalometric values between the common and the local arm. There were no statistically significant differences in the SNA and ANB angles between the common arm in Trial 1a (mean SNA 77.8, mean ANB 2.6) and Trial 2a (mean SNA 79.8, mean ANB 3.6) and no difference between Trial 1a and Trial 3a, but a statistical difference could be seen between Trial 2a and Trial 3a (mean SNA 76.9, mean ANB 1.7). However, the confidence interval was rather large. Intra- and inter-rater reliability were within acceptable range. CONCLUSIONS:The timing and the surgical method is not of major importance as far as growth outcomes (SNA and ANB) in UCLP are concerned. REGISTRATION:ISRCTN29932826. PROTOCOL:The protocol was not published before trial commencement.
目的: 根据不同的手术方案，评估scandrash项目中 8 岁时颅面生长的差异。 设计和地点: 前瞻性、随机、对照临床试验 (RCT)，涉及 10 个中心，包括非综合征性白种人单侧唇腭裂 (ulp)。在试验 1 中，一种常用的手术方法 (1a) 在 3-4 个月大的时候关闭软腭，在 12 个月大的时候关闭硬腭，在 36 个月的时候接受类似手术的测试，但是在硬腭修复 (延迟硬腭关闭) (1b)。在试验 2 中，测试了普通方法 (2a) 在 1 年 (2c) 时同时关闭硬腭和软腭。在试验 3 中，对普通方法 (3a) 进行了 3 个月龄时硬腭闭合联合唇闭合和 1 岁时软腭闭合 (3d) 的测试。参与者通过使用骰子随机分配。操作者盲法是不可能的，但所有结果的所有评价者均盲法。 对象和方法: 8 岁时参与的患者总数为 429 例。分析头颅侧位片 (n = 408)。选择头影测量角度SNA和ANB评估这部分演示的上颌骨生长。 结果: 在每个试验 (试验 1a/1b、试验 2a/2c和试验 3a/3d) 中，普通臂和局部臂的头影测量值无差异。试验 1a (平均SNA 77.8，平均ANB 2.6) 和试验 2a (平均SNA 79.8，平均ANB 3.6) 中常见臂之间的SNA和ANB角度无统计学显著差异试验 1a和试验 3a之间没有区别，但试验 2a和试验 3a之间存在统计学差异 (平均SNA 76.9，平均ANB 1.7)。然而，置信区间相当大。评定者内和评定者间信度在可接受范围内。 结论: 就UCLP的生长结局 (SNA和ANB) 而言，时机和手术方法并不重要。 注册: isrctn29932826。 议定书: 议定书在试验开始前没有公布。
METHODS::Impairments in social cognition have been frequently described in 22q11.2 deletion syndrome (22q11.2DS) and are thought to be a hallmark of difficulties in social interactions. The present study addresses aspects that are critical for everyday social cognitive functioning but have received little attention so far. Sixteen children with 22q11.2DS and 22 controls completed 1 task of facial expression recognition, 1 task of attribution of facial expressions to faceless characters involved in visually presented social interactions, and 1 task of attribution of facial expressions to characters involved in aurally presented dialogues. All three tasks have in common to involve processing of emotions. All participants also completed two tasks of attention and two tasks of visual spatial perception, and their parents completed some scales regarding behavioural problems of their children. Patients performed worse than controls in all three tasks of emotion processing, and even worse in the second and third tasks. However, they performed above chance level in all three tasks, and the results were independent of IQ, age and gender. The analysis of error patterns suggests that patients tend to coarsely categorize situations as either attractive or repulsive and also that they have difficulties in differentiating emotions that are associated with threats. An isolated association between the tasks of emotion and behaviour was found, showing that the more frequently patients with 22q11.2DS perceive happiness where there is not, the less they exhibit aggressive behaviour.
METHODS:BACKGROUND:We describe the first radiographic clinic in the literature for DDH and how this novel clinic can significantly improve the efficiency and cost-effectiveness of service in a tertiary referral centre. AIMS:A radiographic clinic for the management of developmental dysplasia of the hip was introduced in 2017 in our institution. We performed a detailed cost analysis to assess the economic savings made with the introduction of this new clinic. We assessed the efficiency of the service by identifying how many unnecessary outpatient visits were prevented. We also assessed the difference in times from referral to review between the two clinics. METHODS:Analysis of the clinic activity in 2017 was possible as all data was collected prospectively by the DDH CNS and stored in our database. Cost analysis was performed, and the savings made per patient along with the financial benefit to our institution was recorded. RESULTS:The new radiographic clinic reduced the cost of reviewing one patient by €162.51 per patient. There was a 73% discharge rate from the clinic which prevented 251 unnecessary patient visits to the outpatient department over the course of the year. There was a significant 11-day reduction in waiting times between referral and review when comparing the radiographic to the conventional clinic (p < 0.05). CONCLUSIONS:A radiographic clinic for the management of developmental dysplasia of the hip has a significant effect on the efficiency and overall cost-effectiveness of service provision in a tertiary referral centre.
METHODS:INTRODUCTION:Triple pelvic osteotomy (TPO) involves periacetabular osteotomies of the ilium, ischium, and pubis to reorient the acetabulum. This operation is indicated in certain situations for the treatment of developmental dysplasia of the hip, dysplastic neuromuscular hips, and for containment of the femoral head in cases of Legg-Calvé-Perthes disease. METHODS:This retrospective cohort study compares radiographic outcomes of patients who underwent TPO using two different techniques and describes a novel single-incision direct lateral approach. TPO was performed on 22 patients by the senior author. The first 10 patients underwent TPO through a single-incision anterolateral approach. The last 12 patients underwent TPO using the direct lateral approach. Preoperative and postoperative pelvic radiographs were reviewed for each patient, and the migration index and center-edge angle were recorded. RESULTS:The migration index and center-edge angle were evaluated and were not found to be significantly different between the anterolateral and direct lateral groups. The direct lateral approach is described. CONCLUSION:The direct lateral approach for TPO is equivalent to the anterolateral approach on radiographic evaluation. Advantages of the direct lateral approach include direct visualization of the ischial osteotomy, effective mobilization of the acetabulum, and safety of the sciatic nerve.