Normal pediatric values of carotid artery intima-media thickness measured by B-mode ultrasound and radiofrequency echo tracking respecting the consensus: a systematic review.

BACKGROUND: Carotid artery intima-media thickness (IMT) is a sub-clinical radiologic marker of atherosclerosis in children. It is associated with adult-onset vascular disease. OBJECTIVE: To determine normal pediatric values of IMT from results observed in the literature. METHODS: Our systematic review was conducted according to PRISMA guidelines. We reviewed 2298 English articles from inception to February 2023. Inclusion criteria included studies evaluating B-mode and radiofrequency (RF)-based IMT measurements based on the American Heart Association, the Association for European Pediatric Cardiology, the Mannheim Consensus, and the American Society of Echocardiography recommendations. A meta-analysis of aggregate data was conducted to obtain the confidence interval (CI) for IMT, using a 95% confidence level. RESULTS: We obtained 88 B-mode-based IMT measurement studies with 6184 children and six radiofrequency echo-tracking-based studies with 766 children. Mean IMT in the pediatric population was 0.43 mm, 95% [CI] 0,42 to 0.44, using the B-mode technique, and 0.41 mm, 95% [CI] 0.36 to 0.45 using the radiofrequency technique. No significant relationship was detected between IMT and age (p value = 0.83). Finally, no significant effect of sex on IMT was found (p value = 0.82 for B-mode and p value = 0.62 for RF). CONCLUSION: Based on the studies selected in this literature review, we were unable to conclude that there was a significant difference between the average IMT of boys and girls. No relationship was demonstrated between age and IMT. IMT is technique-specific, and normal values should be interpreted according to recommendations of recognized consensus to counteract the current heterogeneity in literature. CLINICAL RELEVANCE STATEMENT: Technique and children-specific Intima media thickness measurements help clinicians and scientists to assess the risk of atherosclerosis in children. KEY POINTS: • Intima-media thickness (IMT) does not correlate with age in children without risk factors. • According to current literature, there is no difference in IMT between healthy boys and girls. • There is heterogeneity, even with studies abiding by the official consensus.

Examining Bias in Published Surgical Glaucoma Clinical Trials.

PRCIS: Our results demonstrate that, among randomized clinical trials examining the use of surgical treatments for glaucoma, the majority were not registered. Publication bias (PB) was less likely. More than a third of registered trials presented outcome reporting bias (ORB). PURPOSE: Despite the optimum of quality evidence provided by randomized controlled trials (RCTs), biases may be introduced and hinder their application. The primary objective of this study was to investigate ORB and PB in RCTs assessing surgical treatments of glaucoma, as well as their registration status. MATERIALS AND METHODS: A literature review was conducted in MEDLINE, EMBASE, and CENTRAL databases. Inclusion criteria were RCTs published in English between 2007 and 2021 that focused on surgical treatments of patients of all ages with glaucoma or elevated intraocular pressure. Exclusion criteria included cadaveric and animal studies. Registration status was correlated with entries from clinical trial registries. PB was determined by the proportion of trials presenting statistically significant results. ORB was evaluated by comparing the study's primary outcome with that listed in the trial registry. Trials quality was assessed using the Jadad score. RESULTS: After deleting duplicates, 7561 citations were screened. One hundred sixty-one RCTs were eligible and included between 13 and 556 participants. Of the total, 91% studied an adult population and 71% included patients suffering from primary open angle glaucoma. Among included studies, 63% were not registered and 47% had statistically significant results. An upward trend in registration was observed with time. However, 37% of the studies showed discrepancies between objectives in cited clinical trial registries and the published results. CONCLUSION: PB in surgical glaucoma trials was not obvious. Among the minority of trials that were registered, more than a third presented ORB. Unregistered trials had lower quality. RCT registration is crucial for the transparent interpretation of studies, improved patient care in surgery, and informed decision-making.

Volar Locking Plating Compared to Conservative Treatment in Distal Radius Fractures in Elderly Patients (>60 years old): A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Purpose: We performed a systematic review and meta-analysis to compare the efficacy of volar locking plating (VLP) to conservative treatment in distal radius fractures in patients aged >60 years old. Methods: English articles were searched in electronic databases including MEDLINE, CENTRAL, Embase, Web of science, and ClinicalTrial.gov from inception to October 2020. Relevant article reference lists also were reviewed. Two reviewers independently screened and extracted data from trials comparing VLP to nonsurgical treatment in distal radial fractures in the elderly. Starting with 3052 citations, 5 trials (539 patients) met the inclusion criteria. The primary outcomes were disabilities of the arm, shoulder, and hand, and patient-rated wrist evaluation scores, grip strength, and range of motion. Results: All trials of this random effect meta-analysis were at a moderate risk of bias due to the lack of blinding. Differences in the disabilities of the arm, shoulder, and hand score (mean difference [MD] -5,91; 95% confidence interval [CI], -8,83; -3,00), patient-rated wrist evaluation score (MD -9.07; 95% CI, -14.57, -3.57), and grip strength (MD 5,12; 95% CI, 0,59-9,65) were statistically significant and favored VLPs, however without reaching clinical significance. No effect was observed in terms of the range of motion and reoperation rates. Conclusion: This review was not able to demonstrate any clinical benefit to the surgical treatment of distal radius fractures with VLP in patients aged >60 years old compared to nonsurgical treatment. Type of study/level of evidence: Therapeutic I.

The risk of venous thromboembolism in surgically treated hip fracture: A retrospective cohort study of 5184 patients.

INTRODUCTION: Elderly patients undergoing surgery for a hip fracture are at risk of venous thromboembolism (VTE). The known risk of VTE is low due to thromboprophylaxis (1.8-2.5% at three months). Most previous studies have ignored the high mortality in that population when calculating the risk of VTE. Hip fracture treatment has also evolved over the last decade. The real risk of VTE today is unknown. We asked what was the risk of symptomatic VTE following surgery for a hip fracture in an elderly population. We also asked what kind of bleeding events were associated with thromboprophylaxis. HYPOTHESIS: The risk of VTE will be lower than previously described due to modern postoperative care. PATIENTS AND METHODS: Retrospective cohort study of all patients≥65-years-old undergoing surgery for a hip fracture in two Canadian academic centers, between January 1, 2008, and January 1, 2019. Symptomatic VTE (pulmonary embolism or deep venous thrombosis) confirmed by imagery were assessed. The follow-up was fixed at 3 months. The cumulated risks of VTE and bleeding events were calculated using the Kaplan-Meier estimator and a logistic regression model was used to determine risk factors. RESULTS: The cohort included 5184 patients. The mean age was 83±8 years old and 76% of patients were female. In total, 98.8% of this cohort received postoperative thromboprophylaxis. Low-molecular-weight heparin was given for 35 days in 87% of this cohort. The risk of venous thromboembolism was 4.7±0.5% at 3 months (n=144). Chronic obstructive pulmonary disease (odds ratio 1.6 [1.0-2.4]) and the use of warfarin as extended thromboprophylaxis (odds ratio 2.1 [1.3-3.6]) were associated with venous thromboembolism. The risk of bleeding was 5.9% (n=179) at 3 months. In total, 78% (n=141) of bleeding events were hematomas, of which only 12% (n=16) needed reoperation. The use of direct oral anticoagulant was associated with an increased risk of bleeding events (odds ratio, 2.8 [1.5-5.0]). Mortality at 3 months was 8.4%. DISCUSSION: The risk of venous thromboembolism is higher than expected in a population treated for this condition (4.7% vs. 1.8-2.5% at 3 months as previously described). Bleeding events were mostly hematomas and few needed reoperations for wound complication. Future research should focus on the management of thromboprophylaxis in that population. LEVEL OF EVIDENCE: III; retrospective cohort study.