human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives To compare collagenase injections and surgery ( fasciectomy ) for Dupuytren 's contracture ( DC ) regarding actual total direct treatment costs and short-term outcomes . Design Retrospective cohort study . Setting Orthopaedic department of a regional hospital in Sweden . Participants Patients aged 65 years or older with previously untreated DC of 30 ° or greater in the metacarpophalangeal ( MCP ) and /or proximal interphalangeal ( PIP ) joints of the small , ring or middle finger . The  collagenase group comprised 16 consecutive patients treated during the first 6 months following the introduction of collagenase as treatment for DC at the study centre . The controls were 16 patients r and omly selected among those operated on with fasciectomy at the same centre during the preceding 3 years . Interventions Treatment with collagenase was given during two st and ard outpatient clinic visits ( injection of 0.9 mg , distributed at multiple sites in a palpable cord , and next-day finger extension under local anaesthesia ) followed by night-time splinting . Fasciectomy was carried out in the operating room ( day surgery ) under general or regional anaesthesia using st and ard technique , followed by therapy and splinting . Primary and secondary outcome measures Actual total direct costs ( salaries of all medical personnel involved in care , medications , material s and other relevant costs ) , and total MCP and PIP extension deficit ( degrees ) measured by h and therapists at 6–12 weeks after the treatment . Results Collagenase injection required fewer hospital outpatient visits to a therapist and nurse than fasciectomy . Total treatment cost for collagenase injection was US$ 1418.04 and for fasciectomy US$ 2102.56 . The post-treatment median ( IQR ) total extension deficit was 10 ( 0–30 ) for the collagenase group and 10 ( 0–34 ) for the fasciectomy group . Conclusions Treatment of DC with one collagenase injection costs 33 % less than fasciectomy with equivalent efficacy at 6 weeks regarding reduction in contracture PURPOSE Collagenase Clostridium histolyticum ( CCH ) injection was introduced commercially as a treatment for Dupuytren contracture following initial phase-3 investigations in 2009 with promising results . However , the efficacy of CCH has not been prospect ively investigated in a direct comparison to other active treatments of Dupuytren contracture with more than 1-year follow-up , despite a wide and increasing clinical use . METHOD In this prospect i ve , independent , open-label , r and omized controlled trial , ( Clinical trials.gov ; NCT 01538017 ) , percutaneous needle fasciotomy ( PNF ) was directly compared with CCH .  Fifty patients with primary isolated proximal interphalangeal joint Dupuytren contractures were enrolled and followed for 2 years . The primary outcome was clinical improvement defined as a reduction in contracture by 50 % or more relative to baseline . Secondary outcomes included change in contracture , recurrence , adverse events , complications , and Disabilities of the Arm , Shoulder , and H and question naire score . RESULTS Clinical improvement at 2 years was maintained in 7 % of CCH patients ( 2 of 29 ) and 29 % of PNF patients ( 6 of 21 ) . Collagenase Clostridium histolyticum led to more , mainly transient , complications , in 93 % of patients versus 24 % of the patients treated with PNF . No other differences were observed . CONCLUSIONS This study provides evidence that CCH is not superior to PNF in the treatment of isolated proximal interphalangeal joint Dupuytren contracture regarding clinical outcome , and it led to more complications than PNF . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic Abstract Background Dupuytren ’s disease ( DD ) is a fibroproliferative pathology that affects the palmar aponeurosis causing the development of nodules and collagen cords and the progressive flexion of the fingers . The st and ard procedure is surgical fasciectomy , followed by high recurrence rates . Collagenase Clostridium histolyticum ( CCH ) injection represents an innovative noninvasive approach to the treatment of DD . This prospect i ve study was design ed to examine the efficacy and safety of CCH injection performed in the outpatient , using local anesthesia . Material s and methods Forty patients [ 32 metacarpophalangeal ( MP ) , 8 proximal interphalangeal ( PIP ) ] with Dupuytren ’s contracture of at least 20 ° for MP joint and any degree for PIP joint were included . The mean age was 66 . All joints were treated with a single vial of collagenase injection and manual breaking of the cord 24 h after . All adverse effects ( AEs ) were monitored . Patients were checked 7 , 30 , 90 , and 180 days after the injection . Primary endpoint was a reduction in digit contracture within 0 ° –5 ° of normal extension . Secondary endpoints were the improvement of range of motion , the evaluation of AEs incidence , and cost-effectiveness of collagenase treatment . Results About 67.5 % of patients obtained a clinical success . At 6 months , a further 7.5 % attained the same result . The mean contracture of treated joints was 5.3º for MP and 6.8 ° for PIP joints . Twenty-three patients had one or more mild-to-moderate side effects . Conclusions The use of collagenase appears to be an effective and safe method for the treatment of Dupuytren ’s contracture . Therapeutic success was achieved in a significant percentage of patients . The incidence of side effects was higher , but they were local reactions of short duration . The use of a single collagenase vial in patients treated in day surgery appears more cost-effective than surgery PURPOSE This study compared the efficacy of collagenase treatment and needle fasciotomy for contracture of the metacarpophalangeal ( MCP ) joint in Dupuytren disease . METHODS This is a prospect i ve , single-blinded , r and omized study with follow-up 1 week and 1 year after treatment . One hundred and forty patients with an MCP contracture of 20 ° or more in a single finger were enrolled , of whom 69 patients were r and omized to collagenase treatment and 71 patients to needle fasciotomy .  The patients were followed at 1 week and were examined by a physiotherapist after 1 year . Measurements of joint movement and grip strength were recorded as well as patient-perceived outcomes measured by the Unité Rhumatologique des Affections de la Main ( URAM ) question naire and a visual analog scale ( VAS ) for the estimation of procedural pain and subjective treatment efficacy . RESULTS Eighty-eight percent of the patients in the collagenase group and 90 % of the patients in the needle fasciotomy group had a reduction in their MCP contracture to less than 5 ° 1 week after treatment , and the median gains in passive MCP movement were 48 ° and 46 ° , respectively . The median VAS score for procedural pain was 4.9 of 10 in the collagenase group and 2.7 of 10 in the needle fasciotomy group . After 1 year , 90 % of the patients in both groups had full extension of the treated MCP joint . One patient in each group had a recurrence of the contracture . The median improvement in URAM score was 8 units in both groups and the VAS estimation of treatment efficacy by the patients was 8.7 of 10 in both groups . CONCLUSIONS There was no significant difference between the treatment outcomes after collagenase and needle fasciotomy treatment after 1 year . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic In POINT X , a study design ed to reflect clinical practice and patient treatment choices , 254 European patients received  open-label collagenase  for Dupuytren ’s contracture . The most severely affected joint was treated first in 74 % of patients . In total , 52 % , 41 % , 7 % , and 1 % of patients selected the little , ring , middle , and index finger , respectively ; 79 % had one or two joints treated . Only 9 % of patients ( n = 24 ) received 4 or 5 injections . The mean improvement in total passive extension deficit ( TPED ) was 34 ° on day 1 , improving further by day 7 to 42 ° . This secondary improvement was maintained by day 90 and month 6 . The mean number of injections/joint was 1.2 for the metacarpophalangeal joint and 1.25 for the proximal interphalangeal joint . Median time to recovery was 4 days ; the mean improvement in h and function was clinical ly relevant as measured by the Unité Rhumatologique des Affections de la Main ( URAM ) score . In total , 87 % and 86 % of patients and physicians , respectively , were very satisfied or satisfied with treatment at month 6 , although correlation between TPED and patient satisfaction was weak ( Spearman −0.18 , 95 % CI −0.32 to  −0.06 ) . Collagenase  was well tolerated , with 10 ( 3.9 % ) patients experiencing severe adverse events . As a real-world study , the POINT X findings can be generalized to the at-large population PURPOSE The Collagenase Option for the Reduction of Dupuytren 's ( CORD ) II study investigated the efficacy and safety of injectable Xiaflex ( collagenase clostridium histolyticum ) , in patients with Dupuytren 's contracture . METHODS This was a prospect i ve , r and omized , placebo-controlled trial with 90-day double-blind and 9-month open-label phases . We r and omized patients with contractures affecting metacarpophalangeal ( MCP ) or proximal interphalangeal ( PIP ) joints 2 to 1 to collagenase ( 0.58 mg ) or placebo . Cords received a maximum of 3 injections . Cord disruption was attempted the day after injection using a st and ardized finger extension procedure . Primary end point was reduction in contracture to 0 ° to 5 ° of normal 30 days after the last injection . RESULTS We enrolled 66 patients ; 45 cords ( 20 MCP to 25 PIP joints )  received collagenase and 21 cords ( 11 MCP to 10 PIP joints ) received placebo in the double-blind phase . Statistically significantly more cords injected with collagenase than placebo met the primary end point ( 44.4 % vs 4.8 % ; p < . 001 ) . The mean percentage decrease in degree of joint contracture from baseline to 30 days after last injection was 70.5 % ± 29.2 % in the collagenase group and 13.6 % ± 26.1 % in the placebo group ( p < .001 ) . The mean increase in range of motion was significantly greater in the collagenase ( 35.4 ° ± 17.8 ° ) than in the placebo ( 7.6 ° ± 14.9 ° ; p < .001 ) group . Efficacy after open-label treatment was similar to that after the double-blind phase : 50.7 % of all joints achieved 0 ° to 5 ° of normal . More patients were satisfied with collagenase ( p < .001 ) . No joint had recurrence of contracture . One patient had a flexion pulley rupture and one patient underwent routine fasciectomy to address cord proliferation and sensory abnormality . No tendon ruptures or systemic allergic reactions were reported . Most adverse events were related to the injection or finger extension procedure . CONCLUSIONS Collagenase clostridium histolyticum is the first Food and Drug Administration-approved , nonsurgical treatment option for adult Dupuytren 's contracture patients with a palpable cord that is highly effective and well tolerated . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic PURPOSE To describe changes in joint motion , sensibility , and scar pliability and to investigate the patients ' expectations , self-reported recovery , and satisfaction with h and function , disability , and quality of life after surgery and h and therapy for Dupuytren disease . METHODS This prospect i ve cohort study collected measurements before surgery and 3 , 6 , and 12 months after surgery and h and therapy .  Ninety patients with total active extension deficits of 60 ° or more from Dupuytren contracture were included . Outcomes measures were range of motion ; sensibility ; scar pliability ; self-reported outcomes on expectations , recovery , and satisfaction with h and function ; Disabilities of the Arm , Shoulder , and H and scores ; safety and social issues of h and function ; physical activity habits ; and quality of life with the Euroqol . RESULTS The extension deficit decreased , and there was a transient decrease in active finger flexion during the first year after surgery . Sensibility remained unaffected . Generally , patients with surgery on multiple fingers had worse scar pliability . The majority of the patients had their expectations met , and at 6 months , 32 % considered h and function as fully recovered , and 73 % were satisfied with their h and function . Fear of hurting the h and and worry about not trusting the h and function were of greatest concern among safety and social issues . The Disability of the Arm , Shoulder , and H and score and the Euroqol improved over time . CONCLUSIONS After surgery and h and therapy , disability decreased independent of single or multiple operated fingers . The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic IV AIM We explored regional variations in the surgical management of patients with Dupuytren 's contracture ( DC ) in 12 European countries using a surgeon survey and patient chart review . METHODS Twelve countries participated : Denmark , Finl 
    Output:
    
agent
Outcomes , such as range of motion , recurrence , and clinical success , were frequently defined , however many different definitions were used .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives To compare collagenase injections and surgery ( fasciectomy ) for Dupuytren 's contracture ( DC ) regarding actual total direct treatment costs and short-term outcomes . Design Retrospective cohort study . Setting Orthopaedic department of a regional hospital in Sweden . Participants Patients aged 65 years or older with previously untreated DC of 30 ° or greater in the metacarpophalangeal ( MCP ) and /or proximal interphalangeal ( PIP ) joints of the small , ring or middle finger . The  collagenase group comprised 16 consecutive patients treated during the first 6 months following the introduction of collagenase as treatment for DC at the study centre . The controls were 16 patients r and omly selected among those operated on with fasciectomy at the same centre during the preceding 3 years . Interventions Treatment with collagenase was given during two st and ard outpatient clinic visits ( injection of 0.9 mg , distributed at multiple sites in a palpable cord , and next-day finger extension under local anaesthesia ) followed by night-time splinting . Fasciectomy was carried out in the operating room ( day surgery ) under general or regional anaesthesia using st and ard technique , followed by therapy and splinting . Primary and secondary outcome measures Actual total direct costs ( salaries of all medical personnel involved in care , medications , material s and other relevant costs ) , and total MCP and PIP extension deficit ( degrees ) measured by h and therapists at 6–12 weeks after the treatment . Results Collagenase injection required fewer hospital outpatient visits to a therapist and nurse than fasciectomy . Total treatment cost for collagenase injection was US$ 1418.04 and for fasciectomy US$ 2102.56 . The post-treatment median ( IQR ) total extension deficit was 10 ( 0–30 ) for the collagenase group and 10 ( 0–34 ) for the fasciectomy group . Conclusions Treatment of DC with one collagenase injection costs 33 % less than fasciectomy with equivalent efficacy at 6 weeks regarding reduction in contracture PURPOSE Collagenase Clostridium histolyticum ( CCH ) injection was introduced commercially as a treatment for Dupuytren contracture following initial phase-3 investigations in 2009 with promising results . However , the efficacy of CCH has not been prospect ively investigated in a direct comparison to other active treatments of Dupuytren contracture with more than 1-year follow-up , despite a wide and increasing clinical use . METHOD In this prospect i ve , independent , open-label , r and omized controlled trial , ( Clinical trials.gov ; NCT 01538017 ) , percutaneous needle fasciotomy ( PNF ) was directly compared with CCH .  Fifty patients with primary isolated proximal interphalangeal joint Dupuytren contractures were enrolled and followed for 2 years . The primary outcome was clinical improvement defined as a reduction in contracture by 50 % or more relative to baseline . Secondary outcomes included change in contracture , recurrence , adverse events , complications , and Disabilities of the Arm , Shoulder , and H and question naire score . RESULTS Clinical improvement at 2 years was maintained in 7 % of CCH patients ( 2 of 29 ) and 29 % of PNF patients ( 6 of 21 ) . Collagenase Clostridium histolyticum led to more , mainly transient , complications , in 93 % of patients versus 24 % of the patients treated with PNF . No other differences were observed . CONCLUSIONS This study provides evidence that CCH is not superior to PNF in the treatment of isolated proximal interphalangeal joint Dupuytren contracture regarding clinical outcome , and it led to more complications than PNF . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic Abstract Background Dupuytren ’s disease ( DD ) is a fibroproliferative pathology that affects the palmar aponeurosis causing the development of nodules and collagen cords and the progressive flexion of the fingers . The st and ard procedure is surgical fasciectomy , followed by high recurrence rates . Collagenase Clostridium histolyticum ( CCH ) injection represents an innovative noninvasive approach to the treatment of DD . This prospect i ve study was design ed to examine the efficacy and safety of CCH injection performed in the outpatient , using local anesthesia . Material s and methods Forty patients [ 32 metacarpophalangeal ( MP ) , 8 proximal interphalangeal ( PIP ) ] with Dupuytren ’s contracture of at least 20 ° for MP joint and any degree for PIP joint were included . The mean age was 66 . All joints were treated with a single vial of collagenase injection and manual breaking of the cord 24 h after . All adverse effects ( AEs ) were monitored . Patients were checked 7 , 30 , 90 , and 180 days after the injection . Primary endpoint was a reduction in digit contracture within 0 ° –5 ° of normal extension . Secondary endpoints were the improvement of range of motion , the evaluation of AEs incidence , and cost-effectiveness of collagenase treatment . Results About 67.5 % of patients obtained a clinical success . At 6 months , a further 7.5 % attained the same result . The mean contracture of treated joints was 5.3º for MP and 6.8 ° for PIP joints . Twenty-three patients had one or more mild-to-moderate side effects . Conclusions The use of collagenase appears to be an effective and safe method for the treatment of Dupuytren ’s contracture . Therapeutic success was achieved in a significant percentage of patients . The incidence of side effects was higher , but they were local reactions of short duration . The use of a single collagenase vial in patients treated in day surgery appears more cost-effective than surgery PURPOSE This study compared the efficacy of collagenase treatment and needle fasciotomy for contracture of the metacarpophalangeal ( MCP ) joint in Dupuytren disease . METHODS This is a prospect i ve , single-blinded , r and omized study with follow-up 1 week and 1 year after treatment . One hundred and forty patients with an MCP contracture of 20 ° or more in a single finger were enrolled , of whom 69 patients were r and omized to collagenase treatment and 71 patients to needle fasciotomy .  The patients were followed at 1 week and were examined by a physiotherapist after 1 year . Measurements of joint movement and grip strength were recorded as well as patient-perceived outcomes measured by the Unité Rhumatologique des Affections de la Main ( URAM ) question naire and a visual analog scale ( VAS ) for the estimation of procedural pain and subjective treatment efficacy . RESULTS Eighty-eight percent of the patients in the collagenase group and 90 % of the patients in the needle fasciotomy group had a reduction in their MCP contracture to less than 5 ° 1 week after treatment , and the median gains in passive MCP movement were 48 ° and 46 ° , respectively . The median VAS score for procedural pain was 4.9 of 10 in the collagenase group and 2.7 of 10 in the needle fasciotomy group . After 1 year , 90 % of the patients in both groups had full extension of the treated MCP joint . One patient in each group had a recurrence of the contracture . The median improvement in URAM score was 8 units in both groups and the VAS estimation of treatment efficacy by the patients was 8.7 of 10 in both groups . CONCLUSIONS There was no significant difference between the treatment outcomes after collagenase and needle fasciotomy treatment after 1 year . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic In POINT X , a study design ed to reflect clinical practice and patient treatment choices , 254 European patients received  open-label collagenase  for Dupuytren ’s contracture . The most severely affected joint was treated first in 74 % of patients . In total , 52 % , 41 % , 7 % , and 1 % of patients selected the little , ring , middle , and index finger , respectively ; 79 % had one or two joints treated . Only 9 % of patients ( n = 24 ) received 4 or 5 injections . The mean improvement in total passive extension deficit ( TPED ) was 34 ° on day 1 , improving further by day 7 to 42 ° . This secondary improvement was maintained by day 90 and month 6 . The mean number of injections/joint was 1.2 for the metacarpophalangeal joint and 1.25 for the proximal interphalangeal joint . Median time to recovery was 4 days ; the mean improvement in h and function was clinical ly relevant as measured by the Unité Rhumatologique des Affections de la Main ( URAM ) score . In total , 87 % and 86 % of patients and physicians , respectively , were very satisfied or satisfied with treatment at month 6 , although correlation between TPED and patient satisfaction was weak ( Spearman −0.18 , 95 % CI −0.32 to  −0.06 ) . Collagenase  was well tolerated , with 10 ( 3.9 % ) patients experiencing severe adverse events . As a real-world study , the POINT X findings can be generalized to the at-large population PURPOSE The Collagenase Option for the Reduction of Dupuytren 's ( CORD ) II study investigated the efficacy and safety of injectable Xiaflex ( collagenase clostridium histolyticum ) , in patients with Dupuytren 's contracture . METHODS This was a prospect i ve , r and omized , placebo-controlled trial with 90-day double-blind and 9-month open-label phases . We r and omized patients with contractures affecting metacarpophalangeal ( MCP ) or proximal interphalangeal ( PIP ) joints 2 to 1 to collagenase ( 0.58 mg ) or placebo . Cords received a maximum of 3 injections . Cord disruption was attempted the day after injection using a st and ardized finger extension procedure . Primary end point was reduction in contracture to 0 ° to 5 ° of normal 30 days after the last injection . RESULTS We enrolled 66 patients ; 45 cords ( 20 MCP to 25 PIP joints )  received collagenase and 21 cords ( 11 MCP to 10 PIP joints ) received placebo in the double-blind phase . Statistically significantly more cords injected with collagenase than placebo met the primary end point ( 44.4 % vs 4.8 % ; p < . 001 ) . The mean percentage decrease in degree of joint contracture from baseline to 30 days after last injection was 70.5 % ± 29.2 % in the collagenase group and 13.6 % ± 26.1 % in the placebo group ( p < .001 ) . The mean increase in range of motion was significantly greater in the collagenase ( 35.4 ° ± 17.8 ° ) than in the placebo ( 7.6 ° ± 14.9 ° ; p < .001 ) group . Efficacy after open-label treatment was similar to that after the double-blind phase : 50.7 % of all joints achieved 0 ° to 5 ° of normal . More patients were satisfied with collagenase ( p < .001 ) . No joint had recurrence of contracture . One patient had a flexion pulley rupture and one patient underwent routine fasciectomy to address cord proliferation and sensory abnormality . No tendon ruptures or systemic allergic reactions were reported . Most adverse events were related to the injection or finger extension procedure . CONCLUSIONS Collagenase clostridium histolyticum is the first Food and Drug Administration-approved , nonsurgical treatment option for adult Dupuytren 's contracture patients with a palpable cord that is highly effective and well tolerated . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic PURPOSE To describe changes in joint motion , sensibility , and scar pliability and to investigate the patients ' expectations , self-reported recovery , and satisfaction with h and function , disability , and quality of life after surgery and h and therapy for Dupuytren disease . METHODS This prospect i ve cohort study collected measurements before surgery and 3 , 6 , and 12 months after surgery and h and therapy .  Ninety patients with total active extension deficits of 60 ° or more from Dupuytren contracture were included . Outcomes measures were range of motion ; sensibility ; scar pliability ; self-reported outcomes on expectations , recovery , and satisfaction with h and function ; Disabilities of the Arm , Shoulder , and H and scores ; safety and social issues of h and function ; physical activity habits ; and quality of life with the Euroqol . RESULTS The extension deficit decreased , and there was a transient decrease in active finger flexion during the first year after surgery . Sensibility remained unaffected . Generally , patients with surgery on multiple fingers had worse scar pliability . The majority of the patients had their expectations met , and at 6 months , 32 % considered h and function as fully recovered , and 73 % were satisfied with their h and function . Fear of hurting the h and and worry about not trusting the h and function were of greatest concern among safety and social issues . The Disability of the Arm , Shoulder , and H and score and the Euroqol improved over time . CONCLUSIONS After surgery and h and therapy , disability decreased independent of single or multiple operated fingers . The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic IV AIM We explored regional variations in the surgical management of patients with Dupuytren 's contracture ( DC ) in 12 European countries using a surgeon survey and patient chart review . METHODS Twelve countries participated : Denmark , Finl 
    Output:
    