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Alashek WA, Ali SA. Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review. Libyan J Med 2024; 19:2301829. [PMID: 38197179 PMCID: PMC10783830 DOI: 10.1080/19932820.2024.2301829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024] Open
Abstract
Background: Telemedicine became a fundamental part of healthcare provision during COVID-19 pandemic. An evaluation of telemedicine-associated satisfaction helps the service develop more viable applications. This review evaluated the satisfaction of healthcare users and providers and their willingness to use this modality in future.Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search on empirical articles published between March 2020 and December 2022 was performed on 'PubMed' and 'Scopus' databases. Findings that reported on satisfaction of patients, families and caregivers as well as clinicians were extracted and analysed. Quality of included studies was assessed. After applying inclusion and exclusion criteria, the review included 27 eligible studies.Results: Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare. Almost all studies were undertaken within the NHS. There were many tools that measured satisfaction. Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%. Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information. Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people. In general, willingness to use telemedicine in future was high in the recipients as well as the providers of healthcare.Conclusion: COVID-19 pandemic has transformed healthcare in the UK and promoted a revolution in telemedicine applications. Satisfaction was high among both recipient and provider of healthcare. Telemedicine managed to provide a continued care throughout the pandemic while maintaining social distance. The current review presented commendable evidence to encourage different specialities to engage in telemedicine application.
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Affiliation(s)
- WA. Alashek
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - SA. Ali
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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2
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Qiu C, Li Z, Peng P. Human umbilical cord mesenchymal stem cells protect MC3T3-E1 osteoblasts from dexamethasone-induced apoptosis via induction of the Nrf2-ARE signaling pathway. Regen Ther 2024; 27:1-11. [PMID: 38476629 PMCID: PMC10926296 DOI: 10.1016/j.reth.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/29/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024] Open
Abstract
Objective To investigate the protective effect human umbilical cord mesenchymal stem cells (hUC-MSCs) have on Dexamethasone (Dex)-induced apoptosis in osteogenesis via the Nrf2-ARE signaling pathway. Methods Glucocorticoid-induced osteonecrosis of the femoral head (GC-ONFH) was developed in rats through the administration of lipopolysaccharide and methylprednisolone. The incidence of femoral head necrosis, cavity notch, apoptosis of osteoblasts, and bone density were observed by HE staining, TUNEL staining, and Micro-CT. HUC-MSCs were co-cultured with mouse pre-osteoblast MC3T3-E1. The survival rate of osteoblasts was determined by CCK8, and apoptosis and ROS levels of osteoblasts were determined by flow cytometer. The viability of antioxidant enzymes SOD, GSH-Px, and CAT was analyzed by biochemistry. Nrf2 expression levels and those of its downstream proteins and apoptosis-related proteins were analyzed by Western blotting. Results In rats, hUC-MSCs can reduce the rates of empty bone lacuna and osteoblast apoptosis that are induced by glucocorticoids (GCs), while reducing the incidence of GC-ONFH. hUC-MSCs can significantly improve the survival rate and antioxidant SOD, GSH-Px, and CAT activity of MC3T3-E1 cells caused by Dex, and inhibit apoptosis and oxidative stress levels. In addition, hUC-MSCs can up-regulate the expression of osteoblast antioxidant protein Nrf2 and its downstream protein HO-1, NQO-1, GCLC, GCLM, and apoptosis-related protein bcl-2, while also down-regulating the expression of apoptosis-related protein bax, cleaved caspase-3, cleaved caspase-9, and cytochrome C in MC3T3-E1 cells. hUC-MSCs improve the ability of MC3T3-E1 cells to mineralize to osteogenesis. However, the promoting effects of hUC-MSCs were abolished following the blocking of the Nrf2-ARE signaling pathway for osteoblasts. Conclusion The results reveal that hUC-MSCs can reduce Dex-induced apoptosis in osteoblasts via the Nrf2-ARE signaling pathway.
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Affiliation(s)
- Chen Qiu
- Department of Sports Medicine, The Affiliated Hospital of Wuhan Sports University, Wuhan, 430000, China
| | - Zhaowen Li
- Department of Sports Medicine, The Affiliated Hospital of Wuhan Sports University, Wuhan, 430000, China
| | - Puji Peng
- Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, 450003, China
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Banerjee R, Patel D, Farooque K, Gupta D, Seth A, Kochhar KP, Garg B, Jain S, Kumar N, Jain S. Cortical intermittent theta burst stimulation on gait pathomechanics and urinary tract dysfunction in incomplete spinal cord injury patients: Protocol for a randomized controlled trial. MethodsX 2024; 13:102826. [PMID: 39049927 PMCID: PMC11268124 DOI: 10.1016/j.mex.2024.102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Gait impairment and neurogenic bladder are co-existing common findings in incomplete spinal cord injury (iSCI). Repetitive transcranial magnetic stimulation (rTMS), evident to be a promising strategy adjunct to physical rehabilitation to regain normal ambulation in SCI. However, there is a need to evaluate the role of Intermittent theta burst stimulation (iTBS), a type of patterned rTMS in restoring gait and neurogenic bladder in SCI patients. The aim of the present study is to quantify the effect of iTBS on spatiotemporal, kinetic, and kinematic parameters of gait and neurogenic bladder dyssynergia in iSCI. After maturing all exclusion and inclusion criteria, thirty iSCI patients will be randomly divided into three groups: Group-A (sham), Group-B (active rTMS) and Group-C (active iTBS). Each group will receive stimulation adjunct to physical rehabilitation for 2 weeks. All patients will undergo gait analysis, as well assessment of bladder, electrophysiological, neurological, functional, and psychosocial parameters. All parameters will be assessed at baseline and 6th week (1st follow-up). Parameters except urodynamics and gait analysis will also be assessed after the end of the 2 weeks of the intervention (post-intervention) and at 12th week (2nd follow-up). Appropriate statistical analysis will be done using various parametric and non-parametric tests based on results.
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Affiliation(s)
- Rohit Banerjee
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deeksha Patel
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamran Farooque
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwal Preet Kochhar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Jain
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Jain
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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4
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Srinivasa V, Thirugnanam B, Pai Kanhangad M, Soni A, Kashyap A, Vidyadhara A, Rao SK. Flattening the learning curve - Early experience of robotic-assisted pedicle screw placement in spine surgery. J Orthop 2024; 57:49-54. [PMID: 38973970 PMCID: PMC11225720 DOI: 10.1016/j.jor.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Abstract
Aims and objectives To determine accuracy of pedicle screws placed by freehand, fluoroscopy-assistance and robotic-assistance with intraoperative image acquisition, and determine the presence of learning curve in robotic spine surgery in a prospective single centre study. Materials and methods In a prospective study, a total of 1120 pedicle screws were placed in Freehand group (n = 175), 1250 screws were placed in fluoroscopy-assisted group (n = 172), and 1225 screws were inserted in Robotic-assisted group(n = 180). Surgical parameters and screw accuracy were analyzed between the three groups. The preoperative plan was overlapped with post operative O-arm scan to determine if the screws were executed as planned. Results The frequency of clinically acceptable screw placement (Gertzbein and Robbins grade A, B) in the Freehand, Fluoroscopy-assisted, and Robotic-assisted groups were 97.7 %, 98.6 %, and 99.34 % respectively. Higher pedicle screw accuracy, and lower blood loss were seen with robotic assistance. There was no significant difference in these parameters between surgeries commencing before and after 2 p.m. We found no statistically significant differences between the planned and executed screw trajectories in robotic assisted group irrespective of surgical experience. Conclusion The third-generation robotic-assisted pedicle screw placement system, used in conjunction with intraoperative 3D O-arm imaging, consistently lowered blood loss and increased accuracy of pedicle screw placement in the thoracolumbar spine. It also has easy adaptability into spine practice with minimal learning curve.
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Affiliation(s)
| | | | - Madhava Pai Kanhangad
- Manipal Robotic Spine Fellow, Manipal Comprehensive Spine Care Center, Manipal Hospital, Bangalore, India
- , Department of Orthopaedics, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Abhishek Soni
- , Manipal Comprehensive Spine Care Center, Manipal Hospital, Bangalore, India
| | - Anjana Kashyap
- Spine Anesthesia Fellow, Manipal Comprehensive Spine Care Center, Manipal Hospital, Bangalore, India
- , Department of Anesthesiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | | | - Sharath K. Rao
- , Department of Orthopaedics, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
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Xu Z, Zhang R, Chen H, Zhang L, Yan X, Qin Z, Cong S, Tan Z, Li T, Du M. Characterization and preparation of food-derived peptides on improving osteoporosis: A review. Food Chem X 2024; 23:101530. [PMID: 38933991 PMCID: PMC11200288 DOI: 10.1016/j.fochx.2024.101530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/18/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Osteoporosis is a systemic bone disease characterized by reduced bone mass and deterioration of the microstructure of bone tissue, leading to an increased risk of fragility fractures and affecting human health worldwide. Food-derived peptides are widely used in functional foods due to their low toxicity, ease of digestion and absorption, and potential to improve osteoporosis. This review summarized and discussed methods of diagnosing osteoporosis, treatment approaches, specific peptides as alternatives to conventional drugs, and the laboratory preparation and identification methods of peptides. It was found that peptides interacting with RGD (arginine-glycine-aspartic acid)-binding active sites in integrin could alleviate osteoporosis, analyzed the interaction sites between these osteogenic peptides and integrin, and further discussed their effects on improving osteoporosis. These may provide new insights for rapid screening of osteogenic peptides, and provide a theoretical basis for their application in bone materials and functional foods.
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Affiliation(s)
- Zhe Xu
- School of Food Science and Technology, State Key Laboratory of Marine Food Processing and Safety Control, Dalian Polytechnic University, Dalian 116034, China
- College of Life Sciences, Key Laboratory of Biotechnology and Bioresources Utilization, Dalian Minzu University, Ministry of Education, Dalian 116600, China
- Institute of Bast Fiber Crops & Center of Southern Economic Crops, Chinese Academy of Agricultural Sciences, Changsha 410205, China
| | - Rui Zhang
- School of Food Science and Technology, State Key Laboratory of Marine Food Processing and Safety Control, Dalian Polytechnic University, Dalian 116034, China
| | - Hongrui Chen
- School of Food and Bioengineering, Food Microbiology Key Laboratory of Sichuan Province, Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, Xihua University, Chengdu, Sichuan 611130, China
| | - Lijuan Zhang
- College of Life Sciences, Key Laboratory of Biotechnology and Bioresources Utilization, Dalian Minzu University, Ministry of Education, Dalian 116600, China
| | - Xu Yan
- College of Life Sciences, Key Laboratory of Biotechnology and Bioresources Utilization, Dalian Minzu University, Ministry of Education, Dalian 116600, China
| | - Zijin Qin
- Department of Food Science and Technology, University of Georgia, Clarke, Athens, GA 30602, USA
| | - Shuang Cong
- College of Life Sciences, Yantai University, Yantai, Shandong 264005, China
| | - Zhijian Tan
- Institute of Bast Fiber Crops & Center of Southern Economic Crops, Chinese Academy of Agricultural Sciences, Changsha 410205, China
| | - Tingting Li
- College of Life Sciences, Key Laboratory of Biotechnology and Bioresources Utilization, Dalian Minzu University, Ministry of Education, Dalian 116600, China
| | - Ming Du
- School of Food Science and Technology, State Key Laboratory of Marine Food Processing and Safety Control, Dalian Polytechnic University, Dalian 116034, China
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Forogh B, Karami A, Bagherzadeh Cham M. Effect of extracorporeal shock wave therapy and ultrasound-guided percutaneous lavage in reducing the pain of rotator cuff calcific tendinopathy; an updated systematic review and meta-analysis. J Orthop 2024; 56:151-160. [PMID: 38882231 PMCID: PMC11169081 DOI: 10.1016/j.jor.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024] Open
Abstract
Background Extracorporeal shockwave therapy (ESWT) and ultrasound-guided percutaneous lavage (UGPL or barbotage) are among those used to treat the pain of rotator cuff calcific tendinopathy (RCCT). This meta-analysis was done to review the effect ESWT and UGPL in reducing the pain of RCCT. Methods A comprehensive search was done based on the PRISMA. PubMed, Web of Science, Scopus, Cochrane Library and Google Scholar were reviewed for articles published by Feb 1, 2024, on ESWT vs. UGPL. The main keywords searched are as follows: "rotator cuff calcific tendinopathy", "tendinitis", " ESWT", " ultrasound-guided percutaneous lavage", " RCCT ″, " UGPL", " extracorporeal shock wave therapy" and titles or abstracts may contain one or a mix of these elements. This study was registered at PROSPERO with code" CRD42022385068". STATA version 13 was applied to analyze. Results In general, 779 patients from 22 studies were analyzed. The mean age was 51.85 ± 3.41 years. The patients were referred after 18.69 months of suffering from tendinopathy symptoms. Right-sided and supraspinatus locations were affected more. ESWT has been effective in a decrease of calcium deposit (-1.70 SMD after 1 week for ESWT, -0.96 SMD after 12 weeks for ESWT and -1.20 SMD after 12 weeks UPGL). ESWT has been effective in decreasing VAS by -4.32 SMD after 1 week while UPGL showed -0.23 SMD reductions in VAS After 1 week but in time >1 week, UPGL showed better effect by more reduction in VAS. ESWT has been effective in an increase of CMS by 1.60 SMD after 4-6 weeks, by 1.79 SMD after 12 weeks, by 2.44 SMD after 24 weeks, and 2.53 SMD after 48 weeks. Conclusion Based on the results, ultrasound-guided lavage is more effective in reducing pain than ESWT, and this effect becomes more evident in the long term. In terms of CMS score, over time, the efficiency of ESWT becomes more visible. In long-term follow-up, UPGL had a better effect on the calcium deposit reduction.
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Affiliation(s)
- Bijan Forogh
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Karami
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Bagherzadeh Cham
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Orthotics & Prosthetics Department, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
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7
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Hazra D, Shaji V R, Dhall A, Rao AP, Bhat AK, Chawla K. A ten-year experience of musculoskeletal tuberculosis at a tertiary care hospital in South India. J Orthop 2024; 56:92-97. [PMID: 38800587 PMCID: PMC11111828 DOI: 10.1016/j.jor.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Background The delayed identification and management of musculoskeletal tuberculosis (MSTB) poses substantial health challenges and leads to significant morbidity. This study aimed to collate ten years of hospital data and provide valuable insights into the clinical, diagnostics, and outcomes of the patients diagnosed with MSTB. Methods A retrospective study was undertaken to review clinic records from 2013 to 2022 for all individuals diagnosed with MSTB in a tertiary care hospital in South India. Results Over a decade, 400 cases of MSTB were diagnosed, revealing 57 % males and 43 % females with a mean age of 43.2 ± 18.9 years. Spinal TB constituted 72 % of cases, with the most common involvement of thoracic vertebrae (50.9 %). Extra-spinal MSTB accounted for 28 %, prevalent more in the pediatric age group (p < 0.05). Surgical intervention was required for 80 % of spinal TB cases and 58 % of extra-spinal MSTB cases. The average follow-up duration was two years, with 73 % completing treatment. Unfortunately, seven patients died, and three experienced relapse. Conclusion Spinal TB is the most common type of MSTB and is predominant in young and middle-aged adults, while extra-spinal MSTB is more frequently observed in children. Where use of MRI facilitates early detection of spinal TB; histopathological and microbiological examination confirm the diagnosis. Combining anti-tubercular drugs with modern surgical approaches is essential for obtaining favorable outcomes and improving the quality of life of such patients. It is crucial to have advanced and affordable diagnostic facilities, along with increased public awareness, to reinforce tuberculosis control strategies.
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Affiliation(s)
- Druti Hazra
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Rosemary Shaji V
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Arushi Dhall
- Department of Radio Diagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Arathi P. Rao
- Department of Health Policy, Prasanna School of Public Health, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Anil K. Bhat
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Kiran Chawla
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
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Al-Bogami MM, Alkhorayef M, Sulieman A, Bradley D, Jawad AS, Mageed RA. The clinical assessment of changes in bone density in rheumatoid arthritis patients': Role of DEXA scan and bone turnover biomarkers. Appl Radiat Isot 2024; 211:111373. [PMID: 38851075 DOI: 10.1016/j.apradiso.2024.111373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 10/12/2023] [Accepted: 05/24/2024] [Indexed: 06/10/2024]
Abstract
In addition to generalised of bone loss and a higher fracture risk, rheumatoid arthritis (RA) causes periarticular bone erosions. Improvements in bone density/erosion and turnover may not go hand in hand with a positive clinical response to biological anti-inflammatory drugs assesed by disease activity score 28 (DAS28) in RA patients. This study aimed to understand how biologic anti-inflammatory drugs affect bone density, erosion, and turnover in RA patients. We examined bone mineral density (BMD) and bone turnover biomarkers. The study population consisted of 62 RA patients, 49 (79%) of whom were female and 13 (21%) of whom were male. The patients ranged in age from 40 to 79 years old. The patients' BMD was measured using a DEXA scan, and their plasma levels of bone turnover biomarkers CTX and osteocalcin were quantified utilizing an ELISA. BMD of the hip and lumbar spine in responder patients rose after therapy by 0.001g/cm2 (0.11 percent, p0.001 vs. before treatment) and 0.0396g/cm2 (3.96 percent, p0.001 vs. before treatment), respectively. Clinically non-responder patients' DAS28 revealed minor reductions in hip BMD values of -0.008g/cm2 (-0.78 percent, p0.001 vs. before therapy), as well as an improvement in lumbar spine BMD of 0.03g/cm2 (3.03 percent, p0.001 vs. before treatment). After 12 weeks of therapy, the CTX levels in responder patients dropped from 164 125 pg/ml to 131 129 pg/ml. Osteocalcin levels in non-responder patients increased substantially from 11.6 ng/ml to 14.9 ng/ml after 12 weeks of therapy compared to baseline (p = 0.01). Treatment with biologic anti-inflammatory medicines decreases widespread bone loss in RA patients' hip and lumbar spine. The beneficial effects of therapy on BMD were not associated with changes in disease activity of RA patients. Changes in plasma levels of bone turnover biomarkers such as sCTX and osteocalcin confirmed the treatment's beneficial effects.
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Affiliation(s)
- M M Al-Bogami
- Bone and Joint Research Unit, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.
| | - M Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O Box 10219 Riyadh 11433, Saudi Arabia
| | - A Sulieman
- Radiological Sciences Department, College of Applied Medical Sciences - Al Ahsa, King Saud bin Abdulaziz University for Health Sciences, Alhofuf, P.O.Box 2477, Al-Ahsa 3198, Saudi Arabia
| | - David Bradley
- Applied Physics and Radiation Technologies Group, CCDCU, Sunway University, Malaysia; School of Mathematics and Physics, University of Surrey, Guildford, United Kingdom
| | - A S Jawad
- Department of Rheumatology, The Royal London Hospital, Mile End Road, London, UK
| | - R A Mageed
- Centre for Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK
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Selestin Raja I, Kim C, Oh N, Park JH, Hong SW, Kang MS, Mao C, Han DW. Tailoring photobiomodulation to enhance tissue regeneration. Biomaterials 2024; 309:122623. [PMID: 38797121 DOI: 10.1016/j.biomaterials.2024.122623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/25/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
Photobiomodulation (PBM), the use of biocompatible tissue-penetrating light to interact with intracellular chromophores to modulate the fates of cells and tissues, has emerged as a promising non-invasive approach to enhancing tissue regeneration. Unlike photodynamic or photothermal therapies that require the use of photothermal agents or photosensitizers, PBM treatment does not need external agents. With its non-harmful nature, PBM has demonstrated efficacy in enhancing molecular secretions and cellular functions relevant to tissue regeneration. The utilization of low-level light from various sources in PBM targets cytochrome c oxidase, leading to increased synthesis of adenosine triphosphate, induction of growth factor secretion, activation of signaling pathways, and promotion of direct or indirect gene expression. When integrated with stem cell populations, bioactive molecules or nanoparticles, or biomaterial scaffolds, PBM proves effective in significantly improving tissue regeneration. This review consolidates findings from in vitro, in vivo, and human clinical outcomes of both PBM alone and PBM-combined therapies in tissue regeneration applications. It encompasses the background of PBM invention, optimization of PBM parameters (such as wavelength, irradiation, and exposure time), and understanding of the mechanisms for PBM to enhance tissue regeneration. The comprehensive exploration concludes with insights into future directions and perspectives for the tissue regeneration applications of PBM.
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Affiliation(s)
| | - Chuntae Kim
- Institute of Nano-Bio Convergence, Pusan National University, Busan, 46241, Republic of Korea; Center for Biomaterials Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Nuri Oh
- Department of Chemistry and Biology, Korea Science Academy of KAIST, Busan, 47162, Republic of Korea
| | - Ji-Ho Park
- Department of Bio and Brain Engineering and KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Suck Won Hong
- Department of Cogno-Mechatronics Engineering, College of Nanoscience & Nanotechnology, Pusan National University, Busan, 46241, Republic of Korea
| | - Moon Sung Kang
- Department of Cogno-Mechatronics Engineering, College of Nanoscience & Nanotechnology, Pusan National University, Busan, 46241, Republic of Korea
| | - Chuanbin Mao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China.
| | - Dong-Wook Han
- Institute of Nano-Bio Convergence, Pusan National University, Busan, 46241, Republic of Korea; Department of Cogno-Mechatronics Engineering, College of Nanoscience & Nanotechnology, Pusan National University, Busan, 46241, Republic of Korea.
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Cheng W, Zhang J, Wang X, Liu G, Yao W, Wang C, Wu R, Li Z. Surgical procedures and complications in placement of totally implantable venous access port in pediatric hemophilia patients: A retrospective analysis. Blood Cells Mol Dis 2024; 108:102862. [PMID: 38889659 DOI: 10.1016/j.bcmd.2024.102862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/12/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
This retrospective study at Beijing Children's Hospital (2020-2023) analyzed surgical procedures and complications in 24 pediatric hemophilia patients undergoing Totally Implantable Venous Access Port (TIVAP) insertion, primarily in the right jugular vein (RJV). We detailed the surgical process, including patient demographics and intraoperative imaging use. The choice of the RJV for TIVAP placement was influenced by its larger diameter and superficial anatomical position, potentially reducing risks like thrombosis and infection. Our findings support the RJV as a safer alternative for port placement in pediatric patients, aligning with current literature. Statistical analysis revealed no significant correlation between complications and baseline characteristics like weight and diagnosis type. However, the length of hospital stay and implant brand were significant risk factors for catheter or port displacement and removal. The limited patient number may introduce bias, suggesting a need for further studies with larger samples. Despite a 14.7 %-33 % complication rate and 5 port removals, the advantages of TIVAP, including reliable venous access, reduced discomfort, and treatment convenience, were evident. Most complications improved with symptomatic treatment, and there were no deaths due to port-related complications, underscoring the impact of TIVAP on improving pediatric hemophilia treatment.
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Affiliation(s)
- Wei Cheng
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jinrui Zhang
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xipeng Wang
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Guoqing Liu
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wanru Yao
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Chunli Wang
- Nursing Department, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - Runhui Wu
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Zhiqiang Li
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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Pharoun J, Berro J, Sobh J, Abou-Younes MM, Nasr L, Majed A, Khalil A, Joseph, Stephan, Faour WH. Mesenchymal stem cells biological and biotechnological advances: Implications for clinical applications. Eur J Pharmacol 2024; 977:176719. [PMID: 38849038 DOI: 10.1016/j.ejphar.2024.176719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Mesenchymal stem cells (MSCs) are multipotent stem cells that are able to differentiate into multiple lineages including bone, cartilage, muscle and fat. They hold immunomodulatory properties and therapeutic ability to treat multiple diseases, including autoimmune and chronic degenerative diseases. In this article, we reviewed the different biological properties, applications and clinical trials of MSCs. Also, we discussed the basics of manufacturing conditions, quality control, and challenges facing MSCs in the clinical setting. METHODS Extensive review of the literature was conducted through the databases PubMed, Google Scholar, and Cochrane. Papers published since 2015 and covering the clinical applications and research of MSC therapy were considered. Furthermore, older papers were considered when referring to pioneering studies in the field. RESULTS The most widely studied stem cells in cell therapy and tissue repair are bone marrow-derived mesenchymal stem cells. Adipose tissue-derived stem cells became more common and to a lesser extent other stem cell sources e.g., foreskin derived MSCs. MSCs therapy were also studied in the setting of COVID-19 infections, ischemic strokes, autoimmune diseases, tumor development and graft rejection. Multiple obstacles, still face the standardization and optimization of MSC therapy such as the survival and the immunophenotype and the efficiency of transplanted cells. MSCs used in clinical settings displayed heterogeneity in their function despite their extraction from healthy donors and expression of similar surface markers. CONCLUSION Mesenchymal stem cells offer a rising therapeutic promise in various diseases. However, their potential use in clinical applications requires further investigation.
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Affiliation(s)
- Jana Pharoun
- Gilbert & Rose-Marie Chagoury School of Medicine, LAU, Byblos, Lebanon, P.O. Box 36
| | - Jana Berro
- Gilbert & Rose-Marie Chagoury School of Medicine, LAU, Byblos, Lebanon, P.O. Box 36
| | - Jeanine Sobh
- Gilbert & Rose-Marie Chagoury School of Medicine, LAU, Byblos, Lebanon, P.O. Box 36
| | | | - Leah Nasr
- Gilbert & Rose-Marie Chagoury School of Medicine, LAU, Byblos, Lebanon, P.O. Box 36
| | - Ali Majed
- Gilbert & Rose-Marie Chagoury School of Medicine, LAU, Byblos, Lebanon, P.O. Box 36
| | - Alia Khalil
- Gilbert & Rose-Marie Chagoury School of Medicine, LAU, Byblos, Lebanon, P.O. Box 36
| | - Joseph
- Gilbert & Rose-Marie Chagoury School of Medicine, LAU, Byblos, Lebanon, P.O. Box 36
| | - Stephan
- Gilbert & Rose-Marie Chagoury School of Medicine, LAU, Byblos, Lebanon, P.O. Box 36
| | - Wissam H Faour
- Gilbert & Rose-Marie Chagoury School of Medicine, LAU, Byblos, Lebanon, P.O. Box 36.
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Debopadhaya S, Toogood P, Ding A, Marmor MT. Nonphysician Evaluators and Recording-Based Tools in Surgical Skill Assessment: A Feasibility Study. JOURNAL OF SURGICAL EDUCATION 2024; 81:1161-1176. [PMID: 38845300 DOI: 10.1016/j.jsurg.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/02/2024] [Accepted: 05/15/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVES To investigate the feasibility of nonmedically trained evaluators and image- and video-based tools in the assessment of surgical skills in a key orthopedic procedure. DESIGN Orthopedic surgeons at varying skill levels were evaluated by their ability to repair a cadaveric bi-malleolar ankle fracture. Nonphysician viewers and expert orthopedic surgeons independently scored video recordings and fluoroscopy images of the procedure through Global Rating Scales (GRS) and procedure-specific checklist tools. Statistical analysis was used to determine if the evaluators and assessment tools were able to differentiate skill level. SETTING An academic tertiary care hospital. PARTICIPANTS The surgical procedure was completed by 3 orthopedic residents, 3 orthopedic trauma fellows, and 4 orthopedic trauma attending surgeons. The procedure was independently evaluated by 2 orthopedic surgeons and 2 nonphysicians. RESULTS Operating participants were stratified by ≤ or >10 bimalleolar ankle fracture cases performed alone (inexperienced, n = 5 vs experienced, n = 5). Expert surgeon viewers could effectively stratify skill group through the GRS for video and fluoroscopy analysis (p < 0.05), and the video procedure-specific checklist (p < 0.05), but not the fluoroscopy procedure-specific checklist. Nonphysician viewers generally recognized skill groupings, although with less separation than surgeon viewers. These evaluators performed the best when aided by video and fluoroscopy procedure-specific checklists. Meanwhile, breakdowns of each tool into critical zones for improvement and evaluator-independent metrics such as case experience, self-reported confidence, and surgical time also indicated some skill differentiation. CONCLUSIONS The feasibility of using video recordings and fluoroscopic imaging based surgical skills assessment tools in orthopedic trauma was demonstrated. The tools highlighted in this study are applicable to both cadaver laboratory settings and live surgeries. The degree of training that is required by the evaluators and the utility of measuring surgical times of specific tasks should be the subject of future studies.
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Affiliation(s)
| | - Paul Toogood
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, CA, 94110
| | - Anthony Ding
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, CA, 94110
| | - Meir T Marmor
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, CA, 94110.
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Ghoshal S, Stovall N, King AH, Miller AS, Harris MB, Succi MD. Orthopedic Surgery Volume Trends During the COVID-19 Pandemic and Postvaccination Era: Implications for Healthcare Planning. J Arthroplasty 2024; 39:1959-1966.e1. [PMID: 38513749 DOI: 10.1016/j.arth.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic decreased surgical volumes, but prior studies have not investigated recovery through 2022, or analyzed specific procedures or cases of urgency within orthopedic surgery. The aims of this study were to (1) quantify the declines in orthopedic surgery volume during and after the pandemic peak, (2) characterize surgical volume recovery during the postvaccination period, and (3) characterize recovery in the 1-year postvaccine release period. METHODS We conducted a retrospective cohort study of 27,476 orthopedic surgeries from January 2019 to December 2022 at one urban academic quaternary referral center. We reported trends over the following periods: baseline pre-COVID-19 period (1/6/2019 to 1/4/2020), COVID-19 peak (3/15/2020 to 5/16/2020), post-COVID-19 peak (5/17/2020 to 1/2/2021), postvaccine release (1/3/2021 to 1/1/2022), and 1-year postvaccine release (1/2/2022 to 12/30/2022). Comparisons were performed with 2 sample t-tests. RESULTS Pre-COVID-19 surgical volume fell by 72% at the COVID-19 peak, especially impacting elective procedures (P < .001) and both hip and knee joint arthroplasty (P < .001) procedures. Nonurgent (P = .024) and urgent or emergency (P = .002) cases also significantly decreased. Postpeak recovery before the vaccine saw volumes rise to 92% of baseline, which further rose to 96% and 94% in 2021 and 2022, respectively. While elective procedures surpassed the baseline in 2022, nonurgent and urgent or emergency surgeries remained low. CONCLUSIONS The COVID-19 pandemic substantially reduced orthopedic surgical volumes, which have still not fully recovered through 2022, particularly nonelective procedures. The differential recovery within an orthopedic surgery program may result in increased morbidity and can serve to inform department-level operational recovery.
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Affiliation(s)
- Soham Ghoshal
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Nasir Stovall
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander H King
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Amitai S Miller
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Mitchel B Harris
- Harvard Medical School, Boston, Massachusetts; Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Marc D Succi
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
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Pastor PCS, Ramos MIP, Roig AG, Safont JA. Superior capsular reconstruction with the long head of the biceps tendon achieves excellent clinical results and low rotator cuff rerupture rates one year after cuff repair surgery. INTERNATIONAL ORTHOPAEDICS 2024; 48:2121-2128. [PMID: 38796811 DOI: 10.1007/s00264-024-06223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To analyze the clinical one-year evolution of healed and rerupture lesions in patients who received a rotator cuff repair plus Superior Capsular Reconstruction (SCR) with the long head of the biceps (LHB). Moreover, to compare this evolution between men and women. METHODS A pilot study was conducted on patients who underwent a rotator cuff repair plus SCR with LHB between February 2021 and June 2022. All patients completed pre-operative and one-year post-operative evaluations for tendon type of tear and tendon integrity using Magnetic Resonance Imaging (MRI)after one year of the surgery. Besides, functionality was evaluated with the American Shoulder and Elbow Surgeons (ASES) score; the visual analog scale for pain (VAS); and the Constant score. RESULTS A total of 38 patients completed the one-year final evaluation, they presented an increased functionality score to 83 and 86 in Constant and ASES scales (p < .001), respectively. Besides, 84% of the patients presented a healed cuff, while rerupture occurred in 16% of the patients. There were differences between the healed and rerupture patients in the total Constant score, with a remarkable increase in the strength subscale, almost double for patients with healed cuff (p < .001); in the same way, daily life activity score, and balance subscale increased, while pain score decreased in the healed cuff group (p < .05). There was no difference in functionality between men and women (p > .05). Besides, almost all patients achieved the MCID in both ASES and Constant total scores, irrespectively of the healing group. CONCLUSION The cuff repair using SCR with the LHB achieved a low percentage of rerupture and a functional improvement after one year of follow-up. Patients who healed the lesion presented more strength and better performance in daily life activities than those with cuff repurture. Thus, SCR + LHB procedure can be considered an efficient technique for rotator cuff repair surgery for both men and women. Although a comparison with a control group is needed to confirm these findings.
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Affiliation(s)
- Pablo Cañete San Pastor
- Universidad Católica de Valencia San Vicente Mártir. Escuela de Doctorado, Valencia, Spain.
- Hospital de Manises, Manises, Spain.
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Avraham D, Herman A, Oulianski M. A case of damage control after polytrauma and bilateral femur fracture. Trauma Case Rep 2024; 52:101037. [PMID: 38883269 PMCID: PMC11176921 DOI: 10.1016/j.tcr.2024.101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Multi-trauma patients require a multidisciplinary team, especially in the presence of various body systems injuries. The evaluation focuses on the decision regarding the DCO and ETC approaches. Case presentation A 24-year-old male patient with Glasgow Coma Score 8, arrived at the emergency room, followed by ATLS protocol. Orthopedic trauma included D8 vertebra unstable burst fracture, right open femur shaft fracture, left closed midshaft femur fracture, and right tibial plateau fracture of the knee. Case summary A hemodynamically stable patient with bilateral femur fractures is directed toward the DCO approach. Discussion An initial treatment for an external fixator across the knee on the right leg and a spine fusion and decompression of D5-10 surgery was made on the day of admission. Definitive fixation and conversion to internal fixators were done on day 9 after the accident. Postoperative drop-foot injury was seen in the right leg. A Masquelet technique was applied for the right femur segmental fracture due to gaps. Conclusion DCO may be employed to temporarily stabilize fractures, allowing the patient to recover from other life-threatening injuries before definitive fixation. Further secondary procedures, such as the Masquelet technique, should be considered to optimize the results. Long-term follow-up and rehabilitation are part of recovery, aiming to optimize functional recovery and improve the patient's quality of life.
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Affiliation(s)
- Dana Avraham
- Orthopedic Department, Kaplan Medical Center, Israel
| | - Amir Herman
- Orthopedic Department, Kaplan Medical Center, Israel
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Torén L, Lagerstrand K, Waldenberg C, Brisby H, Hebelka H. Different Load-Induced Alterations in Intervertebral Discs Between Low Back Pain Patients and Controls: A T2-map Study. Spine (Phila Pa 1976) 2024; 49:E239-E248. [PMID: 38751239 DOI: 10.1097/brs.0000000000005028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/11/2024] [Indexed: 07/11/2024]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE Investigate load-induced effects in lumbar intervertebral discs (IVDs) and differences between low back pain (LBP) patients and controls. SUMMARY OF BACKGROUND DATA T2-map values, obtained from quantitative MRI sequences, reflect IVD tissue composition and integrity. Feasibility studies with T2-mapping indicate different load-induced effects in entire IVDs and posterior IVD parts between LBP patients and controls. Larger studies are required to confirm these findings and increase the understanding of specific characteristics distinguishing IVD changes in LBP patients compared with controls. MATERIALS AND METHODS Lumbar IVDs of 178 patients (mean age: 43.8 yr; range: 20-60 yr) with >3 months of LBP and 74 controls (mean age: 40.3 yr; range: 20-60 yr) were imaged with T2-map sequence in a 3T scanner in supine position without axial load, immediately followed by a repeated examination, using the same sequence, with axial load. On both examinations, mean T2-map values were obtained from entire IVDs and from central/posterior IVD parts on the three midsagittal slices in 855 patient IVDs and 366 control IVDs. Load-induced effect was compared with Fold-change ratio and adjusted for IVD-degeneration grade. RESULTS Loading induced an increase in T2-map values in both patients and controls. Excluding most extreme values, the ranges varied between -15% and +35% in patients and -11% and +36% in controls (first to 99th percentile). Compared with controls, the T2-map value increase in patients was 2% smaller in entire IVDs (Fold-change: 0.98, P =0.031), and for central and posterior IVD parts 3% (Fold-change: 0.98, P =0.005), respectively, 2% (Fold-change: 0.9, P =0.015) smaller. CONCLUSIONS This quantitative study confirmed diverse load-induced behaviors between LBP patients and controls, suggesting deviant biomechanical characteristics between IVDs in patients and controls not only attributed to the global grade of degeneration. These findings are an important step in the continuous work of identifying specific IVD phenotypes for LBP patients. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Leif Torén
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Waldenberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Jamieson F, Rasmussen-Barr E. How do information and physiotherapy affect health-related quality of life among patients with spinal stenosis undergoing decompression surgery: A qualitative study. Musculoskelet Sci Pract 2024; 72:103124. [PMID: 38901062 DOI: 10.1016/j.msksp.2024.103124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND There is a lack of qualitative research on how patients with lumbar spinal stenosis (LSS) undergoing surgery perceive their health-related quality of life (HRQOL). Research that increases our understanding in this area could facilitate a biopsychosocial approach to care. AIM We aimed to investigate the experiences of patients with LSS undergoing decompression surgery regarding their pre- and post-surgery perceptions of HRQOL and the pre-and post-operative information and physiotherapy. METHOD We used a qualitative design with semi-structured interviews to perform content analysis using an inductive approach. Twelve patients (7 female, 5 male) were included post-surgery and interviewed by phone. The interviews were recorded and transcribed verbatim. RESULTS Four distinct categories with nine associated subcategories were identified: Patients' feelings of safety and empowerment are enhanced by healthcare professionals; Divided perceptions of information and physiotherapy in a group context; Health-related quality of life is associated with patients' perceived physical capacity; Patients' optimism and concerns influence health-related quality of life. CONCLUSION Both physical and psychological factors pre- and post-surgery appear to influence patients' HRQOL. Inherent optimism and feelings of empowerment in the care process appear to be important factors, regardless of physical health status. A strong patient-provider relationship is important to promote self-efficacy, which may positively affect perceived HRQOL and is in line with the generally recommended biopsychosocial approach in the treatment of people with low back pain. As qualitative studies in this area are scarce, there is a need for further studies to validate our findings.
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Affiliation(s)
- Fiona Jamieson
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Alfred Nobels Allé 23, 141 83, Huddinge, Stockholm, Sweden
| | - Eva Rasmussen-Barr
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Alfred Nobels Allé 23, 141 83, Huddinge, Stockholm, Sweden.
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Tharakan S, Klein B, Bartlett L, Atlas A, Parada SA, Cohn RM. Do ChatGPT and Google differ in answers to commonly asked patient questions regarding total shoulder and total elbow arthroplasty? J Shoulder Elbow Surg 2024; 33:e429-e437. [PMID: 38182023 DOI: 10.1016/j.jse.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Artificial intelligence (AI) and large language models (LLMs) offer a new potential resource for patient education. The answers by Chat Generative Pre-Trained Transformer (ChatGPT), a LLM AI text bot, to frequently asked questions (FAQs) were compared to answers provided by a contemporary Google search to determine the reliability of information provided by these sources for patient education in upper extremity arthroplasty. METHODS "Total shoulder arthroplasty" (TSA) and "total elbow arthroplasty" (TEA) were entered into Google Search and ChatGPT 3.0 to determine the ten most FAQs. On Google, the FAQs were obtained through the "people also ask" section, while ChatGPT was asked to provide the ten most FAQs. Each question, answer, and reference(s) cited were recorded. A modified version of the Rothwell system was used to categorize questions into 10 subtopics: special activities, timeline of recovery, restrictions, technical details, cost, indications/management, risks and complications, pain, longevity, and evaluation of surgery. Each reference was categorized into the following groups: commercial, academic, medical practice, single surgeon personal, or social media. Questions for TSA and TEA were combined for analysis and compared between Google and ChatGPT with a 2 sample Z-test for proportions. RESULTS Overall, most questions were related to procedural indications or management (17.5%). There were no significant differences between Google and ChatGPT between question categories. The majority of references were from academic websites (65%). ChatGPT produced a greater number of academic references compared to Google (80% vs. 50%; P = .047), while Google more commonly provided medical practice references (25% vs. 0%; P = .017). CONCLUSION In conjunction with patient-physician discussions, AI LLMs may provide a reliable resource for patients. By providing information based on academic references, these tools have the potential to improve health literacy and improved shared decision making for patients searching for information about TSA and TEA. CLINICAL SIGNIFICANCE With the rising prevalence of AI programs, it is essential to understand how these applications affect patient education in medicine.
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Affiliation(s)
- Shebin Tharakan
- New York Institute of Technology - College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Brandon Klein
- Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington, NY, USA.
| | - Lucas Bartlett
- Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington, NY, USA
| | - Aaron Atlas
- Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington, NY, USA
| | - Stephen A Parada
- Department of Orthopaedic Surgery, Augusta University Health, Augusta, GA, USA
| | - Randy M Cohn
- Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington, NY, USA
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Lee H, Nam J, Jang H, Park YS, Son MH, Lee IH, Eyun SI, Yang JH, Jeon J, Yang S. BRD2-specific inhibitor, BBC0403, inhibits the progression of osteoarthritis pathogenesis in osteoarthritis-induced C57BL/6 male mice. Br J Pharmacol 2024; 181:2528-2544. [PMID: 38600628 DOI: 10.1111/bph.16359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/10/2024] [Accepted: 02/20/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND AND PURPOSE The discovery of new bromo- and extra-terminal inhibitors presents new drugs to treat osteoarthritis (OA). EXPERIMENTAL APPROACH The new drug, BBC0403, was identified in the DNA-encoded library screening system by searching for compounds that target BRD (bromodomain-containing) proteins. The binding force with BRD proteins was evaluated using time-resolved fluorescence energy transfer (TR-FRET) and binding kinetics assays. Subsequently, in vitro and ex vivo analyses demonstrated the effects of the BRD2 inhibitor, BBC0403, on OA. For animal experiments, medial meniscus destabilization was performed to create a 12-week-old male C57BL/6 mouse model, and intra-articular (i.a.) injections were administered. Histological and immunohistochemical analyses were then performed. The underlying mechanism was confirmed by gene set enrichment analysis (GSEA) using RNA-seq. KEY RESULTS TR-FRET and binding kinetics assays revealed that BBC0403 exhibited higher binding specificity for BRD2 compared to BRD3 and BRD4. The anti-OA effects of BBC0403 were tested at concentrations of 5, 10 and 20 μM (no cell toxicity in the range tested). The expression of catabolic factors, prostaglandin E2 (PGE2) production and extracellular matrix (ECM) degradation was reduced. Additionally, the i.a. injection of BBC0403 prevented OA cartilage degradation in mice. Finally, BBC0403 was demonstrated to suppress NF-κB and MAPK signalling pathways. CONCLUSION AND IMPLICATIONS This study demonstrated that BBC0403 is a novel BRD2-specific inhibitor and a potential i.a.-injectable therapeutic agent to treat OA.
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Affiliation(s)
- Hyemi Lee
- Department of Biological Sciences, Sungkyunkwan University, Suwon, South Korea
| | - Jiho Nam
- Department of Biological Sciences, Sungkyunkwan University, Suwon, South Korea
| | - Hahyeong Jang
- Department of Biological Sciences, Sungkyunkwan University, Suwon, South Korea
| | | | | | | | - Seong-Il Eyun
- Department of Life Science, Chung-Ang University, Seoul, South Korea
| | - Jae-Hyun Yang
- Paul F. Glenn Center for Biology of Aging Research, Department of Genetics, Blavatnik Institute Harvard Medical School (HMS), Boston, Massachusetts, USA
| | - Jimin Jeon
- Department of Biological Sciences, Sungkyunkwan University, Suwon, South Korea
| | - Siyoung Yang
- Department of Biological Sciences, Sungkyunkwan University, Suwon, South Korea
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Leckenby J, Smith H, Catanzaro M, Reavey P. Compressive Neuropathies of the Upper Extremity: Anatomy for the Peripheral Nerve Surgeon. Hand Clin 2024; 40:315-324. [PMID: 38972676 DOI: 10.1016/j.hcl.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Advance knowledge of anatomy is a prerequisite for the peripheral nerve surgeon. This article serves to provide an outline of anatomic regions where nerve entrapment or compression can occur. Each section is subdivided into anatomic regions where the etiology, indications, and relevant and aberrant anatomy are discussed, as well as common surgical approaches to the problematic anatomic site. The purpose is to provide an overview for the peripheral nerve surgeon and offer a valuable resource to provide a better understanding and optimal care for this patient population.
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Affiliation(s)
- Jonathan Leckenby
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA; Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA.
| | - Hannah Smith
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Catanzaro
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Reavey
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA; Division of Hand Surgery, Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
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Menta AK, Weber-Levine C, Jiang K, Hersh AM, Davidar AD, Bhimreddy M, Ashayeri K, Sacino A, Chang L, Lubelski D, Theodore N. Robotic assisted surgery for the treatment of spinal metastases: A case series. Clin Neurol Neurosurg 2024; 243:108393. [PMID: 38917745 DOI: 10.1016/j.clineuro.2024.108393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE Spinal metastases can significantly affect quality of life in patients with cancer and present complex neurosurgical challenges for surgeons. Surgery with instrumentation is often indicated to alleviate pain, preserve neurological function, and ensure mechanical stability. However, distortions in the bony anatomy due to oncological disease can decrease the accuracy of pedicle screw placement. Robotic-assisted surgery may offer an opportunity to increase screw accuracy and improve navigation of spinal lesions compared to conventional techniques. Therefore, we presented our institutional experience evaluating robotic-assisted surgical fixation for spinal metastases. METHODS Patients undergoing robotic-assisted surgery at a large tertiary care center between January 2019 - January 2023 for the treatment of spinal metastases were identified. Patient characteristics, including demographics, tumor pathology, surgical complications, and post-operative outcomes were extracted. The Gertzbein Robbins classification system (GRS) was used to assess pedicle screw placement accuracy in patients with post-operative computed tomography. RESULTS Twenty patients were identified, including 7 females (35 %), with an overall median age of 66 years (range: 39-80 years) and median BMI of 25 kg/m2 (range: 17-34 kg/m2). An average of four spinal levels were instrumented, with metastases located primarily in the thoracic (n=17, 85 %) spine. Common primary tumor types included prostate (n=4), lung (n=2), and plasma cell (n=2) cancers. Most pedicle screws (92 %) were classified as GRS A in patients with postoperative imaging. Post-operative complications were unrelated to the use of the robot, and included pulmonary embolism (n=1), deep vein thrombosis (n=2), and gastric symptoms (n=3). Three patients were readmitted at 30 days, with one reoperation due to tumor recurrence. Four patients were deceased within 6 months of surgery. CONCLUSIONS Despite the inherent high-risk nature of these surgeries, this study underscores the safety and efficacy of robotic-assisted surgery in the management of spinal metastases. Robots can be helpful in ensuring accuracy of pedicle screw placement in patients with metastatic disease.
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Affiliation(s)
- Arjun K Menta
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Carly Weber-Levine
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kelly Jiang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Andrew M Hersh
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - A Daniel Davidar
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kimberly Ashayeri
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Louis Chang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Daniel Lubelski
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Nicholas Theodore
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA.
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22
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Aneja A, Nazal MR, Griffin JT, Foster JA, Muhammad M, Sierra-Arce CR, Southall WGS, Wagner RK, Ly TV, Srinath A. A Cadaveric Study: Does Ankle Positioning Affect the Quality of Anatomic Syndesmosis Reduction? J Orthop Trauma 2024; 38:e307-e311. [PMID: 39007668 DOI: 10.1097/bot.0000000000002827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE The objective of this study was to compare the quality of syndesmotic reduction with the ankle in maximal dorsiflexion versus neutral plantarflexion (normal resting position). METHODS Baseline computed tomography (CT) imaging of 10 cadaveric ankle specimens from 5 donors was obtained with the ankles placed in normal resting position. Two fellowship-trained orthopaedic surgeons disrupted the syndesmosis of each ankle specimen. All ankles were then placed in neutral plantarflexion and were subsequently reduced with thumb pressure under direct visualization through an anterolateral approach and stabilized with one 0.062-inch K-wire placed from lateral to medial in a quadricortical fashion across the syndesmosis. Postreduction CT scans were then obtained with the ankle in normal resting position. This process was repeated with the ankles placed in maximal dorsiflexion during reduction and stabilization. Postreduction CT scans were then obtained with the ankles placed in normal resting position. All postreduction CT scans were compared with baseline CT imaging using mixed-effects linear regression with significance set at P < 0.05. RESULTS Syndesmotic reduction and stabilization in maximal dorsiflexion led to increased external rotation of the fibula compared with baseline scans [13.0 ± 5.4 degrees (mean ± SD) vs. 7.5 ± 2.4 degrees, P = 0.002]. There was a tendency toward lateral translation of the fibula with the ankle reduced in maximal dorsiflexion (3.3 ± 1.0 vs. 2.7 ± 0.7 mm, P = 0.096). No other statistically significant differences between measurements of reduction with the ankle placed in neutral plantarflexion or maximal dorsiflexion compared with baseline were present (P > 0.05). CONCLUSIONS Reducing the syndesmosis with the ankle in maximal dorsiflexion may lead to malreduction with external rotation of the fibula. There was no statistically significant difference in reduction quality with the ankle placed in neutral plantarflexion compared with baseline. Future studies should assess the clinical implications of ankle positioning during syndesmotic fixation.
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Affiliation(s)
- Arun Aneja
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA
| | - Mark R Nazal
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Jarod T Griffin
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA
| | - Jeffrey A Foster
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA
| | - Maaz Muhammad
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA
| | - Carlos R Sierra-Arce
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA
| | - Wyatt G S Southall
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Robert Kaspar Wagner
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA
| | - Thuan V Ly
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA
| | - Arjun Srinath
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL
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23
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Cheng YC, Murcko L, Benalcazar-Jalkh EB, Bonfante EA. Hypervitaminosis D is correlated with adverse dental implant outcomes: A retrospective case-control study. J Dent 2024; 147:105137. [PMID: 38901822 DOI: 10.1016/j.jdent.2024.105137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES To investigate vitamin-D levels effect on the survival/success and on marginal bone levels of dental implants. METHODS Patients with peri-implant disease and healthy control patients with functionally loaded dental implants were included in this retrospective case-control study. Forty patients with 201 implants were in the diseased-cohort, while thirty-three patients with 90 implants were in the control-cohort. Patient blood 25(OH)D levels were assessed through quantitative blood test. The correlation between abnormal 25(OH)D levels and disease status of each patient was assessed using Fisher's exact tests. The correlation of each implant's outcomes with vitamin-D status was assessed using Kaplan-Meier survival analysis and Mann-Whitney U tests. RESULTS Patients with blood 25(OH)D levels >70 ng/mL (hypervitaminosis-D) had a 21.1-fold increase in the risk of implant failure or severe peri-implant bone loss regarding patients with intermediate (>30, ≤70 ng/mL) levels. Kaplan-Meier survival analysis revealed that implants in the hypervitaminosis-D cohort had a survival probability of 73.7 % (95 % CI:56.5-84.5 %) at 19-years after surgery, compared to 95 % for implants in patients with intermediate 25(OH)D levels (95 % CI:88.3-97.9 %). Additionally, implants in the hypervitaminosis-D cohort lost bone faster than implants in the intermediate cohort. These results were specific to the patient cohort with elevated blood 25(OH)D levels and not observed in patients taking vitamin-D supplementation. The impact of hypervitaminosis-D was enriched for implants in the maxilla, and not as apparent for implants in the mandible. CONCLUSIONS Blood 25(OH)D levels >70 ng/mL were correlated with adverse implant outcomes, including implant failure and peri-implant bone loss, especially in the maxilla. CLINICAL RELEVANCE These results suggest that hypervitaminosis D may be a previously unidentified risk factor for dental implant complications and should be further investigated to elucidate the underlying mechanism.
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Affiliation(s)
- Yu-Chi Cheng
- School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | - Ernesto B Benalcazar-Jalkh
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Al. Octávio Pinheiro Brisolla 9-75, Bauru, SP 17.012-901, Brazil.
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Al. Octávio Pinheiro Brisolla 9-75, Bauru, SP 17.012-901, Brazil
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24
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Ricotti L, Minuti T. Effects of padel activity and proprioception training on soccer players in an off-season period. J Sports Med Phys Fitness 2024; 64:737-748. [PMID: 38470014 DOI: 10.23736/s0022-4707.23.15430-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Off-season periods imply considerable changes in the fitness status of soccer players. So far, no studies evaluated the effects of proprioception-focused training during soccer off-season periods. In this work, we assessed how much some players' abilities (static and dynamic balance, reaction times, quickness, strength, and technical skills) were affected by proprioception training and padel activity during an off-season period of 12 weeks. METHODS Twenty-eight non-professional adult male soccer players were organized into three groups: a group carried out regular padel activity, ~2 h once a week. Another group underwent a regular proprioception training program, ~ 20 min, twice a week. The third group did not perform any specific activity (control). Static and dynamic balance, reaction times, quickness, strength, and technical skills were evaluated at three time-points: before starting, after 6 weeks, and after 12 weeks. RESULTS Both padel activity and specific proprioception training carried out for 12 weeks significantly improved players' monopodalic static balance with eyes open and dynamic balance. No significant effects of these training regimens were found on monopodalic static balance with eyes closed, visual and acoustic reaction times, acyclic quickness, and strength. Furthermore, proprioception training considerably improved technical skills. CONCLUSIONS Coaches may use padel activity and proprioception exercises for off-season programs featured by ease of execution, low training volume, and high compliance.
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Affiliation(s)
- Leonardo Ricotti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy -
- Department of Excellence in Robotics and Artificial Intelligence, Scuola Superiore Sant'Anna, Pisa, Italy -
- Biostimulation and Function Recovery Lab, Fondazione Volterra Ricerche Onlus, Volterra, Pisa, Italy -
| | - Tommaso Minuti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and Artificial Intelligence, Scuola Superiore Sant'Anna, Pisa, Italy
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25
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Ng MK, Magruder ML, Piuzzi NS, Heckmann ND, Delanois RE, Krebs VE, Mont MA. How-To Create an Orthopaedic Systematic Review: A Step-by-step Guide Part II: Study Execution. J Arthroplasty 2024; 39:2124-2129. [PMID: 38692416 DOI: 10.1016/j.arth.2024.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/03/2024] Open
Abstract
Systematic reviews are the apex of the evidence-based pyramid, representing the strongest form of evidence synthesizing results from multiple primary studies. In particular, a quantitative systematic review, or meta-analysis, pools results from multiple studies to help answer a respective research question. The aim of this review is to serve as a guide on how to: (1) design, (2) execute, and (3) publish an orthopaedic arthroplasty systematic review. In Part II, we focus on methods to assess data quality through the Cochrane Risk of Bias, Methodological Index for Nonrandomized Studies criteria, or Newcastle-Ottawa scale; enumerate various methods for appropriate data interpretation and analysis; and summarize how to convert respective findings to a publishable manuscript (providing a previously published example). Use of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines is recommended and standard in all scientific literature, including that of orthopedic surgery. Pooled analyses with forest plots and associated odds ratios and 95% confidence intervals are common ways to present data. When converting to a manuscript, it is important to consider and discuss the inherent limitations of systematic reviews, including their inclusion and/or exclusion criteria and overall quality, which can be limited based on the quality of individual studies (eg, publication bias, heterogeneity, search/selection bias). We hope our papers will serve as starting points for those interested in performing an orthopaedic arthroplasty systematic review.
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Affiliation(s)
- Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland; Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
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26
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Surendran T, Park LK, Lauber MV, Cha B, Jhun RS, Capellini TD, Kumar D, Felson DT, Kolachalama VB. Survival analysis on subchondral bone length for total knee replacement. Skeletal Radiol 2024; 53:1541-1552. [PMID: 38388702 PMCID: PMC11194148 DOI: 10.1007/s00256-024-04627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/01/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Use subchondral bone length (SBL), a new MRI-derived measure that reflects the extent of cartilage loss and bone flattening, to predict the risk of progression to total knee replacement (TKR). METHODS We employed baseline MRI data from the Osteoarthritis Initiative (OAI), focusing on 760 men and 1214 women with bone marrow lesions (BMLs) and joint space narrowing (JSN) scores, to predict the progression to TKR. To minimize bias from analyzing both knees of a participant, only the knee with a higher Kellgren-Lawrence (KL) grade was considered, given its greater potential need for TKR. We utilized the Kaplan-Meier survival curves and Cox proportional hazards models, incorporating raw and normalized values of SBL, JSN, and BML as predictors. The study included subgroup analyses for different demographics and clinical characteristics, using models for raw and normalized SBL (merged, femoral, tibial), BML (merged, femoral, tibial), and JSN (medial and lateral compartments). Model performance was evaluated using the time-dependent area under the curve (AUC), Brier score, and Concordance index to gauge accuracy, calibration, and discriminatory power. Knee joint and region-level analyses were conducted to determine the effectiveness of SBL, JSN, and BML in predicting TKR risk. RESULTS The SBL model, incorporating data from both the femur and tibia, demonstrated a predictive capacity for TKR that closely matched the performance of the BML score and the JSN grade. The Concordance index of the SBL model was 0.764, closely mirroring the BML's 0.759 and slightly below JSN's 0.788. The Brier score for the SBL model stood at 0.069, showing comparability with BML's 0.073 and a minor difference from JSN's 0.067. Regarding the AUC, the SBL model achieved 0.803, nearly identical to BML's 0.802 and slightly lower than JSN's 0.827. CONCLUSION SBL's capacity to predict the risk of progression to TKR highlights its potential as an effective imaging biomarker for knee osteoarthritis.
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Affiliation(s)
- Tejus Surendran
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Lisa K Park
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Meagan V Lauber
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Baekdong Cha
- Sargent College, Boston University, Boston, MA, USA
| | - Ray S Jhun
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Terence D Capellini
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Deepak Kumar
- Sargent College, Boston University, Boston, MA, USA
| | - David T Felson
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA.
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, 02215, USA.
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27
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Mendiratta D, Herzog I, Liggio DF, Ahn D, Vosbikian M, Kaushal N, Chu A. "Top 20" residency-trained academic orthopaedic surgeons have higher academic productivity and funding in their careers. J Orthop Res 2024; 42:1852-1860. [PMID: 38433389 DOI: 10.1002/jor.25826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
"Top 20" status on Doximity, an online networking service for medical professionals, is an indicator of the reputation of a residency program. The study assesses how training at a Top 20 (T20) orthopaedic residency program impacts career productivity and funding. Fellowship and Residency Electronic Interactive Database was used in 2022 to identify active orthopaedic residency programs. Demographic and training data was collected for each orthopaedic surgeon using institutional websites and Doximity. The Residency Navigator feature on Doximity was used to rank residency programs by "reputation." Programs were categorized as either T20 or non-T20. The relative citation ratio (RCR) was calculated using the NIH iCite tool and Hirsch index (h-index) was calculated using Scopus. Industry funding was collected from the Centers for Medicare & Medicaid Services Open Payments Program (CMS) for all available years (2014-2020). A total of 2812 academic orthopaedic surgeons were included in the study. Among academic orthopaedic surgeons in the United States, T20 trained orthopedists had more publications and citations (p < 0.001), along with higher h-indices (p < 0.001), RCR (p < 0.001), and industry funding (p = 0.043). Additionally, T20 trained orthopedists were 1.375 times more likely to obtain professor status (95% confidence interval: 1.150-1.645, p < 0.001). Even after propensity-matched analysis, T20 trained orthopedists maintained these differences. Training at a T20 residency program is associated with promotion, productivity, and funding. These findings are especially of concern to medical students who must consider the importance of a residency program's reputation when deciding where to apply for residency.
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Affiliation(s)
- Dhruv Mendiratta
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Isabel Herzog
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Daniel F Liggio
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David Ahn
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Michael Vosbikian
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Neil Kaushal
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Alice Chu
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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28
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Feroe AG, Clark SC, Hevesi M, Okoroha KR, Saris DBF, Krych AJ, Tagliero AJ. Management of Meniscus Pathology with Concomitant Anterior Cruciate Ligament Injury. Curr Rev Musculoskelet Med 2024; 17:321-334. [PMID: 38822979 PMCID: PMC11219633 DOI: 10.1007/s12178-024-09906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize current clinical knowledge on the prevalence and types of meniscus pathology seen with concomitant anterior cruciate ligament (ACL) injury, as well as surgical techniques, clinical outcomes, and rehabilitation following operative management of these pathologies. RECENT FINDINGS Meniscus pathology with concomitant ACL injury is relatively common, with reports of meniscus pathology identified in 21-64% of operative ACL injuries. These concomitant injuries have been associated with increased age and body mass index. Lateral meniscus pathology is more common in acute ACL injury, while medial meniscus pathology is more typical in chronic ACL deficiency. Meniscus tear patterns associated with concomitant ACL injury include meniscus root tears, lateral meniscus oblique radial tears of the posterior horn (14%), and ramp lesions of the medial meniscus (8-24%). These meniscal pathologies with concomitant ACL injury are associated with increased rotational laxity and meniscal extrusion. There is a paucity of comparative studies to determine the optimal meniscus repair technique, as well as rehabilitation protocol, depending on specific tear pattern, location, and ACL reconstruction technique. There has been a substantial increase in recent publications demonstrating the importance of meniscus repair at the time of ACL repair or reconstruction to restore knee biomechanics and reduce the risk of progressive osteoarthritic degeneration. Through these studies, there has been a growing understanding of the meniscus tear patterns commonly identified or nearly missed during ACL reconstruction. Surgical management of meniscal pathology with concomitant ACL injury implements the same principles as utilized in the setting of isolated meniscus repair alone: anatomic reduction, biologic preparation and augmentation, and circumferential compression. Advances in repair techniques have demonstrated promising clinical outcomes, and the ability to restore and preserve the meniscus in pathologies previously deemed irreparable. Further research to determine the optimal surgical technique for specific tear patterns, as well as rehabilitation protocols for meniscus pathology with concomitant ACL injury, is warranted.
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Affiliation(s)
- Aliya G Feroe
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Sean C Clark
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Adam J Tagliero
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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29
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Rosengart TK, Chen JH, Gantt NL, Angelos P, Warshaw AL, Rosen JE, Perrier ND, Kaups KL, Doherty GM, Zoumpou T, Ashley SW, Doscher W, Welsh D, Savarise M, Sutherland MJ, Sidawy AN, Kopelan AM. Sustaining Lifelong Competency of Surgeons: Multimodality Empowerment Personal and Institutional Strategy. J Am Coll Surg 2024; 239:187-189. [PMID: 38591782 DOI: 10.1097/xcs.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Todd K Rosengart
- From the Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX (Rosengart, Chen)
| | - Jennifer H Chen
- From the Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX (Rosengart, Chen)
| | - Nancy L Gantt
- Department of Surgery, Northeast Ohio Medical University, Youngstown, OH (Gantt)
| | - Peter Angelos
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL (Angelos)
| | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Warshaw)
| | - Jennifer E Rosen
- Division of Endocrine Surgery, MedStar-Washington Hospital Center, Washington, DC (Rosen)
| | - Nancy D Perrier
- Department of Surgical Oncology, Section of Surgical Endocrinology, The University of Texas MD Anderson Cancer Center, Houston, TX (Perrier)
| | - Krista L Kaups
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA (Kaups)
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Doherty, Ashley)
| | - Theofano Zoumpou
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ (Zoumpou)
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Doherty, Ashley)
| | - William Doscher
- Department of Surgery, Zucker School of Medicine at Hofstra, Northwell, NY (Doscher)
| | - David Welsh
- Margaret Mary Health, Batesville, IN (Welsh)
| | - Mark Savarise
- Section of Community General Surgery, University of Utah South Jordan Health Center, South Jordan, UT (Savarise)
| | | | - Anton N Sidawy
- Department of Surgery, George Washington University, Washington, DC (Sidawy)
| | - Adam M Kopelan
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, NJ (Kopelan)
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30
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Atif M, Tewari N, Reshikesh M, Chanda A, Mathur VP, Morankar R. Methods and applications of finite element analysis in dental trauma research: A scoping review. Dent Traumatol 2024; 40:366-388. [PMID: 38279593 DOI: 10.1111/edt.12933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/16/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
Finite Element Analysis (FEA) is vital for understanding dental traumatology (DT) biomechanics, aiding diagnosis, treatment planning, and outcome prediction. This review explores FEA applications in DT research, evaluates their quality and outcomes, and assesses methodological aspects. Accordingly, recommendations for future researchers are provided. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and registered in Open Science framework. A comprehensive search using relevant text-words and MeSH terms was performed in established databases. The inclusion criteria encompassed all Finite element analysis (FEA)-based Dental traumatology (DT) studies without language or publication year restrictions. Risk of bias was assessed with the Risk of bias tool for the use of finite element analysis in dentistry (ROBFEAD) tool. Forty-six studies published from 2001 to 2023 were included in the qualitative synthesis. The studies were categorized into five domains and six subdomains based on objectives. Maxillary central incisors and surrounding structures were commonly modelled (n = 27). Most studies utilized Computed tomography (CT), Cone Beam CT, or micro CT. Traumatic injury forces ranged from 100 N to 2000 N, and occlusal forces ranged from 150 N to 350 N. All studies were rated as high risk of bias. Fory-six studies were categorized, with most focusing on stress distribution and fracture patterns in dento-alveolar structures under various conditions, while few assessed displacements. Methodological quality lacked robustness in model development and substructure properties. Future studies should address these limitations and enhance reporting practices.
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Affiliation(s)
- Mohammad Atif
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Nitesh Tewari
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Reshikesh
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Arnab Chanda
- Centre for Biomedical Engineering, IIT, Delhi, India
| | - Vijay Prakash Mathur
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Morankar
- Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Derks LSM, Smit AL, Thomeer HGXM, Grolman W, Stokroos RJ, Wegner I. The cost evaluation of day-case compared to inpatient cochlear implantation in adults: subanalysis of a randomized controlled trial. Eur Arch Otorhinolaryngol 2024; 281:4009-4019. [PMID: 38528216 PMCID: PMC11266201 DOI: 10.1007/s00405-024-08501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/24/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To investigate the assumption that day-case cochlear implantation is associated with lower costs, compared to inpatient cochlear implantation, while maintaining equal quality of life (QoL) and hearing outcomes, for the Dutch healthcare setting. STUDY DESIGN A single-center, non-blinded, randomized controlled trial in a tertiary referral center. METHODS Thirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group (i.e., one night admission). We performed an intention-to-treat evaluation of the difference of the total health care-related costs, hospital and out of hospital costs, between day-case and inpatient cochlear implantation, from a hospital and patient perspective over the course of one year. Audiometric outcomes, assessed using CVC scores, and QoL, assessed using the EQ-5D and HUI3 questionnaires, were taken into account. RESULTS There were two drop-outs. The total health care-related costs were €41,828 in the inpatient group (n = 14) and €42,710 in the day-case group (n = 14). The mean postoperative hospital stay was 1.2 days (mean costs of €1,069) in the inpatient group and 0.7 days (mean costs of €701) for the day-case group. There were no statistically significant differences in postoperative hospital and out of hospital costs. The QoL at 2 months and 1 year postoperative, measured by the EQ-5D index value and HUI3 showed no statistically significant difference. The EQ-5D VAS score measured at 1 year postoperatively was statistically significantly higher in the inpatient group (84/100) than in the day-case group (65/100). There were no differences in postoperative complications, objective hearing outcomes, and number of postoperative hospital and out of hospital visits. CONCLUSION A day-case approach to cochlear implant surgery does not result in a statistically significant reduction of health care-related costs compared to an inpatient approach and does not affect the surgical outcome (complications and objective hearing measurements), QoL, and postoperative course (number of postoperative hospital and out of hospital visits). LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Laura S M Derks
- Department of Otorhinolaryngology-Head and Neck Surgery, G05.129, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Adriana L Smit
- Department of Otorhinolaryngology-Head and Neck Surgery, G05.129, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology-Head and Neck Surgery, G05.129, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wilko Grolman
- Jean Causse Ear Clinic, Traverse de Béziers, Colombiers, France
| | - Robert J Stokroos
- Department of Otorhinolaryngology-Head and Neck Surgery, G05.129, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Ahmed AS, Clifton T, Subbiah K, Spasojevic M, Young A, Cass B, Marmen A, Yu R, Burton C, Smith MM, Hughes J. Midterm follow-up of the Nexel total elbow arthroplasty. J Shoulder Elbow Surg 2024; 33:1699-1708. [PMID: 38522777 DOI: 10.1016/j.jse.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Aseptic loosening is one of the most common complications of total elbow arthroplasty (TEA). Modern implants, such as the Nexel, have been designed in an attempt to decrease loosening. The present study aims to report implant survivorship, radiographic assessment of loosening and lucency, and patient-reported outcome measures (PROMs) in patients treated with the Nexel TEA at midterm follow-up. METHODS Consecutive series of adult patients underwent TEA using the Nexel by a single surgeon via standardized technique. Patients with minimum 3-year follow-up with radiographic and PROM data were included. Survivorship was defined by the absence of revision. Loosening was assessed via the Wrightington method by 3 independent fellowship-trained shoulder and elbow surgeons. Lucency was analyzed across individual radiographic zones on orthogonal radiographs. PROMs included the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Patient-Rated Elbow Evaluation (PREE), and EuroQoL-5 Dimensions (EQ-5D). RESULTS Thirty-eight consecutive patients (22 female, 16 male) with a mean age of 67 years underwent TEA via a triceps-sparing isolated medial window approach. Mean follow-up was 5.5 years (range 3-9). Primary diagnoses were as follows: 19 osteoarthritis (OA), 9 rheumatoid arthritis (RA), 9 post-traumatic arthritis (PA), and 1 conversion of elbow arthrodesis. Overall survivorship was 97.4%, with 1 patient undergoing revision for infection. Loosening was found in 5.3% of elbows, averaged across 3 observers. Lucency was most pronounced at the level of the humeral condyles. PROMs demonstrated significant and clinically meaningful improvements in 76%, 92%, and 73% of patients for QuickDASH, PREE, and EQ-5D, respectively. No significant correlations were found between patient age, gender, loosening, lucency, and PROMs. CONCLUSION At midterm follow-up, the Nexel TEA demonstrated excellent overall survivorship and low rate of implant loosening. The single failure requiring revision for infection was conversion of a prior elbow arthrodesis. PROMs overall exhibited marked and consistent improvement from preoperative to final postoperative follow-up. Although promising, these results should be interpreted with some caution as long-term data regarding this prosthesis are still lacking.
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Affiliation(s)
- Adil Shahzad Ahmed
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Thomas Clifton
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | | | - Milos Spasojevic
- Rockhampton Department of Orthopaedic Surgery, University of Queensland, Queensland, QLD, Australia
| | - Allan Young
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | - Benjamin Cass
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | | | - Raymond Yu
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | - Codey Burton
- Department of Orthopaedic Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Jeffery Hughes
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
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Gauthier CW, Bakaes YC, Kern EM, Kung JE, Hopkins JS, Hamilton CA, Bishop BC, March KA, Jackson JB. Total Joint Arthroplasty Outcomes in Eligible Patients Versus Patients Who Failed to Meet at Least 1 Eligibility Criterion: A Single-Center Retrospective Analysis. J Arthroplasty 2024; 39:1974-1981.e2. [PMID: 38403078 DOI: 10.1016/j.arth.2024.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND This study looks to investigate how not meeting eligibility criteria affects postoperative outcomes following total joint arthroplasty surgery. METHODS A retrospective review was conducted of total joint arthroplasty patients at a single academic institution. Demographics, laboratory values, and complications were recorded. Continuous and categorical variables were compared using the Student's T-test and the Chi-Square test, respectively. Multivariable analysis was used to control for confounding variables. RESULTS Our study included 915 total hip and 1,579 total knee arthroplasty patients. For total hip and total knee arthroplasty, there were no significant differences in complications (P = .11 and .87), readmissions (P = .83 and .2), or revision surgeries (P = .3 and 1) when comparing those who met all criteria to those who did not. Total hip arthroplasty patients who did not meet two criteria had 16.1 higher odds (P = .02) of suffering a complication. There were no differences in complications (P = .34 and .41), readmissions (P = 1 and .55), or revision surgeries (P = 1 and .36) between ineligible patients treated by total joint arthroplasty surgeons and those who were not. Multivariable analysis demonstrated no eligibility factors were associated with outcomes for both total hip and knee arthroplasty. CONCLUSIONS There was no significant difference in outcomes between those who met all eligibility criteria and those who did not. Not meeting two criteria conferred significantly higher odds of suffering a complication for total hip arthroplasty patients. Total joint arthroplasty surgeons had similar outcomes to non-total joint surgeons, although their patient population was more complex. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chase W Gauthier
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Yianni C Bakaes
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Elizabeth M Kern
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Justin E Kung
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Jeffrey S Hopkins
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Corey A Hamilton
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Braxton C Bishop
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Kyle A March
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - J Benjamin Jackson
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
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Pasqualini I, Turan O, Emara AK, Ibaseta A, Xu J, Chiu A, Piuzzi NS. Outpatient Total Hip Arthroplasty Volume up Nearly 8-Fold After Regulatory Changes With Expanding Demographics and Unchanging Outcomes: A 10-Year Analysis. J Arthroplasty 2024; 39:2074-2081. [PMID: 38401607 DOI: 10.1016/j.arth.2024.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND With the removal of total hip arthroplasty (THA) from the inpatient-only (IPO) lists, the orthopedic landscape across the United States has changed rapidly. Thus, this study aimed to: 1) characterize the change in THA volume for outpatient and inpatient surgeries; 2) elucidate demographical differences before and after removal from the IPO list; and 3) analyze 30-day complications, readmissions, and reoperations. METHODS The National Surgical Quality Improvement Program database was queried for primary THAs between January 2010 and December 2021. The primary outcome was the annual volume of outpatient and inpatient THAs. Secondary outcomes involved 30-day complications, readmissions, and reoperations. The variables between cohorts were analyzed using goodness-of-fit Chi-square tests with summary statistics. RESULTS Of the 332,423 THAs between 2010 and 2021, 88% were inpatient THAs (n = 292,974) and 12% were outpatient THAs (n = 39,449). From 2019 to 2021, the volume of inpatient THA decreased by 55% (42,779 to 19,075), while outpatient THA increased by 751% (2,518 to 21,424). Patients who had a THA after 2019 were older (P < .001), more commonly women (P < .001), white (P < .001), and more likely American Society of Anesthesiologists Class III (P < .001). The outpatient cohort had fewer 30-day complications, readmissions, and reoperations. The length of stay for both cohorts decreased until 2019, before increasing in 2020 and 2021 for inpatient THAs, while home discharge and operative time increased for both. CONCLUSIONS The volume of outpatient THA increased almost eightfold after its removal from the IPO lists in 2020. Despite expanding eligibility with older patients and more comorbidities, 30-day complications, readmissions, and reoperations remain low. These findings support the safe transition to outpatient THA with appropriate patient selection and optimization.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Oguz Turan
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ahmed K Emara
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alvaro Ibaseta
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James Xu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Austin Chiu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Rezaee M, Roshandel H, Rahimibarghani S, Rihani TSS, Mohammadyahya E. Predictors of pain intensity in carpal tunnel syndrome: Development and validation of a model. Clin Neurol Neurosurg 2024; 243:108395. [PMID: 38936177 DOI: 10.1016/j.clineuro.2024.108395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Pain often accompanies carpal tunnel syndrome and affects patients' health-related quality of life. The aim was to develop and validate a predictive model for the pain intensity of carpal tunnel syndrome using demographic, clinical, electrophysiological, and ultrasound findings. METHODS We conducted a secondary analysis of data from a large sample of patients (May 2017 to December 2022) with carpal tunnel syndrome. A total of 520 (53.0 %) mild, 276 (28.1 %) moderate, and 186 (18.9 %) severe syndromes were included in the complete data set of 982 hands (61.1 % female). The mean age was 57.8 (10.7) years and the median duration [interquartile range] of the symptoms was 4 [2,10] months. A regression model was developed and validated to predict pain intensity on a numerical rating scale using a tree-based machine learning algorithm. RESULTS The validation of the regression model showed good performance with a root mean squared error, R-squared, and mean absolute error of 1.35, 0.42, and 1.05, respectively. Overall, the top significant predictors of pain intensity were compound motor nerve action potential latency, nocturnal pain, and thenar weakness. These were followed by the cross-sectional area of the median nerve, sensory nerve action potential, bowing of the flexor retinaculum, disease duration, and body mass index. We did not find strong associations between the median nerve transcarpal latency, age, sex, and diabetes with the pain intensity of carpal tunnel syndrome. CONCLUSION Our model showed good performance in predicting the subjective pain intensity of carpal tunnel syndrome, even in the context of non-linear relations.
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Affiliation(s)
- Mehdi Rezaee
- Department of Anesthesiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Islamic Republic of Iran
| | - Hamid Roshandel
- Department of Orthopedics, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Sarvenaz Rahimibarghani
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Tayebeh Sadat Salehi Rihani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Elham Mohammadyahya
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
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de Souza HCM, Pessoa MF, Clemente RDS, da Silva AV, Cardoso PRG, Fernandes J, Dornelas de Andrade A. Effects of 12 weeks of inspiratory muscle training and whole body vibration on the inflammatory profile, BDNF and muscular system in pre-frail elderly women: A randomized controlled trial. Arch Gerontol Geriatr 2024; 123:105421. [PMID: 38593699 DOI: 10.1016/j.archger.2024.105421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/12/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
AIM to investigate the effects of the whole body vibration (WBV) and inspiratory muscle training (IMT) on the inflammatory profile and in muscle mass and strength in pre-frail older women. METHODS this study was a randomized double-blind trial. Forty two older women aged 60-80 years were randomly allocated to IMT + WBV (G1), IMTsham + WBV (G2) or Sham groups (G3). During 12 weeks G1 received both trainings, whereas G2 received WBV alone and G3 received IMT with a low fixed load and were positioned at the vibratory platform without therapeutic effect. Participants were evaluated before and after the intervention for the following outcomes: Brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers (IB), respiratory (RT) and quadriceps thickness (QT) and diaphragmatic mobility (DM) using muscle ultrasound, body composition (BC) using a bioelectrical impedance scale and inspiratory muscle strength (IMS). RESULTS after the training, G1 (114.93 ± 21.29) improved IMS (p<0.005) compared with G2 (91.29 ± 23.10) and G3 (85.21 ± 27.02). There was also a significant improve on time of the DM (p<0.001) and RT (p=0.006) for G1 (8.59 ± 3.55 and 11.11 ± 12.66) compared with G2 (1.05 ± 3.09 and 1.10 ± 10.60) and G3 (0.40 ± 2.29 and -1.85 ± 7.45). BDNF, IB, QT and BC were similar between groups. CONCLUSIONS IMT associated with WBV is effective to improve in increasing IMS, RT and DM in pre-frail older women. However, these interventions do not modify BDNF, IB, QT or BC in this population.
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Affiliation(s)
- Helga Cecília Muniz de Souza
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Hospital das Clínicas de Pernambuco - Empresa Brasileira de Serviços Hospitalares (HCPE-EBSERH), Federal University of Pernambuco, Recife, Brazil; Laboratory of Cardiopulmonary Physiotherapy, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil.
| | - Maíra Florentino Pessoa
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Laboratory of Cardiopulmonary Physiotherapy, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil
| | - Rafaela Dos Santos Clemente
- Laboratory of Cardiopulmonary Physiotherapy, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil
| | - Alanna Vasconcelos da Silva
- Laboratory of Cardiopulmonary Physiotherapy, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil
| | | | - Juliana Fernandes
- Laboratory of Physiotherapy and Collective Health, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil
| | - Arméle Dornelas de Andrade
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Laboratory of Cardiopulmonary Physiotherapy, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil.
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Chanbour H, Zeoli T, Zuckerman SL. Commentary: Neural Arch Preservation-Posterior Vertebral Column Resection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 27:247-248. [PMID: 38648853 DOI: 10.1227/ons.0000000000001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Tyler Zeoli
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
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Evsyukov A, Kosimshoev M, Kubetskyi Y, Nikitenko E, Rzaev J. Surgical treatment of a patient with Gorham-Stout disease of craniovertebral junction: case report and literature review. Br J Neurosurg 2024; 38:972-977. [PMID: 34585642 DOI: 10.1080/02688697.2021.1981244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
The paper discusses a case of a 58-year-old male suffering from a destructive process affecting the cranial bone and craniovertebral junction. A pathological fracture of the axial vertebrae led to a progressing atlantoaxial dislocation combined with pain syndrome and orthopedic disturbances. After symptom assessment, he was diagnosed to have developed the Gorham-Stout disease (GSD), a rare syndrome accompanied by massive osteolysis. The paper considers GSD etiology and observes the main pathogenetic theories.
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Affiliation(s)
- Aleksey Evsyukov
- Federal State Budgetary Institution "National Ilizarov Medical Research Centre for Traumatology and Ortopaedics" Ministry Healthcare, Novosibirsk, Russian Federation
| | - Murodzhon Kosimshoev
- "Federal Center of Neurosurgery", The Ministry of Health, Novosibirsk, Russian Federation
| | - Yuliy Kubetskyi
- "Federal Center of Neurosurgery", The Ministry of Health, Novosibirsk, Russian Federation
| | - Evgeniy Nikitenko
- Autonomous Non-profit Organization Regional Center of High Medical Technologies, Novosibirsk, Russian Federation
| | - Jamil Rzaev
- "Federal Center of Neurosurgery", The Ministry of Health, Novosibirsk, Russian Federation
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Cruz JP, Michaud JB, Van Rysselberghe NL, Walsh D, Svetgoff R, Bailey R, Pirkle SB, Megerian MF, Harbison GJ, Becerra JA, Sakka B, Vega A, Bohlen HL, Holloway A, Finlay A, Scolaro JA, Patterson JT, Campbell ST, Hebert-Davies J, Warner SJ, Goodnough LH, Bishop JA, Gardner MJ. Outcomes of isolated medial tibial plateau fractures by fracture morphology. Injury 2024; 55:111662. [PMID: 38897069 DOI: 10.1016/j.injury.2024.111662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/18/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To identify a cohort of isolated medial tibial plateau fractures treated with surgical fixation and to categorize them by Moore and Wahlquist classifications in order to determine the rate of complications with each fracture morphology and the predictive value of each classification system. We hypothesized there would be high rates of neurovascular injury, compartment syndrome, and complications overall with a higher incidence of neurovascular injury in Moore type III rim avulsion fractures and Wahlquist type C fractures that enter the plateau lateral to the tibial spines. METHODS Patients who presented to six Level I trauma centers between 2010 and 2021 who underwent surgical fixation for isolated medial tibial plateau fractures were retrospectively reviewed. Data including demographics, radiographs, complications, and functional outcomes were collected. RESULTS One hundred and fifty isolated medial tibial plateau fractures were included. All patients were classified by the Wahlquist classification of medial tibial plateau fractures, and 139 patients were classifiable by the Moore classification of tibial plateau fracture-dislocations. Nine percent of fractures presented with neurovascular injury: 5 % with isolated vascular injury and 6 % with isolated nerve injury. There were no significant differences in neurovascular injury by fracture type (Wahlquist p = 0.16, Moore p = 0.33). Compartment syndrome developed in two patients (1.3 %). The average final range of motion was 0.8-122° with no difference by Wahlquist or Moore classifications (p = 0.11, p = 0.52). The overall complication rate was 32 % without differences by fracture morphology. The overall rate of return to the operating room (OR) was 25 %. CONCLUSIONS Isolated medial tibial plateau fractures often represent fracture-dislocations of the knee and should receive a meticulous neurovascular exam on presentation with a high suspicion for neurovascular injury. No specific fracture pattern was found to be predictive of neurovascular injuries, complications, or final knee range of motion. Patients should be counseled pre-operatively regarding high rates of return to the OR after the index surgery.
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Affiliation(s)
| | - Jack B Michaud
- Stanford University (Primary/Coordinating Site), United States
| | | | - Daniel Walsh
- University of Texas Health Science Center at Houston, United States
| | - Reese Svetgoff
- University of Texas Health Science Center at Houston, United States
| | - Ryan Bailey
- University of Texas Health Science Center at Houston, United States
| | | | | | | | | | | | | | | | | | - Andrea Finlay
- Stanford University (Primary/Coordinating Site), United States
| | | | | | | | | | - Stephen J Warner
- University of Texas Health Science Center at Houston, United States
| | | | - Julius A Bishop
- Stanford University (Primary/Coordinating Site), United States
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Arnold SC, Lagazzi E, Wagner RK, Rafaqat W, Abiad M, Argandykov D, Hoekman AH, Panossian V, Nzenwa IC, Cote M, Hwabejire JO, Schipper IB, Ly TV, Velmahos GC. Two big bones, one big decision: When to fix bilateral femur fractures. Injury 2024; 55:111610. [PMID: 38861829 DOI: 10.1016/j.injury.2024.111610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE For polytrauma patients with bilateral femoral shaft fractures (BFSF), there is currently no consensus on the optimal timing of surgery. This study assesses the impact of early (≤ 24 h) versus delayed (>24 h) definitive fixation on clinical outcomes, especially focusing on concomitant versus staged repair. We hypothesized that early definitive fixation leads to lower mortality and morbidity rates. METHODS The 2017-2020 Trauma Quality Improvement Program was used to identify patients aged ≥16 years with BFSF who underwent definitive fixation. Early definitive fixation (EDF) was defined as fixation of both femoral shaft fractures within 24 h, delayed definitive fixation (DDF) as fixation of both fractures after 24 h, and early staged fixation (ESF) as fixation of one femur within 24 h and the other femur after 24 h. Propensity score matching and multilevel mixed effects regression models were used to compare groups. RESULTS 1,118 patients were included, of which 62.8% underwent EDF. Following propensity score matching, 279 balanced pairs were formed. EDF was associated with decreased overall morbidity (12.9% vs 22.6%, p = 0.003), lower rate of deep venous thrombosis (2.2% vs 6.5%, p = 0.012), a shorter ICU LOS (5 vs 7 days, p < 0.001) and a shorter hospital LOS (10 vs 15 days, p < 0.001). When compared to DDF, early staged fixation (ESF) was associated with lower rates of ventilator acquired pneumonia (0.0% vs 4.9%, p = 0.007), but a longer ICU LOS (8 vs 6 days, p = 0.004). Using regression analysis, every 24-hour delay to definitive fixation increased the odds of developing complications by 1.05, postoperative LOS by 10 h and total hospital LOS by 27 h. CONCLUSION Early definitive fixation (≤ 24 h) is preferred over delayed definitive fixation (>24 h) for patients with bilateral femur shaft fractures when accounting for age, sex, injury characteristics, additional fractures and interventions, and hospital level. Although mortality does not differ, overall morbidity and deep venous thrombosis rates, and length of hospital and intensive care unit stay are significantly lower. When early definitive fixation is not possible, early staged repair seems preferable over delayed definitive fixation.
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Affiliation(s)
- Suzanne C Arnold
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA; Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Emanuele Lagazzi
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA; Department of Surgery, Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, Italy
| | - Robert K Wagner
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - Wardah Rafaqat
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - May Abiad
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - Dias Argandykov
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - Anne H Hoekman
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA; Department of Surgery, Division of Trauma & Emergency Surgery, Amsterdam University Medical Center Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Vahe Panossian
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - Ikemsinachi C Nzenwa
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - Mark Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Thuan V Ly
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA.
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DeBaun MR, Vanderkarr M, Holy CE, Ruppenkamp JW, Parikh A, Vanderkarr M, Coplan PM, Pean CA, McLaurin TM. Persistent racial disparities in postoperative management after tibia fracture fixation: A matched analysis of US medicaid beneficiaries. Injury 2024; 55:111696. [PMID: 38945078 DOI: 10.1016/j.injury.2024.111696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Racial and ethnic disparities in orthopaedic surgery are well documented. However, the extent to which these persist in fracture care is unknown. This study sought to assess racial disparities in the postoperative surgical and medical management of patients after diaphyseal tibia fracture fixation. METHODS Patients with surgically treated tibial shaft fractures from October 1, 2015, to December 31, 2020, were identified in the MarketScan® Medicaid Database. Exclusion criteria included concurrent fractures or amputation. Outcomes included 2-year postoperative complications, reoperation rates, and filled prescriptions. Surgically-treated Black and White cohorts were propensity-score matched using nearest-neighbor matching on patient demographics, comorbidities, fracture pattern and severity, and fixation type. Chi-square tests and survival analyses (Kaplan-Meier and Cox proportional hazard models) were conducted. RESULTS 5,472 patients were included, 2,209 Black and 3,263 White patients. After matching, 2,209 were retained in each cohort. No significant differences in complication rates were observed in the matched Black vs White cohorts. Rates of reoperation, however, were significantly lower in Black as compared to White patients (28.5 % vs. 35.5 % rate, risk difference = 7.0 % (95 % confidence interval (CI): 4.2 % to 9.7 %)). Implant removal was also significantly lower in Black (17.9 %) vs. White (25.1 %) patients (Risk difference = 7.2 %, (95 %CI: 4.8 % to 9.6 %)). The adjusted hazard ratio comparing the reoperation rate in Black versus White patients was 0.77 (95 %CI: 0.69-0.82, p < 0.0001). Significantly lower proportions of Black vs White patients filled at least one prescription for benzodiazepine, antidepressants, strong opiates, or antibiotics at every time point post-index. DISCUSSION Fewer resources were used in post-operative management after surgical treatment of tibial shaft fractures for Black versus White Medicaid-insured patients. These results may be reflective of the undertreatment of complications after tibia fracture surgery for Black patients and highlight the need for further interventions to address racial disparities in trauma care.
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Affiliation(s)
- Malcolm R DeBaun
- Duke University School of Medicine, Orthopedic Surgery, Durham, NC 27710, USA.
| | - Mari Vanderkarr
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | - Chantal E Holy
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | - Jill W Ruppenkamp
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | | | | | - Paul M Coplan
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | - Christian A Pean
- Duke University School of Medicine, Orthopedic Surgery, Durham, NC 27710, USA
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Ishii S, Baba T, Shirogane Y, Hayashi K, Homma Y, Muto O, Kaneko K, Ishijima M. Callus formation after total hip arthroplasty using a short tapered-wedge stem. Skeletal Radiol 2024:10.1007/s00256-024-04756-7. [PMID: 39052073 DOI: 10.1007/s00256-024-04756-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The incidence of periprosthetic fractures after total hip arthroplasty using a short tapered-wedge stem is high. Callus formation preceding this fracture, which indicates postoperative stress fracture around the stem, has been reported. However, previous studies on postoperative callus are limited. Hence, the current study aimed to evaluate the prevalence and risk factors of postoperative callus after total hip arthroplasty with a short tapered-wedge stem. MATERIALS AND METHODS This retrospective study included 127 patients who underwent total hip arthroplasty using a cementless short tapered-wedge stem. The depth of stem insertion was measured as the distance from the lateral corner of the stem to the most medial point of the lesser trochanter along the body axis. Postoperative callus was defined as a bridging callus on the lateral femoral cortex at the distal end of the porous coating of the stem. Plain radiography was performed before surgery and immediately and at 1, 3, and 6 months after surgery to assess postoperative callus. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PC. RESULTS In total, 60 (47.2%) of 127 patients presented with postoperative callus. Multivariate logistic regression analysis with postoperative callus as the dependent variable revealed that the stem depth at 1 month after total hip arthroplasty (odds ratio, 1.14; 95% confidence interval, 1.04-1.24, p = 0.002) was a significant and independent risk factor of postoperative callus. CONCLUSION Deep insertion of a short tapered-wedge stem is a risk factor for postoperative callus.
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Affiliation(s)
- Seiya Ishii
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan.
- Department of Orthopaedic Surgery, Yokohama Tsurugamine Hospital, Kanagawa, Japan.
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuichi Shirogane
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Koju Hayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Osamu Muto
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
- Department of Orthopaedic Surgery, Yokohama Tsurugamine Hospital, Kanagawa, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Reijmer JFH, van Susante JLC, Kruijt MC, van Gorp MJ, de Jong LD. Usability of a novel Hounsfield units measurement procedure to quantify intercorporal bone graft remodeling in patients after posterior lumbar interbody fusion: a case series. J Med Case Rep 2024; 18:337. [PMID: 39044212 PMCID: PMC11267840 DOI: 10.1186/s13256-024-04655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/11/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND There is a lack of knowledge about the biological process of intercorporal bone graft remodeling after posterior lumbar interbody fusion surgery and whether this process is associated with changes in back pain and intercorporal fusion status. As an alternative to the commonly used but unreliable fusion criteria, Hounsfield units can be used to quantify biological activity and changes in bone mineral content. However, studies assessing Hounsfield units conducted to date do not provide sufficient details about how the bone grafts were segmented to measure the Hounsfield units to allow for replication, and did not assess individual patient trends in graft changes over time. Using the data of nine patients after posterior lumbar interbody fusion, a novel Hounsfield units measurement procedure was developed and used to explore its usability to quantify the bone graft remodeling process. CASE DETAILS We report a case series of nine patients (six male, three female, mean age 64 years, all Caucasian) who all had computed tomography scans performed at 1 and 2 years after posterior lumbar interbody fusion surgery. Overall, seven out of the nine (78%) cases had a 3-41% increase in their bone grafts' Hounsfield units between 1 and 2 years after surgery. The cases showed large interindividual variability in their Hounsfield units values over time, which coincided with varying levels of back pain and intercorporal fusion status. CONCLUSION The Hounsfield units measurement procedure used for this case series may be useful to quantify intercorporal bone graft remodeling in patients after posterior lumbar interbody fusion, and may be used as an adjunct diagnostic measure to monitor bone graft remodeling over time. Future research is warranted to explore how to interpret bone graft Hounsfield units-values and Hounsfield units trajectories in light of clinical variables or intercorporal fusion status.
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Affiliation(s)
- Joey F H Reijmer
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands.
| | - Job L C van Susante
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Moyo C Kruijt
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten J van Gorp
- Department of Radiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Lex D de Jong
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
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Sanchez-Garcia E, Cruz-Jentoft AJ, Ravasco P, Suominen M, Pitkälä PK. Nutritional care in older adults: are we doing everything? An expert opinion review. Curr Med Res Opin 2024:1-22. [PMID: 39044672 DOI: 10.1080/03007995.2024.2380007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
Malnutrition is a prevalent, yet often underdiagnosed and undertreated, condition in older adults. It is characterized by weight loss and/or reduced muscle mass due to diminished caloric intake, inflammation, and/or disease burden. In return, malnutrition can lead to diminished skeletal muscle functionality and disability, among others. Malnutrition plays a crucial role in the pathogenesis of two prevalent geriatric syndromes, namely sarcopenia and frailty. The complex interplay between malnutrition, sarcopenia, and frailty significantly impacts the older population, leading to increased morbidity, mortality, hospitalization rates, quality of life, and healthcare costs. Given the prognostic significance of malnutrition in geriatric care, recent guidelines emphasized the role of nutritional support in vulnerable populations. A group of vulnerable populations to malnutrition, sarcopenia, and frailty are older patients with hip fractures, cancer patients, and those with sarcopenic dysphagia. This article highlights the importance of individualized nutritional assessment and treatment in the management of vulnerable populations such as older patients with hip fractures, cancer, and those suffering from sarcopenic dysphagia. It presents practical protocols and guidelines that can be instrumental in enhancing the nutritional care of these groups, thereby improving their overall health outcomes.
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Affiliation(s)
- Elisabet Sanchez-Garcia
- Consultant in Geriatric Medicine, Mater Private Network, Cork, T12 K199, Ireland
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Paula Ravasco
- Universidade Católica Portuguesa, Faculty of Medicine and Centre for Interdisciplinary Research in Health; Centre for Interdisciplinary Research Egas Moniz (CiiEM), Lisbon, Portugal
| | - Merja Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Prof Kaisu Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
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Bogner B, Wenning M, Jungmann PM, Reisert M, Lange T, Tennstedt M, Klein L, Diallo TD, Bamberg F, Schmal H, Jung M. T1ρ relaxation mapping in osteochondral lesions of the talus: a non-invasive biomarker for altered biomechanical properties of hyaline cartilage? Eur Radiol Exp 2024; 8:83. [PMID: 39046607 DOI: 10.1186/s41747-024-00488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/16/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND To evaluate T1ρ relaxation mapping in patients with symptomatic talar osteochondral lesions (OLT) and healthy controls (HC) at rest, with axial loading and traction. METHODS Participants underwent 3-T ankle magnetic resonance imaging at rest and with 500 N loading and 120 N traction, without axial traction for a subcohort of 17/29 HC. We used a fast low-angle shot sequence with variable spin-lock intervals for monoexponential T1ρ fitting. Cartilage was manually segmented to extract T1ρ values. RESULTS We studied 29 OLT patients (age 31.7 ± 7.5 years, 15 females, body mass index [BMI] 25.0 ± 3.4 kg/m2) and 29 HC (age 25.2 ± 4.3 years, 17 females, BMI 22.5 ± 2.3 kg/m2. T1ρ values of OLT (50.4 ± 3.4 ms) were higher than those of intact cartilage regions of OLT patients (47.2 ± 3.4 ms; p = 0.003) and matched HC cartilage (48.1 ± 3.3 ms; p = 0.030). Axial loading and traction induced significant T1ρ changes in the intact cartilage regions of patients (loading, mean difference -1.1 ms; traction, mean difference 1.4 ms; p = 0.030 for both) and matched HC cartilage (-2.2 ms, p = 0.003; 2.3 ms, p = 0.030; respectively), but not in the OLT itself (-1.3 ms; p = 0.150; +1.9 ms; p = 0.150; respectively). CONCLUSION Increased T1ρ values may serve as a biomarker of cartilage degeneration in OLT. The absence of load- and traction-induced T1ρ changes in OLT compared to intact cartilage suggests that T1ρ may reflect altered biomechanical properties of hyaline cartilage. TRIAL REGISTRATION DRKS, DRKS00024010. Registered 11 January 2021, https://drks.de/search/de/trial/DRKS00024010 . RELEVANCE STATEMENT T1ρ mapping has the potential to evaluate compositional and biomechanical properties of the talar cartilage and may improve therapeutic decision-making in patients with osteochondral lesions. KEY POINTS T1ρ values in osteochondral lesions increased compared to intact cartilage. Significant load- and traction-induced T1ρ changes were observed in visually intact regions and in healthy controls but not in osteochondral lesions. T1ρ may serve as an imaging biomarker for biomechanical properties of cartilage.
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Affiliation(s)
- Balázs Bogner
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Markus Wenning
- Department of Orthopedics, BDH Klinik Waldkirch, 79283, Waldkirch, Germany
- Praxis Drescher-Eberbach-Wenning, Orthopedic Surgeons, 79100, Freiburg, Germany
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Marco Reisert
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, University Medical Center Freiburg, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Thomas Lange
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Marcel Tennstedt
- Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Lukas Klein
- Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
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Coletti C, Naaktgeboren R, Tourais J, Van De Steeg-Henzen C, Weingärtner S. Generalized inhomogeneity-resilient relaxation along a fictitious field (girRAFF) for improved robustness in rotating frame relaxometry at 3T. Magn Reson Med 2024. [PMID: 39046914 DOI: 10.1002/mrm.30219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 06/07/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To optimize Relaxation along a Fictitious Field (RAFF) pulses for rotating frame relaxometry with improved robustness in the presence ofB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ field inhomogeneities. METHODS The resilience of RAFF pulses againstB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities was studied using Bloch simulations. A parameterized extension of the RAFF formulation was introduced and used to derive a generalized inhomogeneity-resilient RAFF (girRAFF) pulse. RAFF and girRAFF preparation efficiency, defined as the ratio of the longitudinal magnetization before and after the preparation (M z ( T p ) / M 0 $$ {M}_z\left({T}_p\right)/{M}_0 $$ ), were simulated and validated in phantom experiments.T RAFF $$ {T}_{\mathrm{RAFF}} $$ andT girRAFF $$ {T}_{\mathrm{girRAFF}} $$ parametric maps were acquired at 3T in phantom, the calf muscle, and the knee cartilage of healthy subjects. The relaxation time maps were analyzed for resilience against artificially induced field inhomogeneities and assessed in terms of in vivo reproducibility. RESULTS Optimized girRAFF preparations yielded improved preparation efficiency (0.95/0.91 simulations/phantom) with respect to RAFF (0.36/0.67 simulations/phantom).T girRAFF $$ {T}_{\mathrm{girRAFF}} $$ preparations showed in phantom/calf 6.0/4.8 times higher resilience toB 0 $$ {\mathrm{B}}_0 $$ inhomogeneities than RAFF, and a 4.7/5.3 improved resilience toB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities. In the knee cartilage,T girRAFF $$ {T}_{\mathrm{girRAFF}} $$ (53± $$ \pm $$ 14 ms) was higher thanT RAFF $$ {T}_{\mathrm{RAFF}} $$ (42± $$ \pm $$ 11 ms). Moreover, girRAFF preparations yielded 7.6/4.9 times improved reproducibility acrossB 0 $$ {\mathrm{B}}_0 $$ /B 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneity conditions, 1.9 times better reproducibility across subjects and 1.2 times across slices compared with RAFF. Dixon-based fat suppression led to a further 15-fold improvement in the robustness of girRAFF to inhomogeneities. CONCLUSIONS RAFF pulses display residual sensitivity to off-resonance and pronounced sensitivity toB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities. Optimized girRAFF pulses provide increased robustness and may be an appealing alternative for applications where resilience against field inhomogeneities is required.
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Affiliation(s)
- Chiara Coletti
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Roeland Naaktgeboren
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Joao Tourais
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | | | - Sebastian Weingärtner
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
- HollandPTC, Delft, The Netherlands
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Shamsnia HS, Peyrovinasab A, Amirlou D, Sirouskabiri S, Rostamian F, Basiri N, Shalmani LM, Hashemi M, Hushmandi K, Abdolghaffari AH. BDNF-TrkB Signaling Pathway in Spinal Cord Injury: Insights and Implications. Mol Neurobiol 2024:10.1007/s12035-024-04381-4. [PMID: 39046702 DOI: 10.1007/s12035-024-04381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/18/2024] [Indexed: 07/25/2024]
Abstract
Spinal cord injury (SCI) is a neurodegenerative disorder that has critical impact on patient's life expectance and life span, and this disorder also leads to negative socioeconomic features. SCI is defined as a firm collision to the spinal cord which leads to the fracture and the dislocation of vertebrae. The current available treatment is surgery. However, it cannot fully treat SCI, and many consequences remain after the surgery. Accordingly, finding new therapeutics is critical. BDNF-TrkB signaling is a vital signaling in neuronal differentiation, survival, overgrowth, synaptic plasticity, etc. Hence, many studies evaluate its impact on various neurodegenerative disorders. There are several studies evaluating this signaling in SCI, and they show promising outcomes. It was shown that various exercises, chemical interventions, etc. had significant positive impact on SCI by affecting BDNF-TrkB signaling pathway. This study aims to accumulate and evaluate these data and inspect whether this signaling is effective or not.
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Affiliation(s)
- Hedieh Sadat Shamsnia
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, No. 99, Yakhchal, Gholhak, Shariati St, P. O. Box: 19419-33111, Tehran, Iran
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Amirreza Peyrovinasab
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, No. 99, Yakhchal, Gholhak, Shariati St, P. O. Box: 19419-33111, Tehran, Iran
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Dorsa Amirlou
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, No. 99, Yakhchal, Gholhak, Shariati St, P. O. Box: 19419-33111, Tehran, Iran
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Shirin Sirouskabiri
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, No. 99, Yakhchal, Gholhak, Shariati St, P. O. Box: 19419-33111, Tehran, Iran
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Fatemeh Rostamian
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, No. 99, Yakhchal, Gholhak, Shariati St, P. O. Box: 19419-33111, Tehran, Iran
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nasim Basiri
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, No. 99, Yakhchal, Gholhak, Shariati St, P. O. Box: 19419-33111, Tehran, Iran
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Leila Mohaghegh Shalmani
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, No. 99, Yakhchal, Gholhak, Shariati St, P. O. Box: 19419-33111, Tehran, Iran.
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Mehrdad Hashemi
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
- Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | | | - Amir Hossein Abdolghaffari
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, No. 99, Yakhchal, Gholhak, Shariati St, P. O. Box: 19419-33111, Tehran, Iran.
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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Zhang YN, Xiao P, Zhang BF. The association between preoperative serum cholinesterase and all-cause mortality in geriatric patients with hip fractures: a cohort study of 2387 patients. Perioper Med (Lond) 2024; 13:82. [PMID: 39049017 DOI: 10.1186/s13741-024-00443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE This study is to evaluate the association between preoperative cholinesterase levels and all-cause mortality in geriatric hip fractures. METHODS Elderly patients with hip fractures were screened between Jan 2015 and Sep 2019. Demographic and clinical characteristics of patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between preoperative cholinesterase levels and mortality in these patients. Analyses were performed using EmpowerStats and the R software. RESULTS Two thousand three hundred eighty-seven patients were included in this study. The mean follow-up period was 37.64 months. Seven hundred eighty-seven (33.0%) patients died due to all-cause mortality. Preoperative cholinesterase levels were 5910 ± 1700 U/L. Linear multivariate Cox regression models showed that preoperative cholinesterase level was associated with mortality (HR = 0.83, 95% CI: 0.78-0.88), P < 0.0001) for every 1000 U/L. However, the linear association was unstable, and nonlinearity was identified. A cholinesterase concentration of 5940 U/L was an inflection point. When preoperative cholinesterase level < 5940 U/L, the mortality decreased by 28% for every 1000 U/L increase in cholinesterase (HR = 0.72, 95%CI: 0.66-0.79, P < 0.0001). When cholinesterase was > 5940 U/L, the mortality was no longer decreased with the rise of cholinesterase (HR = 1.01, 95%CI: 0.91-1.11, P = 0.9157). We found the nonlinear association was very stable in the propensity score-matching sensitive analysis. CONCLUSIONS Preoperative cholinesterase levels were nonlinearly associated with mortality in elderly hip fractures, and cholinesterase was a risk indicator of all-cause mortality. TRIAL REGISTRATION This study is registered on the website of the Chinese Clinical Trial Registry (ChiCTR: ChiCTR2200057323) (08/03/2022).
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Affiliation(s)
- Yan-Ning Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, Shaanxi Province, 710054, China
| | - Peng Xiao
- Department of Orthopedics (International Ward), Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, Shaanxi Province, 710054, China.
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49
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Park H, Son H, Kim JH, Kim S, Kim YR, Lee CH, Chung CK, Kim CH. Single-position oblique lumbar interbody fusion with navigation: improved efficiency and screw accuracy compared to dual-position with fluoroscopy. Sci Rep 2024; 14:16907. [PMID: 39043758 PMCID: PMC11266416 DOI: 10.1038/s41598-024-67007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/08/2024] [Indexed: 07/25/2024] Open
Abstract
Dual-position oblique lumbar interbody fusion with fluoroscopy (D-OLIF) requires repositioning the patient to a prone position for pedicle screw insertion. Recently, single-position surgery with navigation has been introduced. However, there are concerns regarding pedicle screw accuracy and achieving appropriate sagittal balance in single-position OLIF with navigation (S-OLIF). The purpose of this study is to evaluate the clinical and radiological outcomes of S-OLIF compared to D-OLIF. A retrospective analysis was conducted on 102 patients who underwent single-level OLIF at a single institution. The patients were divided into two groups: 55 in the S-OLIF group and 47 in the D-OLIF group. The numeric rating scale for back and leg, Oswestry disability index, and walking distance improvements showed no significant difference. However, the EuroQol 5-dimension 5-level index showed higher improvement in the S-OLIF (P = 0.029). The segmental lordosis, lumbar lordosis, and C7 sagittal vertical axis showed no significant difference. S-OLIF had significantly fewer cases of pedicle screw malposition (P = 0.045). Additionally, the surgery time was shorter in the S-OLIF (P = 0.002). In conclusion, S-OLIF exhibited clinical and radiological outcomes comparable to D-OLIF, with the added advantages of reduced surgery time and enhanced accuracy in pedicle screw placement.
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Affiliation(s)
- Hangeul Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hui Son
- College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sum Kim
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young-Rak Kim
- Department of Neurosurgery, Armed Forces Yangju Hospital, Yangju, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chun Kee Chung
- Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea.
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50
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Mohammadivahedi F, Sadeghifar A, Farsinejad A, Jambarsang S, Mirhosseini H. Comparative efficacy of platelet-rich plasma (PRP) injection versus PRP combined with vitamin C injection for partial-thickness rotator cuff tears: a randomized controlled trial. J Orthop Surg Res 2024; 19:426. [PMID: 39044241 PMCID: PMC11267806 DOI: 10.1186/s13018-024-04917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/13/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The optimal approach for managing partial-thickness rotator cuff tears (PTRCT) remains controversial. Recent studies related to PTRCTs have shown that platelet-rich plasma (PRP) injection might be an effective treatment option. Despite the role of vitamin C in collagen synthesis and its antioxidant properties, the effects of combined PRP and vitamin C treatment on rotator cuff repair are not well understood. This study investigated the effect of combined treatment of PRP and vitamin C treatment on PTRCTs. METHODS One hundred-ten patients with PTRCTs were randomly allocated to two groups and underwent subacromial injections of either (A) normal saline and platelet-rich plasma or (B) vitamin C and platelet-rich plasma. The Constant score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale were used to evaluate the outcomes before, 1 month after, and 3 months after injection. RESULTS At the 3-month follow-up, no statistically significant differences were observed between the two groups in terms of ASES and Constant scores. Although a slight difference favoring group B was noted in functional scores and pain reduction, this difference was not statistically significant. However, both groups demonstrated significant pain reduction over time (p-value < 0.001). Additionally, the enhancement of ASES and Constant scores in both groups was statistically significant (p-value < 0.001). CONCLUSIONS In conclusion, both PRP injection alone and PRP combined with vitamin C led to significant reductions in pain and enhancements in function scores over time (p < 0.001), suggesting the effectiveness of PRP as a non-surgical treatment for PTRCTs within 3 months. While PRP alone showed significant benefits, further research is required to ascertain if the combination therapy offers statistically significant advantages over PRP alone. TRIAL REGISTRATION Clinical trial registration code: IRCT20230821059205N1.
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Affiliation(s)
- Fatemeh Mohammadivahedi
- Master Science Student of Surgical Technology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amirreza Sadeghifar
- Department of Orthopedics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Farsinejad
- Stem Cells and Regenerative Medicine Innovation Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Jambarsang
- Departments of Biostatistics and Epidemiology, School of Public Health, Center for Healthcare Data Modeling, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamid Mirhosseini
- Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Department of Operating Room and Anesthesiology, School of Allied Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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