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Shah JK, Abwini LZ, Tang A, Yang JI, Keller DM, Menken LG, Liporace FA, Yoon RS. Comparative outcomes after treatment of peri-implant, periprosthetic, and interprosthetic femur fractures: which factors increase mortality risk? OTA Int 2024; 7:e322. [PMID: 38425489 PMCID: PMC10904097 DOI: 10.1097/oi9.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/01/2023] [Accepted: 12/23/2023] [Indexed: 03/02/2024]
Abstract
Objectives To compare mortality rates between patients treated surgically for periprosthetic fractures (PPF) after total hip arthroplasty (THA), total knee arthroplasty (TKA), peri-implant (PI), and interprosthetic (IP) fractures while identifying risk factors associated with mortality following PPF. Design Retrospective. Setting Single, Level II Trauma Center. Patients/Participants A retrospective review was conducted of 129 consecutive patients treated surgically for fractures around a pre-existing prosthesis or implant from 2013 to 2020. Patients were separated into 4 comparison groups: THA, TKA, PI, and IP fractures. Intervention Revision implant or arthroplasty, open reduction and internal fixation (ORIF), intramedullary nailing (IMN), percutaneous screws, or a combination of techniques. Main Outcome Measurements Primary outcome measures include mortality rates of different types of PPF, PI, and IP fractures at 1-month, 3-month, 6-month, 1-year, and 2-year postoperative. We analyzed risk factors associated with mortality aimed to determine whether treatment type affects mortality. Results One hundred twenty-nine patients were included for final analysis. Average follow-up was similar between all groups. The overall 1-year mortality rate was 1 month (5%), 3 months (12%), 6 months (13%), 1 year (15%), and 2 years (22%). There were no differences in mortality rates between each group at 30 days, 90 days, 6 months, 1 year, and 2 years (P-value = 0.86). A Kaplan-Meier survival curve demonstrated no difference in survivorship up to 2 years. Older than 65 years, history of hypothyroidism and dementia, and discharge to a skilled nursing facility (SNF) led to increased mortality. There was no survival benefit in treating patients with PPFs with either revision, ORIF, IMN, or a combination of techniques. Conclusion The overall mortality rates observed were 1 month (5%), 3 months (12%), 6 months (13%), 1 year (15%), and 2 years (22%), and no differences were found between each group at all follow-up time points. Patients aged 65 and older with a history of hypothyroidism and/or dementia discharged to an SNF are at increased risk for mortality. From a mortality perspective, surgeons should not hesitate to choose the surgical treatment they feel most comfortable performing. Level of Evidence Level III.
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Affiliation(s)
- Jay K. Shah
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Laith Z. Abwini
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Alex Tang
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Jason I. Yang
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - David M. Keller
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Luke G. Menken
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Richard S. Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
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Jung KY, Uprety LP, Jang YJ, Yang JI. Pro-inflammatory mediators and signaling proteins in the decidua of pre-eclampsia. Eur Rev Med Pharmacol Sci 2021; 24:12016-12024. [PMID: 33336719 DOI: 10.26355/eurrev_202012_23990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the role of CD68+ macrophages and inflammatory/signaling proteins in the decidua of singleton pregnancies with late-onset pre-eclampsia. PATIENTS AND METHODS This study was designed as a prospective case-control study. Decidual tissue samples were obtained from twenty healthy pregnant women as a control group and twenty pregnant women with late-onset pre-eclampsia showing severe symptoms as the study group. We examined the abundance of CD68+ macrophages in both groups using flow cytometry. Protein and mRNA expression levels of inflammatory/signaling proteins, including inducible nitric oxide synthase, nuclear factor-κB inhibitor α, cyclooxygenase-2, and phosphorylated c-Jun N-terminal kinase, in the decidua of both groups were measured using Western blotting and Reverse Transcription-Polymerase Chain Reaction, respectively. Student's t-tests were performed for statistical analysis. RESULTS The numbers of CD68+ macrophages were similar in the study and control groups (p=0.47). However, the levels of inducible nitric oxide synthase, nuclear factor-κB, cyclooxygenase-2, and phosphorylated c-Jun N-terminal kinase were significantly increased in the study group. Therefore, pro-inflammatory mediators and signaling proteins in the decidua during pre-eclampsia may be related to the pathogenesis of pre-eclampsia. CONCLUSIONS Pre-eclampsia-induced alterations in the expression of inflammatory/signaling proteins in the decidua during singleton pregnancies may play a critical role in the pathogenesis of pre-eclampsia.
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Affiliation(s)
- K-Y Jung
- Department of Microbiology, Ajou University School of Medicine, Suwon, Korea.
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Concepcion D, Washkowitz AJ, DeSantis A, Ogea P, Yang JI, Douglas NC, Papaioannou VE. Cell lineage of timed cohorts of Tbx6-expressing cells in wild-type and Tbx6 mutant embryos. Biol Open 2017; 6:1065-1073. [PMID: 28606934 PMCID: PMC5550921 DOI: 10.1242/bio.026203] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Tbx6 is a T-box transcription factor with multiple roles in embryonic development as evidenced by dramatic effects on mesoderm cell fate determination, left/right axis determination, and somite segmentation in mutant mice. The expression of Tbx6 is restricted to the primitive streak and presomitic mesoderm, but some of the phenotypic features of mutants are not easily explained by this expression pattern. We have used genetically-inducible fate mapping to trace the fate of Tbx6-expressing cells in wild-type and mutant embryos to explain some of the puzzling features of the mutant phenotype. We created an inducible Tbx6-creERT2 transgenic mouse in which cre expression closely recapitulates endogenous Tbx6 expression both temporally and spatially. Using a lacZ-based Cre reporter and timed tamoxifen injections, we followed temporally overlapping cohorts of cells that had expressed Tbx6 and found contributions to virtually all mesodermally-derived embryonic structures as well as the extraembryonic allantois. Contribution to the endothelium of major blood vessels may account for the embryonic death of homozygous mutant embryos. In mutant embryos, Tbx6-creERT2-traced cells contributed to the abnormally segmented anterior somites and formed the characteristic ectopic neural tubes. Retention of cells in the mutant tail bud indicates a deficiency in migratory behavior of the mutant cells and the presence of Tbx6-creERT2-traced cells in the notochord, a node derivative provides a possible explanation for the heterotaxia seen in mutant embryos. Summary: Embryonic cells that transiently express the transcription factor, Tbx6, during the process of gastrulation have been tracked in later development in wild-type and Tbx6 homozygous mutant embryos, where they give rise to the ectopic neural tubes characteristic of the mutant phenotype.
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Affiliation(s)
- Daniel Concepcion
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Andrew J Washkowitz
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Akiko DeSantis
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Phillip Ogea
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Jason I Yang
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Nataki C Douglas
- Department of Obstetrics and Gynecology, Divisions of Reproductive Sciences and Reproductive Endocrinology and Infertility, Columbia University Medical Center, New York, NY 10032, USA
| | - Virginia E Papaioannou
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
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Byun HJ, Lee HJ, Yang JI, Kim KH, Park KO, Park SM, Lee KE, Choi J, Noh DY, Cho KH. Daily skin care habits and the risk of skin eruptions and symptoms in cancer patients. Ann Oncol 2012; 23:1992-1998. [PMID: 22700992 DOI: 10.1093/annonc/mds141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Cancer patients are at high risk for skin problems because rapidly proliferating skin cells are susceptible to anticancer therapies. However, the effects of daily skin care habits on development of skin problems in cancer patients have rarely been studied. PATIENTS AND METHODS We conducted a survey of daily skin care habits and the presence of skin problems in 866 cancer patients. RESULTS Hot water bath>1 h significantly increased the risk of definite eruptions [odds ratio (OR) 4.09] and the risk of itching or pain on the skin (OR 1.73). Diligent use of moisturizers did not decrease the risk of definite eruptions and symptoms, and daily bathing, scrubbing off the skin while bathing, and sun protection did not influence the risk of definite eruptions and symptoms. Subgroup analysis of 183 breast cancer patients showed results similar to the total results, including that hot water bath>1 h significantly increased the risk of definite eruptions (OR 3.41). CONCLUSIONS Being a cross-sectional study, our study could not prove causality. However, at the present stage of knowledge, avoidance of hot water baths of protracted duration should be first emphasized in patient education to prevent skin problems in cancer patients.
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Affiliation(s)
- H J Byun
- Skin Cancer/Chemotherapy Skin Care Center, Seoul National University Cancer Hospital, Seoul; Department of Dermatology, Seoul, National University College of Medicine, Seoul; Institute of Dermatological Science, Medical Research Center, Seoul National University, Seoul
| | - H J Lee
- Gastric Cancer Center, Seoul National University Cancer Hospital, Seoul; Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul.
| | - J I Yang
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Gangnam Healthcare Center, Seoul
| | - K H Kim
- Skin Cancer/Chemotherapy Skin Care Center, Seoul National University Cancer Hospital, Seoul; Department of Dermatology, Seoul, National University College of Medicine, Seoul; Institute of Dermatological Science, Medical Research Center, Seoul National University, Seoul
| | - K O Park
- Center for Cancer Education and Information, Seoul National University Cancer Hospital and Department of Nursing, Seoul National University Hospital, Seoul
| | - S M Park
- Center for Cancer Education and Information, Seoul National University Cancer Hospital and Department of Nursing, Seoul National University Hospital, Seoul; Department of Family Medicine, Seoul National University College of Medicine, Seoul
| | - K E Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul; Thyroid Cancer Center, Seoul National University Cancer Hospital, Seoul
| | - J Choi
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul
| | - D-Y Noh
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul; Breast Cancer Center, Seoul National University Cancer Hospital, Seoul, South Korea
| | - K H Cho
- Skin Cancer/Chemotherapy Skin Care Center, Seoul National University Cancer Hospital, Seoul; Department of Dermatology, Seoul, National University College of Medicine, Seoul; Institute of Dermatological Science, Medical Research Center, Seoul National University, Seoul.
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Yang JI, Kim HY, Kim HS, Ryu HS. Diagnosis in the first trimester of placenta accreta with previous Cesarean section. Ultrasound Obstet Gynecol 2009; 34:116-118. [PMID: 19521956 DOI: 10.1002/uog.6407] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The prenatal diagnosis of adherent placenta is clinically very important, as this condition can seriously affect perinatal mortality and morbidity. The outcome is generally worse in cases with a history of Cesarean section. Here we report a case of placenta increta associated with previous Cesarean delivery, diagnosed by sonography during the first trimester, enabling earlier counseling of the parents and planning of appropriate treatment.
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Affiliation(s)
- J I Yang
- Department of Obstetrics & Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
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Affiliation(s)
- J I Yang
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Gangnam Healthcare Center, Seoul, Republic of Korea
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Yang JI, Lim YK, Kim HS, Chang KH, Lee JP, Ryu HS. Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior Cesarean section. Ultrasound Obstet Gynecol 2006; 28:178-82. [PMID: 16858740 DOI: 10.1002/uog.2797] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To investigate the value of transvaginal sonographic findings of intraplacental lacunae for predicting adherent placenta and clinical outcome in patients with placenta previa totalis and a history of Cesarean section. METHODS Fifty-one patients with placenta previa totalis diagnosed by transvaginal sonography and with a history of Cesarean section who delivered at our hospital were included in the study. The sonographic findings of intraplacental lacunae were classified into one of four grades. Pathological analysis of the placenta was performed for all patients who delivered, and in cases of hysterectomy, examination of the uterus was also performed. The placental findings and obstetric complications, including massive transfusion, intensive care unit admission and Cesarean hysterectomy, were compared with the grade of lacuna. RESULTS Lacunae were classified as Grade 1+ in 10 cases, Grade 2+ in 11 cases, Grade 3+ in five cases and as Grade 0 (i.e. lacunae were absent) in the remaining 25 cases. When lacunae of > or = Grade 1+ were considered, the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing adherent placenta were 86.9%, 78.6%, 76.9% and 88.0%, respectively. When lacunae of > or = Grade 2+ were considered, the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing placenta increta or percreta were 100%, 97.2%, 93.8% and 100%, respectively. Hysterectomy was performed in 18 cases, among whom two cases showed Grade 1+ lacunae, 11 cases showed Grade 2+ lacunae, and five cases showed Grade 3+ lacunae. No hysterectomy was performed in any case in which lacunae were absent. Compared to those without lacunae, the number of massive transfusions and intensive care unit admissions and cases of disseminated intravascular coagulopathy and Cesarean hysterectomy were significantly greater in those with lacunae (P < 0.0001). CONCLUSION Transvaginal sonographic findings of intraplacental lacunae in patients with placenta previa totalis and a history of Cesarean section are useful in the prediction of adherent placenta and may have a role in the prediction of clinical outcome.
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Affiliation(s)
- J I Yang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
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Abstract
OBJECTIVE To evaluate clinical outcomes of pregnancies with one elevated glucose tolerance test. METHODS We performed a 50 g glucose challenge test (GCT) in 5,019 pregnant women at 24-28 weeks of gestation. In 1,170 women with plasma glucose levels over 130 mg/dl, a 100 g oral glucose tolerance test (OGTT) was performed at 28-32 weeks of gestation. During follow-up, 282 patients were lost and in the 888 cases that were followed-up, 189 were excluded because of GDM. Therefore 699 study patients were divided into four groups: No Elevated group (NE, N = 577) with all four normal 100 g OGTT values, and Groups 1 (N = 16), 2 (N = 35), and 3 (N = 71) with one elevated 100 g OGTT value after 1, 2 and 3 h, respectively. RESULTS Poor maternal outcomes (NE group, Group 1, Group 2, Group 3: 17.5%, 37.6%, 22.9%, 25.3%) with pre-eclampsia, cesarean delivery for cephalopelvic disproportion, failure to progress, or fetal distress, was highest in Group 1 (odds ratio 2.94; 95% confidence interval 1.02-8.42). Poor perinatal outcomes (15.8%, 43.1%, 14.3%, 21.1%) with any one of the following; fetal distress, Apgar score of < 7 at 5 min, hypoglycemia, respiratory distress syndrome, small for gestational age and perinatal death, was also highest in Group 1 (odds ratio 4.24; 95% confidence interval 1.02-17.52). CONCLUSION Pregnancies with one elevated glucose tolerance test value after 1 h exhibited increased adverse maternal and perinatal outcomes compared with the group with all normal OGTT values or the groups with an elevated glucose tolerance test value after 2 or 3 h.
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Affiliation(s)
- H S Kim
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, South Korea
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