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Bienvenu AL, Leray V, Guichon C, Bourget S, Chapuis C, Duréault A, Pavese P, Roux S, Kahale E, Chaabane W, Subtil F, Maucort-Boulch D, Talbot F, Dode X, Ghesquières H, Leboucher G. ANTIFON-CLIC®, a new clinical decision support system for the treatment of invasive aspergillosis: is it clinically relevant? Ann Pharm Fr 2024; 82:514-521. [PMID: 38000506 DOI: 10.1016/j.pharma.2023.11.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Invasive aspergillosis (IA) is increasing especially in new groups of patients. Despite advances in management, morbidity and mortality related to IA remain high. Thus, Clinical Decision Support System (CDSS) dedicated to IA are needed to promote the optimal antifungal for each group of patients. PATIENTS AND METHODS This was a retrospective multicenter cohort study involving intensive care units and medical units. Adult patients who received caspofungin, isavuconazole, itraconazole, liposomal amphotericin B, posaconazole, or voriconazole, for the treatment of IA were eligible for enrollment. The primary objective was the concordance between the clinician's prescription and the prescription recommended by the CDSS. The secondary objective was the concordance according to different hospitals, departments, and indications. RESULTS Eighty-eight patients (n=88) from three medical hospitals were included. The overall concordance was 97% (85/88) including 100% (41/41) for center A, 92% (23/25) for center B, and 95% (21/22) for center C. There was no significant difference in concordance among the hospitals (P=0.973), the departments (P=1.000), and the indications (P=0.799). The concordance was 70% (7/10) for isavuconazole due to its use as an empirical treatment and 100% (78/78) for the other antifungals. DISCUSSION The concordance rate was high whatever the hospital, the department, and the indication. The only discrepancy was attributed to the use of isavuconazole as an empirical treatment which is a therapeutic option not included in the CDSS. CONCLUSIONS This new CDSS dedicated to IA is meeting the clinical practice. Its implementation in routine will help to support antifungal stewardship.
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Affiliation(s)
- A-L Bienvenu
- Service pharmacie, groupement hospitalier nord, hospices civils de Lyon, Lyon, France; Univ Lyon, Malaria Research Unit, SMITh, ICBMS UMR 5246, Lyon, France.
| | - V Leray
- Service d'anesthésie-réanimation, groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - C Guichon
- Service d'anesthésie-réanimation, groupement hospitalier nord, Hospices civils de Lyon, Lyon, France
| | - S Bourget
- Service pharmacie, CH de Valence, Valence, France
| | - C Chapuis
- Service de pharmacie, CHU de Grenoble, Grenoble-Alpes, France
| | - A Duréault
- Service des maladies infectieuses, centre hospitalier de Valence, Valence, France
| | - P Pavese
- Service des maladies infectieuses, CHU de Grenoble, Grenoble-Alpes, France
| | - S Roux
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, Lyon, France
| | - E Kahale
- Direction de l'innovation, hospices civils de Lyon, Lyon, France
| | - W Chaabane
- Direction des services numériques, hospices civils de Lyon, Lyon, France
| | - F Subtil
- Service de biostatistique-bioinformatique, hospices civils de Lyon, Lyon, France
| | - D Maucort-Boulch
- Service de biostatistique-bioinformatique, hospices civils de Lyon, Lyon, France
| | - F Talbot
- Direction des services numériques, hospices civils de Lyon, Lyon, France
| | - X Dode
- Service pharmacie, groupement hospitalier est, hospices civils de Lyon, Lyon, France
| | - H Ghesquières
- Service d'hématologie, groupement hospitalier sud, hospices civils de Lyon, Lyon, France
| | - G Leboucher
- Service pharmacie, groupement hospitalier nord, hospices civils de Lyon, Lyon, France
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Wang Z, Chen H, Chen Q, Zhu Y, Li M, Zhou J, Shi L. Outcomes of 2-SSRS plus bevacizumab therapy strategy for brainstem metastases (BSM) over 2 cm 3: a multi-center study. Neurosurg Rev 2024; 47:137. [PMID: 38564039 DOI: 10.1007/s10143-024-02369-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/17/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Despite 2-staged stereotactic radiosurgery (2-SSRS) has been reported to provide patients with improved survival and limited toxicity, 2-SSRS for brainstem metastases (BSM) larger than 2 cm3 remains challenging. We tried to find out the effectiveness and safety of 2-SSRS plus bevacizumab therapy for BSMs over 2 cm3 and prognostic factors that related to the tumor local control. Patients that received 2-SSRS plus bevacizumab therapy from four gamma knife center were retrospectively studied from Jan 2014 to December 2023. Patients' domestic characteristics and the tumor features were evaluated before and after the treatment. Cox regression model was used to find out prognostic factors for tumor local control. 53 patients with 63 lesions received the therapy. The median peri-tumor edema volume greatly reduced at the end of therapy (P < 0.01), the median tumor volume dramatically reduced (P < 0.01) and patients' KPS score improved significantly (P < 0.05) 3 months after the therapy. Patients' median OS was 12.8 months. The tumor local control rate at 3, 6, and 12 months was 98.4%, 93.4%, and 85.2%. The incidence side effects were mainly oral and nasal hemorrhage (5.7%, 3/53), and radiation necrosis (13.2%, 7/53). Patients with primary lung adenocarcinoma, therapeutic dose over 12 Gy at second-stage SRS, primary peri-tumor edema volume less than 2.3 cm³, primary tumor volume less than 3.7 cm³ would enjoy longer tumor local control. These results suggested that 2-SSRS plus bevacizumab therapy was effective and safe for BSMs over 2 cm3. However, it is important for patients with BSM to receive early diagnosis and treatment to achieve good tumor local control.
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Affiliation(s)
- Zheng Wang
- Cancer center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Haining Chen
- Gamma Knife Treatment Center, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, China
| | - Qun Chen
- Gamma Knife Treatment Center, Jiangsu province hospital, The First affiliated Hospital of Nanjing Medical University, Nanjing, 210001, China
| | - Yucun Zhu
- Gamma Knife Treatment Center, Ming ji Hospital, Affiliated to Nanjing Medical University, Nanjing, 210001, China
| | - Min Li
- Cancer center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Jia Zhou
- Cancer center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Lingfei Shi
- Geriatric Medicine Center, Department of Geriatric medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China.
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Bosco P, Lancione M, Retico A, Nigri A, Aquino D, Baglio F, Carne I, Ferraro S, Giulietti G, Napolitano A, Palesi F, Pavone L, Savini G, Tagliavini F, Bruzzone MG, Gandini Wheeler-Kingshott CAM, Tosetti M, Biagi L. Quality assessment, variability and reproducibility of anatomical measurements derived from T1-weighted brain imaging: The RIN-Neuroimaging Network case study. Phys Med 2023; 110:102577. [PMID: 37126963 DOI: 10.1016/j.ejmp.2023.102577] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/01/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023] Open
Abstract
Initiatives for the collection of harmonized MRI datasets are growing continuously, opening questions on the reliability of results obtained in multi-site contexts. Here we present the assessment of the brain anatomical variability of MRI-derived measurements obtained from T1-weighted images, acquired according to the Standard Operating Procedures, promoted by the RIN-Neuroimaging Network. A multicentric dataset composed of 77 brain T1w acquisitions of young healthy volunteers (mean age = 29.7 ± 5.0 years), collected in 15 sites with MRI scanners of three different vendors, was considered. Parallelly, a dataset of 7 "traveling" subjects, each undergoing three acquisitions with scanners from different vendors, was also used. Intra-site, intra-vendor, and inter-site variabilities were evaluated in terms of the percentage standard deviation of volumetric and cortical thickness measures. Image quality metrics such as contrast-to-noise and signal-to-noise ratio in gray and white matter were also assessed for all sites and vendors. The results showed a measured global variability that ranges from 11% to 19% for subcortical volumes and from 3% to 10% for cortical thicknesses. Univariate distributions of the normalized volumes of subcortical regions, as well as the distributions of the thickness of cortical parcels appeared to be significantly different among sites in 8 subcortical (out of 17) and 21 cortical (out of 68) regions of i nterest in the multicentric study. The Bland-Altman analysis on "traveling" brain measurements did not detect systematic scanner biases even though a multivariate classification approach was able to classify the scanner vendor from brain measures with an accuracy of 0.60 ± 0.14 (chance level 0.33).
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Affiliation(s)
- Paolo Bosco
- Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Marta Lancione
- Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Alessandra Retico
- Pisa Division, INFN - National Institute for Nuclear Physics, Pisa, Italy
| | - Anna Nigri
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Domenico Aquino
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Irene Carne
- Neuroradiology Unit, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Stefania Ferraro
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; MOE Key Laboratory for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Giovanni Giulietti
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; SAIMLAL Department, Sapienza University of Rome, Rome, Italy
| | - Antonio Napolitano
- Medical Physics, IRCCS Istituto Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Fulvia Palesi
- Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Giovanni Savini
- Neuroradiology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Fabrizio Tagliavini
- Scientific Direction, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudia A M Gandini Wheeler-Kingshott
- Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; NMR Research Unit, Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square, Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Michela Tosetti
- Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Laura Biagi
- Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris Foundation, Pisa, Italy
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Delvecchio A, Inchingolo R, Laforgia R, Ratti F, Gelli M, Anelli MF, Laurent A, Vitali G, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, di Benedetto F, de'Angelis N, Briceño J, Rampoldi A, Adam R, Cherqui D, Aldrighetti LA, Memeo R. Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients. World J Gastrointest Surg 2021; 13:1696-1707. [PMID: 35070074 PMCID: PMC8727180 DOI: 10.4240/wjgs.v13.i12.1696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/30/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma. The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients.
AIM To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments.
METHODS A retrospective multicentric study was performed enrolling 77 patients age ≥ 70-years-old with single hepatocellular carcinoma (≤ 30 mm), located in posterosuperior segments (4a, 7, 8). Patients were divided into liver resection and radiofrequency ablation groups and preoperative, peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching.
RESULTS After propensity score matching, twenty-six patients were included in each group. Operative time and overall postoperative complications were higher in the resection group compared to the ablation group (165 min vs 20 min, P < 0.01; 54% vs 19% P = 0.02 respectively). A median hospital stay was significantly longer in the resection group than in the ablation group (7.5 d vs 3 d, P < 0.01). Ninety-day mortality was comparable between the two groups. There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1, 3, and 5 years.
CONCLUSION Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay, better quality of life and does not modify the overall and disease-free survival.
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Affiliation(s)
- Antonella Delvecchio
- Unit of General Surgery, "A. Perrino" Hospital, Ceglie Messapica 70124, Bari, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 75100, Italy
| | - Rita Laforgia
- Unit of Laparoscopic Surgery, University of Bari, Bary 70124, Italy
| | - Francesca Ratti
- Unit of Hepato-Pancreatic-Biliary Surgery, University Vita Salute San Raffaele, Milan 20132, Italy
| | - Maximiliano Gelli
- Department of Surgical Oncology, Gustave Roussy Cancer Campus Grand Paris, Villejuif 94800, France
| | | | - Alexis Laurent
- Department of Digestive and Hepatobiliary Surgery, Henry Mondor University Hospital, Creteil 94000, France
| | - Giulio Vitali
- Division of Transplantation, Geneva University Hospital, Geneva 44041, Switzerland
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 42121, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 42121, Italy
| | - Emanuele Felli
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg 67000, France
| | - Taiga Wakabayashi
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg 67000, France
| | - Patrick Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg 67000, France
| | - Tullio Piardi
- Department of Digestive and Hepatobiliary Surgery, Robert Debrè University Hospital, Reims 51100, France
| | - Fabrizio di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 42121, Italy
| | - Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
| | - Javier Briceño
- Department of General Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Antonio Rampoldi
- Interventional Radiology Unit, Niguarda Hospital, Milan 20162, Italy
| | - Renè Adam
- Department of Hepatobiliary Surgery, Paul Brousse University Hospital, Villejuif 94800, France
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Paul Brousse University Hospital, Villejuif 94800, France
| | | | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
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Mohammed R, Shah P, Durst A, Mathai NJ, Budu A, Woodfield J, Marjoram T, Sewell M. Restoration of elective spine surgery during the first wave of COVID-19 : a UK-wide British Association of Spine Surgeons (BASS) prospective, multicentre, observational study. Bone Jt Open 2021; 2:1096-1101. [PMID: 34939428 PMCID: PMC8711666 DOI: 10.1302/2633-1462.212.bjo-2021-0116.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aims With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective spinal surgery during the pandemic. Methods A prospective observational study was conducted from eight spinal centres for the first month of operating following restoration of elective spine surgery in each individual unit. Primary outcome measure was the 30-day postoperative COVID-19 infection rate. Secondary outcomes analyzed were the 30-day mortality rate, surgical adverse events, medical complications, and length of inpatient stay. Results In all, 257 patients (128 males) with a median age of 54 years (2 to 88) formed the study cohort. The mean number of procedures performed from each unit was 32 (16 to 101), with 118 procedures (46%) done as category three prioritization level. The majority of patients (87%) were low-medium “risk stratification” category and the mean length of hospital stay was 5.2 days. None of the patients were diagnosed with COVID-19 infection, nor was there any mortality related to COVID-19 during the 30-day follow-up period, with 25 patients (10%) having been tested for symptoms. Overall, 32 patients (12%) developed a total of 34 complications, with the majority (19/34) being grade 1 to 2 Clavien-Dindo classification of surgical complications. No patient required postoperative care in an intensive care setting for any unexpected complication. Conclusion This study shows that safe and effective planned spinal surgical services can be restored avoiding viral transmission, with diligent adherence to national guidelines and COVID-19-secure pathways tailored according to the resources of the individual spinal units. Cite this article: Bone Jt Open 2021;2(12):1096–1101.
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Affiliation(s)
| | - Pranav Shah
- University Hospital of Wales, UK.,Noah's Ark Children's Hospital for Wales, UK
| | | | | | | | - Julie Woodfield
- Centre for Clinical Brain Sciences Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Tom Marjoram
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Matthew Sewell
- The Royal Orthopaedic Hospital and Birmingham Children's Hospital, Birmingham, UK
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Rajamani PA, Goparaju P, Kulkarni AG, Bhojraj SY, Rajasekaran S, Chhabra HS, Acharya S, Rajamani A, Nene A, Shetty AP, Dey PC, Bhanot A, Lokhande PV, Patel P. A 2-Year Outcomes and Complications of Various Techniques of Lumbar Discectomy: A Multicentric Retrospective Study. World Neurosurg 2021; 156:e319-28. [PMID: 34555576 DOI: 10.1016/j.wneu.2021.09.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Various techniques of performing lumbar discectomy are prevalent, each having its rationale and claimed benefits. The authors ventured to assess the perioperative factors, outcomes, and complications of each procedure and compare among them with 946 patients contributed by 10 centers and operated by experienced surgeons. METHODS This was a retrospective study of patients operated using open discectomy, microdiscectomy, microendoscopic discectomy, interlaminar endoscopic lumbar discectomy, transforaminal endoscopic lumbar discectomy, and Destandau techniques with a follow-up of minimum 2 years. The inclusion criteria were age >18 years, failed conservative treatment for 4-6 weeks, and the involvement of a single lumbar level. RESULTS There was a significant improvement in the visual analog scale score of back, leg, and Oswestry Disability Index scores postoperatively across the board, with no significant difference between them. Minimally invasive procedures (microendoscopic discectomy, interlaminar endoscopic lumbar discectomy, transforaminal endoscopic lumbar discectomy, and Destandau techniques) had shorter operation time, hospital stay, better cosmesis, and decreased blood loss compared with open procedures (open discectomy and microdiscectomy). The overall complication rate was 10.1%. The most common complication was recurrence (6.86%), followed by reoperation (4.3%), cerebrospinal fluid leak (2.24%), wrong level surgery (0.74%), superficial infection (0.62%), and deep infection (0.37%). There were minor differences in incidence of complications between techniques. CONCLUSION Although minimally invasive techniques have some advantages over the open techniques in the perioperative factors, all the techniques are effective and provide similar pain relief and functional outcomes at the end of 2 years. The various rates of individual complications provide a reference value for future studies.
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Salášek M, Havránek P, Havlas V, Pavelka T, Pešl T, Stančák A, Hendrych J, Džupa V. Paediatric pelvic injuries: a retrospective epidemiological study from four level 1 trauma centers. Int Orthop 2021; 45:2033-48. [PMID: 34218296 DOI: 10.1007/s00264-021-05105-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/31/2021] [Indexed: 10/20/2022]
Abstract
AIM OF THE STUDY Epidemiologic evaluation of pelvic ring injuries in children. METHODS Retrospective analysis over a period of 13 years, excluding pathological fractures. AO/OTA type, epidemiological data, type of treatment, and complications were recorded. Data were assessed using Fisher's exact test and Wilcoxon test. RESULTS 243 boys, 115 girls, mean age (SD) 14.1 ± 3.0 years, AO/OTA types: 281 A, 52 B, 25 C. Multiple trauma: 62, combined trauma: 59, mono-trauma: 237. 281 patients were treated non-operatively, 97 surgically. ETIOLOGY traffic accidents 88, falls from a great height 37, crushing injuries four, and sports injuries 192, simple falls 30, others seven. High-energy mechanisms prevailed in types B and C. Low-energy mechanism in type A (p < 0.0001). Similar differences were found between type A (p = 0.0009) and in case type C requiring surgery and cases treated non-operatively (p < 0.0001). Twenty-six patients (7.3%) had complications (pelvic asymmetry 5, neurological deficits 5, non-union 1, ectopic calcification 4, others 7). Higher complication rates were associated with types B and C (p = 0.0015), with surgically treated cases (p < 0.0001) and multiple trauma (p = 0.0305). DISCUSSION Results of this trial were comparable with other studies. CONCLUSION Sports injuries accounted for most type A injuries, while types B and C tended to be associated with high-energy trauma. Complications were associated with the severity of pelvic trauma, more common in surgically treated group of patients; this is primarily linked to the surgical cases being more serious as well as the associated injuries.
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Benozzi G, Cortina ME, Gimeno E, Vantesone DL, Solas AE, Lorda GM, Facal S, Leiro J, Orman B. A multicentric study of pharmacological treatment for presbyopia. Graefes Arch Clin Exp Ophthalmol 2021; 259:2441-2450. [PMID: 33704563 DOI: 10.1007/s00417-021-05138-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the safety, efficacy, and patient satisfaction with a pharmacological treatment of presbyopia performed with the Benozzi's method. METHODS A non-randomized multicentric case-series retrospective study was developed. Were included patients from 5 centers of Argentina, from January 2010 to June 2019, aged at baseline between 40 and 60 years old, with binocular uncorrected distance visual acuity (UDVA) of 25/20 or better, and with uncorrected near visual acuity (UNVA) at least Jaeger (J) 2 or worse. The treatment was performed with a patented formulation (pilocarpine and diclofenac preservative-free eye drops). The main outcome was binocular UNVA and UDVA. Differences were evaluated by paired t-test. The presence of side effects and patient's satisfaction were also evaluated. Data was analyzed in separated groups according to their follow-up time, from 2 to 10 years. RESULTS A total of 148 patients were included. At baseline, the UNVA for the different groups were between J3 and J8 which was improved to J1 to J2. The mean baseline UDVA has been ranged between 0.02 and 0.04 logMAR. The mean baseline UDVA has been ranged between 0.02 to 0.04 logMAR, after treatment were between 0.01 to 0.03, without a statisticallysignificant improvement. Side effects were spontaneously resolved, and subjective evaluation shows that patients were satisfied. CONCLUSIONS This first multicentric shows that Benozzi's method for presbyopia treatment was safety and improves the UNVA without affecting the UDVA, maintaining their efficacy even after 10 years, in a population aged between 40 and 60 years old, from different ophthalmic centers in Argentina.
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Affiliation(s)
- Giovanna Benozzi
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina.,Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Farmacología, Buenos Aires, Argentina
| | | | | | | | | | | | - Sonia Facal
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
| | - Juliana Leiro
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
| | - Betina Orman
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Farmacología, Buenos Aires, Argentina. .,Pharmacology Unit, School of Dentistry, Universidad de Buenos Aires, M. T. de Alvear 2142 - 4to. Piso "B", 1122AAH, Buenos Aires, Argentina.
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9
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Ferraro L, Murray RM, Di Forti M, Quattrone D, Tripoli G, Sideli L, La Barbera D, La Cascia C. IQ differences between patients with first episode psychosis in London and Palermo reflect differences in patterns of cannabis use. Schizophr Res 2019; 210:81-88. [PMID: 31272907 DOI: 10.1016/j.schres.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/20/2019] [Accepted: 06/10/2019] [Indexed: 11/15/2022]
Abstract
AIMS Cognitive impairment is a possible indicator of neurodevelopmental impairment, but not all psychotic patients are cognitively compromised. It has been suggested that heavy cannabis use may precipitate psychosis in those who show no such compromise. This study compares two samples of patients with first-episode psychosis and their respective non-psychotic controls, in London (UK) and Palermo (Italy), and examines whether different patterns of cannabis use are reflected in differences in IQ. METHODS The two studies used the same inclusion/exclusion criteria and instruments. The sample comprised 249 subjects from London (106 patients and 143 controls) and 247 subjects from Palermo (120 patients and 127 controls). ANCOVA was performed with IQ as the dependent variable and city and frequency of cannabis use as predictors. This was then repeated with the case group only, by adjusting for relevant confounders. RESULTS We found a greater amount of cannabis use in the London sample, compared to Palermo and patients from London had higher IQ than patients from Palermo, a difference that was more significant than that reflected between controls (Fgroup*city(1, 402) = 7.6, p = 0.006). Once corrected for symptomatology and treatment, patients from London who had never used cannabis were similar to patients from Palermo regarding IQ. Thus the higher IQ of patients from London was mainly due to the subgroup of cannabis-using patients (Fcannabis*city(2,145) = 4.6, p = 0.011). CONCLUSIONS We can speculate that a greater amount of cannabis-use may have contributed by precipitating psychosis in patients with a higher IQ in London but less so in patients from Palermo.
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Affiliation(s)
- Laura Ferraro
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy; Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Robin M Murray
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy; Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK; South London and Maudsley NHS Mental Health Foundation Trust, UK.
| | - Marta Di Forti
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy; South London and Maudsley NHS Mental Health Foundation Trust, UK; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, UK.
| | - Diego Quattrone
- South London and Maudsley NHS Mental Health Foundation Trust, UK; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, UK.
| | - Giada Tripoli
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy; Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Lucia Sideli
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy; Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy.
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy.
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10
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Goulème N, Debue M, Spruyt K, Vanderveken C, De Siati RD, Ortega-Solis J, Petrossi J, Wiener-Vacher S, Bucci MP, Ionescu E, Thai-Van H, Deggouj N. Changes of spatial and temporal characteristics of dynamic postural control in children with typical neurodevelopment with age: Results of a multicenter pediatric study. Int J Pediatr Otorhinolaryngol 2018; 113:272-280. [PMID: 30174000 DOI: 10.1016/j.ijporl.2018.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/26/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this multicenter study is to investigate the effect of chronological age and gender in postural control. METHODS To approach an ecological model, we used a multicenter posturography assessment. We analyzed postural control with surface, mean velocity of center of pressure [CoP] and temporal analysis, with Postural Instability Index [PII] being a more sensitive parameter in postural evaluation. A large sample of 156 age- and gender-matched healthy children recruited in several pediatrics hospitals, participated. RESULTS Our current results showed a significant decrease of all postural parameters (surface, mean velocity of CoP and PII) with age, and only on stable support condition. Our study additionally described a gender effect in conditions where all sensory inputs are most challenged with a mean velocity of CoP being significantly smaller in girls with respect to boys. CONCLUSION We concluded that postural control improves with age linked with maturation process. Moreover, this maturation process seems not yet achieved at 16.08 years and still ongoing beyond. Interestingly, our result reported specificities linked with gender effect. Indeed, girls and boys do not proceed in the same way to maintain their postural control. We could make hypothesis that more children maintain their postural control efficiently; with a low energy cost, the more they could allocate attention to learning during childhood.
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Affiliation(s)
- Nathalie Goulème
- Department of Audiology and Otoneurological Evaluation, Civil Hospitals of Lyon, 5 place d'Arsonval, 69003, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard University Lyon 1, France.
| | - Michel Debue
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Karen Spruyt
- Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard University Lyon 1, France
| | - Catherine Vanderveken
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Romolo Daniele De Siati
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - José Ortega-Solis
- Department of Audiology and Otoneurological Evaluation, Civil Hospitals of Lyon, 5 place d'Arsonval, 69003, Lyon, France
| | - Jennifer Petrossi
- Department of Audiology and Otoneurological Evaluation, Civil Hospitals of Lyon, 5 place d'Arsonval, 69003, Lyon, France
| | - Sylvette Wiener-Vacher
- Vestibular and Oculomotor Evaluation Unit, ORL Dept, Robert Debré Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Maria Pia Bucci
- UMR 1141 INSERM, Paris Diderot University, Robert Debré Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Eugen Ionescu
- Department of Audiology and Otoneurological Evaluation, Civil Hospitals of Lyon, 5 place d'Arsonval, 69003, Lyon, France
| | - Hung Thai-Van
- Department of Audiology and Otoneurological Evaluation, Civil Hospitals of Lyon, 5 place d'Arsonval, 69003, Lyon, France; Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Claude Bernard University Lyon 1, France
| | - Naïma Deggouj
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
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11
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Bertoli M, Cereatti A, Trojaniello D, Avanzino L, Pelosin E, Del Din S, Rochester L, Ginis P, Bekkers EMJ, Mirelman A, Hausdorff JM, Della Croce U. Estimation of spatio-temporal parameters of gait from magneto-inertial measurement units: multicenter validation among Parkinson, mildly cognitively impaired and healthy older adults. Biomed Eng Online 2018; 17:58. [PMID: 29739456 PMCID: PMC5941594 DOI: 10.1186/s12938-018-0488-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 12/12/2017] [Accepted: 04/23/2018] [Indexed: 11/11/2022] Open
Abstract
Background The use of miniaturized magneto-inertial measurement units (MIMUs) allows for an objective evaluation of gait and a quantitative assessment of clinical outcomes. Spatial and temporal parameters are generally recognized as key metrics for characterizing gait. Although several methods for their estimate have been proposed, a thorough error analysis across different pathologies, multiple clinical centers and on large sample size is still missing. The aim of this study was to apply a previously presented method for the estimate of spatio-temporal parameters, named Trusted Events and Acceleration Direct and Reverse Integration along the direction of Progression (TEADRIP), on a large cohort (236 patients) including Parkinson, mildly cognitively impaired and healthy older adults collected in four clinical centers. Data were collected during straight-line gait, at normal and fast walking speed, by attaching two MIMUs just above the ankles. The parameters stride, step, stance and swing durations, as well as stride length and gait velocity, were estimated for each gait cycle. The TEADRIP performance was validated against data from an instrumented mat. Results Limits of agreements computed between the TEADRIP estimates and the reference values from the instrumented mat were − 27 to 27 ms for Stride Time, − 68 to 44 ms for Stance Time, − 31 to 31 ms for Step Time and − 67 to 52 mm for Stride Length. For each clinical center, the mean absolute errors averaged across subjects for the estimation of temporal parameters ranged between 1 and 4%, being on average less than 3% (< 30 ms). Stride length mean absolute errors were on average 2% (≈ 25 mm). Error comparisons across centers did not show any significant difference. Significant error differences were found exclusively for stride and step durations between healthy elderly and Parkinsonian subjects, and for the stride length between walking speeds. Conclusions The TEADRIP method was effectively validated on a large number of healthy and pathological subjects recorded in four different clinical centers. Results showed that the spatio-temporal parameters estimation errors were consistent with those previously found on smaller population samples in a single center. The combination of robustness and range of applicability suggests the use of the TEADRIP as a suitable MIMU-based method for gait spatio-temporal parameter estimate in the routine clinical use. The present paper was awarded the “SIAMOC Best Methodological Paper 2017”.
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Affiliation(s)
- Matilde Bertoli
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Andrea Cereatti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy.,Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | | | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Silvia Del Din
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle, UK
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle, UK.,Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Pieter Ginis
- Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, KU Leuven, Louvain, Belgium
| | - Esther M J Bekkers
- Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, KU Leuven, Louvain, Belgium.,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Parkinson Centre Nijmegen, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anat Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Tel Aviv, Israel
| | - Ugo Della Croce
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy. .,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy.
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12
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Sánchez LJ, Piccoli M, Ferrari CG, Cocozza E, Cesari M, Maida P, Iuppa A, Pavone G, Bencini L. Laparoscopic ventral hernia repair: Results of a two thousand patients prospective multicentric database. Int J Surg 2018; 51:31-8. [PMID: 29367031 DOI: 10.1016/j.ijsu.2018.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 12/31/2022]
Abstract
Laparoscopic incisional and ventral hernia repair (LIVHR) has been largely employed by the surgical community worldwide, despite the use of different types of mesh and fixation devices. A large nationwide prospective multicentric database collected 2005 operations from 8 high-volume centers, to investigate the perioeperative and long-term outcomes. The laparoscopic operations were completed in 1979 patients (98.7%), with a mean age of 60.7 years and a Body Mass Index of 28.8 kg/m2. Two hundred and one patient (18.8%) had a previous failed open repair. The average surface areas of the major defects were 47.4 and 18.2 cm 2 for postincisional and primary hernias. The mean operation time and postoperative stay were 94.4 min and s 3.7 days, respectively. We collected a total of 50 (2.5%) intraoperative and 414 (20.6%) postoperative complications, with reoperation needed in 38 cases (1.8%). After a mean follow-up period of 24 months, we recorded 62 (3.8%) confirmed recurrences. Length of surgery, hospital stay, and a previous recurrence were all risk factors for recurrence. Primary hernias had better perioperative outcomes compared to incisional hernias, except for the pain. The laparoscopic approach of both post-incisional and primary hernias seemed to be safe and feasible in short-to medium-term periods.
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13
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Taddei F, Falcinelli C, Balistreri L, Henys P, Baruffaldi F, Sigurdsson S, Gudnason V, Harris TB, Dietzel R, Armbrecht G, Boutroy S, Schileo E. Left-right differences in the proximal femur's strength of post-menopausal women: a multicentric finite element study. Osteoporos Int 2016; 27:1519-1528. [PMID: 26576543 PMCID: PMC5908234 DOI: 10.1007/s00198-015-3404-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/04/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED The strength of both femurs was estimated in 198 post-menopausal women through subject-specific finite element models. Important random differences between contralateral femurs were found in a significant number of subjects, pointing to the usefulness of further studies to understand if strength-based classification of patients at risk of fracture can be affected by laterality issues. INTRODUCTION Significant, although small, differences exist in mineral density and anatomy of contralateral proximal femurs. These differences, and their combined effect, may result in a side difference in femurs' strength. However, this has never been tested on a large sample of a homogenous population. METHODS The strength of both femurs was estimated in 198 post-menopausal women through CT-derived finite element models, built using a validated procedure, in sideways fall conditions. The impact of the resulting asymmetry on the classification of subjects at risk of fracture was analysed. RESULTS The small difference observed between sides (the right femur on average 4 % stronger than the left) was statistically significant but mechanically negligible. In contrast, higher random differences (absolute difference between sides with respect to mean value) were found: on average close to 15 % (compared to 9.2 % for areal bone mineral density (aBMD) alone), with high scatter among the subjects. When using a threshold-based classification, the right and left femurs were discordant up to over 20 % of cases (K always lower than 0.60) but the left femur was concordant (mean K = 0.84) with the minimum strength between right and left. CONCLUSION Considering both femurs may be important when trying to classify subjects at risk of failure with strength estimates. Future studies including fracture assessment would be necessary to quantify the real impact.
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Affiliation(s)
- F Taddei
- Laboratorio di Bioingegneria Computazionale, Istituto Ortopedico Rizzoli, Bologna, Italy.
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136, Bologna, Italy.
| | - C Falcinelli
- Laboratorio di Bioingegneria Computazionale, Istituto Ortopedico Rizzoli, Bologna, Italy
- Università di Roma Tor Vergata, Rome, Italy
| | - L Balistreri
- Laboratorio di Bioingegneria Computazionale, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - P Henys
- Laboratorio di Bioingegneria Computazionale, Istituto Ortopedico Rizzoli, Bologna, Italy
- Technical University of Liberec, Liberec, Czech Republic
| | - F Baruffaldi
- Laboratorio di Bioingegneria Computazionale, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - V Gudnason
- Icelandic Heart Association, Kópavogur, Iceland
- University of Iceland, Reykjavík, Iceland
| | - T B Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - R Dietzel
- Centre for Muscle and Bone Research, Charité-Universitätsmedizin, Berlin, Germany
| | - G Armbrecht
- Centre for Muscle and Bone Research, Charité-Universitätsmedizin, Berlin, Germany
| | - S Boutroy
- INSERM Research Unit 1033 and Université de Lyon, Lyon, France
| | - E Schileo
- Laboratorio di Bioingegneria Computazionale, Istituto Ortopedico Rizzoli, Bologna, Italy
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14
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Pesi B, Ferrero A, Grazi GL, Cescon M, Russolillo N, Leo F, Boni L, Pinna AD, Capussotti L, Batignani G. Liver resection with thrombectomy as a treatment of hepatocellular carcinoma with major vascular invasion: results from a retrospective multicentric study. Am J Surg 2015; 210:35-44. [PMID: 25935229 DOI: 10.1016/j.amjsurg.2014.09.041] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/09/2014] [Accepted: 09/15/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of liver resection (LR) of hepatocellular carcinoma with macroscopic vascular thrombosis (MVT) remains controversial. The aim of this study is to evaluate whether the presence of MVT should still be considered a contraindication for LR. METHODS Retrospective study was carried out on 62 patients who underwent LR and thrombectomy for hepatocellular carcinoma complicated by MVT. Of the 62 patients, 15 (36.5%) had tumor thrombus (TT) in the peripheral portal vein (Vp1), 5 (12.2%) in second branch (Vp2), and 21 (51.3%) in the first branch/portal vein trunk (Vp3), while on the hepatic/cava vein side, 8 (12.9%) had TT in the main trunk of the hepatic veins (Vv2) and 3 (4.8%) had TT reaching the vena cava/right atrium (Vv3). RESULTS Perioperative major morbidity was 14.5%, while in-hospital mortality was 4.8%. Overall, 1, 3, and 5-year survival rates were 53.3%, 30.1%, and 20%, and disease-free survival rates were 31.7%, 20.8%, and 15.6%, respectively. There were no differences in survival about the MVT localized in Vp1, Vp2, or Vp3 (P = .77), while we found a statistical trend between patients with Vv2 and Vv3 (P = .06). CONCLUSION Surgical resection seems to be justified in these patients, and the presence of MVT should no longer be considered an absolute contraindication for LR.
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Affiliation(s)
- Benedetta Pesi
- Gastrointestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Alessandro Ferrero
- Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Turin, Italy
| | - Gianluca L Grazi
- Liver Surgery and Transplantation Unit, Department of Emergency, Surgery and Transplants, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Cescon
- Liver Surgery and Transplantation Unit, Department of Emergency, Surgery and Transplants, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Nadia Russolillo
- Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Turin, Italy
| | - Francesca Leo
- Gastrointestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Luca Boni
- Department of Oncology/Core Research Laboratory, Careggi University Hospital, Florence, Italy
| | - Antonio D Pinna
- Liver Surgery and Transplantation Unit, Department of Emergency, Surgery and Transplants, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lorenzo Capussotti
- Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Turin, Italy
| | - Giacomo Batignani
- Gastrointestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy.
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