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1.
Jacob A. Burns Adam B. Weiner William J. Catalona Eric V. Li Edward M. Schaeffer Stephen B. Hanauer Scott Strong James Burns Maha H.A. Hussain Shilajit D. Kundu 《European urology》2019,75(5):846-852
Background
There are limited data examining the risk of prostate cancer (PCa) in patients with inflammatory bowel disease (IBD).Objective
To compare the incidence of PCa between men with and those without IBD.Design, setting, and participants
This was a retrospective, matched-cohort study involving a single academic medical center and conducted from 1996 to 2017. Male patients with IBD (cases = 1033) were randomly matched 1:9 by age and race to men without IBD (controls = 9306). All patients had undergone at least one prostate-specific antigen (PSA) screening test.Outcome measurements and statistical analysis
Kaplan-Meier and multivariable Cox proportional hazard models, stratified by age and race, evaluated the relationship between IBD and the incidence of any PCa and clinically significant PCa (Gleason grade group ≥2). A mixed-effect regression model assessed the association of IBD with PSA level.Results and limitations
PCa incidence at 10 yr was 4.4% among men with IBD and 0.65% among controls (hazard ratio [HR] 4.84 [3.34–7.02] [3.19–6.69], p < 0.001). Clinically significant PCa incidence at 10 yr was 2.4% for men with IBD and 0.42% for controls (HR 4.04 [2.52–6.48], p < 0.001). After approximately age 60, PSA values were higher among patients with IBD (fixed-effect interaction of age and patient group: p = 0.004). Results are limited by the retrospective nature of the analysis and lack of external validity.Conclusions
Men with IBD had higher rates of clinically significant PCa when compared with age- and race-matched controls.Patient summary
This study of over 10 000 men treated at a large medical center suggests that men with inflammatory bowel disease may be at a higher risk of prostate cancer than the general population. 相似文献2.
Sami Hamid Ian A. Donaldson Yipeng Hu Rachael Rodell Barbara Villarini Ester Bonmati Pamela Tranter Shonit Punwani Harbir S. Sidhu Sarah Willis Jan van der Meulen David Hawkes Neil McCartan Ingrid Potyka Norman R. Williams Chris Brew-Graves Alex Freeman Caroline M. Moore Hashim U. Ahmed 《European urology》2019,75(5):733-740
Background
Multiparametric magnetic resonance imaging (mpMRI)-targeted prostate biopsies can improve detection of clinically significant prostate cancer and decrease the overdetection of insignificant cancers. It is unknown whether visual-registration targeting is sufficient or augmentation with image-fusion software is needed.Objective
To assess concordance between the two methods.Design, setting, and participants
We conducted a blinded, within-person randomised, paired validating clinical trial. From 2014 to 2016, 141 men who had undergone a prior (positive or negative) transrectal ultrasound biopsy and had a discrete lesion on mpMRI (score 3–5) requiring targeted transperineal biopsy were enrolled at a UK academic hospital; 129 underwent both biopsy strategies and completed the study.Intervention
The order of performing biopsies using visual registration and a computer-assisted MRI/ultrasound image-fusion system (SmartTarget) on each patient was randomised. The equipment was reset between biopsy strategies to mitigate incorporation bias.Outcome measurements and statistical analysis
The proportion of clinically significant prostate cancer (primary outcome: Gleason pattern ≥3 + 4 = 7, maximum cancer core length ≥4 mm; secondary outcome: Gleason pattern ≥4 + 3 = 7, maximum cancer core length ≥6 mm) detected by each method was compared using McNemar's test of paired proportions.Results and limitations
The two strategies combined detected 93 clinically significant prostate cancers (72% of the cohort). Each strategy detected 80/93 (86%) of these cancers; each strategy identified 13 cases missed by the other. Three patients experienced adverse events related to biopsy (urinary retention, urinary tract infection, nausea, and vomiting). No difference in urinary symptoms, erectile function, or quality of life between baseline and follow-up (median 10.5 wk) was observed. The key limitations were lack of parallel-group randomisation and a limit on the number of targeted cores.Conclusions
Visual-registration and image-fusion targeting strategies combined had the highest detection rate for clinically significant cancers. Targeted prostate biopsy should be performed using both strategies together.Patient summary
We compared two prostate cancer biopsy strategies: visual registration and image fusion. A combination of the two strategies found the most clinically important cancers and should be used together whenever targeted biopsy is being performed. 相似文献3.
Julien Dagenais Riccardo Bertolo Juan Garisto Matthew J. Maurice Pascal Mouracade Onder Kara Jaya Chavali Jianbo Li Ryan Nelson Amr Fergany Robert Abouassaly Jihad H. Kaouk 《European urology》2019,75(4):628-634
Background
Understanding physician-level discrepancies is increasingly a target of US healthcare reform for the delivery of quality-focused patient care.Objective
To estimate the relative contributions of patient and surgeon characteristics to the variability in key outcomes after partial nephrectomy (PN).Design, setting, and participants
Retrospective review of 1461 patients undergoing PN performed by 19 surgeons between 2011 and 2016 at a tertiary care referral center.Intervention
PN for a renal mass.Outcomes measurements and statistical analysis
Hierarchical linear and logistic regression models were built to determine the percentage variability contributed by fixed patient and surgeon factors on peri- and postoperative outcomes. Residual between- and within-surgeon variability was calculated while adjusting for fixed factors.Results and limitations
On null hierarchical models, there was significant between-surgeon variability in operative time, estimated blood loss (EBL), ischemia time, excisional volume loss, length of stay, positive margins, Clavien complications, and 30-d readmission rate (all p < 0.001), but not chronic kidney disease upstaging (p = 0.47) or percentage preservation of glomerular filtration rate (p = 0.49). Patient factors explained 82% of the variability in excisional volume loss and 0–32% of the variability in the remainder of outcomes. Quantifiable surgeon factors explained modest amounts (10–40%) of variability in intraoperative outcomes, and noteworthy amounts of variability (90–100%) in margin rates and patient morbidity outcomes. Immeasurable surgeon factors explained the residual variability in operative time (27%), EBL (6%), and ischemia time (31%).Conclusions
There is significant between-surgeon variability in outcomes after PN, even after adjusting for patient characteristics. While renal functional outcomes are consistent across surgeons, measured and unmeasured surgeon factors account for 18–100% of variability of the remaining peri- and postoperative variables. With the increasing utilization of value-based medicine, this has important implications for the goal of optimizing patient care.Patient summary
We reviewed our institutional database on partial nephrectomy performed for renal cancer. We found significant variability between surgeons for key outcomes after the intervention, even after adjusting for patient characteristics. 相似文献4.
Jürgen E. Gschwend Matthias M. Heck Jan Lehmann Herbert Rübben Peter Albers Johannes M. Wolff Detlef Frohneberg Patrick de Geeter Axel Heidenreich Tilman Kälble Michael Stöckle Thomas Schnöller Arnulf Stenzl Markus Müller Michael Truss Stephan Roth Uwe-Bernd Liehr Joachim Leißner Margitta Retz 《European urology》2019,75(4):604-611
Background
The extent of lymph node dissection (LND) in bladder cancer (BCa) patients at the time of radical cystectomy may affect oncologic outcome.Objective
To evaluate whether extended versus limited LND prolongs recurrence-free survival (RFS).Design, setting, and participants
Prospective, multicenter, phase-III trial patients with locally resectable T1G3 or muscle-invasive urothelial BCa (T2-T4aM0).Intervention
Randomization to limited (obturator, and internal and external iliac nodes) versus extended LND (in addition, deep obturator, common iliac, presacral, paracaval, interaortocaval, and para-aortal nodes up to the inferior mesenteric artery).Outcome measurements and statistical analysis
The primary endpoint was RFS. Secondary endpoints included cancer-specific survival (CSS), overall survival (OS), and complications. The trial was designed to show 15% advantage of 5-yr RFS by extended LND.Results and limitations
In total, 401 patients were randomized from February 2006 to August 2010 (203 limited, 198 extended). The median number of dissected nodes was 19 in the limited and 31 in the extended arm. Extended LND failed to show superiority over limited LND with regard to RFS (5-yr RFS 65% vs 59%; hazard ratio [HR] = 0.84 [95% confidence interval 0.58–1.22]; p = 0.36), CSS (5-yr CSS 76% vs 65%; HR = 0.70; p = 0.10), and OS (5-yr OS 59% vs 50%; HR = 0.78; p = 0.12). Clavien grade ≥3 lymphoceles were more frequently reported in the extended LND group within 90 d after surgery. Inclusion of T1G3 tumors may have contributed to the negative study result.Conclusions
Extended LND failed to show a significant advantage over limited LND in RFS, CSS, and OS. A larger trial is required to determine whether extended compared with limited LND leads to a small, but clinically relevant, survival difference (ClinicalTrials.gov NCT01215071).Patient summary
In this study, we investigated the outcome in bladder cancer patients undergoing cystectomy based on the anatomic extent of lymph node resection. We found that extended removal of lymph nodes did not reduce the rate of tumor recurrence in the expected range. 相似文献5.
John D. Kelly Wei Shen Tan Nuria Porta Hugh Mostafid Robert Huddart Andrew Protheroe Richard Bogle Jane Blazeby Alison Palmer Jo Cresswell Mark Johnson Richard Brough Sanjeev Madaan Stephen Andrews Clare Cruickshank Stephanie Burnett Lauren Maynard Emma Hall 《European urology》2019,75(4):593-601
Background
Non–muscle-invasive bladder cancer (NMIBC) has a significant risk of recurrence despite adjuvant intravesical therapy.Objective
To determine whether celecoxib, a cyclo-oxygenase 2 inhibitor, reduces the risk of recurrence in NMIBC patients receiving standard treatment.Design, setting, and participants
BOXIT (CRUK/07/004, ISRCTN84681538) is a double-blinded, phase III, randomised controlled trial. Patients aged ≥18 yr with intermediate- or high-risk NMIBC were accrued across 51 UK centres between 1 November 2007 and 23 July 2012.Intervention
Patients were randomised (1:1) to celecoxib 200 mg twice daily or placebo for 2 yr. Patients with intermediate-risk NMIBC were recommended to receive six weekly mitomycin C instillations; high-risk NMIBC cases received six weekly bacillus Calmette-Guérin and maintenance therapy.Outcome measurements and statistical analysis
The primary endpoint was time to disease recurrence. Analysis was by intention to treat.Results and limitations
A total of 472 patients were randomised (236:236). With median follow-up of 44 mo (interquartile range: 36–57), 3-yr recurrence-free rate (95% confidence interval) was as follows: celecoxib 68% (61–74%) versus placebo 64% (57–70%; hazard ratio [HR] 0.82 [0.60–1.12], p = 0.2). There was no difference in high-risk (HR 0.77 [0.52–1.15], p = 0.2) or intermediate-risk (HR 0.90 [0.55–1.48], p = 0.7) NMIBC. Subgroup analysis suggested that time to recurrence was longer in pT1 NMIBC patients treated with celecoxib compared with those receiving placebo (HR 0.53 [0.30–0.94], interaction test p = 0.04). The 3-yr progression rates in high-risk patients were low: 10% (6.5–17%) and 9.7% (6.0–15%) in celecoxib and placebo arms, respectively. Incidence of serious cardiovascular events was higher in celecoxib (5.2%) than in placebo (1.7%) group (difference +3.4% [–0.3% to 7.2%], p = 0.07).Conclusions
BOXIT did not show that celecoxib reduces the risk of recurrence in intermediate- or high-risk NMIBC, although celecoxib was associated with delayed time to recurrence in pT1 NMIBC patients. The increased risk of cardiovascular events does not support the use of celecoxib.Patient summary
Celecoxib was not shown to reduce the risk of recurrence in intermediate- or high-risk non–muscle-invasive bladder cancer (NMIBC), although celecoxib was associated with delayed time to recurrence in pT1 NMIBC patients. The increased risk of cardiovascular events does not support the use of celecoxib. 相似文献6.
Olivier Wegelin Leonie Exterkate Marloes van der Leest Jean A. Kummer Willem Vreuls Peter C. de Bruin J.L.H.Ruud Bosch Jelle O. Barentsz Diederik M. Somford Harm H.E. van Melick 《European urology》2019,75(4):582-590
Background
Guidelines advise multiparametric magnetic resonance imaging (mpMRI) before repeat biopsy in patients with negative systematic biopsy (SB) and a suspicion of prostate cancer (PCa), enabling MRI targeted biopsy (TB). No consensus exists regarding which of the three available techniques of TB should be preferred.Objective
To compare detection rates of overall PCa and clinically significant PCa (csPCa) for the three MRI-based TB techniques.Design, setting, and participants
Multicenter randomised controlled trial, including 665 men with prior negative SB and a persistent suspicion of PCa, conducted between 2014 and 2017 in two nonacademic teaching hospitals and an academic hospital.Intervention
All patients underwent 3-T mpMRI evaluated with Prostate Imaging Reporting and Data System (PIRADS) version 2. If imaging demonstrated PIRADS ≥3 lesions, patients were randomised 1:1:1 for one TB technique: MRI-transrectal ultrasound (TRUS) fusion TB (FUS-TB), cognitive registration TRUS TB (COG-TB), or in-bore MRI TB (MRI-TB).Outcome measurements and statistical analysis
Primary (overall PCa detection) and secondary (csPCa detection [Gleason score ≥3 + 4]) outcomes were compared using Pearson chi-square test.Results and limitations
On mpMRI, 234/665 (35%) patients had PIRADS ≥3 lesions and underwent TB. There were no significant differences in the detection rates of overall PCa (FUS-TB 49%, COG-TB 44%, MRI-TB 55%, p = 0.4). PCa detection rate differences were ?5% between FUS-TB and MRI-TB (p = 0.5, 95% confidence interval [CI] ?21% to 11%), 6% between FUS-TB and COG-TB (p = 0.5, 95% CI ?10% to 21%), and ?11% between COG-TB and MRI-TB (p = 0.17, 95% CI ?26% to 5%). There were no significant differences in the detection rates of csPCa (FUS-TB 34%, COG-TB 33%, MRI-TB 33%, p > 0.9). Differences in csPCa detection rates were 2% between FUS-TB and MRI-TB (p = 0.8, 95% CI ?13% to 16%), 1% between FUS-TB and COG-TB (p > 0.9, 95% CI ?14% to 16%), and 1% between COG-TB and MRI-TB (p > 0.9, 95% CI ?14% to 16%). The main study limitation was a low rate of PIRADS ≥3 lesions on mpMRI, causing underpowering for primary outcome.Conclusions
We found no significant differences in the detection rates of (cs)PCa among the three MRI-based TB techniques.Patient summary
In this study, we compared the detection rates of (aggressive) prostate cancer among men with prior negative biopsies and a persistent suspicion of cancer using three different techniques of targeted biopsy based on magnetic resonance imaging. We found no significant differences in the detection rates of (aggressive) prostate cancer among the three techniques. 相似文献7.
Bahman SahraNavard Parke W. Hudson Cesar de Cesar Netto Bradley W. Wills Ibukunoluwa B. Araoye Shelby Bergstresser Brent M. Cone Ashish Shah 《Foot and Ankle Surgery》2019,25(1):84-89
Background
The number of screws used for sliding calcaneal osteotomy fixation has not been examined in the literature. The purpose of this paper is to examine this topic.Methods
Retrospective chart review was performed on 190 patients who met selection criteria. We compared complication risk for single versus double screw, headed versus headless screw, and short versus longitudinal incision cases.Results
The mean age was 48.4 (18–83) years and average follow up was 28 (12–150) weeks. All cases achieved radiographic union. Overall complication rate was 19.5% (37/190). Risk of complication did not differ significantly between single and double screw (RR: 1.170; 95% CI: 0.66–2.09; p = 0.594) or short and extended incision groups (RR: 0.868; 95% CI: 0.42–1.80; p = 0.704). Risk of complication differed significantly between headed and headless screw fixation (RR: 5.558; 95% CI: 2.69–11.50; p < 0.0001).Conclusions
Single screw fixation of sliding calcaneal osteotomy achieves similar outcomes as double screw fixation. Headless screws are advantageous for minimizing hardware pain and subsequent hardware removal. 相似文献8.
Andrzej Boszczyk Sławomir Kwapisz Martin Krümmel Rene Grass Stefan Rammelt 《Foot and Ankle Surgery》2019,25(1):51-58
Background
The study aims at comparing the bony anatomy of the syndesmosis in patients who sustained a high fibular fracture with syndesmosis disruption and that of the non-injured population. We hypothesised that there are certain anatomical features making the syndesmosis susceptible to injury.Methods
The CT examinations of 75 patients who sustained a high fibular fracture with syndesmosis disruption and control group of 75 patients with unrelated foot problems were compared. The depth, fibular engagement and rotational orientation of the tibial incisura were analyzed.Results
With the median values of the control group as cutoff there were 71% shallow, 71% disengaged and 77% retroverted syndesmoses in the injury group. The differences between the groups were statistically significant for every measure (P < .002 to P > .0001).Conclusions
Patients with a shallow, disengaged and retroverted bony configuration of the syndesmosis are overrepresented among patients with syndesmosis disruption. 相似文献9.
H. Ballentine Carter Brian Helfand Mufaddal Mamawala Yishuo Wu Patricia Landis Hongjie Yu Kathleen Wiley Rong Na Zhuqing Shi Jacqueline Petkewicz Sameep Shah Richard J. Fantus Kristian Novakovic Charles B. Brendler S. Lilly Zheng William B. Isaacs Jianfeng Xu 《European urology》2019,75(5):743-749
Background
Mutations in DNA repair genes are associated with aggressive prostate cancer (PCa).Objective
To assess whether germline mutations are associated with grade reclassification (GR) in patients undergoing active surveillance (AS).Design, setting, and participants
Two independent cohorts of PCa patients undergoing AS; 882 and 329 patients from Johns Hopkins and North Shore, respectively.Outcome measurements and statistical analysis
Germline DNA was sequenced for DNA repair genes, including BRCA1/2 and ATM (three-gene panel). Pathogenicity of mutations was defined according to the American College of Medical Genetics guidelines. Association of mutation carrier status and GR was evaluated by a competing risk analysis.Results and limitations
Of 1211, 289 patients experienced GR; 11 of 26 with mutations in a three-gene panel and 278 of 1185 noncarriers; adjusted hazard ratio (HR) = 1.96 (95% confidence interval [CI] = 1.004–3.84, p = 0.04). Reclassification occurred in six of 11 carriers of BRCA2 mutations and 283 of 1200 noncarriers; adjusted HR = 2.74 (95% CI = 1.26–5.96, p = 0.01). The carrier rates of pathogenic mutations in the three-gene panel, and BRCA2 alone, were significantly higher in those reclassified (3.8% and 2.1%, respectively) than in those not reclassified (1.6% and 0.5%, respectively; p = 0.04 and 0.03, respectively). Carrier rates for BRCA2 were greater for those reclassified from Gleason score (GS) 3 + 3 at diagnosis to GS ≥4 + 3 (4.1% vs 0.7%, p = 0.01) versus GS 3 + 4 (2.1% vs 0.6%; p = 0.03). Results are limited by the small number of mutation carriers and an intermediate end point.Conclusions
Mutation status of BRCA1/2 and ATM is associated with GR among men undergoing AS.Patient summary
Men on active surveillance with inherited mutations in BRCA1/2 and ATM are more likely to harbor aggressive prostate cancer. 相似文献10.
Ibukunoluwa B. Araoye Yvonne E. Chodaba Kenneth S. Smith Ryan W. Hadden Ashish B. Shah 《Foot and Ankle Surgery》2019,25(1):2-7
Background
Current literature on carbon fiber implant use in foot and ankle surgery is scant. The purpose of this paper is to report medium-term outcomes of hindfoot fusion using a carbon fiber intramedullary nail.Methods
We retrospectively reviewed 30 cases of hindfoot fusion using carbon fiber intramedullary nail fixation between 2014 and 2017. We excluded revisions and cases with bulk allograft or ankle infection prior to surgery. We reviewed charts for length of followup, radiographic union, and complications.Results
Eleven patients were included (6 females, 5 males; mean age = 52 ± 15 years; mean BMI = 29.0 ± 6.4 kg/m2). Mean followup was 20 (range, 1.5–107) months. Nine of eleven cases achieved radiographic union while one case developed a complication requiring surgery. The mean time to union was 3 (range, 1.5–6) months.Conclusions
Carbon fiber implants offer several theoretical advantages over traditional metallic implants. They can be used safely in foot and ankle surgery without concern for high failure or complication rate. Larger scale studies with longer followup are needed on this topic. 相似文献11.
Joana Arcângelo Francisco Guerra-Pinto André Pinto André Grenho Alfons Navarro Xavier Martin Oliva 《Foot and Ankle Surgery》2019,25(2):96-105
Background
Periprosthetic cystic osteolysis is a well-known complication of total ankle replacement. Several theories have been proposed for its aetiology, based on individual biomechanical, radiological, histopathology and outcome studies.Methods
Studies that met predefined inclusion/exclusion criteria were analysed to identify literature describing the presence of peri-prosthetic ankle cystic osteolysis. Quantitative data from the selected articles were combined and statistically tested in order to analyse possible relations between ankle peri-prosthetic bone cysts and specific implant characteristics.Results
Twenty-one articles were elected, totalizing 2430 total ankle replacements, where 430 developed peri-prosthetic cystic osteolysis.A statistically significant association (P < .001) was found between the presence of bone cysts and non-anatomic implant configuration, hydroxyapatite-coating, mobile-bearing and non tibial-stemmed implants. No significant association existed between the type of constraining and the presence of cysts (P > .05).Conclusions
Non-anatomic, mobile-bearing, hydroxyapatite-coated and non tibial-stemmed total ankle replacements are positively associated with more periprosthetic bone cysts. 相似文献12.
Background
A recent case series suggested that surgery with wide-awake local anesthesia is tolerated well by most foot and ankle patients. However, patients were assessed retrospectively and there was no comparison group to show the relative efficacy of this approach. The present study was conducted to address these concerns.Methods
Perioperative pain and anxiety were assessed in 40 patients receiving forefoot surgery using either wide-awake local anesthesia or general anesthesia. Ratings were collected on the day of surgery using 11-point (0–10) numerical rating scales.Results
Patients in the two anesthesia groups reported no differences in preoperative pain (p = 0.500) or anxiety (p = 0.820). Patients who received wide-awake local anesthesia reported lower levels of postoperative pain (p < 0.001) and anxiety (p < 0.001) than patients who received general anesthesia. They also reported little pain (M = 0.17, SD = 0.32) or anxiety (M = 1.33, SD = 1.74) during the operation.Conclusions
Results indicate that surgery with wide-awake local anesthesia is tolerated well by most patients, and that it may have some benefit compared to surgery with general anesthesia. 相似文献13.
Federico Giuseppe Usuelli Cristian Indino Camilla Maccario Luigi Manzi Federico Maria Liuni Ettore Vulcano 《Foot and Ankle Surgery》2019,25(1):19-23
Background
Total ankle replacement (TAR) represents an alternative to fusion for the treatment of end-stage ankle osteoarthritis. The aim of the present study was to retrospectively assess the frequency of infections between TARs with anterior and lateral transfibular approach at 12-months follow-up.Methods
81 TARs through an anterior approach and 69 TARs through a lateral approach were performed between May 2011 and July 2015. We compared surgical time and tourniquet time, as well as superficial and deep infections frequency during the first 12 postoperative months.Results
In the anterior approach group, there were 3 (3.7%) deep infections and 4 (4.9%) superficial wound infections. In the lateral approach group, there were 1 (1.4%) deep infection and 2 superficial wound infections (2.9%). There were not statistically significant differences between the groups. There was a significant difference between anterior approach (115 minutes) and lateral approach group (179 minutes) in terms of surgical time (P < 0.001).Conclusions
The frequency of superficial and deep periprosthetic infections during the first postoperative year was not significantly different in the lateral approach group compared to the anterior approach group, despite the significantly longer surgical time in the lateral transfibular approach group. 相似文献14.
Jesús Vilá-Rico Josep María Cabestany-Castellà Bernat Cabestany-Perich César Núñez-Samper Cristina Ojeda-Thies 《Foot and Ankle Surgery》2019,25(1):24-30
Background
Anatomic graft reconstruction of the anterior talo-fibular ligament is an alternative for patients who are bad candidates for standard procedures such as a Broström–Gould reconstruction (high-demand athletes, obesity, hyperlaxity or collagen disorders, capsular insufficiency or talar avulsions). The purpose of this study is to describe an all-inside arthroscopic technique for ATFL reconstruction, and the results in a series of patients with chronic ankle instability.Methods
We reviewed patients with chronic ATFL ruptures treated with an all-inside arthroscopic allograft reconstruction of the ATFL, with a minimum 2-year follow-up. Twenty-two patients with lateral ankle instability were included. Mean follow-up was 34 ± 2.5 months.Results
The mean AOFAS score improved from 62.3 ± 6.7 points preoperatively to 97.2 ± 3.2 points at final follow-up. Three patients suffered complications: one case each of ankle rigidity, superficial peroneal nerve injury and fibular fracture.Conclusions
Chronic ATFL injuries are amenable to all-inside arthroscopic allograft reconstruction fixed with tenodesis screws. This procedure simplifies other reported techniques in that it facilitates identification and bone tunnel placement of the talar ATFL insertion. 相似文献15.
Chloe Xiaoyun Chan Jonathan Zhi-Wei Gan Hwei Chi Chong Inderjeet Rikhraj Singh Sean Yung Chuan Ng Kevin Koo 《Foot and Ankle Surgery》2019,25(2):119-126
Background
We report our experience with the Minimally Invasive Chevron Akin (MICA) technique for correcting hallux valgus, and evaluate its effectiveness and associated complications.Methods
Case series of 13 feet with mild to moderate symptomatic hallux valgus treated surgically from July 2013 to December 2014, with at least 48-months follow-up. Patients were assessed pre-operatively and post-operatively with radiographical measurements (Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA)) and clinical scores (American Orthopaedic Foot and Ankle Society (AOFAS), 36-Item Short Form Health Survery (SF-36), Visual Analog Scale (VAS)).Results
Mean HVA and IMA decreased from 30.4° and 13.9°–10.9° and 10.2° respectively (p < 0.05). The mean AOFAS score improved from an average of 59.0–93.7 (p < 0.05). All patients reported a VAS score of 0 post-operatively, and the 4 SF-36 domains improved significantly (p < 0.05).Conclusions
The MICA technique is a safe and effective method in the surgical correction of mild to moderate hallux valgus deformity, and continued use is justified. 相似文献16.
Luigi Manzi Jorge Hugo Villafañe Cristian Indino Jacopo Tamini Pedro Berjano Federico Giuseppe Usuelli 《Foot and Ankle Surgery》2019,25(2):169-173
Background
The purpose of this study was to investigate the test–retest reliability of the Phi angle in patients undergoing total ankle replacement (TAR) for end stage ankle osteoarthritis (OA) to assess the rotational alignment of the talar component.Methods
Retrospective observational cross-sectional study of prospectively collected data. Post-operative anteroposterior radiographs of the foot of 170 patients who underwent TAR for the ankle OA were evaluated. Three physicians measured Phi on the 170 randomly sorted and anonymized radiographs on two occasions, one week apart (test and retest conditions), inter and intra-observer agreement were evaluated.Results
Test-retest reliability of Phi angle measurement was excellent for patients with Hintegra TAR (ICC = 0.995; p < 0.001) and Zimmer TAR (ICC = 0.995; p < 0.001) on radiographs of subjects with ankle OA. There were no significant differences in the reliability of the Phi angle measurement between patients with Hintegra vs. Zimmer implants (p > 0.05).Conclusions
Measurement of Phi angle on weight-bearing dorsoplantar radiograph showed an excellent reliability among orthopaedic surgeons in determining the position of the talar component in the axial plane.Level of evidence: Level II, cross sectional study. 相似文献17.
R.Scott Eldredge Yan Zhai Amalia Cochran 《Burns : journal of the International Society for Burn Injuries》2019,45(2):317-321
Introduction
Acute respiratory distress syndrome (ARDS) is a complication that affects approximately 40% of burn patients and is associated with high mortality rates. Extracorporeal membrane oxygenation (ECMO) therapy is a management option for severe refractory hypoxemic respiratory failure; however, there is little literature reporting the effectiveness of this therapy in burns. Our study objective was to review patient outcomes in burns following severe ARDS treated with ECMO.Methods
We retrospectively reviewed all patients treated with ECMO for ARDS who received their burn care at a single regional burn center between 9/1/2006 and 8/31/2016. Primary patient outcome examined was discharge disposition.Results
We identified 8 patients who had ARDS secondary to burn who were placed onto ECMO during this 10-year period. The average APACHE score, SOFA score, and P/F ratio were 21 ± 3, 9 ± 2, and 59 ± 8, respectively, at the time of decision for ECMO. No ECMO-related complications were identified. Out of the 8 patients reviewed, 1 died, 4 were discharged to acute rehabilitation or a long-term acute care facility, and 3 were discharged to home.Conclusion
Mortality in burn patients with ARDS who are managed with ECMO is extremely low. Careful selection and timely intervention with ECMO contributed to good clinical outcomes. 相似文献18.
Qiang Fu Le Xu Yiwei Wang Qi Jiang Zheng Liu Junyu Zhang Quan Zhou Han Zeng Shanyou Tong Tao Wang Yangyang Qi Baoying Hu Hangcheng Fu Huyang Xie Lin Zhou Yuan Chang Yu Zhu Bo Dai Jiejie Xu 《European urology》2019,75(5):752-763
Background
Glutamine addiction is a hallmark of clear cell renal cell carcinoma (ccRCC); yet whether glutamine metabolism impacts local immune surveillance is unclear. This knowledge may yield novel immunotherapeutic opportunities.Objective
To seek a potential therapeutic target in glutamine-addicted ccRCC.Design, setting, and participants
Tumors from ccRCC patients from a Shanghai cohort and ccRCC tumor data from The Cancer Genome Atlas (TCGA) cohort were analyzed. In vivo and in vitro studies were conducted with fresh human ccRCC tumors and murine tumor cells.Outcome measurements and statistical analysis
Immune cell numbers and functions were analyzed by flow cytometry. Glutamine and cytokine concentrations were determined. Survival was compared between different subpopulations of patients using Kaplan-Meier and Cox regression analyses.Results and limitations
We found that in ccRCC, high interleukin (IL)-23 expression was significantly associated with poor survival in both TCGA (overall survival [OS] hazard ratio [HR] = 2.04, cancer-specific survival [CSS] HR = 2.95; all p < 0.001) and Shanghai (OS HR = 2.07, CSS HR = 3.92; all p < 0.001) cohorts. IL-23 blockade prolongs the survival of tumor-bearing mice, promotes T-cell cytotoxicity in in vitro cultures of human ccRCC tumors, and augments the therapeutic benefits of anti-PD-1 antibodies. Mechanistically, glutamine consumption by ccRCC tumor cells results in the local deprivation of extracellular glutamine, which induces IL-23 secretion by tumor-infiltrating macrophages via the activation of hypoxia-inducible factor 1α (HIF1α). IL-23 activates regulatory T-cell proliferation and promotes IL-10 and transforming growth factor β expression, thereby suppressing tumor cell killing by cytotoxic lymphocytes. The positive correlations between glutamine metabolism, IL-23 levels, and Treg responses are confirmed in both TCGA cohort and tumors from Shanghai ccRCC patients. Study limitations include the unclear impacts of glutamine deprivation and IL-23 on other immune cells.Conclusions
Macrophage-secreted IL-23 enhanced Treg functions in glutamine-addicted tumors; thus, IL-23 is a promising target for immunotherapy in ccRCC.Patient summary
In this study, we analyzed the immune components in glutamine-addicted clear cell renal cell carcinoma (ccRCC) tumors from two patient cohorts and conducted both in vitro and in vivo studies. We found that ccRCC tumor cell-intrinsic glutamine metabolism orchestrates immune evasion via interleukin (IL)-23, and IL-23–high patients had significantly poorer survival than IL-23–low patients. IL-23 should thus be considered a therapeutic target in ccRCC, either alone or in combination with immune checkpoint inhibitors. 相似文献19.
Rodrigo Díaz Fernández 《Foot and Ankle Surgery》2019,25(2):106-112
Background
With hundreds of operative methods described for correction of hallux valgus we can state that the ideal surgical treatment is still controversial. The Bösch technique has been used as a percutaneous way of correcting hallux valgus deformities with the use of a pin fixation. The aim of this study is to evaluate a new method of fixation by using a percutaneous locking plate.Methods
Between June 2013 and January 2015, 24 consecutive percutaneous subcapital osteotomies of the first metatarsal bone were performed for the treatment of painful hallux valgus deformities in 24 patients. Additional surgical procedures included DMMO’s (Distal Metatarsal Minimally-Invasive Osteotomies) in 12 of the operated feet (44.44%); minor digits were corrected in 7 cases (25.9%). An Akin procedure was performed in 81% of cases and all cases underwent an adductor hallucis tenotomy. All patients were clinically assessed using the AOFAS score. Radiographic measures included the preoperative and postoperative values of the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), and the Distal Metatarsal Articular Angle (DMAA).Results
The mean correction achieved improved for AHV from 36.57 ± 7.1 to 12.22 ± 8.69°, for IMA from 13.8 ± 1.59 to 7.08 ± 2.72 and for DMAA from 13.98 ± 7.38 to 6.07 ± 4.99. Clinically, scores on the AOFAS scale improved from a 45.8 ± 9.6 to 91.29 ± 9.8.Although healing of the osteotomies was observed radiographically within 6 to 12 weeks, two cases (8.3%) exhibited delayed healing. There were no cases of nonunion. There were no superficial or deep infections or wound healing problems. Plate had to be removed in 3 cases (12.5%).Conclusion
This technique modification is an acceptable procedure to correct hallux valgus in patients with a moderate level of deformity.Level of evidence
Level IV. Case series. 相似文献20.
Byung-Ki Cho Ji-Kang Park Seung-Myung Choi Nelson F. SooHoo 《Foot and Ankle Surgery》2019,25(2):127-131
