Outcomes of tissue reconstruction in distal lower leg fractures

xlomafota.13 shared this article with you from Inoreader Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study Via Latest Results for BMC Musculoskeletal Disorders Abstract Background Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage. Methods We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores. Results We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after 1 year. Conclusions Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevalence and predictors of work-related musculoskeletal disorders among workers of a gold mine in south Kivu, Democratic Republic of Congo

xlomafota.13 shared this article with you from Inoreader Prevalence and predictors of work-related musculoskeletal disorders among workers of a gold mine in south Kivu, Democratic Republic of Congo Via Latest Results for BMC Musculoskeletal Disorders Abstract Background Work-related musculoskeletal disorders (WRMSDs) are a major constraint to worker performance and health. However, research on their prevalence and associated factors among workers at gold mines in the Democratic Republic of Congo (DRC) is insufficient. The present study aimed to determine the prevalence and predictors of WRMSDs among workers of a Gold Mine in South Kivu, DRC. Methods Cross sectional data on prevalence of WRMSDs and risk factors was collected using a modified Nordic questionnaire and upper limb Core QX checklist from 196 workers of a gold mine. WRMSDs were defined as pain or injury(ies) or discomfort, numbness or limitation of movement in the musculoskeletal system at any time in the past 12 months which lasted at least 24 h. These had to be either induced or aggravated by work and circumstances of its performance. A generalised linear model of the Poison family with link log and robust error variances was used to generate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the factors associated with WRMSDs. The effect of individual, ergonomic and psychosocial factors on WRMSDs were investigated while controlling for known confounders. Results Most workers were males 187 (95.4%) and their age ranged between 23 and 60 years with mean of 36.3 years. Of the 196 workers, 49 (25.0%) reported having at least one WRMSD during the previous 12 months. WRMSDs with highest occurrence rate were the lower back pain (14.8%), followed by thighs/hip pain (9.2%) and shoulder pain (8.2%). Prolonged heavy lifting/shovelling shovelling (PR = 1.69, 95% CI [1.32, 3.24] and longer work shifts (> 9 h) (PR = 3.56, 95% CI [1.76, 16.58]) were predictive for WRMSDs while jobs with low demands were protective against WRMSDs (PR = 0.18, 95% CI [0.08, 0.44]). Conclusion The prevalence of WRMSDs is high and associated with prolonged heavy lifting/shovelling, longer work shifts and job demands. We recommend lowering workload and job demands and improving work ergonomics to mitigate and prevent the WRMSDs among workers in goldmines. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Higher aggrecan 1-F21 epitope concentration in synovial fluid early after anterior cruciate ligament injury is associated with worse knee cartilage quality assessed by gadolinium enhanced magnetic resonance imaging 20 years later

xlomafota.13 shared this article with you from Inoreader Higher aggrecan 1-F21 epitope concentration in synovial fluid early after anterior cruciate ligament injury is associated with worse knee cartilage quality assessed by gadolinium enhanced magnetic resonance imaging 20 years later Via Latest Results for BMC Musculoskeletal Disorders Abstract Background To investigate if cartilage related biomarkers in synovial fluid are associated with knee cartilage status 20 years after an anterior cruciate ligament (ACL) injury. Methods We studied 25 patients with a complete ACL rupture without subsequent ACL reconstruction or radiographic knee OA. All had a delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) 20 years after the ACL injury, using the T1 transverse relaxation time in the presence of gadolinium (T1Gd) which estimates the concentration of glycosaminoglycans in hyaline cartilage. Synovial fluid samples were aspirated acutely (between 0 and 18 days) and during 1 to 5 follow up visits between 0.5 and 7.5 years after injury. We quantified synovial fluid concentrations of aggrecan (epitopes 1-F21 and ARGS), cartilage oligomeric matrix protein, matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 by immunoassays, and sulfated glycosaminoglycans by Alcian blue precipitation. Western blot was used for qualitative analyses of aggrecan fragments in synovial fluid and cartilage samples. Results Western blot indicated that the 1-F21 epitope was located within the chondroitin sulfate 2 region of aggrecan. Linear regression analyses (adjusted for age, sex, body mass index and time between injury and sampling) showed that acute higher synovial fluid 1-F21-aggrecan concentrations were associated with shorter T1Gd values 20 years after injury, i.e. inferior cartilage quality (standardized effects between − 0.67 and − 1.0). No other statistically significant association was found between molecular biomarkers and T1Gd values. Conclusion Higher acute synovial fluid 1-F21-aggrecan concentrations in ACL injured patients, who managed to cope without ACL reconstruction and were without radiographic knee OA, were associated with inferior knee cartilage quality assessed by dGEMRIC 20 years after injury. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hybrid-Therapie eines Dysphagia-lusoria-Rezidives mittels thorakalem Stentgraft und Transposition der A. subclavia

xlomafota.13 shared this article with you from Inoreader Hybrid-Therapie eines Dysphagia-lusoria-Rezidives mittels thorakalem Stentgraft und Transposition der A. subclavia Via Latest Results for Gefässchirurgie View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Besteht ein Zusammenhang zwischen der peripheren arteriellen Verschlusskrankheit und Parodontitis?

xlomafota.13 shared this article with you from Inoreader Besteht ein Zusammenhang zwischen der peripheren arteriellen Verschlusskrankheit und Parodontitis? Via Latest Results for Gefässchirurgie Zusammenfassung Die periphere arterielle Verschlusskrankheit (PAVK) ist die häufigste Durchblutungsstörung peripherer Gefäße. Die PAVK wird durch Risikofaktoren und Komorbiditäten, wie zum Beispiel Rauchen, Bluthochdruck, Dyslipidämie, Diabetes und chronische Niereninsuffizienz begünstigt. Epidemiologische Studien weisen allerdings auch darauf hin, dass zusätzlich die Parodontitis (PA) das Risiko für eine PAVK erhöhen kann. Die PA ist eine häufige, durch bakteriellen Biofilm ausgelöste, chronische Entzündung des Zahnhalteapparates. Parodontitis wird durch mangelhafte Mundhygiene, Rauchen und Diabetes begünstigt und die Prävalenz steigt mit dem Alter an. Beide Erkrankungen bzw. deren Symptome sind therapierbar, wenn die Behandlung frühzeitig einsetzt. Deshalb ist die Früherkennung besonders wichtig. Obwohl der Nachweis einer kausalen Rolle der PA für die Entstehung der PAVK noch aussteht, unterstützen die in diesem Artikel zusammengefassten Daten den Vorschla g einer interdisziplinären Zusammenarbeit zwischen Gefäß- und Zahnmedizinern. Es kann in der gefäßmedizinischen Praxis erwogen werden, PAVK-Patienten, unabhängig vom Stadium ihrer Erkrankung, zwecks Diagnose und Behandlung einer PA an Zahnärzt*innen zu verweisen. Umgekehrt sollten auch Zahnärzt*innen erwägen, Patienten, die an einer schweren Form der PA leiden, an Gefäßmediziner zu verweisen. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Infektionen in der Shuntchirurgie

xlomafota.13 shared this article with you from Inoreader Infektionen in der Shuntchirurgie Via Latest Results for Gefässchirurgie Zusammenfassung Infektionen im Bereich eines Hämodialysezugangs stellen die zweithäufigste Komplikation nach der Thrombose dar, bei Vorhofkathetern sind Infektionen gar die häufigste Komplikation. Diese Infekte bedrohen sowohl den Dialysezugang selbst als auch das Leben der Patienten, da Zugangsinfektionen die Mortalität des Patientenkollektivs dramatisch erhöhen. Neben der allgemeinen Infektdiagnostik kommt der Sonographie und der frühen Blutkulturentnahme eine besondere Bedeutung für die weitere Therapieplanung zu. Unkomplizierte Infektionen nativer Fisteln können oft ambulant mit peroraler Antibiotikagabe erfolgreich therapiert werden, Abszesse müssen chirurgisch drainiert werden. Bei perianastomotischen Infekten besteht das Hauptrisiko in einer septischen Arrosionsblutung, sodass hier eine dringliche Operationsindikation besteht. Prothetische Hämodialysezugänge können je nach Ausdehnung des Infekts als segmentale oder subtotale Graftexplantation, nach Möglichkeit mit prothetischem Ersatz über nicht vom Infekt tangierten Arealen (aseptischer Bypass) chirurgisch therapiert werden. Bei vollständigem Protheseninfekt muss das prothetische Material in toto entfernt werden. Vorhofkatheterinfekte sollten stadiengerecht behandelt werden, obligat sind hier zentrale und periphere Blutkulturentnahmen. Der unkomplizierte Infekt des Exits kann bei negativer Blutkultur rein antibiotisch therapiert werden. Abszessbildungen im subkutanen Tunnel erfordern einen Katheterwechsel nach kontralateral, sofern keine Bakteriämie besteht. Bakteriäme Formen des Vorhofkatheterinfekts erfordern die dringliche Explantation des Vorhofkatheters und eine Neuanlage nach negativen Blutkulturen. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gefäßmedizin in der ägyptischen Antike

xlomafota.13 shared this article with you from Inoreader Gefäßmedizin in der ägyptischen Antike – Appendix Via Latest Results for Gefässchirurgie Zusammenfassung Ein kurzer Appendix schließt die Serie zur ägyptischen Epoche der Antike ab. In diesem wird das Kuriosum von Ansätzen einer leitliniengerechten Medizin vorgestellt. Des Weiteren wird über den berühmten Imhotep berichtet, der der Heilkunde nahe gestellt wird und angeblich schon zu Lebzeiten eine Vergöttlichung erfuhr. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

EUS is accurate in characterizing pancreatic cystic lesions

xlomafota.13 shared this article with you from Inoreader EUS is accurate in characterizing pancreatic cystic lesions; a prospective comparison with cross-sectional imaging in resected cases Via Latest Results for Surgical Endoscopy Abstract Background Imaging modalities for characterizing pancreatic cystic lesions (PCLs) is a known uncertainty. The aim of this prospective study was to compare the diagnostic performance of endoscopic ultrasound morphology, cytology and cyst fluid carcinoembryonic antigen (EUS-FNA-CEA) with cross-sectional imaging in resected PCLs. Methods The cross-sectional imaging and EUS-FNA-CEA results were collected in an academic tertiary referral centre using histology of the surgical specimen as the diagnostic standard. Results Of 289 patients undergoing evaluation for PCL with cross-sectional imaging and EUS-FNA between February 2007 and March 2017, 58 underwent surgical resection providing a final diagnosis of the PCLs: 45 mucinous, 5 serous, 1 pseudocyst, 2 endocrine, 2 solid pseudopapillary neoplasms and 3 other. EUS-FNA-CEA was more accurate than cross-sectional imaging in diagnosing mucinous PCLs (95% vs. 83%, p = 0.04). Ninety-two percent of the PCLs with high-grade dysplasia or adenocarcinoma were smaller than 3 cm in diameter. The sensitivity of EUS-FNA-CEA and cross-sectional imaging for detecting PCLs with high-grade dysplasia or adenocarcinoma were 33% and 5% (p = 0.03), respectively. However, there was no difference in accuracy between the modalities (62% vs. 66%, p = 0.79). The sensitivity for detecting pancreatic adenocarcinomas only was 64% for EUS-FNA-CEA and 9% for cross-sectional imaging (p = 0.03). Overall, E US-FNA-CEA provided a correct diagnosis in more patients with PCLs than cross-sectional imaging (72% vs. 50%, p = 0.01). Conclusions EUS-FNA-CEA is accurate and should be considered a complementary test in the diagnosis of PCLs. However, the detection of PCLs with high-grade dysplasia or adenocarcinoma needs to be improved. Cyst size does not seem to be a reliable predictor of high-grade dysplasia or adenocarcinoma. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Myocardial Perfusion Simulation for Coronary Artery Disease: A Coupled Patient-Specific Multiscale Model

xlomafota.13 shared this article with you from Inoreader Myocardial Perfusion Simulation for Coronary Artery Disease: A Coupled Patient-Specific Multiscale Model Via Latest Results for Annals of Biomedical Engineering Abstract Patient-specific models of blood flow are being used clinically to diagnose and plan treatment for coronary artery disease. A remaining challenge is bridging scales from flow in arteries to the micro-circulation supplying the myocardium. Previously proposed models are descriptive rather than predictive and have not been applied to human data. The goal here is to develop a multiscale patient-specific model enabling blood flow simulation from large coronary arteries to myocardial tissue. Patient vasculatures are segmented from coronary computed tomography angiography data and extended from the image-based model down to the arteriole level using a space-filling forest of synthetic trees. Blood flow is modeled by coupling a 1D model of the coronary arteries to a single-compartment Darcy myocardium model. Simulated results on five patients with non-obstructive coronary artery disease compare overall well to [ \(^{15}\) O] \(\text {H}_{{2}}\) O PET exam data for both resting and hyperemic conditions. Results on a patient with severe obstructive disease link coronary artery narrowing with impaired myocardial blood flow, demonstrating the model's ability to predict myocardial regions with perfusion deficit. This is the first report of a computational model for simulating blood flow from the epicardial coronary arteries to the left ventricle myocardium applied to and validated on human data. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Adalimumab Biosimilars in the Treatment of Rheumatoid Arthritis

xlomafota.13 shared this article with you from Inoreader Adalimumab Biosimilars in the Treatment of Rheumatoid Arthritis: A Systematic Review of the Evidence for Biosimilarity Via Latest Results for Rheumatology and Therapy Abstract Although treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) has significantly improved clinical outcomes in patients with rheumatoid arthritis (RA), many patients do not have access to these treatments. As cost-effective alternatives to their reference products (RPs), biosimilars provide an opportunity to increase access to bDMARDs. The European Medicines Agency and the US Food and Drug Administration have detailed pathways for the approval of biosimilars based on establishing the similarity of the biosimilar to the RP in terms of structure and function, pharmacokinetics (PK), efficacy, safety, and immunogenicity. A number of biosimilars of adalimumab, infliximab, etanercept, and rituximab RPs have been approved in the United States and/or European Union. This article is focused on the seven adalimumab biosimilars. A review of the data for the biosimilars FKB327, ABP 501, BI 695501, GP2017, MSB11022, PF-06410293, and SB5 confirm that these pr oducts are highly similar to the adalimumab RP with regard to structure, physicochemical and biological properties, PK, safety, immunogenicity, and efficacy in the treatment of RA and other chronic immune-mediated, inflammatory conditions. Data from several switching studies showed no changes in efficacy, safety, trough serum drug concentration, or immunogenicity between the biosimilars and their RP. Trial registration: ClinicalTrials.gov identifiers: NCT02260791, NCT02405780, NCT01970475, NCT02137226, NCT02045979, NCT02744755, NCT02144714, NCT02167139, NCT03014947, NCT02114931, NCT02640612, NCT02640612, NCT02167139, NCT03052322, NCT02480153. EudraCT numbers: 2012-005140-23, 2012-000785-37, 2013-003722-84, 2015-000579-28, 2014-002879-29, 2014-000662-21, 2013-004654-13, 2015-002634-41, 2014-005229-11, 2016-002852-26, 2014-000352-29 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Autotransplanted teeth including an evaluation of a novel surgical technique

xlomafota.13 shared this article with you from Inoreader A retrospective analysis of autotransplanted teeth including an evaluation of a novel surgical technique Via Latest Results for Clinical Oral Investigations Abstract Objectives To assess survival rates and frequency of complications for immature and mature autotransplanted teeth after at least 1 year in function. Materials and methods All consecutive patients who had undergone tooth autotransplantation between 2000 and 2018 were invited to a clinical and radiographic follow-up examination. First, survival rates were calculated on the basis of a phone inquiry. A clinical follow-up examination allowed for the calculation of the success rate, i.e., absence of any potentially adverse clinical and radiographic findings of the autotransplanted teeth. Moreover, the effect of demographic, dental, and surgical variables on survival/success was analyzed statistically. Results Thirty-eight teeth in 35 patients were transplanted during the study period. Three teeth in 3 patients were excluded due to missing records. All other patients were successfully contacted and interviewed by phone. Out of these 35 transplants, 32 were still in function, and 3 had been extracted, yielding a 91.4% survival probability after a median follow-up of 3.4 years. Of the 32 teeth qualifying for the success analysis, 20 (62.5%) showed absence of potentially adverse findings, while 3 (9.4%) required root canal treatment (RCT). Out of the 9 mature, root-end resected transplants, 4 exhibited ongoing pulp canal obliteration, all with a single root canal. Postoperative and potentially adverse findings or failures were found more frequently in the group of mature transplants (55.6%) than immature transplants (30.4%) and for molars (72.7%) than premolars (17.6%) or canines (25%). None of the potential predictors had a statistically significant effect on survival or success. Conclusion Autotransplanted teeth yielded a satisfying midterm survival rate regardless of their stage of development. An additional, extraoral root-end resection of mature transplants may lead to rates of revascularization and postoperative pulp canal obliteration higher than the data reported on unmodified mature transplants. Clinical relevance Extraoral root-end resection of mature teeth shows promising outcomes for transplants especially with a single root canal and uncomplicated root morphology. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.