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BACKGROUND: Previously published research describes short-term outcomes after proximal interphalangeal (PIP) joint arthroplasty, however, long-term outcomes are scarce. Therefore, we evaluated patient-reported outcomes and complications after a follow-up of at least five years following PIP joint arthroplasty. METHODS: We used prospectively gathered data from patients undergoing PIP joint arthroplasty with silicone or surface replacement implants. Time points included preoperative, one year, and at least five years postoperatively. We were able to include 74 patients. Primarily, we focussed on patient satisfaction with the treatment outcome, measured using a validated 5-point Likert scale. Secondary outcomes included the question whether patients would undergo the same surgery again, the assessment of factors associated with (dis)satisfaction, the Michigan Hand outcomes Questionnaire (MHQ), and the number of reoperations. RESULTS: The mean follow-up was seven years (SD 1.2, range 5-11 years). Patient satisfaction was excellent in 14 (19%), good in 17 (23%), reasonable in 18 (24%), moderate in 10 (14%), and poor in 15 (20%) patients. Seventy-three percent of patients (n=54) would undergo the same procedure again. We found no factors associated with (dis)satisfaction. All MHQ scores improved significantly in the first year after surgery and did not deteriorate afterward. Sixteen (16%) fingers required a reoperation, of whom 3 (4%) needed a prosthesis replacement. CONCLUSION: Patient satisfaction with treatment outcomes seven years post-PIP implant surgery ranges from moderate to good for many patients, with a notable proportion expressing dissatisfaction. Patient-reported outcomes improve primarily within the first year and remain stable at five years or more. LEVEL OF EVIDENCE: II.
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BACKGROUND: Color match of a reconstructed breast with the surrounding area is of importance for the overall aesthetic result. The objective of our study was to quantify the degree of color match achieved with different autologous breast reconstructions and to analyze the changes in color over time by analyzing digital photographs. METHODS: 193 patients that underwent a delayed autologous breast reconstruction (DIEP, PAP, LAP, LD) were included. Standardized pictures from 242 flaps at 3 months and 9-12 months postoperative were analyzed and the L*a*b* values and delta E2000 (dE) values were determined to qualify the color match. The Kruskal-Wallis and Wilcoxon rank-sum tests were used for statistical analysis. RESULTS: Initially, DIEP flaps had a significant lower dE value compared to LD (p=0.012) and PAP flaps (p < 0.001) when compared with the natural breast. PAP flaps showed a significant decrease after 9-12 months (p=0.003). Perception of color match was in all flaps comparable. Compared to the cleavage, at late follow-up, DIEP flaps had a significant higher dE value compared to LD (p=0.017) and PAP flaps (p < 0.001). PAP flaps presented a significant decrease of dE after 9-12 months (p =0.031). Abdominal skin presented no better skin color match in patients with PAP, LD, and LAP flaps. CONCLUSIONS: All analyzed flaps have a comparable color match with the surrounding tissue as well as with the contralateral breast about one year after surgery. The color of PAP flaps changes more, which leads to an improvement at a later follow-up.
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BACKGROUND: The Belgian Precision initiative aims to maximize the implementation of tumor-agnostic next-generation sequencing in patients with advanced cancer and enhance access to molecularly guided treatment options. Academic tumor-agnostic basket phase II studies are part of this initiative. The current investigator-driven trial aimed to investigate the efficacy of olaparib in advanced cancers with a (likely) pathogenic mutation (germline or somatic) in a gene that plays a role in homologous recombination (HR). PATIENTS AND METHODS: This open-label, multi-cohort, phase II study examines the efficacy of olaparib in patients with an HR gene mutation in their tumor and disease progression on standard of care. Patients with a somatic or germline mutation in the same gene define a cohort. For each cohort, a Simon minimax two-stage design was used. If a response was observed in the first 13 patients, 14 additional patients were included. Here, we report the results on four completed cohorts: patients with a BRCA1, BRCA2, CHEK2 or ATM mutation. RESULTS: The overall objective response rate across different tumor types was 11% in the BRCA1-mutated (n = 27) and 21% in the BRCA2-mutated (n = 27) cohorts. Partial responses were seen in pancreatic cancer, gallbladder cancer, endocrine carcinoma of the pancreas and parathyroid cancer. One patient with a BRCA2 germline-mutated colon cancer has an ongoing complete response with 19+ months on treatment. Median progression-free survival in responding patients was 14+ months (5-34+ months). The clinical benefit rate was 63% in the BRCA1-mutated and 46% in the BRCA2-mutated cohorts. No clinical activity was observed in the ATM (n = 13) and CHEK2 (n = 14) cohorts. CONCLUSION: Olaparib showed efficacy in different cancer types harboring somatic or germline mutations in the BRCA1/2 genes but not in ATM and CHEK2. Patients with any cancer type harboring BRCA1/2 mutations should have access to olaparib.
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Proteína BRCA2 , Neoplasias Pancreáticas , Humanos , Proteína BRCA2/genética , Proteína BRCA1/genética , Bélgica , Mutación , Células Germinativas , Quinasa de Punto de Control 2/genética , Proteínas de la Ataxia Telangiectasia Mutada/genéticaRESUMEN
In outcome measures, item response theory (IRT) validation can deliver interval-scaled high-quality measurement that can be harnessed using computerized adaptive tests (CATs) to pose fewer questions to patients. We aimed to develop a CAT by developing an IRT model for the Patient Evaluation Measure (PEM) for patients undergoing cubital tunnel syndrome (CuTS) surgery. Nine hundred and seventy-nine completed PEM responses of patients with CuTS in the United Kingdom Hand Registry were used to develop and calibrate the CAT. Its performance was then evaluated in a simulated cohort of 1000 patients. The CAT reduced the original PEM length from ten to a median of two questions (range two to four), while preserving a high level of precision (median standard error of measurement of 0.27). The mean error between the CAT score and full-length score was 0.08%. A Bland-Altman analysis showed good agreement with no signs of bias. The CAT version of the PEM can substantially reduce patient burden while enhancing construct validity by harnessing IRT for patients undergoing CuTS surgery.
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Síndrome del Túnel Cubital , Humanos , Síndrome del Túnel Cubital/diagnóstico , Síndrome del Túnel Cubital/cirugía , Pruebas Adaptativas Computarizadas , Encuestas y Cuestionarios , Evaluación de Resultado en la Atención de Salud , Extremidad SuperiorRESUMEN
BACKGROUND: The time until return to work (RTW) and possible factors affecting this time after proximal interphalangeal (PIP) joint arthroplasty are unknown. Therefore, we aim to evaluate the RTW after PIP joint arthroplasty for osteoarthritis and assess factors affecting the time until return to their usual work. METHODS: We used prospectively gathered data from 74 patients undergoing PIP joint arthroplasty with daily hand surgery practice routine outcome collection. Standardized RTW questionnaires were completed at 6 weeks and 3, 6, and 12 months after surgery. Return to work was defined as the first time a patient reported returning to work and performing the original work for a minimum of 50% of the original hours a week, as stated in the patient's contract. Second, we evaluated baseline factors affecting the time until RTW. RESULTS: The probability of RTW within 12 months after surgery was 88%. The median time until RTW was 8 weeks (interquartile range: 4-10). Physical occupational intensity (hazard ratio [HR]: 0.36, P = .001) and the baseline Michigan Hand Outcomes Questionnaire work scores (HR: 1.02, P = .005) were independently associated with RTW. CONCLUSION: In conclusion, patients returned to work after a median of 8 weeks following PIP arthroplasty. Patients with medium or heavy physical occupations returned to work later than patients with light physical occupations. Better patient-reported work outcomes at baseline also led to an earlier RTW. This information can be valuable for providing adequate information during the preoperative consultation.
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PURPOSE: To describe patient-reported pain and function 12 months after proximal row carpectomy (PRC). Secondary outcomes included return to work, grip strength, range of wrist motion, satisfaction with treatment results, and complications. METHODS: This cohort study was part of the British Society for Surgery of the Hand Studyathon 2021, using ongoing routinely-collected data of 304 eligible patients who underwent PRC (73% scapholunate advanced collapse, 11% scaphoid nonunion advanced collapse wrist; 11% Kienböck, 5% other indications) from Xpert Clinics, the Netherlands between 2012-2020. The primary outcome was the Patient Rated Wrist/Hand Evaluation total score (range, 0-100, lower scores indicate better performance). RESULTS: Of the 304 patients, the primary outcome was available in 217 patients. The total Patient Rated Wrist/Hand Evaluation score improved from 60 (95% confidence interval [CI], 57-63) to 38 (95% CI, 35-41) at 3 months, and 26 (95% CI, 23-29) at 12 months. The pain and function subscales improved by 18 (95% CI, 17-20) and 16 (95% CI, 14-18) points, respectively. At 12 months, 82% had returned to work at a median time of 12 (95% CI, 9-14) weeks following PRC. Grip strength did not improve. Wrist flexion and extension demonstrated a clinically irrelevant decrease. Satisfaction with treatment result was excellent in 27% of patients, good in 42%, fair in 20%, moderate in 6%, and poor in 5%. Complications occurred in 11% of patients, and conversion to wrist arthroplasty occurred in 2 patients. CONCLUSION: A clinically relevant improvement in patient-reported pain and function was observed at 3 months after PRC, with continued improvement to 12 months. These data can be used for shared-decision making and expectation management. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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PRECISION is an initiative from the Belgian Society of Medical Oncology (BSMO) in collaboration with several stakeholders, encompassing four programs that aim to boost genomic and clinical knowledge with the ultimate goal to offer patients with metastatic solid tumors molecularly guided treatments. The PRECISION 1 study has led to the creation of a clinico-genomic database. The Belgian Approach for Local Laboratory Extensive Tumor Testing (BALLETT) and GeNeo studies will increase the number of patients with advanced cancer that have comprehensive genotyping of their cancer. The PRECISION 2 project consists of investigator-initiated phase II studies aiming to provide access to a targeted drug for patients whose tumors harbor actionable mutations in case the matched drug is not available through reimbursement or clinical trials in Belgium.
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Neoplasias , Medicina de Precisión , Bélgica , Genómica , Humanos , Oncología MédicaRESUMEN
Surgeons often prefer to use a tourniquet during minor procedures, such as carpal tunnel release (CTR) or trigger finger release (TFR). Besides the possible discomfort for the patient, the effect of tourniquet use on long-term results and complications is unknown. Our primary aim was to compare the patient-reported outcomes 1 year after CTR or TFR under local anesthesia with or without tourniquet. Secondary outcomes included satisfaction, sonographically estimated scar tissue thickness after CTR' and postoperative complications. Methods: Between May 2019 and May 2020, 163 patients planned for open CTR or TFR under local anesthesia were included. Before surgery, and at 3, 6, and 12 months postoperatively, Quick Disabilities of the Arm, Shoulder and Hand and Boston Carpal Tunnel questionnaires were administered, and complications were noted. At 6 months postoperatively, an ultrasound was conducted to determine the thickness of scar tissue in the region of median nerve. Results: A total of 142 patients (51 men [38%]) were included. The Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Boston Carpal Tunnel Questionnaire scores improved significantly in both groups during follow-up, wherein most improvements were seen in the first 3 months. No difference in clinical outcome and scar tissue formation was found between the two groups after 12 months. The complication rate was comparable between both groups. Thirty-two (24%) patients had at least one complication, none needed surgical interventions, and no recurrent symptoms were seen. Conclusions: Our study shows similar long-term clinical outcomes, formation of scar tissue, and complication rates for patients undergoing CTR or TFR with or without a tourniquet. Tourniquet usage should be based on shared decision-making.
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AIMS: The primary aim of this study was to describe long-term patient-reported outcomes after ulna shortening osteotomy for ulna impaction syndrome. METHODS: Overall, 89 patients treated between July 2011 and November 2017 who had previously taken part in a routine outcome evaluation up to 12 months postoperatively were sent an additional questionnaire in February 2021. The primary outcome was the Patient-Rated Wrist and Hand Evaluation (PRWHE) total score. Secondary outcomes included patient satisfaction with treatment results, complications, and subsequent treatment for ulnar-sided wrist pain. Linear mixed models were used to compare preoperative, 12 months, and late follow-up (ranging from four to nine years) PRWHE scores. RESULTS: Long-term outcomes were available in 66 patients (74%) after a mean follow-up of six years (SD 1). The mean PRWHE total score improved from 63 before surgery to 19 at late follow-up (difference in means (Δ) 44; 95% confidence interval (CI) 39 to 50; p = <0.001). Between 12 months and late follow-up, the PRWHE total score also improved (Δ 12; 95% CI 6 to 18; p = < 0.001). At late follow-up, 14/66 of patients (21%) reported a PRWHE total score of zero, whereas this was 3/51 patients (6%) at 12 months (p = 0.039). In all, 58/66 patients (88%) would undergo the same treatment again under similar circumstances. Subsequent treatment (total n = 66; surgical n = 57) for complications or recurrent symptoms were performed in 50/66 patients (76%). The most prevalent type of reoperation was hardware removal in 42/66 (64%), and nonunion occurred in 8/66 (12%). CONCLUSION: Ulna shortening osteotomy improves patient-reported pain and function that seems to sustain at late follow-up. While satisfaction levels are generally high, reoperations such as hardware removal are common. Cite this article: Bone Jt Open 2022;3(5):375-382.
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Hardware removal after ulna shortening osteotomy is common. We evaluated the association between plate location and hardware removal rate in 326 procedures in 321 patients with a median follow-up of 4.3 years (IQR 3.3) and corrected for confounding variables and did survival analyses. Complications were scored using the International Consortium for Health Outcome Measurement complications in Hand and Wrist Conditions tool. The 1-year and 5-year reoperation rates for hardware removal were 21% and 46% in the anterior group versus 37% and 64% in the dorsal group. Anterior plate placement was independently associated with a decreased immediate risk of hardware removal. Higher age, male sex and treatment on the dominant side were also associated with a reduced risk of hardware removal. We did not find a difference in hardware removal rates between freehand or jig-guided ulna shortening osteotomies. We noted perioperative problems in 3% of the procedures and complications in 20%.Level of evidence: III.
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Osteotomía , Cúbito , Placas Óseas , Estudios de Cohortes , Humanos , Masculino , Osteotomía/efectos adversos , Osteotomía/métodos , Estudios Retrospectivos , Cúbito/cirugía , Articulación de la Muñeca/cirugíaRESUMEN
This study aimed to identify factors contributing to the timing of return to work after surgical treatment of trapeziometacarpal joint osteoarthritis and to calculate the costs of lost productivity. We included 627 patients with paid employment who underwent trapeziectomy and ligament reconstruction with tendon interposition. Time to return to work was measured through filling online questionnaires and analysed using survival analysis at 6 weeks and 3, 6 and 12 months after the surgery. Patients also filled in the Michigan Hand Outcomes Questionnaire. Costs of lost productivity were calculated using the human capital method. After 1 year, 78% of the patients returned to work. The median time to return to work was 12 weeks. Factors that significantly affected the time to return to work were occupational intensity (light, moderate or heavy physical labour), whether the dominant hand was treated and the Michigan Hand Outcomes Questionnaire work score and hand function score of the unoperated side at baseline. The costs of lost productivity were estimated at 11,000 on the patient level, resulting in 16.8 million on the Dutch population level per year.Level of evidence: II.
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Articulaciones Carpometacarpianas , Osteoartritis , Hueso Trapecio , Articulaciones Carpometacarpianas/cirugía , Humanos , Osteoartritis/cirugía , Rango del Movimiento Articular , Reinserción al Trabajo , Pulgar/cirugía , Hueso Trapecio/cirugíaRESUMEN
Triple-negative breast cancer (TNBC) accounts for 10-20% of all breast cancers (BCs), and conventional chemotherapy is the only effective systemic treatment. Germline BRCA1/2 mutations are found in approximately 15% of TNBC patients. In the past, we have documented pathogenic mutations in BARD1, a BRCA1 interacting protein, in families at high risk for BC. In this study, we have analyzed germline DNA from 61 estrogen receptor negative patients (of which 42 were TNBC) for the presence of mutations in the BRCA1, BRCA2 and BARD1 gene. BRCA1/2 mutations were found in 8 out of 42 (19%) TNBC patients, but not in the ER-/HER2+ cohort. We also found four good candidate pathogenic BARD1 mutations in the TNBC cohort, including two protein-truncating mutations (p.Gln564Ter and p.Arg641Ter). Our data suggest that TNBC patients are enriched for pathogenic BARD1 germline mutations as compared to control samples and high BC risk families. Ten of the 42 investigated TNBC patients carry a BRCA pathway mutation (in BRCA1, BRCA2 or BARD1) rendering them susceptible to homologous recombination deficiency. These patients should become eligible for exploring the efficacy of poly (ADP-ribose) polymerase (PARP) inhibitors.
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Mutación de Línea Germinal , Neoplasias de la Mama Triple Negativas/genética , Proteínas Supresoras de Tumor/genética , Ubiquitina-Proteína Ligasas/genética , Adulto , Anciano , Proteína BRCA1/genética , Proteína BRCA2/genética , Femenino , Predisposición Genética a la Enfermedad , Recombinación Homóloga , Humanos , Persona de Mediana Edad , Neoplasias de la Mama Triple Negativas/metabolismoRESUMEN
The fungus Aspergillus niger is an industrial producer of pectin-degrading enzymes. The recent solving of the genomic sequence of A. niger allowed an inventory of the entire genome of the fungus for potential carbohydrate-degrading enzymes. By applying bioinformatics tools, 12 new genes, putatively encoding family 28 glycoside hydrolases, were identified. Seven of the newly discovered genes form a new gene group, which we show to encode exoacting pectinolytic glycoside hydrolases. This group includes four exo-polygalacturonan hydrolases (PGAX, PGXA, PGXB and PGXC) and three putative exo-rhamnogalacturonan hydrolases (RGXA, RGXB and RGXC). Biochemical identification using polygalacturonic acid and xylogalacturonan as substrates demonstrated that indeed PGXB and PGXC act as exo-polygalacturonases, whereas PGXA acts as an exo-xylogalacturonan hydrolase. The expression levels of all 21 genes were assessed by microarray analysis. The results from the present study demonstrate that exo-acting glycoside hydrolases play a prominent role in pectin degradation.
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Aspergillus niger/enzimología , Proteínas Fúngicas/metabolismo , Glicósido Hidrolasas/metabolismo , Pectinas/metabolismo , Acetilesterasa/genética , Acetilesterasa/metabolismo , Secuencia de Aminoácidos , Aspergillus niger/efectos de los fármacos , Aspergillus niger/genética , Carbohidratos/farmacología , ADN de Hongos/química , ADN de Hongos/genética , Proteínas Fúngicas/genética , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Regulación Fúngica de la Expresión Génica/efectos de los fármacos , Genoma Fúngico/genética , Glicósido Hidrolasas/genética , Concentración de Iones de Hidrógeno , Isoenzimas/genética , Isoenzimas/metabolismo , Datos de Secuencia Molecular , Análisis de Secuencia por Matrices de Oligonucleótidos , Filogenia , ARN Mensajero/genética , ARN Mensajero/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Alineación de Secuencia , Análisis de Secuencia de ADN , Homología de Secuencia de Aminoácido , Especificidad por SustratoRESUMEN
In a short-distance homing task, golden hamsters derive the homing direction both from visual extra-maze cues and from the integration of the outward journey. The relative importance of visual configurations in the control of homing was assessed by presenting these cues in conflict with path integration. The hamsters depended mainly on path integration during the presentation of 3 objects at the periphery of the experimental arena or of a background pattern which surrounded the arena at a certain distance. However, they switched to visually controlled behaviour when the objects were superimposed on the patterned background. The possibility is discussed that the enhancement of the depth dimension through the simultaneous presentation of a foreground and a background may increase the effectiveness of visual cues in spatial orientation.
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Atención , Señales (Psicología) , Percepción de Profundidad , Aprendizaje Discriminativo , Orientación , Medio Social , Animales , Aprendizaje por Asociación , Cricetinae , Femenino , Recuerdo Mental , Mesocricetus , Reconocimiento Visual de ModelosRESUMEN
This study examines the effects of nonaromatizable androgens, methyltrienolone (R1881) and 5 alpha-dihydrotestosterone (DHT) on aggressive courtship and vocal behavior in the male ring dove. Since androgens may influence behavior by increasing the formation of estrogen in the brain, the effects of R1881 and DHT on brain aromatase activity were also studied using an in vitro microassay. Under conditions in which testosterone induced aggressive courtship patterns, the nonaromatizable androgens were ineffective. But DHT and R1881 induced vocal behavior with equal efficiency, indicating that androgens can influence mechanisms of vocal behavior without conversion to estrogens. The behavioral effectiveness of both hormones was reduced (approximately 50%) when the period between castration and treatment was doubled. Testosterone propionate increased formation of E2 from 3H-testosterone in both the preoptic (POA) and anterior hypothalamic areas. Neither of the nonaromatizable androgens affected POA aromatase activity. The results suggest that only the aromatizable androgen, testosterone, which is also required specifically for male courtship, increases preoptic formation of estrogen.