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1.
Foot Ankle Surg ; 2024 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-38714454

RESUMEN

INTRODUCTION: This study aimed to compare the degree of posterior malleolar exposure, the tension of the flap containing the posteromedial neurovascular bundle (NVB), and the distance between the surgical incision and the NVB using three different posteromedial ankle approaches. METHODS: Three approaches were compared: medial posteromedial (MePM) modified posteromedial (MoPM) and posteromedial (PM). We measured the minimal tension of the flap containing the NVB that allowed proper exposure. In the second stage, an axial cut was performed, and we measured the degree of posterior malleolar exposure and the distance between the incision and the NVB RESULTS: There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV,favoring the PM approach (71,00% ± 1.83 and 25.50 mm ± 4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ± 1.28) compared to the other two approaches CONCLUSION: The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choicefor large fractures of the posteromedial aspect of the PM.

2.
Foot Ankle Surg ; 28(6): 750-755, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34686414

RESUMEN

Intraoperative fluoroscopic parameters have shown to be poor predictors for ankle syndesmosis reduction, with up to 52% of syndesmotic malreduction (SMR) reported in the literature. Anteroposterior Tibio-Fibular index (APTF) was previously described to evaluate sagittal tibiofibular alignment in lateral ankle radiographs with a high correlation between both ankles in uninjured subjects. Reproducible intraoperative measurements for sagittal syndesmotic reduction are lacking. We propose the use of the "cAPTF," calculated as the absolute difference between the APTF of the non-injured and the operated ankle, to evaluate sagittal syndesmotic reduction. OBJECTIVE: Determine the predictive capability of cAPTF for SMR. METHOD: Prospective observational study. INCLUSION CRITERIA: patients with unstable ankle fractures requiring syndesmotic fixation, with a healthy contralateral ankle. Intraoperatively APTF was measured in both ankles after syndesmotic fixation. Postoperatively cAPTF was calculated. Only direct syndesmosis visualization through the lateral approach and AP and mortise views were used by surgeons to assess syndesmotic reduction. Quality of syndesmotic reduction was evaluated with bilateral postoperative CT. To estimate cAPTF discriminatory power for SMR, a receiver operative characteristic (ROC) curve was obtained and the area under the ROC curve was calculated. Youden index was used to determine the ideal cAPTF cut-off value for predicting SMR. For this determined cut-off value, sensitivity, specificity, and likelihood ratio were calculated. RESULTS: Fifty-two patients were included. Sixteen (30%) had SMR. Patients with SMR had a statistically significant higher cAPTF value than the well reduced (median 0.26 vs 0.09; P < 0.01). The cAPTF cut-off value to predict SMR was 0.161. A cAPTF greater than 0.161 had 100% sensitivity and 97,2% specificity for SMR. The area under the ROC curve was 0.99. CONCLUSION: Intraoperative cAPTF has excellent discriminatory power for predicting syndesmotic malreduction. We propose the routine use of intraoperative bilateral comparative fluoroscopy to assess sagittal syndesmotic reduction.


Asunto(s)
Fracturas de Tobillo , Traumatismos del Tobillo , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Traumatismos del Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Fluoroscopía , Fijación Interna de Fracturas , Humanos , Tomografía Computarizada por Rayos X
3.
Eur Spine J ; 25(7): 2185-92, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-26945747

RESUMEN

PURPOSE: We performed an agreement study using two subaxial cervical spine classification systems: the AOSpine and the Allen and Ferguson (A&F) classifications. We sought to determine which scheme allows better agreement by different evaluators and by the same evaluator on different occasions. METHODS: Complete imaging studies of 65 patients with subaxial cervical spine injuries were classified by six evaluators (three spine sub-specialists and three senior orthopaedic surgery residents) using the AOSpine subaxial cervical spine classification system and the A&F scheme. The cases were displayed in a random sequence after a 6-week interval for repeat evaluation. The Kappa coefficient (κ) was used to determine inter- and intra-observer agreement. RESULTS: Inter-observer: considering the main AO injury types, the agreement was substantial for the AOSpine classification [κ = 0.61 (0.57-0.64)]; using AO sub-types, the agreement was moderate [κ = 0.57 (0.54-0.60)]. For the A&F classification, the agreement [κ = 0.46 (0.42-0.49)] was significantly lower than using the AOSpine scheme. Intra-observer: the agreement was substantial considering injury types [κ = 0.68 (0.62-0.74)] and considering sub-types [κ = 0.62 (0.57-0.66)]. Using the A&F classification, the agreement was also substantial [κ = 0.66 (0.61-0.71)]. No significant differences were observed between spine surgeons and orthopaedic residents in the overall inter- and intra-observer agreement, or in the inter- and intra-observer agreement of specific type of injuries. CONCLUSION: The AOSpine classification (using the four main injury types or at the sub-types level) allows a significantly better agreement than the A&F classification. The A&F scheme does not allow reliable communication between medical professionals.


Asunto(s)
Vértebras Cervicales/lesiones , Fracturas de la Columna Vertebral/clasificación , Vértebras Cervicales/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Traumatismos del Cuello/clasificación , Traumatismos del Cuello/diagnóstico por imagen , Variaciones Dependientes del Observador , Cirujanos Ortopédicos , Radiografía , Reproducibilidad de los Resultados , Fracturas de la Columna Vertebral/diagnóstico por imagen , Traumatismos Vertebrales/clasificación , Traumatismos Vertebrales/diagnóstico por imagen , Tomografía Computarizada por Rayos X
4.
Foot Ankle Int ; 45(1): 10-19, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-37885224

RESUMEN

BACKGROUND: Ankle arthritis leads to an elevated joint line compared to the nonarthritic ankle, as measured by the "joint line height ratio" (JLHR). Previous work has shown that the JLHR may remain elevated after total ankle arthroplasty (TAA). However, the clinical impact of this has yet to be determined. This study assessed the correlation between postoperative JLHR, post-TAA range of motion (ROM), and 1-year Patient-Reported Outcome Measurement Information System (PROMIS) scores. METHODS: A retrospective review of 150 patients who underwent primary TAA was performed. Preoperative and postoperative JLHR, as well as postoperative dorsiflexion, plantarflexion, and total ROM, was calculated on weightbearing radiographs at a minimum of 1-year follow-up. Correlation between JLHR, post-TAA ROM, and 1-year PROMIS scores was investigated using Pearson correlation and multiple linear regression models. Interobserver reliability for the JLHR was also calculated. RESULTS: Interobserver reliability for the JLHR was excellent (r = 0.98). Mean (SD) JLHR changed from 1.66 (0.45) to 1.55 (0.26) after TAA (P < .001), indicating that the joint line was lowered after TAA. An elevated joint line was correlated with decreased post-TAA dorsiflexion (r = -0.26, P < .001), total ROM (r = -0.18, P = .025), and worse 1-year PROMIS physical function (r = -0.22, P = .046), pain intensity (r = 0.22, P = .042), and pain interference (r = 0.29, P = .007). There was no correlation between the JLHR and post-TAA plantarflexion (r = -0.025, P = .76). Regression analysis identified a 0.5-degree reduction in post-TAA dorsiflexion with each 0.1-unit increase in JLHR (Coeff. = -5.13, P = .005). CONCLUSION: In this patient cohort, we found that an elevated joint line modestly correlated with decreased postoperative dorsiflexion, total ROM, and worse 1-year PROMIS scores. These data suggest that effort likely should be made toward restoring the native joint line at the time of TAA. In addition, future studies investigating the clinical outcomes after TAA may consider including a measure of joint line height, such as the JLHR, because we found it was associated with patient-reported outcomes. LEVEL OF EVIDENCE: Level III, retrospective review of prospectively collected data.


Asunto(s)
Tobillo , Artroplastia de Reemplazo de Tobillo , Humanos , Tobillo/cirugía , Reproducibilidad de los Resultados , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Estudios Retrospectivos , Rango del Movimiento Articular , Resultado del Tratamiento
5.
Foot Ankle Int ; : 10711007241258167, 2024 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-38912602

RESUMEN

BACKGROUND: There are limited data regarding risk factors associated with periprosthetic medial malleolar fractures in total ankle arthroplasty (TAA). This case-control study aimed to identify the risk factors and analyze the effect of prophylactic screw fixation in preventing a medial malleolar fracture after TAA. METHODS: A case-control study was conducted on 149 patients who underwent primary TAA. Twenty patients with postoperative medial malleolar fractures >4 weeks postoperatively (cases) were identified. An additional 129 patients (controls) were randomly selected from the TAA database. Radiographic evaluation included tibial component coronal alignment and postoperative medial malleolar width. Demographics and radiographic variables were compared between cohorts. Logistic regression was used to investigate the association between medial malleolar fracture and postoperative coronal alignment, medial malleolar width, and prophylactic fixation of the medial malleolus. RESULTS: Mean (SD) medial malleolar width was significantly smaller in the fracture cohort (8.52 mm [1.6]) than in the control group (11.78 mm [1.74]) (P < .001). Mean (SD) tibial component coronal alignment was 92.17 degrees (2.77) in the fracture cohort and 90.21 degrees (1.66) in the control group (P = .002). Regression analysis identified a significant negative association between postoperative medial malleolar width and the probability of fracture (OR = 0.06, 95% CI 0.01, 0.26, P < .001). Varus malalignment of the tibial component was positively associated with the probability of fracture (OR = 1.90, 95% CI 1.27, 2.86, P = .002). Prophylactic screw fixation resulted in more than 90% reduction in the odds of a fracture (OR = 0.04, 95% CI 0.01, 0.45, P = .01). ROC curve analysis determined a medial malleolar width of 10.3 mm as a potential threshold for predicting fracture. CONCLUSION: Decreased medial malleolar width and postoperative varus malalignment were associated with an increased risk of postoperative medial malleolar fracture. Therefore, surgeons should consider prophylactic screw fixation in patients with a medial malleolar width <10.3 mm or at risk of postoperative varus deformity.

6.
Foot Ankle Int ; 45(5): 426-434, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38482821

RESUMEN

BACKGROUND: Although intraoperative ankle motion serves as a foundational reference for anticipated motion after surgery and guides the addition of procedures to enhance ankle motion in total ankle arthroplasty (TAA), the relationship between intraoperative and postoperative ankle motion remains unclear. This study aimed to investigate the discrepancy between intraoperative and postoperative ankle range of motion (ROM) following TAAs using the anterior-approach, fixed-bearing systems. METHODS: This study retrospectively reviewed 67 patients (67 ankles) who underwent primary TAA at a single institution. Three different types of anterior-approach, fixed-bearing TAA systems were included. Intraoperative fluoroscopy was used to document the maximal dorsiflexion and plantar flexion at the end of the case. Standardized weightbearing maximum dorsiflexion and plantar flexion sagittal radiographs were obtained pre- and postoperatively, following a previously described method. The motion between 3 different time points (preoperative, intraoperative, and postoperative [mean 11.4 months]) was compared using pairwise t tests, and their differences were quantified. RESULTS: The mean total tibiotalar ROM was 38.1 degrees (SD 7.8) intraoperatively, and the postoperative total tibiotalar ROM was 24.2 degrees (SD 9.7) (P < .001), indicating that a mean of 65.3% (SD 26.7) of the intraoperative motion was maintained postoperatively. Intraoperative dorsiflexion (mean 11.6 [SD 4.5] degrees) showed no evidence of difference from postoperative dorsiflexion (mean 11.4 [SD 5.8] degrees, P > .99), indicating that a median of 95.6% (interquartile range: 66.2-112) of the intraoperative maximum dorsiflexion was maintained postoperatively. However, there was a significant difference between intraoperative plantarflexion (mean 26.4 [SD 6.3]) and postoperative plantarflexion (12.8 [SD 6.9] degrees, P < .001), indicating a mean 50.6% (SD 29.6) of intraoperative motion maintained in the postoperative assessment. There was an improvement of 2.5 degrees in the total tibiotalar ROM following TAA with statistical significance (P < .043). CONCLUSION: This study revealed a significant difference between intraoperative ankle ROM and ankle ROM approximately 1 year after anterior-approach, fixed-bearing TAA, mainly due to plantarflexion motion restriction. Minimal difference in dorsiflexion suggests the importance of achieving the desired postoperative dorsiflexion motion during the surgery using the best possible adjunct procedures. LEVEL OF EVIDENCE: Level IV, case series.


Asunto(s)
Articulación del Tobillo , Artroplastia de Reemplazo de Tobillo , Rango del Movimiento Articular , Humanos , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Articulación del Tobillo/cirugía , Articulación del Tobillo/fisiopatología , Anciano , Persona de Mediana Edad , Femenino , Masculino , Fluoroscopía , Periodo Posoperatorio , Soporte de Peso/fisiología , Periodo Intraoperatorio
7.
Foot Ankle Int ; : 10711007241251819, 2024 May 26.
Artículo en Inglés | MEDLINE | ID: mdl-38798112

RESUMEN

BACKGROUND: Minimally invasive bunionectomy (MISB) has emerged as a popular approach to treat symptomatic hallux valgus deformity. Although previous studies focused on distal foot width changes postsurgery, this research introduces a novel midshaft measurement to evaluate proximal transverse midfoot width, aiming for a comprehensive understanding of foot changes post-MISB. METHODS: A retrospective review of 44 HV patients from an institutional registry was conducted. Demographic data, surgical details, radiographs, and foot width measurements were collected. Changes in hallux valgus angle (HVA) and intermetatarsal angle (IMA) were also measured. RESULTS: Intraclass correlation coefficients (ICCs) demonstrated good to excellent interobserver reliability (all ICCs > 0.70) for all measurements. MISB resulted in a consistent reduction in distal foot width (P < .001). These reductions correlated with changes in HVA and IMA, suggesting that the extent of deformity correction influenced distal foot width: distal bone width decreased an average of 8 mm, P < .001). However, midshaft bony width increased an average of 4 mm, P < .001). Changes in midshaft foot width showed no correlation with HVA or IMA alterations. CONCLUSION: We found in this cohort of 44 patients that MISB for HV leads to an expected decrease in distal bony foot width but, on average, an increase in midshaft foot width. LEVEL OF EVIDENCE: Level III, retrospective comparison of prospectively collected data.

8.
Foot Ankle Int ; : 10711007241251817, 2024 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-38757722

RESUMEN

BACKGROUND: Isolated subtalar and talonavicular joint arthrodeses have been associated with adjacent joint arthritis and altered hindfoot kinematics during simplified loading scenarios. However, the effect on kinematics during dynamic activity is unknown. This study assessed changes in subtalar and talonavicular kinematics after isolated talonavicular (TNiso) and subtalar (STiso) arthrodesis, respectively, during stance simulations. METHODS: Fourteen midtibia specimens received either a TNiso or STiso arthrodesis, with 7 randomized to each group. A 6-degree-of-freedom robot sequentially simulated the stance phase for the intact and arthrodesis conditions. Bootstrapped bias-corrected 95% CIs of the talonavicular and subtalar joint kinematics were calculated and compared between conditions. RESULTS: The TNiso decreased subtalar inversion, adduction, and plantarflexion in late stance (P < .05). The subtalar range of motion in the sagittal and coronal planes decreased by 40% (P = .009) and 46% (P = .002), respectively. No significant changes in talonavicular joint kinematics were observed after isolated subtalar arthrodesis; however, the range of motion was reduced by 61% (P = .007) and 50% (P = .003) in the coronal and axial planes, respectively. CONCLUSION: In this model for arthrodesis, changes in subtalar kinematics and motion restriction were observed after isolated talonavicular arthrodesis, and motion restriction was observed after isolated subtalar arthrodesis. Surprisingly, talonavicular kinematics did not appear to change after isolated subtalar arthrodesis. CLINICAL RELEVANCE: Both joint fusions substantially decrease the motion of the reciprocal adjacent joint. Surgeons should be aware that the collateral costs with talonavicular fusion appear higher, and it has a significant effect on subtalar kinematics during the toe-off phase of gait.

9.
Artículo en Inglés | MEDLINE | ID: mdl-36622849

RESUMEN

BACKGROUND: Posterior malleolus fractures occur in up to 50% of all ankle fractures. Several classification systems exist for their characterization, especially under CT. However, those classifications do not report the level of agreement or do it incompletely. This study aims to independently assess three posterior malleolus fracture classifications (Haraguchi, Bartonícek/Rammelt, and Mason). METHODS: This study was designed according to the Guidelines for Reporting Reliability and Agreement Studies. Ninety-four CT scans of patients with ankle fractures that had posterior malleolus fractures were included. Posterior malleolus fractures were assessed by six evaluators (three attending foot and ankle surgeons and three orthopaedic surgery residents) according to Haraguchi, Bartonícek/Rammelt, and Mason classifications. All images were reassessed by the same evaluators in a random sequence 3 weeks later. The kappa (k) coefficient was used to determine the interobserver and intraobserver agreement. Statistical significance was established using P < 0.05 with a 95% confidence interval (CI). RESULTS: The interobserver agreement was moderate for Haraguchi, Bartonícek/Rammelt, and Mason classifications with a global k value of 0.52 (95% CI, 0.43 to 0.60), 0.53 (95% CI, 0.46 to 0.61), and 0.54 (95% CI, 0.47 to 0.62), respectively. The intraobserver agreement was substantial for Haraguchi, Bartonícek/Rammelt, and Mason classifications, with an overall k value of 0.70 (95% CI, 0.64 to 0.74), 0.73 (95% CI, 0.68 to 0.78), and 0.73 (95% CI, 0.69 to 0.78), respectively. Interobserver and intraobserver agreement among orthopaedic surgeons and residents had no significant difference. CONCLUSION: The current classifications for posterior malleolus fractures showed a substantial intraobserver agreement. Nevertheless, the interobserver agreement obtained was just moderate for all classifications, independent of the level of expertise of the evaluators.


Asunto(s)
Fracturas de Tobillo , Humanos , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Reproducibilidad de los Resultados , Variaciones Dependientes del Observador , Tomografía Computarizada por Rayos X/métodos , Articulación del Tobillo
10.
Foot Ankle Int ; 44(10): 1051-1060, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37542424

RESUMEN

BACKGROUND: Although hindfoot arthrodeses relieve pain and correct deformity, they have been associated with progressive tibiotalar degeneration. The objective was to quantify changes in tibiotalar kinematics after hindfoot arthrodeses, both isolated subtalar and talonavicular, as well as double arthrodesis, and to determine if the order of joint fixation affects tibiotalar kinematics. METHODS: Hindfoot arthrodeses were performed in 14 cadaveric mid-tibia specimens. Specimens randomly received isolated fixation of the subtalar or talonavicular joint first, followed by fixation of the remaining joint for the double arthrodesis. A 6-degree-of-freedom robot sequentially simulated the stance phase of level walking for intact, isolated, and double arthrodesis conditions. Tibiotalar kinematic changes were compared for the intact and arthrodesis conditions. A subsequent analysis assessed the effect of the joint fixation order on tibiotalar kinematics. RESULTS: Isolated and double hindfoot arthrodeses increased tibiotalar plantarflexion, inversion, and internal rotation during late stance. Tibiotalar kinematics changes occurring after isolated arthrodesis remained consistent after the double arthrodesis for both the subtalar- and talonavicular-first conditions. The order of joint fixation influenced tibiotalar kinematics through some portions of stance, where the talonavicular-first double arthrodesis increased tibiotalar plantarflexion, eversion, and internal rotation compared to the subtalar-first double. CONCLUSION: Tibiotalar kinematics were modestly altered for all conditions, both isolated and double hindfoot arthrodeses. Changes in tibiotalar kinematics were consistent from the isolated to the double arthrodesis conditions and varied depending on which isolated hindfoot arthrodesis was performed first. Further research is needed to assess the clinical implications of the observed changes in tibiotalar kinematics, particularly as it pertains to the development of adjacent joint arthritis. CLINICAL RELEVANCE: These findings may correlate with clinical research that has cited hindfoot arthrodesis as a risk factor for adjacent tibiotalar arthritis. Once either the subtalar or talonavicular joint is fused, avoiding the arthrodesis of the second joint may not necessarily protect the tibiotalar joint.


Asunto(s)
Artritis , Articulación Talocalcánea , Humanos , Articulación del Tobillo/cirugía , Fenómenos Biomecánicos , Pie , Artritis/cirugía , Artrodesis , Articulación Talocalcánea/cirugía
11.
J Am Acad Orthop Surg ; 28(5): 208-213, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-31800439

RESUMEN

BACKGROUND DATA: A new pilon fracture classification system based on CT scan data was recently published, showing almost perfect interobserver and intraobserver agreement among the authors who developed it. However, an independent assessment has not been done. OBJECTIVE: To do an independent agreement evaluation of the new pilon fracture classification system with physicians with different levels of expertise in the management of pilon fractures. METHODS: Seventy-one cases of acute pilon fracture were retrospectively collected. Fractures were classified by six evaluators (three foot and ankle surgeons and three orthopaedic surgery residents) using CT scans according to the morphological grading of the new pilon fracture classification system developed by Leonetti et al. Cases were presented to the same evaluators in a random sequence after a 6-week interval to determine intraobserver agreement. The kappa coefficient (κ) was used to determine agreement among evaluators. RESULTS: The interobserver agreement was substantial regarding the main fracture type (I, II, III, or IV), with an overall κ value of 0.69 (0.65 to 0.72). When including the II and III subtypes, the overall agreement was still substantial, with a κ value of 0.61 (95% confidence interval: 0.58 to 0.64). The intraobserver agreement was substantial when considering the main fracture categories (I, II, III, or IV), with a κ value of 0.78 (confidence interval: 0.72 to 0.84), and full agreement at the type level was observed in 76% (324/426) of evaluations. There was no notable difference between the foot and ankle surgeons and orthopaedic surgery residents in the interobserver and intraobserver agreement. CONCLUSION: The new classification system demonstrated substantial interobserver and intraobserver agreement between evaluators with different levels of expertise in the management of pilon fractures. Prospective studies should be done to evaluate its prognostic value and utility in clinical practice.


Asunto(s)
Fracturas de Tobillo/clasificación , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de la Tibia/clasificación , Fracturas de la Tibia/diagnóstico por imagen , Humanos , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
12.
Sci Rep ; 10(1): 11636, 2020 07 15.
Artículo en Inglés | MEDLINE | ID: mdl-32669659

RESUMEN

N-methyl-2-pyrrolidone (NMP) is a versatile water-miscible polar aprotic solvent. It is used as a drug solubilizer and penetration enhancer in human and animal, yet its bioactivity properties remain elusive. Here, we report that NMP is a bioactive anti-inflammatory compound well tolerated in vivo, that shows efficacy in reducing disease in a mouse model of atherosclerosis. Mechanistically, NMP increases the expression of the transcription factor Kruppel-like factor 2 (KLF2). Monocytes and endothelial cells treated with NMP express increased levels of KLF2, produce less pro-inflammatory cytokines and adhesion molecules. We found that NMP attenuates monocyte adhesion to endothelial cells inflamed with tumor necrosis factor alpha (TNF-α) by reducing expression of adhesion molecules. We further show using KLF2 shRNA that the inhibitory effect of NMP on endothelial inflammation and subsequent monocyte adhesion is KLF2 dependent. Enhancing KLF2 expression and activity improves endothelial function, controls multiple genes critical for inflammation, and prevents atherosclerosis. Our findings demonstrate a consistent effect of NMP upon KLF2 activation and inflammation, biological processes central to atherogenesis. Our data suggest that inclusion of bioactive solvent NMP in pharmaceutical compositions to treat inflammatory disorders might be beneficial and safe, in particular to treat diseases of the vascular system, such as atherosclerosis.


Asunto(s)
Inflamación/tratamiento farmacológico , Factores de Transcripción de Tipo Kruppel/química , Pirrolidinonas/química , Solventes/química , Animales , Antiinflamatorios/farmacología , Aorta/metabolismo , Apoptosis , Aterosclerosis , Adhesión Celular , Línea Celular , ADN Complementario/metabolismo , Células Endoteliales/efectos de los fármacos , Perfilación de la Expresión Génica , Biblioteca de Genes , Células Endoteliales de la Vena Umbilical Humana , Humanos , Ratones , Ratones Noqueados para ApoE , Monocitos/citología , Monocitos/efectos de los fármacos , ARN Interferente Pequeño/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo
13.
Spine (Phila Pa 1976) ; 42(5): 298-303, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26630415

RESUMEN

STUDY DESIGN: An agreement study. OBJECTIVE: The aim of this study was to perform an independent interobserver and intraobserver agreement assessment of the AOSpine subaxial cervical spine injury classification system. SUMMARY OF BACKGROUND DATA: The AOSpine subaxial cervical spine injury classification system was recently described. It showed substantial inter- and intraobserver agreement in the study describing it; however, an independent evaluation has not been performed. METHODS: Anteroposterior and lateral radiographs, computed tomography scans, and magnetic resonance imaging of 65 patients with acute traumatic subaxial cervical spine injuries were selected and classified using the morphologic grading of the subaxial cervical spine injury classification system by 6 evaluators (3 spine surgeons and 3 orthopedic surgery residents). After a 6-week interval, the 65 cases were presented to the same evaluators in a random sequence for repeat evaluation. The kappa coefficient (κ) was used to determine the inter- and intraobserver agreement. RESULTS: The interobserver agreement was substantial when considering the fracture main types (A, B, C, or F), with κ = 0.61 (0.57-0.64), but moderate when considering the subtypes: κ = 0.57 (0.54-0.60). The intraobserver agreement was substantial considering the fracture types, with κ = 0.68 (0.62-0.74) and considering subtypes, κ = 0.62 (0.57-0.66). No significant differences were observed between spine surgeons and orthopedic residents in the overall inter- and intraobserver agreement, or in the inter- and intraobserver agreement of specific A, B, C, or F type of injuries. CONCLUSION: This classification allows adequate agreement among different observers and by the same observer on separate occasions. Future prospective studies should determine whether this classification allows surgeons to decide the best treatment for patients with subaxial cervical spine injuries. LEVEL OF EVIDENCE: 3.


Asunto(s)
Vértebras Cervicales/lesiones , Vértebras Lumbares/lesiones , Variaciones Dependientes del Observador , Traumatismos Vertebrales/diagnóstico , Vértebras Torácicas/lesiones , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Estudios Prospectivos , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos X/métodos
14.
Nefrologia ; 37(1): 47-53, 2017.
Artículo en Inglés, Español | MEDLINE | ID: mdl-27575931

RESUMEN

BACKGROUND: Chronic fluid overload is frequent in hemodialysis patients (P) and it associates with hypertension, left ventricular hypertrophy (LVH) and higher mortality. Moreover, echocardiographic data assessing fluid overload is limited. Our aim was to evaluate the relationship between fluid overload measured by bioimpedance spectroscopy (BIS) and different echocardiographic parameters. METHODS: Cross-sectional observational study including 76 stable patients. Dry weight was clinically assessed. BIS and echocardiography were performed. Weekly time-averaged fluid overload (TAFO) and relative fluid overload (FO/ECW) were calculated using BIS measurements. RESULTS: Based on TAFO three groups were defined: A- dehydrated, TAFO <-0.25 L 32 P (42%); B- normohydrated, TAFO between -0.25 and 1.5 l: 26 (34%); C- overhydrated, TAFO>1.5 l: 18 (24%). We found significant correlation between TAFO and left atrial volume index (LAVI) (r: 0.29; p=0.013) but not with FO/ECW (r 0.06; p=0.61). TAFO, but not FO/ECW kept a significant relationship with LAVI (p=0.03) using One-Way ANOVA test and linear regression methods. LVH was present in 73.7% (concentric 63.2%, eccentric in 10.5%). No differences between groups in the presence of LVH or left ventricular mass index were found. CONCLUSIONS: We found that left atrial volume index determined by echocardiographic Area-length method, but not left ventricle hypertrophy or dimensions of cavities, are related on hydration status based on bioimpedance measured time-averaged fluid overload (TAFO), and not with FO/ECW.


Asunto(s)
Ecocardiografía , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Estado de Hidratación del Organismo , Diálisis Renal , Insuficiencia Renal Crónica/complicaciones , Anciano , Estudios Transversales , Espectroscopía Dieléctrica , Femenino , Atrios Cardíacos/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/etiología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Hipertensión/etiología , Hipertrofia Ventricular Izquierda/etiología , Masculino , Persona de Mediana Edad , Diálisis Renal/efectos adversos
15.
Injury ; 47(4): 859-64, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26653269

RESUMEN

INTRODUCTION: It has been postulated that the complex patterns of spinal injuries have prevented adequate agreement using thoraco-lumbar spinal injuries (TLSI) classifications; however, limb fracture classifications have also shown variable agreements. This study compared agreement using two TLSI classifications with agreement using two classifications of fractures of the trochanteric area of the proximal femur (FTAPF). MATERIAL AND METHODS: Six evaluators classified the radiographs and computed tomography scans of 70 patients with acute TLSI using the Denis and the new AO Spine thoraco-lumbar injury classifications. Additionally, six evaluators classified the radiographs of 70 patients with FTAPF using the Tronzo and the AO schemes. Six weeks later, all cases were presented in a random sequence for repeat assessment. The Kappa coefficient (κ) was used to determine agreement. RESULTS: Inter-observer agreement: For TLSI, using the AOSpine classification, the mean κ was 0.62 (0.57-0.66) considering fracture types, and 0.55 (0.52-0.57) considering sub-types; using the Denis classification, κ was 0.62 (0.59-0.65). For FTAPF, with the AO scheme, the mean κ was 0.58 (0.54-0.63) considering fracture types and 0.31 (0.28-0.33) considering sub-types; for the Tronzo classification, κ was 0.54 (0.50-0.57). Intra-observer agreement: For TLSI, using the AOSpine scheme, the mean κ was 0.77 (0.72-0.83) considering fracture types, and 0.71 (0.67-0.76) considering sub-types; for the Denis classification, κ was 0.76 (0.71-0.81). For FTAPF, with the AO scheme, the mean κ was 0.75 (0.69-0.81) considering fracture types and 0.45 (0.39-0.51) considering sub-types; for the Tronzo classification, κ was 0.64 (0.58-0.70). CONCLUSION: Using the main types of AO classifications, inter- and intra-observer agreement of TLSI were comparable to agreement evaluating FTAPF; including sub-types, inter- and intra-observer agreement evaluating TLSI were significantly better than assessing FTAPF. Inter- and intra-observer agreements using the Denis classification were also significantly better than agreement using the Tronzo scheme.


Asunto(s)
Fémur/diagnóstico por imagen , Fracturas Óseas/clasificación , Fracturas Óseas/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Traumatismos Vertebrales/clasificación , Traumatismos Vertebrales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Fémur/anatomía & histología , Fémur/patología , Fracturas Óseas/patología , Humanos , Vértebras Lumbares/anatomía & histología , Vértebras Lumbares/patología , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Estudios Retrospectivos , Traumatismos Vertebrales/patología
16.
Spine (Phila Pa 1976) ; 40(1): E54-8, 2015 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-25341990

RESUMEN

STUDY DESIGN: Agreement study. OBJECTIVE: To perform an independent interobserver and intraobserver agreement evaluation of the new AOSpine Thoracolumbar Spine Injury Classification System. SUMMARY OF BACKGROUND DATA: The new AOSpine Thoracolumbar Spine Injury Classification System was recently published. It showed substantial reliability and reproducibility among the surgeons who developed it; however, an independent evaluation has not been performed. METHODS: Anteroposterior and lateral radiographs, and computed tomographic scans of 70 patients with acute traumatic thoracolumbar injuries were selected and classified using the morphological grading of the new AOSpine Thoracolumbar Spine Injury Classification System by 6 evaluators (3 spine surgeons and 3 orthopedic surgery residents). After a 6-week interval, the 70 cases were presented in a random sequence to the same evaluators for repeat evaluation. The Kappa coefficient (κ) was used to determine the interobserver and intraobserver agreement. RESULTS: The interobserver reliability was substantial when considering the fracture type (A, B, or C), with a κ= 0.62 (0.57-0.66). The interobserver agreement when considering the subtypes was moderate; κ= 0.55 (0.52-0.57). The intraobserver reproducibility was also substantial, with 85.95% full intraobserver reproducibility considering the fracture type, with κ= 0.77 (0.72-0.83), and was also substantial when considering subtypes with 75.71% full agreement and κ= 0.71 (0.67-0.76). No significant differences were observed between spine surgeons and orthopedic residents in the overall interobserver reliability and intraobserver reproducibility, or in the inter- and intraobserver agreement of specific A, B, or C types of injuries. CONCLUSION: This classification allows adequate agreement among different observers and by the same observer on separate occasions. Future prospective studies should evaluate whether this classification improves clinical decision making.


Asunto(s)
Vértebras Lumbares/lesiones , Ortopedia , Fracturas de la Columna Vertebral/clasificación , Vértebras Torácicas/lesiones , Competencia Clínica , Becas , Humanos , Internado y Residencia , Vértebras Lumbares/diagnóstico por imagen , Variaciones Dependientes del Observador , Radiografía , Reproducibilidad de los Resultados , Fracturas de la Columna Vertebral/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagen
17.
Nefrología (Madr.) ; 37(1): 47-53, ene.-feb. 2017. tab
Artículo en Inglés | IBECS (España) | ID: ibc-160598

RESUMEN

Background: Chronic fluid overload is frequent in hemodialysis patients (P) and it associates with hypertension, left ventricular hypertrophy (LVH) and higher mortality. Moreover, echocardiographic data assessing fluid overload is limited. Our aim was to evaluate the relationship between fluid overload measured by bioimpedance spectroscopy (BIS) and different echocardiographic parameters. Methods: Cross-sectional observational study including 76 stable patients. Dry weight was clinically assessed. BIS and echocardiography were performed. Weekly time-averaged fluid overload (TAFO) and relative fluid overload (FO/ECW) were calculated using BIS measurements. Results: Based on TAFO three groups were defined: A- dehydrated, TAFO <-0.25 L 32 P (42%); B- normohydrated, TAFO between -0.25 and 1.5 l: 26 (34%); C- overhydrated, TAFO>1.5 l: 18 (24%). We found significant correlation between TAFO and left atrial volume index (LAVI) (r: 0.29; p=0.013) but not with FO/ECW (r 0.06; p=0.61). TAFO, but not FO/ECW kept a significant relationship with LAVI (p=0.03) using One-Way ANOVA test and linear regression methods. LVH was present in 73.7% (concentric 63.2%, eccentric in 10.5%). No differences between groups in the presence of LVH or left ventricular mass index were found. Conclusions: We found that left atrial volume index determined by echocardiographic Area-length method, but not left ventricle hypertrophy or dimensions of cavities, are related on hydration status based on bioimpedance measured time-averaged fluid overload (TAFO), and not with FO/ECW (AU)


Introducción: La sobrehidratación es frecuente en pacientes en hemodiálisis (P) y se asocia con hipertensión, hipertrofia ventricular izquierda (LVH) y mayor mortalidad. Los datos ecocardiográficos evaluando sobrecarga hídrica son escasos. Nuestro objetivo fue evaluar la relación entre sobrehidratación medida por Bioimpedancia multifrecuencia (BIS) y parámetros ecocardiográficos. Métodos: Estudio transversal observacional, con 76 P estables; El peso seco fue determinado clínicamente; se realizaron ecocardiograma, BIS y analítica sanguínea. Se calcularon la sobrehidratación promedio semanal (TAFO) y sobrehidratación relativa (FO/ECW). Resultados: 3 grupos: A- deshidratados, TAFO <-0.25 L: 32 P (42,1%); B- normohidratado, TAFO -0.25 - 1.5 L: 26 P (34,2%); C- sobrehidratados TAFO > 1.5 L: 18 P (23,7%). Encontramos correlación significativa entre TAFO e índice de volumen auricular izquierdo (LVAI) (r: 0.29; p=0.013) y no con FO/ECW (rho 0,06; p = 0,61). TAFO, pero no FO/ ECW, mantuvo una relación significativa con LVAI (p = 0,03) utilizando test de ANOVA y regresión lineal. LVH estuvo presente en 73,7% de P (concéntrica 63,2%, excéntrica 10,5%). No encontramos diferencias entre grupos en cuanto a la presencia de LVH, ni del índice de masa ventricular izquierda. Conclusiones: Nosotros observamos que el índice de volumen auricular izquierdo determinado por longitud de área medida por ecocardiograma y no la hipertrofia ventricular izquierda o dimensión de cavidades se relaciona con el estado de hidratación medido por sobrehidatación semanal y no con FO/ECW (AU)


Asunto(s)
Humanos , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/complicaciones , Desequilibrio Hidroelectrolítico/fisiopatología , Composición Corporal , Impedancia Eléctrica , Estudios Transversales , Deshidratación/fisiopatología , Función del Atrio Izquierdo , Ecocardiografía
18.
Rev Med Chil ; 135(4): 529-33, 2007 Apr.
Artículo en Español | MEDLINE | ID: mdl-17554464

RESUMEN

Authors of clinical articles have similar motivations and rules than authors in other scientific fields. In addition, medical research must obey specific ethical rules that apply to studies involving human subjects, including biological samples, tissues, cellular or sub cellular samples obtained from them. When submitting their reports for publication, authors must declare that they have followed such ethical rules and also should declare any possible conflict of interest that may have arisen. External peer reviewers and the editors should also conform to limitations by eventual conflicts of interest. Authors should respect specific ethical norms that apply to the process of submitting, publishing and reproducing their manuscripts. In recent years, the editors of Revista Médica de Chile have become aware of five instances of misconduct committed by authors of articles submitted or already published. Four correspond to redundant publications and one exhibits overt plagiarism in the text and syntax. Appropriate actions have been taken following recommendations published by the International Committee of Medical Journal Editors, the World Association of Medical Editors and other groups. The present article stresses that authors and their sponsoring institutions must be aware of the importance of following ethical rules when reporting scientific work.


Asunto(s)
Investigación Biomédica/ética , Publicaciones Periódicas como Asunto/ética , Edición/ética , Chile , Conflicto de Intereses , Publicaciones Duplicadas como Asunto , Políticas Editoriales , Ética en Investigación , Experimentación Humana/ética , Humanos , Revisión de la Investigación por Pares , Plagio , Mala Conducta Científica
19.
Hepatology ; 43(4): 715-22, 2006 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-16557543

RESUMEN

Increased gastrointestinal permeability has been demonstrated in several liver diseases. It may facilitate the absorption of gut-derived endotoxin-stimulating Kupffer cells to release proinflammatory cytokines or other potentially hepatotoxic compounds. We examined gastrointestinal permeability, plasma levels of anti-lipopolysacharides (anti-LPS), and four proinflammatory cytokines in 20 patients with intrahepatic cholestasis of pregnancy (ICP) compared with 22 normal pregnant and 29 non-pregnant women. Urinary excretion of sucrose and the urinary lactulose/mannitol (L/M) ratio after a standard oral load were used to assess gastrointestinal permeability. Anti-LPS (IgA, IgM, and IgG) were measured in peripheral blood by Human EndoCAb test kit; TNF-alpha, IL-1beta, IL-6, and IL-10 by Quantikine HS human immunoassays. Sucrose urinary excretion was similar in the three groups, indicating normal gastric permeability. The urinary L/M ratio was significantly higher in ICP than in the other groups [median (interquartile range): 0.018% (0.011-0.023) in ICP, 0.012% (0.009-0.016) in normal pregnancies, and 0.009% (0.008-0.012) in non-pregnant women, P < .01]. No significant differences were found in anti-LPS or cytokines plasma levels except slightly higher levels of IL-6 in ICP patients than in non-pregnant women (P < .05). Four of five women with abnormal urinary L/M ratio during ICP continued to show abnormalities in tests up to 2 years after delivery. In conclusion, an increased intestinal permeability was detected in ICP patients during and after pregnancy. A "leaky gut" may participate in the pathogenesis of ICP by enhancing the absorption of bacterial endotoxin and the enterohepatic circulation of cholestatic metabolites of sex hormones and bile salts.


Asunto(s)
Colestasis Intrahepática/etiología , Mucosa Intestinal/metabolismo , Complicaciones del Embarazo/etiología , Adulto , Anticuerpos/sangre , Estudios de Casos y Controles , Colestasis Intrahepática/sangre , Colestasis Intrahepática/inmunología , Colestasis Intrahepática/orina , Citocinas/sangre , Citocinas/metabolismo , Femenino , Humanos , Interleucina-6/sangre , Lactulosa/orina , Lipopolisacáridos/inmunología , Lipopolisacáridos/farmacología , Manitol/orina , Monocitos/efectos de los fármacos , Monocitos/metabolismo , Permeabilidad , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/inmunología , Complicaciones del Embarazo/orina , Resultado del Embarazo
20.
Liver Int ; 25(3): 548-54, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15910492

RESUMEN

OBJECTIVE: To assess the efficacy of ursodeoxycholic acid (UDCA) in patients with intrahepatic cholestasis of pregnancy (ICP) and in the outcome of pregnancy. METHODS: Retrospective analysis of our 12-year experience treating ICP patients with UDCA. Thirty-two patients with pruritus starting before week 34 of pregnancy and with increased serum bile salts (BS) and alanine aminotransferase (ALT) received UDCA (15 mg/kg/day) for at least 3 weeks before delivery. They were compared with 16 historical controls who did not receive UDCA. All patients were followed up until delivery and in puerperium. Newborns were followed up during 3 months. RESULTS: UDCA treatment attenuated pruritus (P < 0.05), serum bilirubin and ALT decreased (P < 0.05) and BS declined. Delivery at term (> or = 37 weeks) occurred in 65.7% of UDCA-treated patients compared with only 12.5% in controls (P < 0.01). Infants born to mothers treated with UDCA weighed a mean of 500 g more than the controls (2882+/-582 vs 2385+/-582; P < 0.01). At 3 months, all infants developed normally. Twenty-six children whose mothers received UDCA were re-examined after 1-12 years and they and their mothers were healthy. CONCLUSIONS: UDCA improved pruritus and biochemical cholestasis, and facilitated deliveries at term in ICP patients, with a higher birthweight compared with historical controls. The drug was well tolerated and no adverse effects were detected in their infants.


Asunto(s)
Colagogos y Coleréticos/administración & dosificación , Colestasis Intrahepática/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico , Ácido Ursodesoxicólico/administración & dosificación , Adulto , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Colagogos y Coleréticos/efectos adversos , Femenino , Humanos , Pacientes Internos , Pacientes Ambulatorios , Embarazo , Resultado del Embarazo , Prurito/tratamiento farmacológico , Estudios Retrospectivos , Ácido Ursodesoxicólico/efectos adversos , gamma-Glutamiltransferasa/sangre
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