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OBJECTIVES: The safety and analgesic efficacy of perioperative glucocorticoids have been established for patients without rheumatoid arthritis. Therefore, our study aims to investigate whether similar benefits can be observed in patients with rheumatoid arthritis undergoing total joint arthroplasty. Specifically, we aim to explore the impact of perioperative glucocorticoid use on postoperative complications, opioid consumption, incidence of hypotension, hyperglycemia, 30-day mortality, and 90-day re-admission in this patient population. METHODS: Approval for the study protocol was obtained from the Medical Research Ethics Committee at Sichuan University, aligning with the principles outlined in the Declaration of Helsinki. We retrospectively analyzed a consecutive series of patients with rheumatoid arthritis who underwent total joint arthroplasty at our medical center between November 2009 and April 2021 and who were not on chronic glucocorticoid therapy before surgery. Those who received glucocorticoids at any time during hospitalization were compared to those who did not in terms of acute complications within 90 days after surgery as well as postoperative rescue opioid consumption, hypotension, and hyperglycemia during hospitalization. The two groups were also compared in terms of overall duration of hospitalization, all-cause mortality within 30 days, and readmission for any reason within 90 days. Continuous data were assessed for significance using the independent-samples t test. Categorical data were assessed using the Pearson chi-squared test. RESULTS: Of the 849 patients included in the analysis, 598 administered perioperative glucocorticoids and 251 did not. Prior to surgery, the two groups did not differ significantly in any clinicodemographic variable that we examined. The incidence of acute postoperative complications (2.3% vs. 4.0%, p = 0.187) and acute postoperative infection (2.0% vs. 2.8%, p = 0.482) was comparable between those who received perioperative glucocorticoids and those who did not, but the former group exhibited a significantly lower incidence of rescue opioid use (17.9% vs. 44.6%, p < 0.001) as well as significantly lower total rescue opioid consumption (4.7 ± 2.1 mg vs. 8.9 ± 4.6 mg, p < 0.001). However, the two groups showed similar incidences of postoperative hypotension, hyperglycemia, 30-day mortality, and 90-day re-admission. CONCLUSION: Perioperative glucocorticoids may reduce the need for rescue opioids after total joint arthroplasty of rheumatoid arthritis patients, without increasing the incidence of acute complications, hypotension or hyperglycemia.
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Artrite Reumatoide , Glucocorticoides , Complicações Pós-Operatórias , Humanos , Glucocorticoides/uso terapêutico , Artrite Reumatoide/cirurgia , Artrite Reumatoide/tratamento farmacológico , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Incidência , Idoso , Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho , Artroplastia de Quadril , Assistência Perioperatória/métodos , Readmissão do Paciente/estatística & dados numéricos , AdultoRESUMO
BACKGROUND: Identifying rheumatoid arthritis patients at higher risk of complications after total hip arthroplasty could make perioperative management more effective. Here we examined whether disease activity is associated with risk of such complications. METHODS: We retrospectively analyzed data for 337 rheumatoid arthritis patients at our medical center who underwent primary total hip arthroplasty. Rheumatoid arthritis patients were categorized according to the simplified disease activity index (SDAI), the values of which at admission and follow-up were averaged together. Logistic regression was used to examine associations of mean SDAI with rates of dislocation, infection, periprosthetic fracture and aseptic loosening. As controls, 337 osteoarthritis patients who did not have systemic inflammation and who underwent the same procedure were matched across numerous clinicodemographic variables. RESULTS: Among the 337 rheumatoid arthritis patients, 38 (11.3%) had postoperative complications, the rates of which varied significantly from 0 to 17.5% (p = 0.003) among the four subgroups whose disease activity based on mean SDAI was categorized as high, moderate, low or in remission. Each 1-unit increase in mean SDAI was associated with a significant increase in risk of postoperative complications (OR 1.015, 95% CI 1.001-1.029, p = 0.035). Across all rheumatoid arthritis patients, rate of complications did not differ significantly between patients who received disease-modifying anti-rheumatic drugs or other treatments. Rates of dislocation, of infection or of all postoperative complications combined were significantly lower among osteoarthritis controls than among rheumatoid arthritis patients. CONCLUSION: Greater mean SDAI is associated with higher risk of dislocation, infection and composite postoperative complications after total hip arthroplasty in rheumatoid arthritis patients. These patients show a significantly higher rate of postoperative complications than osteoarthritis patients, likely reflecting the influence of systemic inflammation. Disease activity should be reduced as much as possible in rheumatoid arthritis patients before they undergo total hip arthroplasty.
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Artrite Reumatoide , Artroplastia de Quadril , Complicações Pós-Operatórias , Humanos , Artroplastia de Quadril/efeitos adversos , Artrite Reumatoide/cirurgia , Artrite Reumatoide/complicações , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Estudos de Coortes , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
Critical-size bone defects pose a formidable challenge in clinical treatment, prompting extensive research efforts to address this problem. In this study, an inorganic-organic multifunctional composite hydrogel denoted as PLG-g-TA/VEGF/Sr-BGNPs is developed, engineered for the synergistic management of bone defects. The composite hydrogel demonstrated the capacity for mineralization, hydroxyapatite formation, and gradual release of essential functional ions and vascular endothelial growth factor (VEGF) and also maintained an alkaline microenvironment. The composite hydrogel promoted the proliferation and osteogenic differentiation of rat bone marrow mesenchymal stem cells (rBMSCs), as indicated by increased expression of osteogenesis-related genes and proteins in vitro. Moreover, the composite hydrogel significantly enhanced the tube-forming capability of human umbilical vein endothelial cells (HUVECs) and effectively inhibited the process of osteoblastic differentiation of nuclear factor kappa-B ligand (RANKL)-induced Raw264.7 cells and osteoclast bone resorption. After the implantation of the composite hydrogel into rat cranial bone defects, the expression of osteogenic and angiogenic biomarkers increased, substantiating its efficacy in promoting bone defect repair in vivo. The commendable attributes of the multifunctional composite hydrogel underscore its pivotal role in expediting hydrogel-associated bone growth and repairing critical bone defects, positioning it as a promising adjuvant therapy candidate for large-segment bone defects.
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Regeneração Óssea , Hidrogéis , Osteogênese , Fator A de Crescimento do Endotélio Vascular , Animais , Ratos , Regeneração Óssea/efeitos dos fármacos , Hidrogéis/química , Hidrogéis/farmacologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Osteogênese/efeitos dos fármacos , Humanos , Diferenciação Celular/efeitos dos fármacos , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/metabolismo , Camundongos , Células Endoteliais da Veia Umbilical Humana , Ratos Sprague-Dawley , Vidro/química , Modelos Animais de Doenças , Silicatos/química , Silicatos/farmacologia , Proliferação de Células/efeitos dos fármacos , MasculinoRESUMO
OBJECTIVE: Despite the established success of total knee arthroplasty (TKA) with end-stage osteoarthritis, there is a notable scarcity of research on its long-term outcomes in individuals suffering from end-stage Kashin-Beck disease (KBD). This retrospective study aimed to assess the long-term outcomes and effectiveness of clinical function, quality of life, and complications of TKA and end-stage KBD patients in Tibetan highland areas. METHODS: The retrospective cohort included 43 KBD patients, comprising a total of 59 knees, who had undergone TKA at West China Hospital, Sichuan University between 2008 and 2021. Patients were subsequently followed up for a minimum of 3 years, and received rigorous radiological and clinical assessments at 3, 6, and 12 months post surgery, followed by annual examinations thereafter. The evaluation included various efficacy indices, including visual analogue scale (VAS) scores, hospital for special surgery (HSS) scores, functional score for adult Tibetans with Kashin-Beck disease (FSAT-KBD), and radiographic findings. Comparison of indicators within the same group was conducted using one-way repeated-measures analysis of variance or paired sample t-tests, whereas between-group differences were compared using an independent t-test. RESULTS: Throughout the average follow-up duration of 10.8 years, patients experienced a substantial reduction in knee pain and noteworthy functional improvement. The VAS scores decreased significantly from 77.47 ± 4.12 mm before surgery to 10.91 ± 1.97 mm after surgery, indicating considerable alleviation of knee pain. The HSS scores improved markedly, increasing from 44.26 ± 4.95 preoperatively to 91.26 ± 4.37, indicating enhanced joint function. Similarly, the FSAT-KBD exhibited positive progression, increasing from 25.90 ± 3.12 to 36.95 ± 3.54. Importantly, at the last follow-up, none of the patients presented with periprosthetic infection, prosthesis loosening, or periprosthetic fracture. CONCLUSION: At long-term follow-up, compared with patients in the preoperative period, patients in Tibetan highland areas with KBD of the knee who underwent TKA benefited from a significant reduction in pain, improvement in joint function, and satisfactory improvement in quality of life.
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Artroplastia do Joelho , Doença de Kashin-Bek , Humanos , Artroplastia do Joelho/métodos , Estudos Retrospectivos , Masculino , Pessoa de Meia-Idade , Feminino , Doença de Kashin-Bek/cirurgia , Seguimentos , Tibet , Idoso , Qualidade de Vida , Medição da Dor , Adulto , Osteoartrite do Joelho/cirurgia , ChinaRESUMO
BACGROUND: The aim of this study was to assess the learning curve of a novel seven-axis robot-assisted total hip arthroplasty (RaTHA) system. METHODS: A total of 59 patients who underwent unilateral total hip arthroplasty at our institution from June 2022 to September 2022 were prospectively included in the study. In this randomized controlled clinical trial, robot-assisted THA (RaTHA) and Conventional THA (CoTHA) were performed using cumulative sum (CUSUM) analysis to evaluate the learning curve of the RaTHA system. The demographic data, preopera1tive clinical data, duration of operation, postoperative Harris Hip Score (HHS), postoperative Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and duration of operation between the learning stage and the proficiency stage of the RaTHA group were compared between the two groups. RESULTS: The average duration of operation of the RaTHA group was increased by 34.73 min compared with the CoTHA group (104.26 ± 19.33 vs. 69.53 ± 18.38 min, p < 0.01). The learning curve of the RaTHA system can be divided into learning stage and proficiency stage, and the former consists of the first 13 cases by CUSUM analysis. In the RaTHA group, the duration of operation decreased by 29.75 min in the proficiency stage compared to the learning stage (121.12 ± 12.84 vs.91.37 ± 12.92, p < 0.01). CONCLUSIONS: This study demonstrated that the surgical team required a learning curve of 13 cases to become proficient using the RaTHA system. The duration of operation, total blood loss, and drainage gradually shortened (decreased) with the learning curve stage, and the differences were statistically significant. TRIAL REGISTRATION: Number: ChiCTR2200061630, Date: 29/06/2022.
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Artroplastia de Quadril , Curva de Aprendizado , Duração da Cirurgia , Procedimentos Cirúrgicos Robóticos , Humanos , Artroplastia de Quadril/educação , Artroplastia de Quadril/métodos , Artroplastia de Quadril/instrumentação , Feminino , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Estudos Prospectivos , Resultado do Tratamento , AdultoRESUMO
STUDY DESIGN: A retrospective cohort study. OBJECTIVE: The goal of this study was to develop a useful clinical prediction nomogram to accurately predict the cancer-specific survival (CSS) of patients with primary spinal cord tumor (SCT), thereby formulating scientific prevention and aiding clinical decision-making. METHODS: In this study, patients with SCT diagnoses from the surveillance, epidemiology, and end results (SEER) database (2000-2018) were taken into account. Initially, a nomogram was created using the CSS-associated independent factors that were determined from both univariate and multivariable Cox regression analyses. Furthermore, the nomogram's capacity for calibration, ability to discriminate, and actual clinical effectiveness were assessed through calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA), respectively. Finally, a strategy for categorizing SCT patients' risk was developed. RESULTS: This study included 909 SCT individuals. A novel nomogram was developed to forecast SCT patients' CSS, taking into account age, histological type, tumor grade, tumor stage, and radiotherapy. These factors were identified as independent prognostic indicators for CSS in SCT patients. Elderly SCT patients with distant metastasis, advanced tumor grade, received radiotherapy, and confirmed lymphoma have a poor prognosis. Meanwhile, the risk classification system could differentiate SCT patients and realize targeted management. CONCLUSIONS: The developed nomogram has the ability to accurately forecast the CSS in SCT individuals, aiding in precise decision-making during clinical practice, enhancing health planning, maximizing treatment advantages, and ultimately improving patient prognosis.
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Foreign body reaction (FBR) is a prevalent yet often overlooked pathological phenomenon, particularly within the field of biomedical implantation. The presence of FBR poses a heavy burden on both the medical and socioeconomic systems. This review seeks to elucidate the protein "fingerprint" of implant materials, which is generated by the physiochemical properties of the implant materials themselves. In this review, the activity of macrophages, the formation of foreign body giant cells (FBGCs), and the development of fibrosis capsules in the context of FBR are introduced. Additionally, the relationship between various implant materials and FBR is elucidated in detail, as is an overview of the existing approaches and technologies employed to alleviate FBR. Finally, the significance of implant components (metallic materials and non-metallic materials), surface CHEMISTRY (charge and wettability), and physical characteristics (topography, roughness, and stiffness) in establishing the protein "fingerprint" of implant materials is also well documented. In conclusion, this review aims to emphasize the importance of FBR on implant materials and provides the current perspectives and approaches in developing implant materials with anti-FBR properties.
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Reação a Corpo Estranho , Próteses e Implantes , Reação a Corpo Estranho/etiologia , Humanos , Próteses e Implantes/efeitos adversos , Animais , Materiais Biocompatíveis/química , Propriedades de Superfície , Células Gigantes de Corpo Estranho/patologiaRESUMO
Background: Previous studies have demonstrated the efficacy of bone wax in reducing blood loss in various orthopedic surgeries. However, the effect of bone wax on total hip arthroplasty (THA) remains unclear. The objective of this study was to assess the efficacy of bone wax in THA. Methods: We enrolled 104 patients in this randomized controlled trial. These patients were randomized (1:1) to either the bone wax or control group. The primary outcome was total blood loss after THA. The secondary outcomes included serum hemoglobin (Hb) level, change in Hb level, lower limb diameters on the first and third postoperative day (POD), range of motion at discharge, length of postoperative hospital stay, and adverse events. Results: Patients in the bone wax group had significantly lower total blood loss on PODs 1 and 3 (p < 0.05). Moreover, patients in the bone wax group performed better in terms of postoperative serum Hb level, change in Hb level on PODs 1 and 3, and length of postoperative hospital stay (all p < 0.05). Patients in the bone wax group did not experience any bone wax-related adverse events. Conclusion: Bone wax administration in THA significantly reduced perioperative blood loss. Therefore, bone wax is promising for optimizing blood-conserving management protocols in THA. Clinical trial registration: [https://clinicaltrials.gov/], identifier [ChiCTR2100043868].
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BACKGROUND: Whether symptomatic benign prostatic hyperplasia (sBPH), which is common among middle-aged and older men, affects the risk of periprosthetic joint infection (PJI) remains controversial. The present study explored this question among men undergoing total knee arthroplasty and total hip arthroplasty (TKA and THA). METHODS: We retrospectively analyzed medical data from 948 men who underwent primary TKA or THA at our institution between 2010 and 2021. We compared the incidence of postoperative complications such as PJI, urinary tract infection (UTI), and postoperative urinary retention (POUR) between 316 patients (193 hips and 123 knees) who did and 632 patients who did not have sBPH; the 2 groups of patients were matched to each other in a 1:2 ratio based on numerous clinical demographic variables. In the subgroup analyses, we stratified sBPH patients according to whether they began anti-sBPH medical therapy prior to arthroplasty. RESULTS: PJI following primary TKA was significantly more common among sBPH patients than among patients who did not have sBPH (4.1 vs 0.4%; P = .029), as were UTI (P = .029), and POUR (P < .001). Patients who had sBPH also had an increased incidence of UTI (P = .006) and POUR (P < .001) following THA. Among sBPH patients, those who started anti-sBPH medical therapy before TKA suffered significantly lower incidence of PJI than those who did not. CONCLUSION: Symptomatic benign prostatic hyperplasia is a risk factor for PJI after primary TKA among men, and starting appropriate medical therapy before surgery can reduce the risk of PJI following TKA and postoperative urinary complications following TKA and THA.
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Artrite Infecciosa , Artroplastia do Joelho , Hiperplasia Prostática , Infecções Relacionadas à Prótese , Masculino , Pessoa de Meia-Idade , Humanos , Idoso , Artroplastia do Joelho/efeitos adversos , Hiperplasia Prostática/cirurgia , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Periarticular infiltration analgesia (PIA) is widely administered to relieve postoperative pain following total knee arthroplasty (TKA). The present study aimed to evaluate the effect of prolonging the analgesic duration by adding dexmedetomidine to PIA for pain management after TKA. METHODS: One hundred and sixteen patients were randomly allocated into 3 groups based on PIA regimens including group R (ropivacaine), group E (ropivacaine plus epinephrine), and group D (ropivacaine plus dexmedetomidine). The primary outcomes were postoperative visual analog scale scores, time until the administration of first rescue analgesia, and opioid consumption. The secondary outcomes included postoperative inflammatory biomarkers and functional recovery. The tertiary outcomes were postoperative complications and adverse events. RESULTS: The patients in group D had significantly lower resting visual analog scale scores than those in groups R and E at 6 hours after surgery. Group R showed the higher pain scores at rest and motion than groups D and E 12 hours postoperatively. The use of dexmedetomidine or epinephrine postponed the time until the administration of first rescue analgesia and led to lower opioid consumption in the first 24 hours after TKA. The levels of interleukin-8 and tumor necrosis factor-α in groups D and E were significantly lower than those in group R on postoperative day 3. Furthermore, no significant differences were observed in functional recovery, postoperative complications, or adverse events among the three groups. CONCLUSIONS: Adding dexmedetomidine as an adjuvant to PIA could potentiate and prolong the analgesic effect in the early stage following TKA without increasing the risk of adverse events.
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Analgesia , Artroplastia do Joelho , Dexmedetomidina , Humanos , Ropivacaina , Artroplastia do Joelho/efeitos adversos , Manejo da Dor/efeitos adversos , Dexmedetomidina/uso terapêutico , Analgésicos Opioides , Estudos Prospectivos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Epinefrina/uso terapêutico , Complicações Pós-Operatórias/etiologia , Método Duplo-Cego , Anestésicos Locais/uso terapêuticoRESUMO
BACKGROUND: Primary osseous sarcoma of the pelvis is rare and has a particularly sinister outcome. This study aims to identify independent prognostic factors of cancer-specific survival (CSS) in patients with primary pelvic sarcoma (PS) and develop a nomogram to predict 3-, 5-, and 10-year probability of CSS in these patients. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 416 patients with primary PS, who were divided into two groups: a training cohort and a validation cohort. Univariate and multivariate Cox analyses were used to screen independent prognostic factors in patients with primary PS. Based on these independent prognostic factors, a prognostic nomogram was developed to predict 3-, 5-, and 10-year probability of CSS. The nomogram's predictive performance and clinical value were evaluated using the calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Finally, a mortality risk stratification system was developed. RESULTS: Tumor size, tumor stage, histological type, surgery, and chemotherapy were identified as independent prognostic factors for the CSS of primary PS patients. Based on these factors, a nomogram was created to predict the 3-, 5-, and 10-year probability of CSS in these patients. The calibration curve, ROC, and DCA indicated that the nomogram performed well and was appropriate for clinical use, with 3-, 5-, and 10-year areas under ROC curve all higher than 0.800. Furthermore, the nomogram-based mortality risk stratification system could effectively divide these patients into three risk subgroups. CONCLUSIONS: The nomogram constructed in this study could accurately predict 3-, 5-, and 10-year probability of CSS in patients with primary PS. Clinicians can use the nomogram to categorize these patients into risk subgroups and provide personalized treatment plans.
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Neoplasias , Pelve , Humanos , Estudos Retrospectivos , Osso e Ossos , Calibragem , Nomogramas , Programa de SEERRESUMO
BACKGROUND: Major symptoms of depression are commonly observed in patients requiring total hip arthroplasty (THA), and this is associated with increased pain scores and opioid consumption. We aimed to investigate the analgesic effect of duloxetine in these high-risk patients. METHODS: Among 263 patients scheduled for primary unilateral THA, 67 patients who scored at least 8 on the 17-item Hamilton Depression Scale (HAMD) were enrolled in this study. Patients were randomized to the duloxetine group (60 mg daily, from the day of surgery to postoperative day 6) or the placebo group. The postoperative visual analog scale (VAS) score during walking, the VAS score during hip flexion, and resting VAS score was measured. Postoperative morphine consumption, hip range of motion (ROM), Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, postoperative length of stay (LOS), and adverse events were recorded. RESULTS: The duloxetine group had significantly lower VAS scores during walking and hip flexion from postoperative day 3 to week 3 than the placebo group. With regard to the resting VAS score, duloxetine showed a better analgesic effect from postoperative day 3 to week 2 than placebo. Patients in the duloxetine group had less consumption of morphine. The duloxetine group exhibited better hip function scores, including ROM, HHS, and WOMAC function scores than the placebo group. No significant difference was observed in LOS or adverse events between groups. CONCLUSION: Perioperative short-term duloxetine provides advantages in decreasing pain, reducing morphine consumption, and increasing hip function in THA patients who have depressive symptoms.
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Artroplastia de Quadril , Humanos , Cloridrato de Duloxetina/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Depressão , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/diagnóstico , Analgésicos/uso terapêutico , Morfina/uso terapêutico , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Resultado do TratamentoRESUMO
BACKGROUND: This study aims to determine the independent prognostic predictors of cancer-specific survival (CSS) in patients with primary Ewing sarcoma (ES) that underwent chemotherapy and create a novel prognostic nomogram and risk stratification system. METHODS: Demographic and clinicopathologic characteristics related to patients with primary ES that underwent chemotherapy between 2000 and 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. CSS was the primary endpoint of this study. First, independent prognostic predictors of CSS identified from univariate and multivariate Cox regression analyses were used to construct a prognostic nomogram for predicting 1-, 3-, and 5-year CSS of patients with primary ES that underwent chemotherapy. Then, calibration curves and receiver operating characteristic (ROC) curves were used to evaluate the nomogram's prediction accuracy, while decision curve analysis (DCA) was used to evaluate the nomogram's clinical utility. Finally, a mortality risk stratification system was constructed for this subpopulation. RESULTS: A total of 393 patients were included in this study. Age, tumor size, bone metastasis, and surgery were independent prognostic predictors of CSS. The calibration curves, ROC, and DCA showed that the nomogram had excellent discrimination and clinical value, with the 1-, 3-, and 5-year AUCs higher than 0.700. Moreover, the mortality risk stratification system could effectively divide all patients into three risk subgroups and achieve targeted patient management. CONCLUSIONS: Based on the SEER database, a novel prognostic nomogram for predicting 1-, 3-, and 5- year CSS in patients with primary ES that underwent chemotherapy has been constructed and validated. The nomogram showed relatively good performance, which could be used in clinical practice to assist clinicians in individualized treatment strategies.
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Sarcoma de Ewing , Humanos , Sarcoma de Ewing/tratamento farmacológico , Estudos Retrospectivos , Nomogramas , Área Sob a Curva , Calibragem , Programa de SEER , PrognósticoRESUMO
Background: The past decade has witnessed an improvement in survival rates for breast cancer, with significant inroads achieved in diagnosis and treatment approaches. Even though chemotherapy is effective for this patient population, cardiotoxicity remains a major challenge, especially in older people. It has been established that cardiovascular events are a major cause of death in older female primary breast cancer patients that underwent chemotherapy. In the present study, the independent prognostic factors were identified to develop a novel nomogram for predicting long-term heart disease-specific survival (HDSS) and improving patient management. Method: Older female primary breast cancer patients that underwent chemotherapy from 2010 to 2015 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and randomly assigned to a training cohort and a validation cohort at a ratio of 7:3. HDSS was the primary endpoint of this study. Univariate and multivariate Cox regression analyses were conducted on the training cohort to identify independent prognostic factors of HDSS and construct a nomogram to predict the 5- and 8-year HDSS. The performance of the constructed nomogram was evaluated by calibration curve, receiver operating characteristic (ROC) curve, and decision curve analyses. Finally, a risk classification system was constructed to assist in patient management. Result: A total of 16,340 patients were included in this study. Multivariate Cox regression analysis identified six independent prognostic factors: age, race, tumor stage, marital status, surgery, and radiotherapy. A nomogram based on these six factors yielded excellent performance, with areas under the curve of the ROC for 5- and 8-year HDSS of 0.759 and 0.727 in the training cohort and 0.718 and 0.747 in the validation cohort. Moreover, the established risk classification system could effectively identify patients at low-, middle-, and high- risk of heart disease-associated death and achieve targeted management. Conclusion: Independent prognostic factors of HDSS in older female primary breast cancer patients that underwent chemotherapy were determined in this study. A novel nomogram for predicting 5- and 8-year HDSS in this patient population was also established and validated to help physicians during clinical decision-making and screen high-risk patients to improve outcomes.
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Neoplasias da Mama , Cardiopatias , Idoso , Neoplasias da Mama/tratamento farmacológico , Estudos de Coortes , Feminino , Humanos , Nomogramas , Prognóstico , Estudos RetrospectivosRESUMO
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Primary osseous sarcomas originating from the spine and pelvis are rare and usually portend inferior prognoses. Currently, the standard treatment for spinal and pelvic sarcomas is surgical resection, but the poor prognosis limits the benefits to postoperative patients. This study aims to identify the independent prognostic factors of cancer-specific survival (CSS) in postoperative patients with primary spinal and pelvic sarcomas and construct a nomogram for predicting these patients' 3-, 5-, and 10-year CSS probability. METHODS: A total of 452 patients were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. They were divided into a training cohort and a validation cohort. Univariate and multivariate Cox regression analyses were used to identify these patients' CSS-related independent prognostic factors. Then, those factors were used to construct a prognostic nomogram for predicting the 3-, 5-, and 10-year CSS probability, whose predictive performance and clinical value were verified by the calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Finally, a mortality risk stratification system was constructed. RESULTS: Sex, histological type, tumor stage, and tumor grade were identified as CSS-related independent prognostic factors. A nomogram with high predictive performance and good clinical value to predict the 3-, 5-, and 10-year CSS probability was constructed, on which a mortality risk stratification system was constructed based to divide these patients into 3 mortality risk subgroups effectively. CONCLUSIONS: This study constructed and validated a clinical nomogram to predict CSS in postoperative patients with primary spinal and pelvic sarcomas. It could assist clinicians in classifying these patients into different mortality risk subgroups and realize sarcoma-specific management.
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Retroperitoneal leiomyosarcomas (RLS) are the second most common type of retroperitoneal sarcoma and one of the most aggressive tumours. The lack of early warning signs and delay in regular checkups lead to a poor prognosis. This study aims to create a nomogram to predict RLS patients' overall survival (OS). Patients diagnosed with RLS in the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2018 were enrolled in this study. First, univariable and multivariable Cox regression analyses were used to identify independent prognostic factors, followed by constructing a nomogram to predict patients' OS at 1, 3, and 5 years. Secondly, the nomogram's distinguishability and prediction accuracy were assessed using receiver operating characteristic (ROC) and calibration curves. Finally, the decision curve analysis (DCA) investigated the nomogram's clinical utility. The study included 305 RLS patients, and they were divided into two groups at random: a training set (216) and a validation set (89). The training set's multivariable Cox regression analysis revealed that surgery, tumour size, tumour grade, and tumour stage were independent prognostic factors. ROC curves demonstrated that the nomogram had a high degree of distinguishability. In the training set, area under the curve (AUC) values for 1, 3, and 5 years were 0.800, 0.806, and 0.788, respectively, while in the validation set, AUC values for 1, 3, and 5 years were 0.738, 0.780, and 0.832, respectively. As evidenced by the calibration curve, the nomogram had high prediction accuracy. Moreover, DCA revealed that the nomogram had high clinical utility. Furthermore, the risk stratification system based on the nomogram could effectively categorise patients into three mortality risk subgroups. Therefore, the developed nomogram and risk stratification system may aid in optimising the treatment decisions of RLS patients to improve treatment prognosis and maximise their healthcare outcomes.
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Leiomiossarcoma , Nomogramas , Humanos , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Programa de SEERRESUMO
OBJECTIVE: To investigate the safety, efficiency and cost of total joint arthroplasty (TJA) under the enhanced recovery after surgery (ERAS) program and identify predictors facilitating further decrease in length of stay (LOS). METHODS: We retrospectively collected the information of patients who underwent primary unilateral TJA by a single surgical team between January 2017 and June 2019. A total of 604 patients with LOS ≤ 3 was enrolled in this study. All patients completed 12-month or longer follow-up. Patients received the same ERAS protocol, mainly including preoperative preparation (patient education, preoperative functional exercises, nutritional support), blood management, pain management, sleep management, prevention of infection, prevention of thrombosis and strict discharge criteria. Preoperative characteristics of patients were collected from the medical record system and were compared between the LOS ≤ 2 group and the LOS = 3 group. Factors with significant difference were included in multivariate logistic regression analysis to find independent preoperative predictors for LOS. Joint function at the latest follow-up, adverse events rate and hospitalization costs were compared between the LOS ≤ 2 group and the LOS = 3 group. RESULTS: Of the enrolled 604 patients, 271 patients (44.9%) had a LOS of 2 days or less while 333 patients (55.1%) had a LOS of 3 days. Pittsburgh Sleep Quality Index score (odds ratio [OR] = 1.084, 95% confidence interval [CI] = 1.024-1.147, P = 0.005), preoperative albumin level (OR = 0.945, 95% CI = 0.905-0.988, P = 0.012), digestive diseases (OR = 1.084, 95% CI = 1.024-1.147, P = 0.005) and total hip arthroplasty (THA) (OR = 0.273, 95% CI = 0.170-0.439, P < 0.001) were predictors of LOS ≤ 2 in the multivariate logistic analysis model. The postoperative joint function scores and adverse event rates were comparable between the LOS ≤ 2 group and the LOS = 3 group. The hospital costs were lower in the LOS ≤ 2 group than the LOS = 3 group. CONCLUSION: Under the rigorous ERAS program, 2-day discharge in unselected TJA patients can be routinely applied. Patients with high preoperative sleep quality, high preoperative albumin level, free of digestive disease and undergoing THA procedure are more likely to be discharged within 2 days.
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Artroplastia de Quadril , Artroplastia do Joelho , Albuminas , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Humanos , Tempo de Internação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Qualidade do SonoRESUMO
Background: Bone metastasis (BM) is one of the typical metastatic types of head and neck cancer (HNC). The occurrence of BM prevents the HNC patients from obtaining a long survival period. Early assessment of the possibility of BM could bring more therapy options for HNC patients, as well as a longer overall survival time. This study aims to identify independent BM risk factors and develop a diagnostic nomogram to predict BM risk in HNC patients. Methods: Patients diagnosed with HNC between 2010 and 2015 were retrospectively evaluated in the Surveillance, Epidemiology, and End Results (SEER) database, and then eligible patients were enrolled in our study. First, those patients were randomly assigned to training and validation sets in a 7:3 ratio. Second, univariate and multivariate logistic regression analyses were used to determine the HNC patients' independent BM risk factors. Finally, the diagnostic nomogram's risk prediction capacity and clinical application value were assessed using calibration curves, receiver operating characteristic (ROC), and decision curve analysis (DCA) curves. Results: 39,561 HNC patients were enrolled in the study, and they were randomly divided into two sets: training (n = 27,693) and validation (n = 11,868). According to multivariate logistic regression analysis, race, primary site, tumor grade, T stage, N stage, and distant metastases (brain, liver, and lung) were all independent risk predictors of BM in HNC patients. The diagnostic nomogram was created using the above independent risk factors and had a high predictive capacity. The training and validation sets' area under the curves (AUC) were 0.893 and 0.850, respectively. The AUC values of independent risk predictors were all smaller than that of the constructed diagnostic nomogram. Meanwhile, the calibration curve and DCA also proved the reliability and accuracy of the diagnostic nomogram. Conclusion: The diagnostic nomogram can quickly assess the probability of BM in HNC patients, help doctors allocate medical resources more reasonably, and achieve personalized management, especially for HNC patients with a potentially high BM risk, thus acquiring better early education, early detection, and early diagnosis and treatment to maximize the benefits of patients.
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PURPOSE: There is scant literature on the evaluation of dislocation after total hip arthroplasty (THA) in patients with ipsilateral valgus knee deformity. This study aimed to investigate the post-operative dislocation rate in patients with valgus knee deformity who underwent ipsilateral THA and identify whether ipsilateral valgus knee deformity increases the dislocation rate after THA. METHODS: We retrospectively reviewed patients with valgus knee deformity who underwent ipsilateral THA in our institution from January 2016 to December 2018. Each hip with ipsilateral valgus knee deformity was matched with a hip without valgus knee deformity according to sex, affected side, and date of surgery. The primary outcome was the dislocation rate after THA. Univariate analyses were initially used to compare data between the dislocation group and the non-dislocation group. Independent risk factors for dislocation were determined using multivariate logistic regression. RESULTS: There were 257 THAs with ipsilateral valgus knee deformity (valgus knee group) and 257 THAs without valgus knee deformity (control group). The valgus knee group showed a significantly higher dislocation rate than the control group (9.7% versus 1.6%, p < 0.001). Older age (p = 0.020) and malposition of the acetabular cup (p = 0.048) were independent risk factors of post-operative dislocation. CONCLUSION: Patients with valgus knee deformity have a higher risk of dislocation after ipsilateral THA. If ipsilateral THA and total knee arthroplasty must be performed successively, total knee arthroplasty may have an earlier priority than THA.
Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Luxação do Quadril , Luxações Articulares , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Luxação do Quadril/epidemiologia , Luxação do Quadril/etiologia , Luxação do Quadril/cirurgia , Humanos , Luxações Articulares/cirurgia , Articulação do Joelho/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: To investigate the analgesic effect of perioperative use of duloxetine in patients received total knee arthroplasty (TKA). METHOD: This prospective randomized, double-blind, placebo-controlled trial study was registered in the Chinese Clinical Trial Registry (ChiCTR2000033910). 100 patients were finally enrolled. The hospital pharmacy prepared small capsules containing either duloxetine or starch (placebo) which were all identical in appearance and weight (50:50). The 100 enrolled patients were given a capsule (containing either 60 mg duloxetine or 60 mg placebo) every night before sleep since preoperative day 2 till postoperative day 14 (17 days in all) by a nurse who were not involved in this trial. Other perioperative managements were the same in the two groups. The primary outcome was the VAS score, including rVAS (visual analogue scale at rest) and aVAS (visual analogue scale upon ambulation) throughout the perioperative period. The secondary outcomes included opioid consumption, range of motion, including both active range of motion (aROM) and passive range of motion (pROM) and adverse events. The patients were followed up everyday until 7 days after TKA, afterwards, they were followed up at the time of 3 weeks and 3 months after TKA. RESULT: rVAS in duloxetine group were significantly less than placebo group throughout the postoperative period: 4.7 ± 2.3 vs 5.9 ± 2.6 (P = 0.016) at 24 h postoperative; 2.1 ± 1.6 vs 2.8 ± 1.7 (P = 0.037) at 7 days postoperative. In terms of aVAS, similarly, duloxetine group had less aVAS than placebo group throughout the postoperative period: 6.2 ± 2.1 vs 7.1 ± 2.2 (P = 0.039) at 24 h postoperative; 3.3 ± 1.7 vs 4.1 ± 2.0 (P = 0.034) at 7 days postoperative. Patients in duloxetine group consumed significantly less opioids per day than the placebo group: 24.2 ± 10.1 g vs 28.5 ± 8.3 g (P = 0.022) at 24 h postoperative; 2.7 ± 2.5 g vs 4.1 ± 2.6 g (P = 0.007) at 7 days postoperative. aROM in duloxetine group were significantly better than placebo group until postoperative day 6, the aROM became comparable between the two groups: 110.2 ± 9.9° in duloxetine group vs 107.5 ± 11.5° in control group (P = 0.211). In terms of pROM, duloxetine group had significantly better pROM until postoperative day 5, the pROM became comparable between the two groups: 103.8 ± 12.1° in duloxetine group vs 99.5 ± 10.8° in control group (P = 0.064). No significant difference was found between the two groups in the rates of dizziness, bleeding, sweating, fatigue and dryness of mouth. In the placebo group, more patients got nausea/vomiting and constipation (P < 0.05). However, in terms of drowsiness, duloxetine group was reported higher rate (P < 0.05). CONCLUSION: Several other RCTs have already mentioned the analgesic effect of duloxetine, but not in the immediate postoperative period. In this study, we found duloxetine could reduce acute postoperative pain in the immediate postoperative period and decrease the opioids consumption as well as accelerating postoperative recovery, without increasing the risk of adverse medication effects in patients undergoing TKA. Duloxetine could act as a good supplement in multimodal pain management protocol for patients undergoing TKA. TRIAL REGISTRATION STATEMENT: This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000033910). The date of registration was 06/16/2020.