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We report a case of a 17-year-old male presenting with acute compartment syndrome (CS) of the lower extremity as the initial manifestation of CRLF2-positive, Ph-like B-cell acute lymphoblastic leukemia (B-ALL), without evidence of leukemic infiltration or hematoma. Emergent fasciotomy was performed, followed by cytoreduction with hydroxyurea to allow wound healing before induction chemotherapy. The patient fully recovered and completed induction without complications. This case highlights the importance of recognizing CS as a rare presenting feature of leukemia, and supports hydroxyurea bridging as a viable strategy when immediate chemotherapy is contraindicated to support surgical recovery.
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Síndromes Compartimentais , Hidroxiureia , Leucemia-Linfoma Linfoblástico de Células Precursoras B , Humanos , Masculino , Adolescente , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Síndromes Compartimentais/terapia , Síndromes Compartimentais/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patologia , Hidroxiureia/uso terapêutico , FasciotomiaRESUMO
Background/Objectives: This review discusses the resistance mechanisms in the tumor microenvironment (TME) of malignant melanoma that disrupt the efficacy of immune checkpoint inhibitors (ICIs). In this review, we focus on the roles of immune cells, including tumor-infiltrating lymphocytes (TILs), macrophages, dendritic cells, and other signaling pathways. We explore the interplay between innate and adaptive immunity in the TME and tumor intrinsic resistance mechanisms, such as ß-catenin, which has future implications for the usage of ICIs in patients with therapy-resistant tumors. Methods: A total of 1052 studies were extracted from the PubMed database searching for keywords and phrases that included [melanoma AND immune checkpoint inhibitor resistance]. After a title/abstract and full-text review, 101 studies were identified that fit the inclusion/exclusion criteria. Results: Cancer-associated fibroblasts (CAFs), M2 macrophages, and myeloid-derived suppressor cells (MDSCs) are significant in remodeling the TME to promote melanoma growth. Melanoma resistance to ICIs is complex and involves TME alterations, tumor intrinsic factors, and immune evasion. Key components of resistance include reduced CD8+ T cell infiltration, decreased host immune response, and immunosuppressive cytokines. Conclusions: Predictive biomarkers and specific models are the future of individualized melanoma management and show great promise in their approach to targeted therapy production. Tumor profiling can be utilized to help predict the efficacy of ICIs, and specific biomarkers predicting therapy responses are instrumental in moving towards personalized and more efficacious medicine. As more melanoma resistance emerges, alternative and combinatorial therapy based on knowledge of existing resistance mechanisms will be needed.
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BACKGROUND: Unicompartmental knee arthroplasty (UKA) is an increasingly popular surgical option, constituting approximately 10% of knee arthroplasty operations, with an anticipated upward trend. However, UKA presents technical challenges and higher revision rates compared to total knee arthroplasty (TKA). This study evaluates the outcomes and economic implications of using two robotic systems for UKA: the image-based (IBRA-UKA) and image-free (IFRA-UKA) robotic-assisted systems. We hypothesized that the image-free system, while incurring lower costs, would demonstrate clinical outcomes comparable to the image-based system. MATERIALS AND METHODS: We conducted a retrospective study using the PearlDiver™ Database, selecting patients older than 40 years without previous knee surgeries who underwent robotic-assisted UKA (RA-UKA). Individuals with contralateral knee arthroplasty within 2 years were excluded. The procedures were divided into two cohorts, matched one-to-one for demographics and clinical characteristics. We compared 90-day, 1-year, and 2-year postoperative complications, along with cost analysis of preoperative computed tomography imaging and surgical expenses. RESULTS: A total of 2,490 patients were evaluated, with 1,245 in each cohort. No statistical differences were observed in postoperative complications, including revision rates, between the two cohorts. However, preoperative and surgical costs were significantly higher for the IBRA-UKA cohort compared to the IFRA-UKA cohort. Preoperative computed tomography scan costs averaged $916±$1,092 versus $0 (P<0.001), and surgical costs averaged $5,675±$9,436 versus $3,056±$5,419 (P<0.001). CONCLUSION: The similar complication rates highlight the value of robotic technique in UKA regardless of system choice. However, the higher costs of IBRA-UKA raise financial concerns amid diminishing health care reimbursements. Further research is needed to evaluate robotic systems, focusing on intraoperative, postoperative, and functional outcomes.
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Artroplastia do Joelho , Custos de Cuidados de Saúde , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos , Humanos , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Feminino , Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Custos de Cuidados de Saúde/estatística & dados numéricosRESUMO
Purpose: To describe a double-allograft technique used for patients with severe, symptomatic multidirectional instability and hyperlaxity of the shoulder as well as to introduce a modification of the Beighton score that helps determine when this procedure should be utilized and report long-term outcomes of this procedure in the management of these patients. Methods: A retrospective review of patients with multidirectional instability who were managed with the double-allograft technique after failure of extensive physical therapy was conducted. The final analysis included 43 patients (46 shoulders). Included patients had minimum 2 years of in-office follow-up with a Tulane modified Beighton score of 11 or greater and severe multidirectional instability/hyperlaxity of the shoulder. Preoperative and postoperative patient-reported outcome (PRO) measures were compared using 2-tailed paired t -tests. Subgroup analyses were performed using 2-tailed, independent t -tests. Results: Mean postoperative outcome scores were significantly improved compared with preoperative scores for all PRO measures evaluated from the 6-month postoperative visit on (all P < .001). Subgroup analyses of gender, age, and patients with versus without genetically confirmed Ehlers-Danlos syndrome were equivalent with respect to postoperative improvements in PRO scores. The average Tulane modified Beighton score was 14, range 11 to 15. Among the 46 operative cases, there were a total of 7 (15.2%) complications and 5 recurrences requiring additional surgery. The 5 (10.9%) patients who underwent a subsequent revision procedure did so at a mean time of 5.36 ± 2.64 years. Conclusions: The double allograft reconstruction technique appears to be a safe and effective method to restore shoulder stability in patients with severe ligamentous laxity. Level of Evidence: Level IV, therapeutic case series.
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Background: Venous thromboembolism (VTE) is a possible complication following total knee arthroplasty (TKA). The presence of varicose veins has been associated with increased risk of VTEs following arthroplasty procedures. The purpose of the present study was to assess the impact of previous varicose vein surgery on the incidence of VTE following TKA. Methods: A retrospective matched cohort study was performed using the PearlDiver database. Patients undergoing primary TKA with diagnoses of lower extremity varicose veins were identified. Subsequently, patients who underwent varicose vein surgery before TKA (n = 7,730) were matched 1:2 with controls who did not have vein surgery (n = 15,460) across age, sex, Elixhauser comorbidity index, anticoagulation exposure, and comorbidities. Rates of venous thromboembolism (VTE) associated with the index TKA within six months postoperatively were compared between the matched cohorts using multivariable logistic regression. Results: Patients who had prior varicose vein surgery exhibited significantly lower rates of VTE events during the 0-30 day interval (0.76 % vs. 1.05 %; OR: 0.70), the 31-90 day interval (0.34 % vs. 0.52 %; OR: 0.60), and the 91-180 day interval (0.94 % vs 1.37 %; OR: 0.65). In subgroup analyses of the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE), the varicose vein surgery cohort exhibited significantly lower rates of PE at 31-90 days (0.07 % vs. 0.30 %; OR: 0.42) and 91-180 days (0.48 % vs. 0.80 %; OR: 0.59), while rates of DVT were comparable. Conclusion: Patients who underwent previous varicose vein surgery exhibited significantly lower rates of VTE within six months after TKA compared to matched controls. The present study suggests operative treatment of varicose veins before TKA may reduce rates of VTE events postoperatively.
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Viral infections can cause cellular dysregulation of metabolic reactions. Viruses alter host metabolism to meet their replication needs. The impact of viruses on specific metabolic pathways is not well understood, even in well-studied viruses, such as human adenovirus. Adenoviral infection is known to influence cellular glycolysis and respiration; however, global effects on overall cellular metabolism in response to infection are unclear. Furthermore, few studies have employed an untargeted approach, combining emphasis on viral dosage and infection. To address this, we employed untargeted metabolomics to quantify the dynamic metabolic shifts in fibroblasts infected with human adenovirus serotype 5 (HAdV-5) at three dosages (0.5, 1.0, and 2.0 multiplicity of infection [MOI]) and across 4 time points (6-, 12-, 24-, and 36-h post-infection [HPI]). The greatest differences in individual metabolites were observed at 6- and 12-h post-infection, correlating with the early phase of the HAdV-5 infection cycle. In addition to its effects on glycolysis and respiration, adenoviral infection downregulates cysteine and unsaturated fatty acid metabolism while upregulating aspects of purine metabolism. These results reveal specific metabolic pathways dysregulated by adenoviral infection and the associated dynamic shifts in metabolism, suggesting that viral infections alter energetics via profound changes in lipid, nucleic acid, and protein metabolism. The results revealed previously unconsidered metabolic pathways disrupted by HAdV-5 that can alter cellular metabolism, thereby prompting further investigation into HAdV mechanisms and antiviral targeting.
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Infecções por Adenovirus Humanos , Adenovírus Humanos , Cisteína , Ácidos Graxos Insaturados , Fibroblastos , Purinas , Humanos , Fibroblastos/metabolismo , Fibroblastos/virologia , Adenovírus Humanos/fisiologia , Infecções por Adenovirus Humanos/metabolismo , Infecções por Adenovirus Humanos/virologia , Cisteína/metabolismo , Purinas/metabolismo , Ácidos Graxos Insaturados/metabolismo , Glicólise , Metabolômica/métodosRESUMO
Background: Despite increased utilization of robotic assistance during unicompartmental knee arthroplasty (UKA), its impact on postoperative outcomes remains unclear. This study aimed to compare rates of postoperative revision and complications among patients undergoing robotic-assisted UKA (RA-UKA) versus manual UKA. Methods: A retrospective matched cohort study was performed. Trends analysis of the annual proportion of RA-UKA between 2010 and 2021 was performed, and RA-UKA patients (n = 3976) were matched 1:3 with manual UKA patients (n = 11,766) across age, sex, Elixhauser Comorbidity Index, and comorbidities. Rates of 2-year prosthesis-related complications were compared between the matched cohorts using multivariable logistic regression. Results: The annual proportion of UKA procedures performed with robotic assistance trended significantly upward (1.51% to 5.19%, P < .001). Within 2 years postoperatively, the RA-UKA cohort exhibited significantly lower rates of aseptic revision (1.84% vs 2.37%; odds ratio: 0.76; P = .040) and aseptic loosening (0.13% vs 0.42%; odds ratio: 0.32; P = .010). Total cost for the index UKA was significantly higher for the RA-UKA cohort ($10,321 vs $7,366; P < .001). Conclusions: There has been a marked increase in utilization of RA-UKA. Compared to matched manual UKA, RA-UKA had lower rates of revision and aseptic loosening at 2-year follow-up, but at a higher total cost for the index procedure. Further research exploring the use of robotics in UKA with attention to patient outcomes and cost is crucial for defining its evolving role in orthopaedic surgery.
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Wood-feeding termites harbor specialized protists in their hindguts in a classic nutritional mutualism. The protists are vertically inherited, which has generated a broad-scale pattern of codiversification over â¼150 million years, but there are many incongruences due to lineage-specific loss and transfer of symbionts. Despite the evolutionary and economic importance of this symbiosis, the symbiont communities of most termite species are incompletely characterized or entirely unstudied. Here, we have investigated the protist symbiont community of Reticulitermes tibialis, using single-cell PCR to link morphology to 18S rRNA gene sequences. The protists belong to at least 41 species in 3 major lineages within Metamonada: Spirotrichonymphida, Pyrsonymphidae, and Trichonympha. The Spirotrichonymphida symbionts belong to 6 genera, including Pseudospironympha, which has not been found in Reticulitermes until now, and Dexiohelix, a new genus. Pyrsonymphidae traditionally include just Pyrsonympha and Dinenympha, but our morphology-linked 18S phylogeny indicates that both genera are polyphyletic. We accordingly restrict the definitions of Pyrsonympha and Dinenympha to the clades that include their type species, and we propose 5 new genera to accommodate the remaining clades. Short-read 18S amplicon sequencing revealed considerable variation in community composition across R. tibialis colonies in Arizona, suggestive of a symbiont metacommunity. Symbiont species varied in their prevalence across colonies, with a core set of about 12 highly prevalent symbiont species, 11 species with intermediate prevalence, and 18 rare species. This pattern contrasts with the traditional paradigm of consistent symbiont community composition across colonies of a termite species.
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Biodiversidade , Eucariotos , Isópteros , Simbiose , Animais , Filogenia , Isópteros/parasitologia , RNA Ribossômico 18S/genética , Eucariotos/classificação , Eucariotos/genética , Eucariotos/fisiologia , Análise de Sequência de DNA , DNA de Protozoário/genética , DNA de Protozoário/química , Dados de Sequência MolecularRESUMO
We present the first documented case of polyethylene liner fracture in a primary dual-mobility cup (DMC) total hip arthroplasty leading to intraprosthetic dislocation. A 50-year-old female with a history of hip dysplasia and leg length discrepancy underwent primary total hip arthroplasty with a DMC. She presented with an anterior intraprosthetic hip dislocation. Revision surgery revealed a fractured highly cross-linked polyethylene liner. The liner and fragments were removed and a new liner was implanted. This case underscores the potential mechanical limitations of highly cross-linked polyethylene in DMC configurations.
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The success of cultured epithelial autografts (CEAs) in treating large surface area burns is limited by their fragility and poor adhesion to the wound bed. Rete ridges, interdigitations at the dermal-epidermal junction, are stem cell niches critical to dermal-epidermal adhesion and distribution of mechanical forces within the skin, but are slow to develop in CEA-treated burn wounds. A porcine burn-excise-autograft model was used to investigate the efficacy of an allogeneic dermal template (DT), seeded with fibroblasts and laser micropatterned to have dermal papillae-like topography, in improving outcomes with CEA. Autologous CEAs were applied to full-thickness wounds alone or with DTs that were flat (CEA+Flat) or micropatterned (CEA+Ridged). The use of a DT improved graft handleability and integration at the wound margins, and restored epidermal barrier function two weeks faster than CEAs alone. In CEA+Ridged grafts, increases in keratinocyte proliferation and basement membrane deposition were observed at 2 weeks post-grafting. Rete ridges were only present in CEA+Ridged grafts at week 2, and developed less frequently and shallower in CEA and CEA+Flat grafts over the course of the study. These results suggest that laser micropatterned DTs are suitable for co-transplantation with CEAs and can significantly improve graft adhesion and development.
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Membrana Basal , Queimaduras , Derme , Transplante de Pele , Animais , Suínos , Queimaduras/cirurgia , Transplante de Pele/métodos , Transplante Autólogo , Autoenxertos , Queratinócitos , Lasers , Proliferação de Células , Cicatrização/fisiologia , Fibroblastos/transplanteRESUMO
South Africa has a high burden of human immune deficiency virus (HIV)-associated Hodgkin lymphoma (HL) which is typically Epstein-Barr virus (EBV) infected, detected by histological stains. Circulating plasma EBV derived from apoptotic EBV infected tumour cells is a potential biomarker. This study aimed to evaluate the role of plasma EBV load testing in newly diagnosed HL patients and correlate pretreatment plasma EBV levels, HIV status and EBV tumour status with overall survival (OS). Untreated HL patients were prospectively included. Polymerase chain reaction measured EBV plasma viral loads. Kaplan-Meier curves with log-rank tests estimated the impact of HIV, EBV tumour status and plasma EBV viral loads on OS. Multivariable analysis was performed using a Cox proportional hazards model. Receiver operative characteristic curve analysis determined cutoff plasma EBV DNA levels with optimal sensitivity, specificity and concordance with tumour EBV status. The 68 patients included 21 (31%) HIV +ve and 33 (49%) EBV tumour +ve. EBV plasma ≥ 10 000 IU/ml (P = 0.008), EBV +ve tumour (P = 0.014), HIV +ve status (P = 0.009) and age ≥ 45 years (P = 0.018) predicted poorer OS on univariate analysis. Plasma EBV levels > 762 IU/ml had 89.29% sensitivity and 96.77% specificity for detecting EBV +ve HL. High plasma EBV levels ≥ 10 000 IU/ml, HIV +ve status and EBV tumour +ve status predicted poorer OS. Plasma EBV levels > 762 IU/ml predicted EBV +ve tumour status with high sensitivity and specificity. Plasma EBV viral DNA testing is a promising biomarker for EBV +ve HL.
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DNA Viral , Infecções por Vírus Epstein-Barr , Infecções por HIV , Herpesvirus Humano 4 , Doença de Hodgkin , Carga Viral , Humanos , Doença de Hodgkin/virologia , Doença de Hodgkin/sangue , Doença de Hodgkin/diagnóstico , Masculino , Feminino , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/isolamento & purificação , Adulto , Pessoa de Meia-Idade , Infecções por Vírus Epstein-Barr/virologia , Infecções por Vírus Epstein-Barr/sangue , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por HIV/virologia , Infecções por HIV/sangue , DNA Viral/sangue , DNA Viral/genética , Estudos Prospectivos , África do Sul , Adulto Jovem , Sensibilidade e Especificidade , Plasma/virologia , Análise de Sobrevida , Adolescente , Curva ROCRESUMO
One of the major challenges in processing rare-earth element (REE) materials arises from the large amounts of radioactive thorium (Th) that are often found within REE minerals, encouraging enhanced metal separation procedures. We report here a study aimed at developing improved systems for REE processing with the goal of efficient extraction of Th(IV) from acidic solution. A tripodal ligand, TRPN-CMPO-Ph, was prepared that utilizes carbamoylmethylphosphine oxide (CMPO) chelators tethered to a tris(3-aminopropyl)amine (TRPN) capping scaffold. The ligand and its metal complexes were characterized by using elemental analysis, NMR, Fourier transform infrared spectroscopy, mass spectrometry, and luminescence spectroscopy. Using a liquid-liquid metal extraction protocol, TRPN-CMPO-Ph selectively extracts Th(IV) at an efficiency of 79% from a mixture of Th(IV), UO22+, and all rare-earth metal cations (except promethium) dissolved in nitric acid into an organic solvent. Th(IV) extraction selectivity is maintained upon extraction from a mixture that approximates a typical monazite leach solution containing several relevant lanthanide ions, including two ions at higher concentration relative to Th(IV). Comparative studies with a tris(2-aminoethyl)amine (TREN)-capped derivative are presented and support the need for a larger TRPN capping scaffold in achieving Th(IV) extraction selectivity.
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The mammalian gastrointestinal tract hosts a diverse community of trillions of microorganisms, collectively termed the microbiota, which play a fundamental role in regulating tissue physiology and immunity. Recent studies have sought to dissect the cellular and molecular mechanisms mediating communication between the microbiota and host immune system. Epithelial cells line the intestine and form an initial barrier separating the microbiota from underlying immune cells, and disruption of epithelial function has been associated with various conditions ranging from infection to inflammatory bowel diseases and cancer. From several studies, it is now clear that epithelial cells integrate signals from commensal microbes. Importantly, these non-hematopoietic cells also direct regulatory mechanisms that instruct the recruitment and function of microbiota-sensitive immune cells. In this review, we discuss the central role that has emerged for epithelial cells in orchestrating intestinal immunity and highlight epithelial pathways through which the microbiota can calibrate tissue-intrinsic immune responses.
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Doenças Inflamatórias Intestinais , Microbiota , Animais , Humanos , Intestinos , Doenças Inflamatórias Intestinais/metabolismo , Sistema Imunitário , Mucosa Intestinal , MamíferosRESUMO
AIM: The aim of this work was to evaluate colorectal cancer (CRC) outcomes after 'low' (sub-threshold) faecal immunochemical test (FIT) results in symptomatic patients tested in primary care. METHOD: This work comprised a retrospective audit of 35 289 patients with FIT results who had consulted their general practitioner with lower gastrointestinal symptoms and had subsequent CRC diagnoses. The Rapid Colorectal Cancer Diagnosis pathway was introduced in November 2017 to allow incorporation of FIT into clinical practice. The local '4F' protocol combined FIT results with blood tests and digital rectal examination (DRE): FIT, full blood count, ferritin and finger [DRE]. The outcome used was detection rates of CRC, missed CRC and time to diagnosis in local 4F protocols for patients with a subthreshold faecal haemoglobin (fHb) result compared with thresholds of 10 and 20 µg Hb/g faeces. RESULTS: A single threshold of 10 µg Hb/g faeces identifies a population in whom the risk of CRC is 0.2%, but this would have missed 63 (10.5%) of 599 CRCs in this population. The Nottingham 4F protocol would have missed fewer CRCs [42 of 599 (7%)] despite using a threshold of 20 µg Hb/g faeces for patients with normal blood tests. Subthreshold FIT results in patients subsequently diagnosed with a palpable rectal tumour yielded the longest delays in diagnosis. CONCLUSION: A combination of FIT with blood results and DRE (the 4F protocol) reduced the risk of missed or delayed diagnosis. Further studies on the impact of such protocols on the diagnostic accuracy of FIT are expected. The value of adding blood tests to FIT may be restricted to specific parts of the fHb results spectrum.
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Neoplasias Colorretais , Neoplasias Retais , Humanos , Neoplasias Colorretais/patologia , Sensibilidade e Especificidade , Estudos Retrospectivos , Hemoglobinas/análise , Colonoscopia , Fezes/química , Sangue Oculto , Detecção Precoce de Câncer/métodosRESUMO
PURPOSE: To compare postoperative complication rates between patients who underwent medial patellofemoral ligament reconstruction (MPFLR) and those who underwent MPFLR with tibial tubercle osteotomy (TTO) in a large-scale study. A secondary goal was to investigate demographic associations with outcomes. METHODS: Patients who underwent MPFLR (n = 3,480) or MPFLR-TTO (n = 615) for patellar instability were identified in the PearlDiver database. Rates of surgery for infection, procedures for knee stiffness, patellar fracture, and revision MPFLR within 2 years postoperatively were compared using multivariable logistic regression. Demographic associations with outcomes were also investigated. RESULTS: The MPFLR-TTO cohort exhibited a significantly lower rate of revision surgery at 2 years (0.8% vs 1.9%; odds ratio [OR], 0.33; 95% confidence interval [CI], 0.10-0.80; P = .036) when compared with the MPFLR group. Independent of index procedure, patients younger than 21 years had significantly lower rates of requiring procedures for knee stiffness (OR, 0.35; 95% CI, 0.22-0.54; P < .001) and any complication at 2 years (OR, 0.59; 95% CI, 0.45-0.78; P < .001) when compared with older patients. Male patients displayed a significantly lower rate of requiring procedures for knee stiffness at 2 years than female patients (OR, 0.46; 95% CI, 0.25-0.78; P = .007). Tobacco use was associated with a significantly higher rate of postoperative infection at 2 years (OR, 2.35; 95% CI, 1.00-5.38; P = .046). CONCLUSIONS: The MPFLR cohort exhibited higher rates of revision surgery at 2 years compared with the MPFLR-TTO cohort. Patient age under 21 years was associated with lower rates of any complication and requiring procedures for knee stiffness, male sex was associated with a lower rate of requiring procedures for knee stiffness, and tobacco use was associated with a higher rate of surgery for postoperative infection. This information can assist surgeons when counseling patients before these procedures are performed. LEVEL OF EVIDENCE: Level III, retrospective, comparative prognostic trial.
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Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Instabilidade Articular/cirurgia , Instabilidade Articular/etiologia , Ligamentos Articulares/cirurgia , Osteotomia/métodos , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos RetrospectivosRESUMO
Background: The association between tendon damage and fluoroquinolone (FQ) antibiotics has been well documented. However, there is limited data evaluating the impact of postoperative FQ use on outcomes of primary tendon repairs. The purpose of this study was to compare rates of reoperation for patients with FQ exposure after primary tendon repair versus controls. Methods: A retrospective cohort study was conducted using the PearlDiver database. All patients who underwent primary repair of distal biceps ruptures, Achilles tendon ruptures, and rotator cuff tears were identified. For each tendon, patients who were prescribed FQs within 90 days postoperatively were propensity score matched at a 1:3 ratio with controls without postoperative FQ prescriptions across age, sex, and several comorbidities. Rates of reoperation were compared at two years postoperatively with multivariable logistic regression. Results: A total of 124,322 patients who underwent primary tendon procedures were identified, including 3,982 (3.2%) patients with FQ prescriptions within 90 days postoperatively: 448 with distal biceps repair, 2,538 with rotator cuff repair, and 996 with Achilles tendon repair. These cohorts were matched with 1,344, 7,614, and 2,988 controls, respectively. Patients with postoperative FQ prescriptions exhibited significantly higher rates of revision surgery after primary repair of distal biceps ruptures (3.6% vs. 1.7%; OR 2.13; 95% CI, 1.09-4.04), rotator cuff tears (7.1% vs. 4.1%; OR 1.77; 95% CI, 1.48-2.15), and Achilles tendon ruptures (3.8% vs. 1.8%; OR 2.15; 95% CI, 1.40-3.27). Conclusion: Patients with FQ prescriptions within 90 days after primary tendon repair demonstrated significantly higher rates of reoperations for distal biceps, rotator cuff, and Achilles tendon repair at two years postoperatively. To achieve optimal outcomes and avoid complications in patients following primary tendon repair procedures, physicians should consider prescribing alternative non-FQ antibiotics and counsel patients on the risk of reoperation associated with postoperative FQ use.
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BACKGROUND: The prevalence of gout is increasing along with the number of total knee arthroplasties (TKA) performed annually. The purpose of this study was to evaluate the incidence of gout following TKA in patients who had a previous history of gout and to determine if it is associated with an increased rate of postoperative joint complications. METHODS: Patients who did and did not have a preoperative diagnosis of gout and underwent a primary TKA were identified from a national database. The gout patients were matched 1:1 to patients who did not have gout and rates of postoperative gout diagnoses within 2 years of surgery were compared. Complication rates at mean 1 and 2 years were then compared for both patient cohorts using multivariable logistic regressions. A total of 17,463 patients with a prior diagnosis of gout were matched with 17,463 controls. RESULTS: There were 53.8% of patients who had previous gout and had a recurrence of gout within 2 years versus 3.6% of controls (Odds Ratios [OR]: 30.86). At mean 1-year, patients who had gout were significantly more likely to experience prosthetic joint infections (PJIs) and revision procedures. At mean 2 years, gout patients were at increased risk of prosthetic loosening, PJI, revision, and incision and debridement procedures. CONCLUSION: This study suggests that patients who had a prior diagnosis of gout are significantly more likely to experience recurrent episodes of gout after TKA. Gout attacks after TKA are associated with an increase in the rate of joint complications. LEVEL OF EVIDENCE: Level III.
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Artrite Infecciosa , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Humanos , Artroplastia do Joelho/efeitos adversos , Estudos Retrospectivos , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/diagnóstico , Incidência , Artrite Infecciosa/etiologia , Reoperação/efeitos adversosRESUMO
INTRODUCTION: Pelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures. METHODS: We conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined. RESULTS: Of 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy. CONCLUSIONS: Pelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.
Assuntos
Amputação Traumática , Traumatismos por Explosões , Fraturas Ósseas , Militares , Ossos Pélvicos , Humanos , Guerra do Iraque 2003-2011 , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Traumatismos por Explosões/complicações , Traumatismos por Explosões/epidemiologia , Traumatismos por Explosões/cirurgia , Ossos Pélvicos/lesõesRESUMO
AIMS: This studied aimed to compare rates of reoperation for patients who received primary ankle arthrodesis (AA) versus total ankle replacement (TAR) for posttraumatic indications between 2010 and 2016 Q2 using a nationwide claims database. METHODS: A retrospective cohort study analyzing patients who received primary AA or TAR for posttraumatic indications was performed using PearlDiver. Reoperations assessed included prosthetic joint infection (PJI), hardware removal, adjacent joint fusion, and local open reduction internal fixation (ORIF). Multivariable logistic regression was used to compare rates of reoperations at 1 and 2 years postdischarge. RESULTS: A total of 862 (74%) patients received AA and 318 (26%) patients underwent TAR for a posttraumatic indication. At 1 year, 305 (35.4%) AA patients had at least 1 reoperation compared with 55 (17.3%) TAR patients (OR 2.32; 95% CI, 1.68-3.26). At 2 years, 364 (42.2%) AA patients and 66 (20.8%) TAR patients had at least 1 reoperation (OR 2.51; 95% CI, 1.84-3.45). ORIF, hardware removal, and adjacent joint fusions were more likely for AA patients at both time intervals (all Ps < .05). CONCLUSION: Patients who received primary AA for posttraumatic indications exhibited higher rates of major reoperations in the short to medium term compared with patients who underwent TAR. LEVELS OF EVIDENCE: Level III: Retrospective cohort study.
Assuntos
Artroplastia de Substituição do Tornozelo , Humanos , Artroplastia de Substituição do Tornozelo/efeitos adversos , Articulação do Tornozelo/cirurgia , Tornozelo/cirurgia , Reoperação , Estudos Retrospectivos , Assistência ao Convalescente , Resultado do Tratamento , Alta do Paciente , Artrodese/efeitos adversosRESUMO
BACKGROUND: Many regularly prescribed classes of drugs are known to negatively impact bone health. However, it is unclear if perioperative use of these drugs impacts total shoulder arthroplasty (TSA) outcomes. The purpose of this study was to analyze the impact of perioperative use of 10 drug classes with known negative effects on bone health on prosthesis-related outcomes of TSA. METHODS: Patients who underwent primary TSA were retrospectively identified in the PearlDiver database. Within this population, patients prescribed proton pump inhibitors (PPIs), thiazolidinediones (TZDs), loop diuretics, glucocorticoids, aromatase inhibitors, calcineurin inhibitors, selective serotonin reuptake inhibitors (SSRIs), antiepileptic drugs (AEDs), first-generation antipsychotics (FGAs), and second-generation antipsychotics (SGAs) within 6 months before or 6 months after primary TSA were identified (n = 23,748). These patients were propensity score matched 1:1 with controls (n = 23,748) on age, sex, and several comorbidities. After matching, patients with perioperative drug exposure were divided into 10 subgroups (ie, 1 for each drug class). Rates of prosthesis-related complications among patients taking each medication class vs. controls were compared with multivariable logistic regression. RESULTS: Relative to controls, SGA exposure was associated with significantly higher rates of all-cause revision (odds ratio [OR] 1.68) and aseptic revision (OR 1.57). Loop diuretic exposure was associated with significantly higher rates of all-cause revision (OR 1.44) and aseptic revision (OR 1.43). Glucocorticoid exposure was associated with significantly higher rates of all-cause revision (OR 1.32) and aseptic revision (OR 1.30). SSRI exposure was associated with significantly higher rates of all-cause revision (OR 1.27) and aseptic revision (OR 1.24). Periprosthetic fracture, aseptic loosening, and septic revision was comparable for all drug cohorts compared to matched controls (all P > .05). Patients with perioperative exposure to PPIs, TZDs, FGAs, AEDs, aromatase inhibitors, and calcineurin inhibitors displayed comparable rates of all queried complications compared with controls (all P > .05). CONCLUSION: Compared with matched controls, patients with perioperative exposure to SGAs, loop diuretics, glucocorticoids and SSRIs exhibited significantly higher rates of all-cause and aseptic revisions following primary TSA. Several other medications that are risk factors for osteoporosis and fragility fractures did not demonstrate significant associations with any complications, including periprosthetic fracture. These results highlight the need for a thorough review of patients' medical history and current medication usage prior to preoperative risk counseling for patients seeking TSA.