Bullous Pemphigoid-Associated Mortality Rate in a Canadian Tertiary Referral Centre.

BACKGROUND: Bullous pemphigoid (BP) is the most common autoimmune blistering disorder in adults. Most individuals with BP are over the age of 60. Its worldwide incidence has been increasing owing to population aging. Observational studies published over the last 2 decades highlight the non-negligible, albeit variable overall mortality of BP patients, with reported 12-month mortality rates of 10.8% to 40.8%, and 24-month mortality rates of 20.1% to 51.0%. Data in the Canadian population are lacking. OBJECTIVES: We aimed to estimate the 12- and 24-month overall mortality rate of Canadian patients diagnosed with BP, and to identify independent risk factors adversely impacting overall survival. METHODS: A retrospective cohort study of 166 patients with a diagnosis of BP between 2010 and 2020 was carried out at Centre hospitalier de l'Université de Montréal (CHUM), a tertiary referral center in Montréal, Québec, Canada. Cumulative mortality was calculated using the Kaplan-Meier estimator, and independent prognostic factors were identified using a Cox proportional hazards regression model. RESULTS: Eighty-five patients (51.2%) in our study were female. The median age was 79.1 years old, and 80 patients (48.2%) were 80 years old or older. Mortality at 12 and 24 months in our study cohort was 16.2% (CI95% = 10.5 - 21.8) and 27.6% (CI95% = 20.5 - 34.7), respectively. In a multivariate analysis, patients who were male, 80 years old or older, and/or had a diagnosis of a major neurocognitive disorder had a poorer overall survival. CONCLUSIONS: The all-cause mortality of patients with BP in our study population compared favorably with international data reported in the literature.

Three-dimensional kinematic evaluation of Tightrope CCL in a canine in vitro cranial cruciate deficient stifle model.

The impact of surgical correction of cranial cruciate ligament-deficient stifles (CCDS) on the 3-dimensional (3D) kinematics of the canine stifle has been sparsely evaluated. Tightrope (TR) cranial cruciate ligament (CCL) has been proposed to restore baseline 3D kinematics in CCDS by using isometric points. We hypothesized that TR would restore baseline 3D kinematics of the stifle in our model. Ten pelvic limbs were used with a previously validated apparatus. Three experimental conditions were evaluated: i) intact stifle, ii) cranial cruciate ligament transection (CCLt), and iii) CCLt stabilized with TR; kinematic data was recorded. Tightrope CCL in CCDS did not limit sagittal flexion. Tightrope CCL neutralized internal rotation without restoring baseline curves, but it did not restore abduction, nor did it neutralize or restore cranial translation, but it did restore latero-medial and proximo-distal translations. In our model, TR without pre-conditioning of the FiberTape strands did not restore baseline stifle 3D kinematics and residual cranial translation could result in frequent meniscal tears.

L'impact de la correction chirurgicale d'une déficience du ligament croisé crânial du genou (CCDS) sur la cinématique du grasset canin a été peu étudié. La technique de restauration du ligament croisé crânial (CCL) appelée 'Tightrope' (TR) a été proposée pour restaurer la cinématique 3D lors de CCDS en utilisant des points isométriques. Nous avons émis l'hypothèse que la technique TR restaurerait la cinématique 3D d'origine du grasset dans notre modèle. Dix membres pelviens ont été utilisés avec un appareil préalablement validé. Trois conditions expérimentales furent évaluées : i) grasset intact, ii) transsection du ligament croisé crânial (CCLt), et iii) CCLt stabilisé par TR; et les données de cinématique furent enregistrées. La technique TR lors de CCL n'a pas limité la flexion sagittale. Cette technique neutralisait la rotation interne sans restaurer les courbes d'origine, mais elle ne restaurait pas l'abduction, ni ne neutralisait ou restaurait une translation crâniale, mais elle a restauré les translations latéro-médiale et proximo-distale. Dans notre modèle, la technique TR sans préconditionnement des bandes FiberTape n'a pas restauré la cinématique 3D d'origine et une translation crâniale résiduelle pourrait résulter en des déchirures fréquentes du ménisque.(Traduit par Docteur Serge Messier).