Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections

Background@#The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. @*Methods@#We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P<0.05. @*Results@#The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00–1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05–2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80–0.95; P=0.003). @*Conclusions@#There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.

Association between High Diffusion-Weighted Imaging-Derived Functional Tumor Burden of Peritoneal Carcinomatosis and Overall Survival in Patients with Advanced Ovarian Carcinoma

Objective@#To investigate the association between functional tumor burden of peritoneal carcinomatosis (PC) derived from diffusion-weighted imaging (DWI) and overall survival in patients with advanced ovarian carcinoma (OC). @*Materials and Methods@#This prospective study was approved by the local research ethics committee, and informed consent was obtained. Fifty patients (mean age ± standard deviation, 57 ± 12 years) with stage III–IV OC scheduled for primary or interval debulking surgery (IDS) were recruited between June 2016 and December 2021. DWI (b values: 0, 400, and 800 s/mm2 ) was acquired with a 16-channel phased-array torso coil. The functional PC burden on DWI was derived based on K-means clustering to discard fat, air, and normal tissue. A score similar to the surgical peritoneal cancer index was assigned to each abdominopelvic region, with additional scores assigned to the involvement of critical sites, denoted as the functional peritoneal cancer index (fPCI). The apparent diffusion coefficient (ADC) of the largest lesion was calculated. Patients were dichotomized by immediate surgical outcome into high- and low-risk groups (with and without residual disease, respectively) with subsequent survival analysis using the Kaplan-Meier curve and log-rank test. Multivariable Cox proportional hazards regression was used to evaluate the association between DWI-derived results and overall survival. @*Results@#Fifteen (30.0%) patients underwent primary debulking surgery, and 35 (70.0%) patients received neoadjuvant chemotherapy followed by IDS. Complete tumor debulking was achieved in 32 patients. Patients with residual disease after debulking surgery had reduced overall survival (p = 0.043). The fPCI/ADC was negatively associated with overall survival when accounted for clinicopathological information with a hazard ratio of 1.254 for high fPCI/ADC (95% confidence interval, 1.007–1.560; p = 0.043). @*Conclusion@#A high DWI-derived functional tumor burden was associated with decreased overall survival in patients with advanced OC.

Surgical prevention of terminal neuroma and phantom limb pain: a literature review

The incidence of extremity amputation is estimated at about 200,000 cases annually. Over 25% of patients suffer from terminal neuroma or phantom limb pain (TNPLP), resulting in pain, inability to wear a prosthetic device, and lost work. Once TNPLP develops, there is no definitive cure. Therefore, there has been an emerging focus on TNPLP prevention. We examined the current literature on TNPLP prevention in patients undergoing extremity amputation. A literature review was performed using Ovid Medline, Cochrane Collaboration Library, and Google Scholar to identify all original studies that addressed surgical prophylaxis against TNPLP. The search was conducted using both Medical Subject Headings and free-text using the terms “phantom limb pain,” “amputation neuroma,” and “surgical prevention of amputation neuroma.” Fifteen studies met the inclusion criteria, including six prospective trials, two comprehensive literature reviews, four retrospective chart reviews, and three case series/technique reviews. Five techniques were identified, and each was incorporated into a targetbased classification system. A small but growing body of literature exists regarding the surgical prevention of TNPLP. Targeted muscle reinnervation (TMR), a form of physiologic target reassignment, has the greatest momentum in the academic surgical community, with multiple recent prospective studies demonstrating superior prevention of TNPLP. Neurorrhaphy and transposition with implantation are supported by less robust evidence, but merit future study as alternatives to TMR.

Surgical prevention of terminal neuroma and phantom limb pain: a literature review

The incidence of extremity amputation is estimated at about 200,000 cases annually. Over 25% of patients suffer from terminal neuroma or phantom limb pain (TNPLP), resulting in pain, inability to wear a prosthetic device, and lost work. Once TNPLP develops, there is no definitive cure. Therefore, there has been an emerging focus on TNPLP prevention. We examined the current literature on TNPLP prevention in patients undergoing extremity amputation. A literature review was performed using Ovid Medline, Cochrane Collaboration Library, and Google Scholar to identify all original studies that addressed surgical prophylaxis against TNPLP. The search was conducted using both Medical Subject Headings and free-text using the terms “phantom limb pain,” “amputation neuroma,” and “surgical prevention of amputation neuroma.” Fifteen studies met the inclusion criteria, including six prospective trials, two comprehensive literature reviews, four retrospective chart reviews, and three case series/technique reviews. Five techniques were identified, and each was incorporated into a targetbased classification system. A small but growing body of literature exists regarding the surgical prevention of TNPLP. Targeted muscle reinnervation (TMR), a form of physiologic target reassignment, has the greatest momentum in the academic surgical community, with multiple recent prospective studies demonstrating superior prevention of TNPLP. Neurorrhaphy and transposition with implantation are supported by less robust evidence, but merit future study as alternatives to TMR.

Prevalence of overweight and obesity among children six to ten years of age in the North-East Health region of Jamaica / Prevalencia del sobrepeso y la obesidad entre niños de seis a diez años de edad en la región Noreste de atención a la salud en Jamaica

OBJECTIVE: To estimate the prevalence and correlates of overweight and obesity among children six to ten years old in the NorthEast Health Region (NEHR) of Jamaica. METHODS: Weights and heights were measured in a representative sample of 5710 children between the ages of six and ten years in 34 schools between October 2008 and March 2009. Overweight and obesity were defined as body mass index (BMI) Zscore >1SD and >2SD, respectively based on the World Health Organization (WHO)endorsed age and genderspecific growth standards for children. Point prevalence estimates of overweight and obesity were calculated. Odds ratios (OR) and 95% confidence intervals (CI) were used to estimate associations between overweight and obesity and age, gender and school location. RESULTS: Overweight and obesity prevalence among children six to ten years old in NEHR, Jamaica, was 10.6% and 7.1%, respectively. Overweight (OR = 1.11, 95% CI: 1.04, 1.18) and obesity (OR = 1.17, 95% CI: 1.08, 1.26) prevalence increased significantly with age. Overweight (OR = 1.51, 95% CI: 1.27, 1.80) and obesity (OR = 1.36, 95% CI: 1.11, 1.67) prevalence was significantly higher among girls than boys. Children attending ruralpublic schools had less risk of being overweight (OR = 0.57, 95% CI: 0.46, 0.70) and obese (OR = 0.35, 95% CI: 0.28, 0.44) when compared with urbanpublic schools and private schools. Both overweight (OR = 2.11, 95% CI: 1.60, 2.78) and obesity (OR = 1.68, 95% CI: 1.24, 2.28) were significantly more common among children attending private schools. After adjusting for age and gender, the results still remained statistically significant. CONCLUSIONS: Overweight/obesity prevalence among children six to ten years old in NEHR of Jamaica is 17.7% with older children and girls having higher rates. Children attending urbanpublic and private schools have higher prevalence than those attending rural schools. Appropriately targeted interventions are needed to combat this problem.

OBJETIVO: Estimar la prevalencia y los correlatos de sobrepeso y obesidad entre niños de seis a diez años en la región noreste de atención a la salud (RNAS) de Jamaica. SUJETOS Y MÉTODOS: Se midió el peso y la altura en una muestra representativa de 5710 niños en edades entre seis y diez años, en 34 escuelas, entre octubre de 2008 y marzo de 2009. El sobrepeso y la obesidad se definieron como el índice de masa corporal (IMC) de puntuación Z > 1SD y > 2SD, respectivamente, tomando como base las normas específicas de crecimiento por género y edad para los niños, aprobadas por la Organización Mundial de la Salud (OMS). Se calcularon los estimados de prevalencia puntual del sobrepeso y la obesidad. Se utilizaron los cocientes de probabilidades relativas (OR) e intervalos de confianza (IC) del 95%, a fin de determinar las asociaciones entre el sobrepeso y la obesidad por un lado, y la edad, el género y lugar de la escuela, por otro lado. RESULTADOS: La prevalencia del sobrepeso y la obesidad entre los niños de seis a diez años en la RNAS, Jamaica, fue de 10.6% y 7.1%, respectivamente. La prevalencia del sobrepeso (OR = 1.11, IC de 95%: 1.04, 1.18) y de la obesidad (OR = 1.17, IC del 95%: 1.08, 1.26) aumentó significativamente con la edad. La prevalencia del sobrepeso (OR = 1.51, IC del 95%: 1.27, 1.80) y la obesidad (OR = 1,36, IC de 95%: 1.11, 1.67) fue significativamente mayor entre las hembras que entre los varones. Los niños que asistían a las escuelas públicas rurales tuvieron menos riesgo de tener sobrepeso (OR = 0.57, IC del 95%: 0.46, 0.70) y ser obesos (OR = 0.35, IC del 95%: 0.28, 0.44) en comparación con los de las escuelas urbanas públicas o privadas. Tanto el sobrepeso (OR = 2.11, IC del 95%: 1.60, 2.78) como la obesidad (OR = 1.68, IC del 95%: 1.24, 2.28) fueron significativamente más frecuentes entre los niños que asisten a escuelas privadas. Después de ajustar por edad y género, los resultados continuaban siendo todavía estadísticamente significativos. CONCLUSIONES: La prevalencia del sobrepeso/obesidad entre niños de seis a diez años en la RNAS en Jamaica es de 17.7%, correspondiendo las tasas más altas a las hembras, y a los niños o niñas de mayor edad. Los niños y niñas que asisten a escuelas urbanas públicas y privadas presentan una mayor prevalencia que los que asisten a escuelas rurales. Se necesitan intervenciones dirigidas adecuadamente a combatir este problema.

Efficacy and safety of gefitinib or docetaxel in Chinese patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) who had failed previous platinum-based first-line chemotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety of gefitinib or docetaxel in Chinese patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) who had failed previous platinum-based first-line chemotherapy.</p><p><b>METHODS</b>We retrospectively reviewed 222 Chinese NSCLC patients in the subgroup of INTEREST (gefitinib versus docetaxel in previously treated non-small cell lung cancer) study. Survival analysis was evaluated by Kaplan-Meier method, and Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to compare the quality of life between gefitinib group and docetaxel group.</p><p><b>RESULTS</b>A total of 222 patients were analyzed in this subgroup study. 107 patients were treated with gefitinib, and 115 patients treated with docetaxel. There were all balanced between the two groups in terms of sex, age, staging and pathology in patient characteristics. The median overall survival in the two groups was similar (11 months in the gefitinib group vs. 14.0 months in the docetaxel group, P = 0.783). The progression-free survival (PFS) was also similar between the two groups (median PFS: 3.4 months in gefitinib group vs. 3.8 months in docetaxel group, P = 0.214). The response rate in gefitinib group was significantly higher than that in the docetaxel group (21.9% vs. 9.1%, P = 0.016).</p><p><b>CONCLUSION</b>The efficacy of gefitinib is similar with that of docetaxel in pretreated patients with locally advanced or metastatic NSCLC, however, gefitinib is more favorable in the tolerance and quality of life improvement.</p>