Reactance inversion in moderate to severe persistent asthma: low birth weight, prematurity effect, and bronchodilator response.

INTRODUCTION: Reactance inversion (RI) has been associated with impaired peripheral airway function in persistent asthma. However, there is little to no data about the difference between asthmatic children with and without RI. This study aimed to detect clinical and lung function differences in moderate-severe asthmatic children with and without RI. METHODS: This study was conducted between 2021 and 2022 in asthmatic school-age children. Impulse oscillometry (IOS) and spirometry were performed according to ATS/ERS standards. RESULTS: A total of 62 patients, with a mean age of 8.4 years, 54.8% were males and were divided into three groups: group 1 (32.3%) with no RI, group 2 (27.4%) with RI but disappearing after bronchodilator test and group 3 (40.3%) with persistent RI after bronchodilator test. Children in groups 2 and 3 had significantly lower birth weights than in group 1. Group 2 had lower gestational age compared to group 1. FEV1 and FEF25-75 of forced vital capacity were significantly lower in groups 2 and 3. In group 3, R5, AX, R5-20, and R5-R20/R5 ratios were significantly higher. Bronchodilator responses (BDR) in X5c, AX, and R5-R20 were significantly different between groups and lower in group 3. CONCLUSION: RI is frequently found in children with moderate-severe persistent asthma, particularly in those with a history of prematurity or low birth weight. In some patients, RI disappears after the bronchodilator test; however, it, persists in those with the worst pulmonary function. RI could be a small airway dysfunction marker.

Impulse oscillometry in preschool children with persistent asthma can predict spirometry at school age.

BACKGROUND: Lung function in children with persistent asthma may be impaired during preschool and school ages. The aim of this study was to describe if some preschool impulse oscillometry (IOS) parameters are related to spirometry alterations on reaching school age. METHODS: In 66 diagnosed with persistent asthma, an IOS was performed at entrance and followed-up to school age where a spirometry was done. RESULTS: The mean age was 4.9 years at the first evaluation and 7.9 years at the second evaluation, and 59.1% were male. During preschool, R5, R20, Fres, AX, and D5-20 were found to have diagnostic accuracy (area under the curve > 0.7) for predicting abnormal spirometry during school age (defined as FEV1 and/or FEV/FVC and/or FVC values below the lower limit of normality according to Quanjer predictive values). AX, D5-20, and R5 had the best LR+ to increase the probability of abnormal spirometry (50, 10, and 7.1, respectively). R20, R5, and AX was the best IOS parameters for discriminating bronchodilator response (BDR) in schoolchildren (LR+ = 3.4, 2.9, and 2.8, respectively). CONCLUSION: The findings of this study indicate that some IOS parameters between 3 and 5 years of age are useful for predicting abnormal spirometry and BDR at school age.

Fracturas de la base del quinto metatarsiano: ¿es útil mi tornillo de esponjosa con rosca parcial? Experiencia de 10 años / Fractures of the base of the fifth metatarsal bone: is my partially-threaded cancellous screw useful? 10-year experience

OBJETIVO Evaluar el resultado quirúrgico de fracturas de las zonas 2 y 3 de la base del quinto metatarsiano usando tornillos de esponjosa de diámetro de 4,0 mm con rosca parcial. MATERIALES Y MÉTODOS Evaluación retrospectiva de pacientes operados entre 2010 a 2019. Incluimos todos los casos sintetizados con este dispositivo con seguimiento mínimo de tresmeses, y excluimos casos operados con otros dispositivos y seguimiento menor a tres meses. Evaluamos la consolidació n y la presencia de complicaciones. Determinamos el largo del tornillo, el diámetro del canal endomedular, la distancia entre el borde proximal de la tuberosidad y la fractura, y la distancia de paso de la rosca sobre el rasgo de la fractura en radiografías anteroposterior (AP) y oblicua del pie. RESULTADOS Evaluamos 39 casos, y la muestra tenía una edad promedio de 27 años, y predominio del sexo masculino. El largo de tornillo más usado fue el de 45 mm, y los diámetros promedios del canal endomedular medidos en las radiografías AP y oblicua fueron de 4,6 mm y 3,96 mm, respectivamente. La distancia del borde de la tuberosidad hasta la fractura fue de 25,8 mm, y la distancia de paso de la rosca sobre el rasgo de la fractura fue en promedio de 24 mm. Hubo 100% de consolidación, en un promedio de 9,4 semanas, y 3 casos de retardo de consolidación, 2 de retroceso de tornillo, 1 de rosca intrafoco, y 1 de fractura cortical superior. No hubo retiros de tornillos a la fecha. DISCUSION No existe consenso respecto al tornillo ideal. La literatura internacional recomienda dispositivos intramedulares de diámetro de al menos 4,5 mm. Existen pocos reportes del uso de tornillos de diámetro de 4,0 mm. CONCLUSIONES El tornillo de esponjosa de diámetro de 4,0 mm con rosca parcial es una alternativa eficaz, segura y con baja tasa de complicaciones para el manejo de estas fracturas en nuestra población.

OBJETIVE To evaluate the surgical result of zone-2 and -3 fractures of the base of the fifth metatarsal bone using partially-threaded cancellous screws with a diameter of 4.0 mm. MATERIALS AND METHODS A retrospective evaluation of patients submitted to surgery between 2010 and 2019. We included all of the cases synthesized with this device with a minimum follow-up of three months, and excluded the cases operated on with other devices and follow-up shorter than three months. We evaluated the consolidation and the presence of complications, and determined, screw length, diameter of the endomedullary canal, the distance between the proximal edge of tuberosity and the fracture, and thread pitch over the fracture line on anteroposterior (AP) and oblique radiographs. RESULTS We evaluated 39 cases, and the sample had an average age of 27 years and male predominance. The most used screw length was 45 mm, and the average diameters of the medullary canal measured on the AP and oblique radiographs were of 4.6 mm and 3.96 mm respectively. The distance from the edge of the tuberosity to the fracture was of 25.8 mm, and the thread pitch over the fracture line was on average 24 mm. The rate of consolidation was of 100%, occurring in an average of 9.4 weeks, and there were 3 cases of consolidation delay, 2 of screw recoil, 1 of intrafocus thread, and 1 of superior cortex fracture. To date, there have been no cases of screw removal. DISCUSSION There is no consensus regarding the ideal screw. The international literature recommends intramedullary devices with a diameter of at least 4.5 mm. There are few reports of the use of screws with 4.0 mm in diameter. CONCLUSIONS The partially-threaded cancellous screw with a diameter of 4.0 mm is an effective and safe option, with a low complication rate for the management of these fractures.

"Reactance inversion" at low frequencies during lung function measurement by impulse oscillometry in children with persistent asthma.

BACKGROUND: Small airway dysfunction (SAD) in asthma can be measured by impulse oscillometry (IOS). Usually, the reactance should decrease with decreases in frequency oscillation. Sometimes an upward shift of the curve at low frequencies can be observed together with lower than expected reactance values. The actual value of the reactance at 5 Hz (X5) is calculated by the Sentry Suite application of the Jaeger Master screen iOS system™, providing the corrected X5 parameter (CX5). Our hypothesis is that correction of X5 is common in persistent asthma and it correlates better than X5 with the IOS parameters for evaluating SAD. METHODS: In this transversal study, we evaluated 507 children (3-18 years old) using IOS-spirometry (Sentry Suite, Vyntus®). Resistance of all airways (R5), reactance area (AX), resonant frequency (Fres), X5, CX5, difference between R5 and R20 (D5-20), and spirometry parameters were analyzed. Reactance inversion and CX5 prevalence by age range was determined. The mean IOS-Spyrometry values in children with and without CX5 were compared, and correlations with each IOS-spirometry parameter in the age groups were performed. RESULTS: CX5 was found in 83.5% of preschool children, 66.2% of schoolchildren, and 43.3% of adolescents (p < 0.001). The means of R5, AX, and D5-20 were significantly higher and FEV1 was significantly lower in children with CX5 (p < 0.05). In all ages, CX5 correlated better than X5 with IOS-spirometry parameters. CONCLUSION: Reactance inversion and CX5 are frequent in asthmatic children, decrease with age, and correlate more closely than X5 with other IOS-spirometry parameters for evaluating SAD.

Evolutionary lung function evaluated by impulse oscillometry in preschoolers with asthma. / Función pulmonar evolutiva evaluada por oscilometría de impulso en prescolares con asma.

INTRODUCTION: Impulse oscillometry (IOS) is useful for measuring lung function in preschool children. Our objec tive was to describe the alterations and evolutionary profile of IOS in asthmatic children under 6 years of age after one year of follow-up. PATIENTS AND METHOD: 62 preschoolers performed IOS at the begin ning of the study and after one year. The proportion of altered IOS and bronchodilator response (BR +) at both times was compared, in addition to sub-analysis according to asthma control and presence of atopy. For the statistical analysis, we used McNemar's %2 and the Student's t-test with a 5% a error. RESULTS: The initial IOS was altered in 80.6% and in 64.5%% after one year (p = 0.04). 77.4% of the children presented BR+ at the beginning of the study and 83.9% after one year. The uncontrolled asthma group presented a significant improvement in the X5 and D5-20 means, but the controlled asthma group did not. In atopic patients, only uncontrolled asthmatics improved X5, AX, and D5-20. CONCLUSION: IOS shows alterations in a high percentage of preschoolers with uncontrolled asthma, which decreases significantly at one year, but remains altered and with BR + in most children. Ad ditional studies are required to identify different preschool asthma phenotypes and their evolution with treatment.

Vancouver type B2 and B3 periprosthetic fractures treated with revision total hip arthroplasty.

PURPOSE: Periprosthetic fractures are the fourth most common cause for hip revision and a devastating complication. Our purpose is to report results and quality of life following revision THA for Vancouver B2 and B3 fractures. METHODS: This was a retrospective review from January 2000 to November 2012 to identify all revision THA performed for Vancouver types B2 and B3 that had a minimum follow-up of two years. Routine post-operative and radiographic evaluation to assess patient survival, implant failure, complications and quality of life was involved. Statistical analysis was made with the Kaplan-Meier survival curve with 95 % confidence interval and the log rank (Mantel-Cox) test. RESULTS: A total of 76 fractures were included, with an average follow-up 74.4 months. Mean age at the revision surgery was 75.7 years (range, 41-97 years; SD, 12.4). Sixty-six cases were classified as Vancouver B2 and treated with distal fixation stem. Ten cases were Vancouver B3 and a proximal femoral allograft technique was used. The overall five-year Kaplan-Meier survival rate for the patients was 77.9 % (95 % CI, 67.4-88.4), and the ten-year rate was 65.1 % (95 % CI, 51.4-78.8). Five-year Kaplan-Meier survival rate for the implants was 89.6 % (95 % CI, 82.2-97); we presented seven failures. The mean SF-12 mental was 55.1 (range, 31-68; SD, 8.1) and the physical was 37.4 (range, 16-55; SD, 9.4). CONCLUSION: Mortality rate after periprosthetic fractures is high as compared to other hip surgeries; our Kaplan-Meier analysis showed that it tends to plateau after five years. In our series the failure rate was low and occurred early in the post-operative period.