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1.
Khirurgiia (Mosk) ; (4): 47-52, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32352668

RESUMEN

The researches devoted to postoperative liver regeneration and influence in this process were analyzed. Liver injury is followed by hypertrophy of residual liver parenchyma. The use of various cytokines is perspective for activation, acceleration and inhibition of liver recovery. Cellular technologies in the treatment of liver diseases can affect its repair. Moreover, these methods could make unnecessary resection and transplantation of liver in certain cases. It is generally accepted that the main effect of multipotent stromal cells (MSC) in liver failure is associated with their differentiation to the cellular elements of this organ. At the same time, recent reports revealed that MSC injection to the liver is followed by their quick death, dissemination to other organs and tissues or even elimination from the organism. Regeneration of non-parenchymal structures (vascular network and bile ducts) should be considered in addition to functional recovery of liver parenchyma after resection. Clarification of indications and contraindications for MSC therapy, as well as prevention of possible complications associated with cellular technologies are required.


Asunto(s)
Hepatectomía , Hepatopatías/fisiopatología , Hepatopatías/cirugía , Regeneración Hepática/fisiología , Hígado/fisiología , Humanos , Recuperación de la Función
2.
Medicine (Baltimore) ; 99(18): e19642, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358345

RESUMEN

BACKGROUND: Clinical symptoms of Parkinson disease (PD) included both motor and nonmotor symptoms. Previous studies indicated inconsistent results for the therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on motor and depression in PD. The study aimed to assess the therapeutic effect of rTMS with different mode on motor and depression in PD using a meta-analysis. METHODS: Articles published before July 2019 were searched based on the following databases (PubMed, Web of Science, Medline, Embase, and Google Scholar). The therapeutic effects were assessed by computing the standard mean difference (SMD) and a 95% confidence interval (CI). RESULTS: The present study indicated that rTMS showed significant therapeutic effects on motor in PD (SMD 2.05, 95% CI 1.57-2.53, I = 93.0%, P < .001). Both high-frequency (HF)-rTMS and low-frequency rTMS showed therapeutic effects on motor; stimulation over primary motor cortex (M1), supplementary motor area, dorsal lateral prefrontal cortex (DLPFC) or M1+DLPFC showed therapeutic effects; stimulation during "on" and "off" states showed therapeutic effects; the study showed long-term effect of rTMS on motor in PD. In addition, the study indicated that rTMS showed significant therapeutic effects on depression in PD (SMD 0.80, 95% CI 0.31-1.29, I = 89.1%, P < .001). Stimulation over left DLPFC showed significant therapeutic effects on depression in PD; only HF-rTMS showed therapeutic effects; ages, disease durations, numbers of pulses, and session durations displayed influence on the therapeutic effects of rTMS on depression in PD; the therapeutic effects on depression was long term. However, no significant difference in therapeutic effects on depression were showed between rTMS and oral Fluoxetine (SMD 0.74, 95% CI -0.83 to 2.31, I = 92.5%, P < .001). CONCLUSION: The rTMS showed significant therapeutic effects on motor in PD. HF-rTMS showed a significant positive antidepressive effect in PD only over DLPFC.


Asunto(s)
Depresión/terapia , Enfermedad de Parkinson/terapia , Estimulación Magnética Transcraneal/métodos , Anciano , Depresión/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/psicología , Desempeño Psicomotor , Recuperación de la Función , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 99(18): e19899, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358356

RESUMEN

INTRODUCTION: The anterior cruciate ligament (ACL) is the region where spraining or tearing is most prevalent when the knee is injured. Complete ACL ruptures have a much less favorable outcome without surgical intervention. Polydeoxyribonucleotide (PDRN) is a relatively safe substance widely used for regenerative therapy. PATIENT CONCERNS: A 43-year-old female patient visited our clinic with Rt. knee pain after slipping, which she rated as 7/10 on a numeric rating scale. DIAGNOSIS: She was diagnosed as having a near complete tear of the ACL at the femoral attachment, partial tear of the lateral collateral ligament. INTERVENTIONS: Ultrasound-guided PDRN injections were carried out 5 times at intervals of about 2 weeks. OUTCOMES: At 3-month follow-up, the patient demonstrated an improvement in knee symptoms (numeric rating scale 0) and ROM without any complications. Even after 2 years and 5 months since the diagnosis, she has been doing her daily life well without any pain. CONCLUSION: This is the first report of successful PDRN injection for near complete tear of ACL and partial tear of lateral collateral ligament without surgery.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/terapia , Polidesoxirribonucleótidos/administración & dosificación , Rotura Espontánea/terapia , Adulto , Femenino , Humanos , Inyecciones Intraarticulares , Recuperación de la Función , Medicina Regenerativa/métodos , Resultado del Tratamiento , Cicatrización de Heridas
5.
Bone Joint J ; 102-B(5): 632-637, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32349595

RESUMEN

AIMS: Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients' long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. METHODS: In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired t-test. RESULTS: Patient-reported functional outcomes as assessed by overall SMFA were statistically significantly improved at five years (p < 0.001) compared with one-year data from the same patients. Patients additionally reported an improvement in the Standardized Mobility Index (p < 0.001), Standardized Emotional Index (p < 0.001), as well as improvement in Standardized Bothersome Index (p = 0.003) between the first year and latest follow-up. Patient-reported pain and knee ROM were similar at five years to their one-year follow-up. In total, 15 of the patients had undergone subsequent orthopaedic surgery for their knees at the time of most recent follow-up. Of note, only one patient had undergone knee arthroplasty following plateau fixation related to post-traumatic osteoarthritis (OA). CONCLUSION: Knee pain following tibial plateau fracture stabilizes at one year. However, PROs continue to improve beyond one year following tibial plateau fracture, at least in a statistical sense, if not also clinically. Patients displayed statistical improvement across nearly all SMFA index scores at their minimum five-year follow-up compared with their one-year follow-up. Cite this article: Bone Joint J 2020;102-B(5):632-637.


Asunto(s)
Fijación Interna de Fracturas/métodos , Reducción Abierta/métodos , Medición de Resultados Informados por el Paciente , Fracturas de la Tibia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Rango del Movimiento Articular , Recuperación de la Función
6.
Medicine (Baltimore) ; 99(19): e20010, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384457

RESUMEN

INTRODUCTION: Long-term oxygen therapy is reported to improve hypoxemia and survival in patients with respiratory failure. The demand oxygen delivery system (DODS) saves oxygen and extends the usable time of an oxygen cylinder 2- to 3-fold. A portable oxygen concentrator with an auto-DODS has been developed to switch its sensitivity among 3 levels (standard, high, and extra high) and to supply pulsed-flow oxygen when it detects apnea. The aim of this study is to evaluate the efficacy of this newly developed portable oxygen concentrator with auto-DODS compared to the efficacy of conventional DODS in oxygenation. METHODS AND ANALYSIS: Twenty-six patients with chronic obstructive pulmonary disease or interstitial pneumonia will be randomized to use auto-DODS or conventional DODS at rest and during a 6-minute walk test. Primary endpoints are mean oxygen saturation (SpO2) at rest and during the 6-minute walk test. Secondary endpoints are the ratios of the times during which the oxygen concentrator operates at each sensitivity mode (standard, high, and extra high) and at a constant pulse rate to the examination time, the ratio of the times during which SpO2 fall below 90% to the examination time, the lowest value of SpO2 during the examination time, the mean and highest pulse rates during the examination time, 6-minute walking distance, recovery time, Borg scale, comfort, and reliability, which are measured by a numerical rating scale and a questionnaire, respectively. ETHICS AND DISSEMINATION: The study was conducted in accordance with the Declaration of Helsinki and was registered on Aug 23, 2019 (https://jrct.niph.go.jp/en-latest-detail/jRCTs052190041). The results of the study will be presented at academic conferences and submitted to a peer-reviewed journal. TRIAL REGISTRATION NUMBER: jRCTs052190041.


Asunto(s)
Enfermedades Pulmonares Intersticiales/complicaciones , Terapia por Inhalación de Oxígeno , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Insuficiencia Respiratoria , Adulto , Estudios Cruzados , Femenino , Humanos , Masculino , Nebulizadores y Vaporizadores , Oximetría/métodos , Terapia por Inhalación de Oxígeno/instrumentación , Terapia por Inhalación de Oxígeno/métodos , Prioridad del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Reproducibilidad de los Resultados , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/metabolismo , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Prueba de Paso/métodos
7.
Medicine (Baltimore) ; 99(19): e20018, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384460

RESUMEN

BACKGROUND: Parkinson disease (PD) is a progressive neuromuscular disease associated with bradykinesia, tremor, and postural instability. We aimed to compare outcomes and complications of total hip arthroplasty (THA) between patients with PD and those without. METHODS: A single institution retrospective cohort from 2000 to 2018 was reviewed. PD patients were matched 1:2 with non-PD control patients for age, gender, American Society of Anesthesiologists score, and body mass index using a propensity score matching procedure. The primary outcome measures were postoperative complications and revision between PD and cohort groups. Secondary outcome measures were Harris Hip Score, hip range of motion, patient satisfaction, and surgery time. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort. RESULTS: Using prospectively collated data, we identified 35 PD patients after primary THA. A control cohort of 70 primary THA patients was matched. CONCLUSION: Our hypothesis was that PD would have adverse impact on complication rates, range of movement, or improvement in functional outcome after subsequent THA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5446).


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Osteoartritis de la Cadera , Enfermedad de Parkinson/complicaciones , Complicaciones Posoperatorias , Recuperación de la Función , Reoperación , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Casos y Controles , Protocolos Clínicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/cirugía , Evaluación de Resultado en la Atención de Salud , Prioridad del Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Rango del Movimiento Articular , Reoperación/métodos , Reoperación/estadística & datos numéricos
8.
Medicine (Baltimore) ; 99(19): e20019, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384461

RESUMEN

This study aimed to assess the efficacy of needle-knife (NK) combined with etanercept (NKCE) in attenuating pain, inflammation, disease activity, and improving hip joint function in ankylosing spondylitis (AS) patients with hip joint involvement.Totally, 90 patients with active AS involving unilateral hip joint were enrolled and randomly assigned in 1:1:1 ratio to receive NKCE, NK or conventional drugs (control). The ESR, CRP, hip joint pain Visual Analogue Scale (VAS) score, bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI), modified Harris hip score (mHHS), and range of motion (ROM) of affected hip joint were assessed at baseline (W0), after 1-week treatment (W1) and after 24-week treatment (W24).ESR and CRP were decreased in NKCE group compared with NK and control groups, while was not attenuated in NK group compared with control group. Regrading pain and disease activity, NKCE group presented a reduction in hip pain VAS score and BASDAI compared with NK and control groups, and NK group showed a decrease in hip pain VAS score and BASDAI compared with control group. Besides, BASFI was lowered in NKCE and NK groups compared with control group, but similar between NKCE and NK groups. mHHS and hip ROM were raised in NKCE and NK groups compared with control group, but similar between NKCE and NK groups.NKCE decreases hip pain, inflammation, disease activity and improves hip joint function in AS patients with hip joint involvement.


Asunto(s)
Terapia por Acupuntura/métodos , Artralgia , Etanercept/administración & dosificación , Articulación de la Cadera , Espondilitis Anquilosante , Adolescente , Adulto , Antirreumáticos/administración & dosificación , Artralgia/diagnóstico , Artralgia/etiología , Artralgia/terapia , Femenino , Articulación de la Cadera/patología , Articulación de la Cadera/fisiopatología , Humanos , Masculino , Manejo del Dolor/métodos , Dimensión del Dolor/métodos , Gravedad del Paciente , Rango del Movimiento Articular , Recuperación de la Función , Espondilitis Anquilosante/diagnóstico , Espondilitis Anquilosante/fisiopatología , Espondilitis Anquilosante/terapia , Resultado del Tratamiento
9.
Medicine (Baltimore) ; 99(19): e20031, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384462

RESUMEN

BACKGROUND: It has not been determined that demand valve oxygen therapy is effective for nocturnal hypoxia. A portable oxygen concentrator with an auto-demand oxygen delivery system (auto-DODS; standard, high, and extra high) has recently been developed to improve oxygenation and comfort. This oxygen concentrator can supply a pulsed flow when it detects apnoea. The aim of this study is to demonstrate that this newly developed portable oxygen concentrator with an auto-demand function is non-inferior to a continuous-flow oxygen concentrator for nocturnal hypoxemia. METHODS: Twenty patients with chronic obstructive pulmonary disease or interstitial pneumonia will be randomized to receive a portable oxygen concentrator with an auto-DODS or a continuous-flow oxygen concentrator during sleep. The primary endpoint is mean oxygen saturation (SpO2) during the total sleep time. The secondary endpoints are the ratios of time that the oxygen concentrator spends in each sensitivity mode (standard, high, and extra-high) and at a constant pulse rate to the total sleep time, the total time and ratio of time for which SpO2 is less than 90% during the total sleep time, the lowest value of SpO2 during the total sleep time, the mean and highest pulse rate during the total sleep time, the apnoea index during the total sleep time, the total sleep duration itself, and comfort and reliability as measured by numerical rating scale and questionnaires. DISCUSSION: If the auto-DODS demonstrates non-inferiority to continuous flow in oxygenation during sleep, the auto-DODS can be used even at night, and the patient will need only 1 device. TRIAL REGISTRATION: The study was registered on Aug 23, 2019 (jRCTs052190042).


Asunto(s)
Hipoxia , Enfermedades Pulmonares Intersticiales/complicaciones , Nebulizadores y Vaporizadores , Terapia por Inhalación de Oxígeno , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Adulto , Estudios Cruzados , Femenino , Humanos , Hipoxia/sangre , Hipoxia/diagnóstico , Hipoxia/etiología , Hipoxia/terapia , Masculino , Oximetría/métodos , Terapia por Inhalación de Oxígeno/instrumentación , Terapia por Inhalación de Oxígeno/métodos , Polisomnografía/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Reproducibilidad de los Resultados , Prueba de Paso/métodos
10.
Medicine (Baltimore) ; 99(19): e20032, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384463

RESUMEN

RATIONALE: Spontaneous spinal subdural hematoma (SSDH) is a rare disease that can cause severe permanent neurological dysfunction. Here we present a case of spontaneous SSDH, in which a series of magnetic resonance images (MRIs) taken through the course of the disease facilitated understanding of the resolution process of the hematoma and the diagnosis of SSDH. PATIENT CONCERNS: A 59-year-old male presented with sudden severe back pain and rapid onset of paraplegia. This symptom had continued developing while he was transferred to the emergency department. Initial physical examination showed flaccid paralysis of both lower limbs with areflexia and loss of all sensation below T6 bilaterally. MRI images showed an anterior subdural hematoma from C7 to T7 with spinal cord compression. DIAGNOSIS: Based on MRI findings, the diagnosis was SSDH. INTERVENTIONS: We chose conservative treatment of 1-week bed rest and intensive rehabilitation for the patient due to the presence of sacral sparing and the slight motor recovery at 24 hours after the onset. OUTCOMES: Frequent MRI images demonstrated that the spinal cord compression was surprisingly mitigated only 2 days and mostly absorbed 4 days after the onset. The patient's motor function was recovered completely and he was discharged after 8 weeks of hospitalization. LESSONS: Our chronological MRI findings provide crucial information for diagnosing SSDH and also suggest that spinal surgeons should consider the potential option of a conservative approach for treating SSDH. Although prompt selection of a therapeutic strategy for SSDH could be challenging, the surgeons could observe the course of the patient's neurological status for a few days to detect signs of spontaneous recovery.


Asunto(s)
Tratamiento Conservador/métodos , Hematoma Subdural Espinal , Imagen por Resonancia Magnética/métodos , Paraplejía , Conducto Vertebral/diagnóstico por imagen , Hematoma Subdural Espinal/complicaciones , Hematoma Subdural Espinal/diagnóstico , Hematoma Subdural Espinal/fisiopatología , Hematoma Subdural Espinal/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Examen Neurológico/métodos , Paraplejía/etiología , Paraplejía/fisiopatología , Paraplejía/rehabilitación , Recuperación de la Función , Remisión Espontánea , Resultado del Tratamiento
11.
Medicine (Baltimore) ; 99(16): e19780, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32311986

RESUMEN

Segmental fusion is not necessarily needed in treatment of thoracolumbar unstable burst fracture requiring surgery. Our objective was to report the results of follow-up for at least 10 years in patients with thoracolumbar unstable burst fracture requiring surgery in which fractured segment was healed following temporary posterior instrumentation without fusion, and in whom implants were subsequently removed.Retrospective Cohort Study.Nineteen patients in whom union of fractured vertebra was observed following surgery and in whom implants were removed within an average 12.2 months, and who could be followed up for at least 10 years, were enrolled.At the last follow-up, we evaluated the segmental motions, anterior body height ratio, progress of further kyphotic deformity, Oswestry Disability Index, Rolland Morris Disability Questionnaire and Short Form 36.Results: The follow-up period after implant removal surgery was 151 months on average. The local kyphotic angle was 26.89 ±â€Š6.08 degrees at the time of injury and 10.11 ±â€Š2.22 degrees at the last follow-up. The anterior body height ratio was 0.54 ±â€Š0.16 at the time of injury and 0.89 ±â€Š0.05 at the last follow-up. Thus, the fractured vertebra was significantly reduced after surgery and maintained till last follow-up. The segmental motion was 9.84 ±â€Š3.03, Oswestry Disability Index was 7.95 ±â€Š7.38, Rolland Morris Disability Questionnaire was 2.17 ±â€Š2.67, short form 36 Physical Component Score was 77.50 ±â€Š16.61, and short form 36 Mental Component Score was 79.21 ±â€Š13.32 at last follow-up.We conducted at least 10-year follow-up and found that temporary posterior instrumentation without fusion should be considered one of the useful alternative treatments for thoracolumbar unstable burst fracture in place of the traditional posterior instrumentation and fusion.


Asunto(s)
Fijación Interna de Fracturas/instrumentación , Vértebras Lumbares/cirugía , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/cirugía , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Calidad de Vida , Radiografía , Recuperación de la Función , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagen , Adulto Joven
12.
Medicine (Baltimore) ; 99(17): e19854, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332643

RESUMEN

This study aimed to study the effects of surgical approaches and identify the morphological characteristics associated with the 1-year follow-up outcome of patients with posterolateral tibial plateau fractures after successful surgery.We followed 200 postoperative patients for 1 year. The modified Hospital for Special Knee Surgery score (HSS score) was used to evaluate the functional recovery of the knee. We supposed 4 morphological characteristics in CT images acting as possible risk factors, including the anteroposterior diameters of posterolateral broken bone fragments (fragment-diameter), the damage to the posterolateral cortex of the tibial head (cortex-damage), the combinational fracture of the proximal fibula (fibula-fracture) or fracture of the medial tibial condyle (medial-condyle-fracture). Multivariate regression models were used to analyze the effect of these factors on the HSS score after adjusting the 2 surgical approaches and other confounders.The average HSS score was 85.1 ±â€Š5.8 for all the patients. We treated 155 patients with the anterolateral approach and 45 patients with the posterolateral approach. The surgical approach, fragment-diameter, fibula-fracture, and medial-condyle-fracture were correlated with the HSS scores (P < .05). After adjusting for the above factors, the Schatzker type, age and gender, compared with anterolateral approach, the posterolateral approach could improve the HSS scores by an average of 3.7 points. The fragment-diameter <20 mm and posterolateral approach interacted on the HSS scores. Comparing posterolateral and anterolateral approaches, we found that the HSS scores of patients with fragment-diameter <20 mm increased by 6.1 points (95% CI: 4.1-8.2) in the posterolateral approach, while those with fragment-diameter ≥20 mm did not significantly improve the HSS scores.The surgical approach, fragment-diameter, fibula-fracture, and medial-condyle-fracture were independent risk factors associated with the follow-up outcome of patients with posterolateral tibial plateau fractures after successful surgery. The posterolateral approach could significantly improve the HSS score in the studied hospital.


Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas de la Tibia/patología , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Rodilla/fisiología , Masculino , Persona de Mediana Edad , Recuperación de la Función , Factores de Riesgo , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/fisiopatología , Adulto Joven
13.
Medicine (Baltimore) ; 99(17): e19858, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332644

RESUMEN

This study aims to evaluate the timing of surgery in surgically treated humeral shaft fractures, to investigate the effects of surgical time on fracture recovery and complications.This was a retrospective and observational study, based on patient data who underwent surgical treatment of humeral shaft fractures from January 2012 to January 2019. There were 52 patients (19 were women and 33 men) with traumatic humeral shaft fractures who were treated consecutively at our hospital.There was a statistically significant difference in time to start physical therapy, time between surgery and bone union, and time between bone fracture and bone union. The mean time to start physical therapy in group 1 was 6.5 weeks (range, 5-12 weeks), it was 10 weeks (range, 6-14 weeks) in group 2 (P < .001). The mean time between surgery and bone union in group 1 was 14.58 weeks (range, 12-20 weeks), it was 17.4 weeks (range, 8-30 weeks) in group 2 (P: .009). The mean time between bone fracture and bone union in group 1 was 113.2 days (range, 86-114 days), it was 179.2 days (range, 89-355 days) in group 2 (P < .001).Classically the first treatment option for humerus shaft fractures is conservative if there is no absolute surgical indication. Surgical treatment may be the first option if patients want to return to early everyday life. Delayed surgery means delayed physical therapy and this means delayed recovery and return to everyday life. In today's technology world, it should be discussed that the initial treatment of uncomplicated humerus shaft fractures is a conservative treatment.


Asunto(s)
Fracturas del Húmero/cirugía , Tiempo de Tratamiento , Adulto , Anciano , Reducción Cerrada/métodos , Tratamiento Conservador , Femenino , Curación de Fractura , Humanos , Fracturas del Húmero/terapia , Masculino , Persona de Mediana Edad , Modalidades de Fisioterapia , Cuidados Posoperatorios , Recuperación de la Función , Estudios Retrospectivos , Férulas (Fijadores) , Adulto Joven
14.
Medicine (Baltimore) ; 99(17): e19861, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332646

RESUMEN

The best treatment for medial humeral epicondyle fractures in children has been debated. In case of incarceration of the epicondylar fragment, particularly after elbow dislocation, several materials are used for fixation, including Kirschner wires (K-wires), metallic compression screws, tension band wire, and suture anchors. Herein, we introduce a new fixation material: the absorbable self-reinforced polylactide (SR-PLA) pin.The aim of the study was to prove the feasibility of a new fixation material (absorbable SR-PLA pins) for the treatment of medial epicondyle fracture in children.Thirty-two patients who underwent surgery in our hospital from August 2007 to January 2012 were retrospectively analyzed. The patients were divided into group A (K-wires) and group B (absorbable SR-PLA pin). Group A comprised 11 males and 4 females, aged 8 to 14 years (average, 12.6 years), with 12 patients with elbow dislocation. Group B comprised 13 males and 4 females, aged 7 to 15 years (average, 11.8 years), with 13 patients with elbow dislocation. The same approach was used for all patients by the same team of surgeons, and all the patients were followed up for over 12 months. In all patients, rehabilitation training was started after 3 weeks. The Broberg and Morrey elbow scale was used to evaluate elbow function at follow-up.Four patients from group A developed pin-track infections that gradually resolved after removal of the K-wires, whereas no infections occurred in group B. One patient refractured her humerus after K-wire removal. Using the Broberg and Morrey elbow scale, outcomes in group A were classified as excellent in 5 patients (33.33%), good in 7 patients (46.67%), fair in 2 patients (13.33%), and poor in 1 (0.07%). Group B outcomes were scored as excellent in 12 patients (70.58%), good in 4 (23.53%), and fair in 1 (0.06%) and no patient (0.00%) had a poor outcome. The average Broberg and Morrey score for group A was significantly lower than that for group B (83.27 ±â€Š7.02 vs 95.21 ±â€Š5.04; P = .0238).Absorbable SR-PLA pins can be safely used for medial epicondyle fractures in children. Our results indicate that SR-PLA pins are associated with better short-term functional outcome than K-wires.Level of evidence: III.


Asunto(s)
Implantes Absorbibles , Clavos Ortopédicos , Fijación Interna de Fracturas/instrumentación , Fracturas del Húmero/cirugía , Poliésteres , Adolescente , Niño , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Fractura-Luxación/cirugía , Fijación Interna de Fracturas/métodos , Humanos , Masculino , Recuperación de la Función , Estudios Retrospectivos
15.
Bone Joint J ; 102-B(4): 458-462, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228079

RESUMEN

AIMS: Varus-valgus constrained (VVC) implants are often used during revision total knee arthroplasty (TKA) to gain coronal plane stability. However, the increased mechanical torque applied to the bone-cement interface theoretically increases the risk of aseptic loosening. We assessed mid-term survivorship, complications, and clinical outcomes of a fixed-bearing VVC device in revision TKAs. METHODS: A total of 416 consecutive revision TKAs (398 patients) were performed at our institution using a single fixed-bearing VVC TKA from 2007 to 2015. Mean age was 64 years (33 to 88) with 50% male (199). Index revision TKA diagnoses were: instability (n = 122, 29%), aseptic loosening (n = 105, 25%), and prosthetic joint infection (PJI) (n = 97, 23%). All devices were cemented on the epiphyseal surfaces. Femoral stems were used in 97% (n = 402) of cases, tibial stems in 95% (n = 394) of cases; all were cemented. In total, 93% (n = 389) of cases required a stemmed femoral and tibial component. Femoral cones were used in 29%, and tibial cones in 40%. Survivorship was assessed via competing risk analysis; clinical outcomes were determined using Knee Society Scores (KSSs) and range of movement (ROM). Mean follow-up was four years (2 to 10). RESULTS: The five-year cumulative incidence of subsequent revision for aseptic loosening and instability were 2% (95% confidence interval (CI) 0.2 to 3, number at risk = 154) and 4% (95% CI 2 to 6, number at risk = 153), respectively. The five-year cumulative incidence of any subsequent revision was 14% (95% CI 10 to 18, number at risk = 150). Reasons for subsequent revision included PJI (n = 23, of whom 12 had previous PJI), instability (n = 13), and aseptic loosening (n = 11). The use of this implant without stems was found to be a significant risk factor for subsequent revision (hazard ratio (HR) 7.58 (95% CI 3.98 to 16.03); p = 0.007). KSS improved from 46 preoperatively to 81 at latest follow-up (p < 0.001). ROM improved from 96° prerevision to 108° at latest follow-up (p = 0.016). CONCLUSION: The cumulative incidence of subsequent revision for aseptic loosening and instability was very low at five years with this fixed-bearing VVC implant in revision TKAs. Routine use of cemented and stemmed components with targeted use of metaphyseal cones likely contributed to this low rate of aseptic loosening. Cite this article: Bone Joint J 2020;102-B(4):458-462.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/instrumentación , Cementación/métodos , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/etiología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Falla de Prótesis/etiología , Infecciones Relacionadas con Prótesis/etiología , Rango del Movimiento Articular , Recuperación de la Función , Reoperación/métodos , Factores de Riesgo , Resultado del Tratamiento
16.
Rev Fac Cien Med Univ Nac Cordoba ; 77(1): 19-23, 2020 03 12.
Artículo en Español | MEDLINE | ID: mdl-32238254

RESUMEN

Background: Accelerated recovery protocols in colorectal surgery have enhanced the perioperative cares optimizing recovery in this group of patients. A reduction in surgical stress and therefore early hospital discharge and lower morbidity is pursued, however, the literature offers few outcomes regarding its application in developing countries. Objective: to analyze short- and medium-term outcomes of the application of an accelerated recovery protocol in a terciary care hospital in Argentina. Methods: In the period between January 2015 and March 2017 patients were included prospectively and consecutively with indication of elective laparoscopic colorectal surgery and under strict follow-up according to the protocol created by the institution. Patients older than 80 years, ASA IV, emergency surgeries and conventional approach were excluded. We analyzed demographic data, diagnosis of surgery, type of intervention, hospital stay, complications, readmissions and reinterventions at 30 postoperative days. Results: Sixty-four patients with a mean age of 62 years were included. The mean hospitalization was 4.9 days, with 10.9% readmissions and 4.7% of reinterventions. We recorded 69% of the patients whit not complications at all and 5 major complications (8%) . Conclusion: Based on the adaptation of the international guidelines to our health reality, it is feasible to create an accelerated recovery protocol applicable in our country, with a low complication rate and early discharge.


Asunto(s)
Cirugía Colorrectal/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Laparoscopía/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Atención Perioperativa , Estudios Prospectivos , Recuperación de la Función , Factores de Tiempo
17.
Medicine (Baltimore) ; 99(14): e19610, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32243385

RESUMEN

BACKGROUND: Postoperative gastrointestinal dysfunction (PGD) refers to one of the common postoperative complications. Acupuncture can facilitate the recovery of PGD, whereas no therapeutic schedule of acupuncture has been internationally recognized for treating PGD. In the present study, a scientific trial protocol has been proposed to verify the feasibility of acupuncture in treating gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. We conduct this protocol to investigate whether acupuncture recovery gastrointestinal dysfunction by influencing the expression of gastrointestinal hormone. METHOD: The present study refers to a randomized, evaluator blinded, controlled, multi-center clinical trial; it was designed complying with the Consolidated Standards of Reporting Trials (CONSORT 2010) as well as the Standard for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA). The subjects will be taken from the inpatients having undergone laparoscopic surgery of Mianyang Affiliated Hospital of Chengdu University of traditional Chinese medicine, Mianyang Third Hospital and Mianyang Anzhou Hospital. Based on the random number yielded using SPSS 25.0 software, the qualified subjects will be randomly classified to the experimental group and the control group. Therapies will be performed 30 min once after operation, the experimental group will be treated with acupuncture, while the control group will receive intravenous injection of granisetron. The major outcome will be the time to first flatus, and the secondary outcomes will include the time to first defecation, abdominal pain, dosage of analgesia pump, abdominal distention, nausea, vomiting, gastrointestinal hormone, as well as mental state. The efficacy and safety of acupuncture will be also assessed following the principle of Good Clinical Practice (GCP). DISCUSS: A standardized and scientific clinical trial is conducted to assess the efficacy and safety of acupuncture for gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. The aim is to objectively evidence and improves the clinical practice of acupoint prescription, as an attempt to promote the clinical application of this technology.


Asunto(s)
Terapia por Acupuntura/métodos , Anestesia General/efectos adversos , Colecistectomía Laparoscópica/efectos adversos , Enfermedades Gastrointestinales/terapia , Hormonas Gastrointestinales/sangre , Complicaciones Posoperatorias/terapia , Adolescente , Adulto , Anciano , Estudios de Factibilidad , Femenino , Enfermedades Gastrointestinales/sangre , Enfermedades Gastrointestinales/etiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Método Simple Ciego , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
18.
Yonsei Med J ; 61(4): 323-330, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32233175

RESUMEN

PURPOSE: This study aimed to analyze radiological outcomes in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior correction with high-density pedicle screw-only constructs. We hypothesized that high-density pedicle screw-only constructs in AIS would provide a high correction rate and would facilitate the maintenance of the correction or obviate the loss thereof. MATERIALS AND METHODS: We retrospectively analyzed radiological outcomes over a minimum follow-up period of 5 years in patients with AIS who underwent posterior correction with high-density pedicle screw-only constructs. A total of 124 consecutive patients were included. Demographic data, including age, sex, operated fusion level, numbers of screw, Lenke curve type, Risser stage, and follow-up period were retrospectively collected from electronic medical records and radiological measurements including serial follow-up. RESULTS: The average number of pedicle screws was 1.96/vertebra. The average curve correction was 48.3% for the proximal thoracic (PT) curve, 83.1% for the main thoracic (MT) curve, and 80.2% for the thoracolumbar/lumbar (TL/L) curve at final follow-up. Use of high-density pedicle screw-only constructs helped achieve excellent correction rates, with no significant loss of correction at final follow-up. CONCLUSION: We obtained excellent correction rates of 48.3% for PT, 83.1% for MT, and 80.2% for TL/L curves using high-density pedicle screw-only constructs in AIS, with no significant loss of correction at final follow-up.


Asunto(s)
Tornillos Pediculares , Escoliosis/cirugía , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía , Adolescente , Femenino , Estudios de Seguimiento , Humanos , Masculino , Radiografía , Recuperación de la Función , Estudios Retrospectivos , Escoliosis/complicaciones , Vértebras Torácicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven
19.
Medicine (Baltimore) ; 99(14): e19495, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32243365

RESUMEN

INTRODUCTION: Upper extremity motor impairment is one of the major sequelae of stroke, resulting in limitations of activities of daily living. Recently, contralesional cortical activation has been reported to be important for motor recovery in stroke patients with severe upper extremity hemiparesis due to the extensive corticospinal tract involvement. We therefore designed this study to investigate the effects of contralesional anodal transcranial direct current stimulation (tDCS), which induces cortical activation, in stroke patients with severe upper extremity motor impairment. METHODS AND ANALYSIS: We will recruit patients with subacute stroke (<3 months after onset) with unilateral upper extremity weakness who meet the following criteria: Shoulder Abduction and Finger Extension (SAFE) score below 8, Fugl-Meyer Assessment for upper extremity (FMA-UE) score ≤25, and absent motor evoked potential (MEP) response on the affected extensor carpi radialis muscle. Subjects will be randomly allocated to either the intervention (n = 18) or the control group (n = 18). The intervention group will undergo 10 sessions of robotic arm rehabilitation with simultaneous anodal tDCS over the contralesional premotor area, whereas the control group will receive sham tDCS during the same sessions. One daily session consists of 25 minutes.The primary outcome measure of this study is the Fugl-Meyer Assessment score of the upper extremity; the secondary outcome measures are the Korean version of the Modified Barthel Index, the Brunnstrom stage of the affected arm and hand, the Box and Block Test, the Modified Ashworth Scale, the Manual Muscle Power Test, and the patient's encephalographic laterality index. DISCUSSION: Findings of this study will help to establish an individualized tDCS protocol according to the stroke severity and to find out the EEG parameters to predict the better recovery in subacute stroke patients with severe upper extremity hemiparesis. ETHICS AND DISSEMINATION: The study was approved by the Seoul National University Bundang Hospital Institutional Review Board (IRB No. B-1806-475-006) and will be carried out in accordance with the approved guidelines. The results of the trial will be submitted for publication in a peer-reviewed journal.


Asunto(s)
Paresia/rehabilitación , Rehabilitación de Accidente Cerebrovascular/métodos , Estimulación Transcraneal de Corriente Directa/métodos , Extremidad Superior , Actividades Cotidianas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Potenciales Evocados Motores , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Corteza Motora/fisiopatología , Recuperación de la Función , Adulto Joven
20.
Hu Li Za Zhi ; 67(2): 65-74, 2020 Apr.
Artículo en Chino | MEDLINE | ID: mdl-32281084

RESUMEN

BACKGROUND: Functional decline is a common complication in hospitalized older adults, and decline in the ability to walk is often the first change in physical functioning in this population. Decline in walking ability leads to a loss of independence in the activities of daily living in older adults after discharge from the hospital. PURPOSE: To explore the factors associated with the recovery of walking ability in older adults after discharge from the hospital. METHODS: This study used a longitudinal research design. Potential participants were recruited from a tertiary medical center in southern Taiwan. Patients were eligible for inclusion if they were at least 65 years old and were affected by a decline in walking ability at discharge. The data collected at discharge included: demographic information, Charlson Comorbidity Index, Modified Katz Index of Independence in Activities of Daily Living (walking item), Mini Nutritional Assessment, Mini-Mental State Examination, and ambulation during hospital stay. The follow-up data collected at three months after discharge included: Modified Katz Index of Independence in Activities of Daily Living (walking item), exercise habit, rehabilitation, and social support. RESULTS: A total of 78 older adults were enrolled as participants. Three-quarters (75.64%) of the participants had regained their ability to walk at three months after discharge. Moreover, nutritional status, cognitive function, and exercise habit were significantly associated with the recovery of walking ability. The results of multiple logistic regression analysis showed having an exercise habit to be significantly associated with the recovery of walking ability at three months after discharge (OR = 10.212, p = .004). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: In addition to treating the acute medical issues of older patients, healthcare professionals should screen and provide them with appropriate nutritional, cognitive, and physical care plans. Moreover, emphasizing the importance of an exercise habit in nursing discharge plans is also important. This effort may help older adults recover their walking ability and maintain their independence.


Asunto(s)
Recuperación de la Función , Caminata/fisiología , Anciano , Humanos , Planificación de Atención al Paciente , Alta del Paciente , Taiwán
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