ANALYSIS THE RESULTS OF SURGICAL TREATMENT AND EARLY REHABILITATION OF PATIENTS WITH MASSIVE TEARS THE ROTATOR CUFF THE SHOULDER.

The aim of the study was to evaluate the treatment outcomes in patients who underwent arthroscopic repair of large and massive rotator cuff tears and underwent rehabilitation at different stages of the recovery process. The clinical study group consisted of 88 patients, with an age range of 47 to 68 years (mean age 52,7±9,5 years). All patients underwent a double-row repair of the rotator cuff tendons and tenodesis or tenotomy of the long head of the biceps tendon under arthroscopic guidance. The results were assessed using the Constant Shoulder Score and the Oxford Shoulder Score scales at 6 and 12 months after the surgery. A total of 88 patients were selected, with 50 patients in the main group (MG) who had a 6-week immobilization period. The control group (CG) consisted of 38 patients who had a shortened immobilization period of 3-4 weeks due to patient preference or recommendations from other rehabilitation centers where patients underwent rehabilitation. Shoulder immobilization was performed using a standard sling with a triangular pillow and a 15° abduction angle in the shoulder joint. Following the surgeon's recommendation, all patients were offered a rehabilitation program consisting of three periods: immobilization (0-6 weeks), functional (6-12 weeks), and training (>12 weeks) periods. Comparative analysis of the treatment results using the Oxford Shoulder Score scale showed that significantly better results were obtained in the MG patients (41,5±2,1 points) compared to the CG patients (34,2±3,6 points) at 6,2±1,2 months (p˂0.05). Comparative analysis of the treatment results using the Oxford Shoulder Score scale at 12,2±1,3 months showed that there were no statistically significant differences between the MG and CG results (MG - 44,5±2,2 and CG - 42,4±3, p>0,05). Similarly, according to the Constant Shoulder Score scale, better results were observed in the MG both at 6 months and 12 months after the surgery (excellent in 82% of MG vs 36.8% in CG, good in 18% of MG vs 57.9% in CG, respectively). Thus, in the short term, early activation of the operated joint leads to delayed healing of the operated tissues and worsening of joint function, as confirmed by the comparative analysis of the examined groups. Significant advantages of prolonged immobilization (at least 6 weeks) were found in short-term observation (up to 6 months), and no differences in functional outcomes were observed in the long term during the follow-up at 12 months.

A history of cesarean section and future maternal long-term risk for neoplasms: a population-based cohort study.

OBJECTIVE: Mode of delivery has long-term implications on the mother, including recent data regarding the level of transmission of fetal microchimeric cells (FMc) and their possible effect on cancer development. We aimed to evaluate the association between cesarean section (CS) and future risk for neoplasms. STUDY DESIGN: A population-based cohort analysis comparing the long-term risk for neoplasms between patients that delivered only by CS to those that delivered only vaginally (VD). Neoplasms were pre-defined based on ICD-9 codes. Deliveries occurred between the years 1991-2017 in a tertiary medical center. Kaplan-Meier survival curves were used to compare the cumulative incidence of neoplasms and Cox proportional hazards models were constructed to control for confounders. RESULTS: During the study period 105,992 patients met the inclusion criteria; 14150 (13.4%) of patients had only CS and 91842 (86.6%) had VD (comparison group). The CS group had significantly higher incidence of benign and malignant neoplasms (4.73 per 1000 patient-years versus 3.88 per 1000 patient-years, OR = 1.26, 95% CI 1.16-1.37; p = 0.001; 2.19 per 1000 patient-years of follow up versus 1.93 per 1000 patient-years, OR = 1.16, 95% CI 1.03-1.31; p = 0.013). Specifically, the CS group had higher incidence of uterine cancer (1.2 versus 0.06 per 1000 patient-years, OR = 1.97, 95% CI 1.14-3.39; p = 0.013). The cumulative incidence of benign, malignant and uterine neoplasms was significantly higher in the CS group (Log rank test p = 0.001; 0.036 and 0.014; respectively). Importantly, no significant association was found with breast and ovarian malignancies." When performing a Cox regression model controlling for confounders, the risk for malignancy-related hospitalizations remained significant (adjusted HR = 1.22, 95% CI 1.01-1.48; p = 0.031) but not for uterine cancer (adjusted HR = 1.6, 95% CI 0.9-2.8; p = 0.103). CONCLUSION: Our findings provide support to linkage between delivery by cesarean section and future maternal malignancy.

Like mother like daughter: low birth weight and preeclampsia tend to reoccur at the next generation.

BACKGROUND: Low birth weight and preeclampsia are both adverse pregnancy and delivery outcomes, with possible influence on future health status. Previous studies have shown that intergenerational factors may be important prognostic information in evaluating women prior to or after conception. Our objective was to evaluate the role of intergenerational factors on the incidence of preeclampsia and low birth weight (LBW). METHODS: A retrospective population-based study was conducted. Perinatal information was gathered from 2311 familial triads, comprising mothers (F1), daughters (F2), and children (F3). All births occurred in a tertiary medical center between 1991 and 2013. A multivariate generalized estimating equation logistic regression model analysis was used to study the association between LBW and preeclampsia across generations while controlling for confounders and for clusters of families in the database. RESULTS: A total of 1490 in F1, 1616 in F2, and 2311 in F3 were included. LBW in mothers (F2), adjusted for possible confounders, was found to be a significant predictor for LBW in offspring (OR = 1.6, 95% CI 1.02-2.6, p = .043). Likewise, preeclampsia was also noted as a significant intergenerational factor following adjustments for possible confounders (OR = 2.9, 95% CI 1.4-5.8, p = .004). CONCLUSIONS: Maternal LBW and preeclampsia are both independent risk factors for recurrence in the next generation.

The association between birth weight at term and long-term endocrine morbidity of the offspring.

OBJECTIVE: To investigate whether small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth weight at-term poses an increased risk for long-term pediatric endocrine morbidity. STUDY DESIGN: A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to endocrine morbidity of singleton children born SGA, appropriate-for-gestational-age (AGA), and LGA at-term. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders. RESULTS: During the study period, 235,614 deliveries met the inclusion criteria; of which 4.7% were SGA (n = 11,062), 91% were AGA (n = 214,249), and 4.3% were LGA neonates (n = 10,303). During the follow-up period, children born SGA or LGA at-term had a significantly higher rate of long-term endocrine morbidity. Using a multivariable GEE logistic regression model, controlling for confounders, being delivered SGA or LGA at-term was found to be an independent risk factor for long-term pediatric endocrine morbidity (Adjusted OR = 1.4; 95%CI = 1.1-1.8; p = .015 and aOR = 1.4; 95%CI = 1.1-1.8; p = .005, respectively). Specifically, LGA was found an independent risk factor for overweight and obesity (aOR = 1.7; 95%CI = 1.2-2.5; p = .001), while SGA was found an independent risk factor for childhood hypothyroidism (aOR = 3.2; 95%CI = 1.8-5.8; p = .001). CONCLUSIONS: Birth weight either SGA or LGA at-term is an independent risk factor for long-term pediatric endocrine morbidity.

Maternal Asthma Is an Independent Risk Factor for Long-Term Respiratory Morbidity of the Offspring.

OBJECTIVE: The objective of this study was to investigate whether maternal bronchial asthma increases the risk for long-term respiratory morbidity of the offspring. STUDY DESIGN: A population-based cohort study compared the incidence of long-term pediatric hospitalizations due to respiratory disease of the offspring of mothers with and without bronchial asthma. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. Congenital malformations as well as multiple pregnancies were excluded. Kaplan-Meier's survival curve was used to estimate cumulative incidence of respiratory morbidity. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders. RESULTS: During the study period, 253,808 deliveries met the inclusion criteria; of which 1.3% were born to mothers with bronchial asthma (n = 3,411). During the follow-up period, children born to women with bronchial asthma had a significantly higher rate of long-term respiratory morbidity (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.3-1.7; p < 0.001). Specifically, the rate of childhood asthma was higher among offspring of mothers with asthma (OR = 2.3; 95% CI = 1.8-2.9; p < 0.001). Children born to women with asthma had higher cumulative incidence of respiratory morbidity, using a Kaplan-Meier's survival curve (log-rank test; p < 0.001). Using two multivariable GEE logistic regression models, controlling for the time to event, maternal age, and gestational age at delivery, maternal bronchial asthma was found to be an independent risk factor for long-term respiratory disease of the offspring (adjusted OR = 1.6; 95% CI = 1.4-1.9; p < 0.001), and specifically for bronchial asthma (adjusted OR = 2.5; 95% CI = 1.9-3.1; p < 0.001). CONCLUSION: Maternal bronchial asthma is an independent risk factor for long-term respiratory morbidity of the offspring.

Coping strategies, satisfaction with life, and quality of life in Crohn's disease: A gender perspective using structural equation modeling analysis.

OBJECTIVE: To identify coping strategies and socio-demographics impacting satisfaction with life and quality of life in Crohn's disease (CD). METHODS: 402 patients completed the Patient Harvey-Bradshaw Index, Brief COPE Inventory, Satisfaction with Life Scale (SWLS), Short Inflammatory Bowel Disease Questionnaire (SIBDQ). We performed structural equation modeling (SEM) of mediators of quality of life and satisfaction with life. RESULTS: The cohort comprised: men 39.3%, women 60.1%; P-HBI 4.75 and 5.74 (p = 0.01). In inactive CD (P-HBI≤4), both genders had SWLS score 23.8; men had SIBDQ score 57.4, women 52.6 (p = 0.001); women reported more use of emotion-focused, problem-focused and dysfunctional coping than men. In active CD, SWLS and SIBDQ scores were reduced, without gender differences; men and women used coping strategies equally. A SEM model (all patients) had a very good fit (X2(6) = 6.68, p = 0.351, X2/df = 1.114, SRMR = 0.045, RMSEA = 0.023, CFI = 0.965). In direct paths, economic status impacted SWLS (ß = 0.39) and SIBDQ (ß = 0.12), number of children impacted SWLS (ß = 0.10), emotion-focused coping impacted SWLS (ß = 0.11), dysfunctional coping impacted SWLS (ß = -0.25). In an indirect path, economic status impacted dysfunctional coping (ß = -0.26), dysfunctional coping impacted SIBDQ (ß = -0.36). A model split by gender and disease activity showed that in active CD economic status impacted SIBDQ in men (ß = 0.43) more than women (ß = 0.26); emotional coping impacted SWLS in women (ß = 0.36) more than men (ß = 0.14). CONCLUSIONS: Gender differences in coping and the impacts of economic status and emotion-focused coping vary with activity of CD. Psychological treatment in the clinic setting might improve satisfaction with life and quality of life in CD patients.

Fertility Treatments in Women Who Become Pregnant and Carried to Viability, and the Risk for Long-Term Maternal Cardiovascular Morbidity.

Objective The objective of this study was to investigate whether patients who undergo fertility treatments (ovulation induction or in vitro fertilization) have an increased risk for future maternal cardiovascular morbidity. Design A population-based study compared the incidence of long-term cardiovascular morbidity in a cohort of women with and without a previous exposure to fertility treatments. Deliveries occurred during a 25-year period, with a mean follow-up of 11.7 years. Women with known cardiovascular disease and congenital cardiovascular malformations diagnosed before the index pregnancy and multiple pregnancies were excluded. Results During the study period, 99,291 patients met the inclusion criteria; 4.1% (n = 4,153) occurred in patients with exposure to fertility treatments. Patients with exposure to fertility treatments did not have higher rates of cardiovascular morbidity. Using a Kaplan-Meier survival curve, patients with an exposure to fertility treatments had no higher cumulative incidence of cardiovascular hospitalizations. Using a Cox proportional hazards model, adjusted for confounders such as preeclampsia, diabetes mellitus, and obesity, exposure to fertility treatments remained unassociated with cardiovascular hospitalizations (adjusted hazard ratio = 1.1; 95% confidence interval, 0.9-1.3; p = 0.441). Conclusion In our population, during a mean follow-up period of 11.7, results showed no increased risk for cardiovascular morbidity in women undergoing fertility treatments.

The risk of female malignancies after fertility treatments: a cohort study with 25-year follow-up.

OBJECTIVE: To investigate whether an association exists between a history of fertility treatments and future risk of female malignancies. STUDY DESIGN: A population-based study compared the incidence of long-term female malignancies in a cohort of women with and without a history of fertility treatments including in vitro fertilization (IVF) and ovulation induction (OI). Deliveries occurred between the years 1988-2013, with a mean follow-up duration of 12 years. Excluded from the study were women with known genetic predisposition for malignancies or known malignancies prior to the index pregnancy. Female malignancies were divided into specific types including ovarian, uterine, breast and cervix. Kaplan-Meier survival curve was used to estimate cumulative incidence of malignancies. Cox proportional hazard models were used to estimate the adjusted hazard ratios (HRs) for female malignancy. RESULTS: During the study period, 106,031 women met the inclusion criteria; 4.1 % (n = 4363) occurred in patients following fertility treatments. During the follow-up period, patients with a history of IVF treatments had a significantly increased risk of being diagnosed with ovarian and uterine cancer as compared to patients after OI and patients with no history of fertility treatments. Cox proportional hazard models were constructed for ovarian and uterine cancer separately, controlling for confounders such as maternal age and obesity. A history of IVF treatment remained independently associated with ovarian and uterine cancer (adjusted HR 3.9; 95 % CI 1.2-12.6; P = 0.022 and adjusted HR 4.6; 95 % CI 1.4-14.9; P = 0.011; respectively). CONCLUSION: IVF treatments pose a significant risk of subsequent long-term ovarian and uterine cancer.

Can slight glucose intolerance during pregnancy predict future maternal atherosclerotic morbidity?

AIM: o examine the association between glucose level during pregnancy and the subsequent development of long-term maternal atherosclerotic morbidity. METHODS: A retrospective case-control study was conducted. The study included all women who had at least one glucose measurement during their pregnancies. Cases were all women who delivered between the years 2000-2012 and subsequently developed atherosclerotic morbidity (n = 815). Controls were randomly matched by age and year of delivery (n = 6065). The atherosclerotic morbidity group was further divided by severity: major events (cardiovascular, cerebrovascular disease, chronic renal failure), minor events (hypertension, diabetes mellitus and hyperlipidaemia without target organ damage or complications) and cardiac evaluation tests (such as coronary angiography without records of atherosclerosis, cardiac scan and stress test). The mean follow-up duration for the study group was 74 months. Cox proportional hazards model was used to control for confounders. RESULTS: A significant linear association was found between glucose levels during pregnancy and long-term maternal atherosclerotic morbidity. Among the cases with severe atherosclerotic morbidity, the proportion of women with a high glucose level (> 5.5 mmol/l) was the highest, whereas in controls it was the lowest (P < 0.001). In a Cox proportional hazard model, adjusted for atherosclerotic confounders such as gestational diabetes, pre-eclampsia and obesity, a glucose level of > 5.5 mmol/l was noted as an independent risk factor for hospitalizations later in non-pregnant life (hazard ratio = 1.3, 95% confidence interval 1.1-1.5, P < 0.003). CONCLUSION: A high glucose level during pregnancy, even if within the range of slight glucose intolerance, may serve as a marker for future maternal atherosclerotic morbidity. Further long-term studies are needed to confirm our findings.

Is there an association between a history of placental abruption and long-term maternal renal complications?

OBJECTIVE: To investigate whether patients with a history of placental abruption have an increased risk for subsequent maternal long-term morbidity. STUDY DESIGN: A population-based study compared the incidence of long-term renal morbidity in cohort of women with and without a history of placental abruption. Deliveries occurred during a 25-year period, with a mean follow-up duration of 11.2 years. Renal morbidity included kidney transplantation, chronic renal failure, hypertensive renal disease, etc. RESULTS: During the study period 99 354 deliveries met the inclusion criteria; 1.8% (n = 1807) occurred in patients with a diagnosis of placental abruption. Patients with placental abruption did not have higher cumulative incidence of renal related hospitalizations, using Kaplan-Meier survival curve. During the follow-up period patients with a history of placental abruption did not have higher rate of renal morbidity (0.2% versus 0.1%; OR 1.8; 95% CI 0.6-4.8; p = 0.261). When performing a Cox proportional hazards model, adjusted for confounders such as parity and diabetes mellitus, a history of placental abruption was not associated with renal related hospitalizations (adjusted HR, 1.6; 95% CI, 0.6-4.2; p = 0.381). CONCLUSION: Placental abruption, even though considered a part of the "placental syndrome" with possible vascular etiology, is not a risk factor for long-term maternal renal complications.

Creatinine level as a predictor of hypertensive disorders during pregnancy.

This study aims to examine the association between creatinine level during the first 20 weeks of pregnancy and the development of pre-eclampsia in the second half of the pregnancy. The study population included all registered births (n=9341) between 2001 and 2007 in a tertiary medical centre. Student's t-test and receiver operating characteristic (ROC) curves were used to determine any association. Significant association was documented between creatinine level in the first 20 weeks and the prevalence of hypertensive disorders. The mean plasma creatinine value in women with mild pre-eclampsia versus healthy women was 0.59 mg/dL +/- 0.14 versus 0.57 mg/dL +/- 0.15, respectively (P = 0.023). The mean plasma creatinine value in women with severe pre-eclampsia versus healthy women was 0.61 mg/dL +/- 0.17 versus 0.58 mg/dL +/- 0.15, respectively (P = 0.040). The mean plasma creatinine value in women with hypertensive disorders versus healthy women was 0.60 mg/dL +/- 0.15 versus 0.58 mg/dL +/- 0.15, respectively (P=0.003). The ROC curve demonstrated a significant association between creatinine level in the first 20 weeks of pregnancy and the development of mild and severe pre-eclampsia in the second half of pregnancy (area under the curve: 0.54, 95% confidence interval [CI]: 0.51-0.57, P = 0.02, and 0.56, 95% CI: 0.50-0.62, P = 0.033, respectively). Higher creatinine levels during the first 20 weeks of pregnancy are associated with a higher risk of developing mild and severe pre-eclampsia.