Clinical implications of anticoagulant oral therapy in elderly patients with hip fracture.

BACKGROUND AND AIM: Proximal femur fractures (PFFs) are among the most common fractures, especially in the elderly population. A PFF often represents a life-changing event. Their dramatic effects are attributable not only to the massive hemorrhages caused by the fracture, but also to the high risk of dramatic complications. These risks are supposed to be even higher for patients under oral anticoagulant treatment. In this study we evaluated how oral anticoagulant therapy effected patient's prognosis.   Methods:Ours was a case-control review of over-65 patients treated surgically for proximal femur fractures between 2013 and 2019. Cases were divided in 2 groups depending if they were (Group A) or were not (Group B) under oral anticoagulant therapy at the moment of hospitalization.   Results:200 cases were included in our study: 100 in Group A and 100 in Group B. Surgical delay was significantly higher for cases under oral anticoagulant treatment compared to the other cases. Group A cases were transfused with a significantly higher frequency and with more blood units compared to Group B (p=0.0300; p=0.013). Combined cardiological and vascular complications occurred in 21 cases (10.5%), being significantly more common in Group A (16) than Group B (5), as testified by a chi-square test (P=0.011).   Conclusions:Cases under oral anticoagulant therapy are frail patients with a higher risk to develop massive hemorrhages after an hip fracture. For this reason, it is mandatory to achieve an early stabilization of patient's clinical conditions and then perform surgery as soon as possible.

Results of arthroscopically assisted reduction and fixation of anteromedial facet coronoid fractures at short-term follow-up.

BACKGROUND: Varus posteromedial rotatory instability is a typical pattern of elbow injury that involves fracture of the anteromedial facet (AMF) of the coronoid, as well as injuries to the lateral ligament complex and the posterior bundle of the medial collateral ligament. Some authors support the idea that subtype II AMF coronoid fractures require fixation to restore elbow stability, but this topic is still an issue in the literature. The purpose of this study was to assess the clinical and radiologic outcomes of arthroscopically assisted reduction and internal fixation (ARIF) of AMF fractures. METHODS: This retrospective single-center trial evaluated consecutive patients who underwent ARIF of isolated subtype II AMF coronoid fractures between 2014 and 2020. At the final follow-up, the patients were examined for elbow range of motion, stability, and pain. Injury and post-treatment radiographs were reviewed to assess fracture healing and heterotopic ossification. RESULTS: A total of 32 patients (21 male and 11 female patients) with a median age of 47 ± 16 years were included. The average follow-up period was 28 ± 12.4 months. Coronoid process fractures were fixed by cannulated screws in 26 cases (81.25%); in 2 of these cases, additional Kirschner wires were used. Two Kirschner wires were used in 1 case (3.12%), and in the remaining 5 cases (15.62%), osteosuture was used. The lateral ulnar collateral ligament was injured in 27 cases (84.4%) and was always repaired. Other associated lesions were medial collateral ligament injury, osteochondral lesion, and radial head fracture. There were no surgical complications. At the final follow-up, the average Mayo Elbow Performance Score was 98.4 ± 2.7 and the mean Oxford Elbow Score was 47.3 ± 1.4. No cases of nonunion were detected on radiographic assessment. CONCLUSIONS: Although technically demanding, ARIF has several potential advantages in comparison to open surgery: less scarring, a decreased risk of infection, and less postoperative pain.

Correlation Between Choriocapillaris Density and Retinal Sensitivity in Age-Related Macular Degeneration.

Purpose: The purpose of this study was to investigate the relationship between perfusion of the choriocapillaris (CC) and retinal sensitivity in eyes with intermediate age-related macular degeneration (iAMD). Methods: This prospective study included patients with iAMD and healthy controls. All enrolled subjects underwent optical coherence tomography angiography (OCT-A) in order to compute the percent perfused choriocapillaris area (PPCA). In patients with iAMD, microperimetry (MP) testing was performed in order to quantify: mean retinal sensitivity (MRS), over an area of 10 degrees; mean macular sensitivity (MMS), over the macular area scanned with OCT-A; and retinal sensitivity (RS) in each macular point. Results: Eighteen eyes of 13 patients were included in the analysis. In addition, 18 eyes of 12 healthy subjects were enrolled as controls. No statistically significant difference (P value > 0.2) was observed in age between patients (73.9 ± 2.0 years) and controls (70.1 ± 2.8 years). We observed significantly lower values of PPCA between patients with iAMD and healthy controls (42.0% ± 3.8% vs. 66.4% ± 3.0%; -ß = 23.8%; P value < 0.001). Among iAMD eyes, higher values of PPCA were significantly associated with higher values of MRS (P value = 0.002) and MMS (P value = 0.013). Finally, higher values of RS in each macular point analyzed with MP were significantly (P value < 0.001) associated with higher values of PPCA computed in circular regions of interest (ROIs) centered in each analyzed MP point with radii of 0.5 degrees and 1.0 degree. Conclusions: Using OCT-A, we demonstrated a significant association between CC impairment and macular dysfunction, quantified by MP, in iAMD eyes. Translational Relevance: OCT-A could be a useful tool for detecting CC alterations and to monitor disease progression.

Automatic segmentation of pigment deposits in retinal fundus images of Retinitis Pigmentosa.

Retinitis Pigmentosa is an eye disease that presents with a slow loss of vision and then evolves until blindness results. The automatic detection of the early signs of retinitis pigmentosa acts as a great support to ophthalmologists in the diagnosis and monitoring of the disease in order to slow down the degenerative process. A large body of literature is devoted to the analysis of Retinitis Pigmentosa. However, all the existing approaches work on Optical Coherence Tomography (OCT) data, while hardly any attempts have been made working on fundus images. Fundus image analysis is a suitable tool in daily practice for an early detection of retinal diseases and the monitoring of their progression. Moreover, the fundus camera represents a low-cost and easy-access diagnostic system, which can be employed in resource-limited regions and countries. The fundus images of a patient suffering from retinitis pigmentosa are characterized by an attenuation of the vessels, a waxy disc pallor and the presence of pigment deposits. Considering that several methods have been proposed for the analysis of retinal vessels and the optic disk, this work focuses on the automatic segmentation of the pigment deposits in the fundus images. The image distortions are attenuated by applying a local pre-processing. Next, a watershed transformation is carried out to produce homogeneous regions. Working on regions rather than on pixels makes the method very robust to the high variability of pigment deposits in terms of color and shape, so allowing the detection even of small pigment deposits. The regions undergo a feature extraction procedure, so that a region classification process is performed by means of an outlier detection analysis and a rule set. The experiments have been performed on a dataset of images of patients suffering from retinitis pigmentosa. Although the images present a high variability in terms of color and illumination, the method provides a good performance in terms of sensitivity, specificity, accuracy and the F-measure, whose values are 74.43, 98.44, 97.90, 59.04, respectively.

Wearable Improved Vision System for Color Vision Deficiency Correction.

Color vision deficiency (CVD) is an extremely frequent vision impairment that compromises the ability to recognize colors. In order to improve color vision in a subject with CVD, we designed and developed a wearable improved vision system based on an augmented reality device. The system was validated in a clinical pilot study on 24 subjects with CVD (18 males and 6 females, aged 37.4 ± 14.2 years). The primary outcome was the improvement in the Ishihara Vision Test score with the correction proposed by our system. The Ishihara test score significantly improved ([Formula: see text]) from 5.8 ± 3.0 without correction to 14.8 ± 5.0 with correction. Almost all patients showed an improvement in color vision, as shown by the increased test scores. Moreover, with our system, 12 subjects (50%) passed the vision color test as normal vision subjects. The development and preliminary validation of the proposed platform confirm that a wearable augmented-reality device could be an effective aid to improve color vision in subjects with CVD.