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1.
Trends Cancer ; 8(4): 273-275, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35101413

RESUMO

Sex hormones are crucial for the body's development and function. Therefore, many transgender people seek hormone therapy as part of their transition. However, sex hormones modulate cancer risk. Studying sex hormones in cisgender and transgender populations will improve our knowledge of their biological role in cancer and reduce health disparities.


Assuntos
Neoplasias , Pessoas Transgênero , Transexualidade , Hormônios Esteroides Gonadais , Humanos , Neoplasias/etiologia
3.
Hepatology ; 75(2): 309-321, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34766362

RESUMO

BACKGROUND AND AIMS: Gallbladder cancer (GBC) has a female predominance, whereas the other biliary tract cancers (BTCs) have a male predominance, suggesting that sex hormones may be involved in carcinogenesis. We sought to evaluate the association between menopausal hormone therapy (MHT) and the risk of BTC in women. APPROACH AND RESULTS: This nested case-control study was conducted in the UK Clinical Practice Research Datalink. Cases diagnosed between 1990 and 2017 with incident primary cancers of the gallbladder (GBC), cholangiocarcinoma (CCA), ampulla of Vater (AVC), and mixed type were matched to 5 controls on birth year, diagnosis year, and years in the general practice using incidence density sampling. Conditional logistic regression was used to calculate ORs and 95% CIs for associations between MHT use and BTC type. The sample consisted of 1,682 BTC cases (483 GBC, 870 CCA, 105 AVC, and 224 mixed) and 8,419 matched controls with a mean age of 73 (SD, 11) years. Combined formulations (estrogen-progesterone) were associated with an increased GBC risk (OR, 1.97; 95% CI, 1.08, 3.59). Orally administered MHT was associated with an increased GBC risk (OR, 2.28; 95% CI, 1.24, 4.17). Estrogen-only formulations (OR, 0.59; 95% CI, 0.34, 0.93) and cream or suppository administrations (OR, 0.57; 95% CI, 0.34, 0.95) were associated with decreased CCA risk. The number of prescriptions, dose, duration of use, and time since last use were not associated with GBC or CCA risk. MHT use was not associated with risk of AVC or mixed cancer. CONCLUSIONS: Combination MHT formulations and oral administrations were associated with increased GBC risk, whereas estrogen-only formulations were associated with a lower CCA risk. MHT formulation and administration should be carefully considered when prescribing.


Assuntos
Ampola Hepatopancreática , Colangiocarcinoma/epidemiologia , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias da Vesícula Biliar/epidemiologia , Terapia de Reposição Hormonal , Neoplasias Complexas Mistas/epidemiologia , Administração Oral , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Combinação de Medicamentos , Estrogênios/uso terapêutico , Feminino , Humanos , Incidência , Menopausa , Pessoa de Meia-Idade , Progesterona/uso terapêutico , Progestinas/uso terapêutico , Fatores de Risco , Supositórios , Reino Unido/epidemiologia
4.
Phys Sportsmed ; 50(2): 181-184, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34346850

RESUMO

OBJECTIVE: Hallux sesamoid injuries are well described and can be debilitating and chronically disabling. The role of orthobiologics such as platelet-rich plasma (PRP) in sesamoid injuries has not been reported. This study describes three cases of recalcitrant hallux sesamoid injuries in teenage athletes who returned to impact activities, pain free, following one treatment of PRP. METHODS: This is a case-series study describing three teenage athletes presenting to a tertiary level pediatric sports medicine practice with chronic hallux sesamoid injuries. RESULTS: The three patients (two female, one male) described in this case series were 13-, 16-, and 17-year-old athletes. Their primary sports were ballet, basketball, and Irish step dance, respectively. All three athletes received PRP: two received unilateral treatment (one tibial sesamoid, one fibular sesamoid) and one received treatment to bilateral tibial sesamoids. The average duration of symptoms prior to PRP was 52.5 weeks (14-128 weeks). The average time out of their primary sport was 48.7 weeks (20-78 weeks). Three of the 4 sesamoids treated with PRP were tibial sesamoids. Each site of injury was treated with one treatment of leukocyte-rich PRP. All three athletes were cleared to return to impact activities such as running and jumping at 6-9 weeks following PRP, specifically 9 weeks after the final PRP injection for the patient who underwent bilateral treatments. CONCLUSION: In the three cases provided of sesamoid injuries treated with PRP, the time to return to impact activities was less than reported for athletes not treated with PRP. Acknowledging that other management factors likely contributed to return to impact activities, this case series sets the groundwork for future research investigating the role of PRP with needle fenestration in the treatment of sesamoid injuries.


Assuntos
Dança , Hallux , Plasma Rico em Plaquetas , Corrida , Ossos Sesamoides , Adolescente , Atletas , Criança , Dança/lesões , Feminino , Humanos , Masculino , Ossos Sesamoides/diagnóstico por imagem , Ossos Sesamoides/lesões
5.
Hepatology ; 74(4): 1994-2006, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33942350

RESUMO

BACKGROUND AND AIMS: Biliary tract cancer (BTC) is rare and has limited treatment options. We aimed to examine aspirin use on cancer-specific survival in various BTC subtypes, including gallbladder cancer, ampulla of Vater cancer, and cholangiocarcinoma. APPROACH AND RESULTS: Nationwide prospective cohort of newly diagnosed BTC between 2007 and 2015 were included and followed until December 31, 2017. Three nationwide databases, namely the Cancer Registration, National Health Insurance, and Death Certification System, were used for computerized data linkage. Aspirin use was defined as one or more prescriptions, and the maximum defined daily dose was used to evaluate the dose-response relationship. Cox's proportional hazards models were applied for estimating HRs and 95% CIs. Analyses accounted for competing risk of cardiovascular deaths, and landmark analyses to avoid immortal time bias were performed. In total, 2,519 of patients with BTC were exposed to aspirin after their diagnosis (15.7%). After a mean follow-up of 1.59 years, the 5-year survival rate was 27.4%. The multivariate-adjusted HR for postdiagnosis aspirin users, as compared with nonusers, was 0.55 (95% CI: 0.51 to 0.58) for BTC-specific death. Adjusted HRs for BTC-specific death were 0.53 (95% CI: 0.48 to 0.59) and 0.42 (95% CI: 0.31 to 0.58) for ≤ 1 and > 1 maximum defined daily dose, respectively, and showed a dose-response trend (P < 0.001; nonusers as a reference). Cancer-specific mortality was lower with postdiagnosis aspirin use in patients with all major BTC subtypes. CONCLUSIONS: The nationwide study revealed that postdiagnosis aspirin use was associated with improved BTC-specific mortality of various subtypes. The findings suggest that additional randomized trials are required to investigate aspirin's efficacy in BTC.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Neoplasias dos Ductos Biliares/mortalidade , Colangiocarcinoma/mortalidade , Neoplasias do Ducto Colédoco/mortalidade , Neoplasias da Vesícula Biliar/mortalidade , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática , Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Extra-Hepáticos , Ductos Biliares Intra-Hepáticos , Neoplasias do Sistema Biliar/diagnóstico , Neoplasias do Sistema Biliar/mortalidade , Carcinoma/diagnóstico , Carcinoma/mortalidade , Colangiocarcinoma/diagnóstico , Estudos de Coortes , Neoplasias do Ducto Colédoco/diagnóstico , Feminino , Neoplasias da Vesícula Biliar/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Proteção
6.
J Natl Cancer Inst ; 113(9): 1221-1227, 2021 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-33704460

RESUMO

BACKGROUND: Transgender persons face many barriers to health care that may delay cancer diagnosis and treatment, possibly resulting in decreased survival. Yet, data on cancer in this population are limited. We examined cancer stage at diagnosis, treatment, and survival among transgender patients compared with cisgender patients in the National Cancer Database (NCDB). METHODS: Gender (male, female, or transgender) was extracted from medical records from patients diagnosed with cancer between 2003 and 2016. Logistic regression estimated odds ratios (ORs) for the associations between gender and stage at diagnosis and treatment receipt. Cox proportional hazards regression estimated hazard ratios (HRs) for associations between gender and all-cause survival. RESULTS: Among 11 776 699 persons with cancer in NCDB, 589 were transgender. Compared with cisgender patients, transgender patients may be more likely to be diagnosed with advanced stage lung cancer (OR = 1.76, 95% confidence interval [CI] = 0.95 to 3.28); be less likely to receive treatment for kidney (OR = 0.19, 95% CI = 0.08 to 0.47) and pancreas (OR = 0.33, 95% CI = 0.11 to 0.95) cancers; and have poorer survival after diagnosis with non-Hodgkin lymphoma (HR = 2.34, 95% CI = 1.51 to 3.63), prostate (HR = 1.91, 95% CI = 1.06 to 3.45), and bladder cancers (HR = 2.86, 95% CI = 1.36 to 6.00). Similar associations were found for other cancer sites, although not statistically significant. CONCLUSION: Transgender patients may be diagnosed at later stages, be less likely to receive treatment, and have worse survival for many cancer types. Small sample size hampered our ability to detect statistically significant differences for some cancer sites. There is a need for transgender-focused cancer research as the population ages and grows.


Assuntos
Neoplasias , Pessoas Transgênero , Atenção à Saúde , Feminino , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapia , Razão de Chances , Estados Unidos/epidemiologia
7.
Curr Sports Med Rep ; 20(2): 109-112, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33560035

RESUMO

ABSTRACT: The availability of handheld ultrasound offers physicians an opportunity to better define anatomy and pathophysiology, thus enhancing the diagnostic capabilities of a standard physical examination. The medical community increasingly embraces the potential for point-of-care ultrasound across medical specialties. The primary aim of this review was to identify and compile information on the current clinical utility of point-of-care ultrasound for musculoskeletal examination. This information will enable health care providers to understand the current utility and potential of musculoskeletal point-of-care ultrasound, thus facilitating its appropriate adoption into clinical practice.


Assuntos
Sistema Musculoesquelético/diagnóstico por imagem , Sistema Musculoesquelético/lesões , Exame Físico/métodos , Testes Imediatos , Traumatismos em Atletas/diagnóstico por imagem , Humanos , Ultrassonografia
8.
Sci Rep ; 11(1): 3686, 2021 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-33574564

RESUMO

Chile has high incidence rates of gallbladder cancer globally, particularly among Amerindian women, who also have a high prevalence of gallstones. We examined differences in inflammatory biomarkers between Mapuche and non-Mapuche women from the Chile Biliary Longitudinal Study, a cohort of women with ultrasound-detected gallstones. We randomly selected 200 Mapuche women frequency matched to non-Mapuche women on age and statin use Inflammatory biomarkers were analyzed using a multiplex assay and linear regression to assess associations of a priori markers (CCL20, CXCL10, IL-6, and IL-8) with ethnicity. Novel biomarkers were analyzed using exploratory factor analysis (EFA) and sufficient dimension reduction (SDR) to identify correlated marker groups, followed by linear regression to examine their association with ethnicity. The mean values of IL-8 were higher in Mapuche than non-Mapuche women (P = 0.04), while CCL20, CXCL10, and IL-6 did not differ significantly by ethnicity. EFA revealed two marker groups associated with ethnicity (P = 0.03 and P < 0.001). SDR analysis confirmed correlation between the biomarkers and ethnicity. We found higher IL-8 levels among Mapuche than non-Mapuche women. Novel inflammatory biomarkers were correlated with ethnicity and should be studied further for their role in gallbladder disease. These findings may elucidate underlying ethnic disparities in gallstones and carcinogenesis among Amerindians.


Assuntos
Quimiocina CCL20/genética , Quimiocina CXCL10/genética , Neoplasias da Vesícula Biliar/sangue , Interleucina-6/genética , Interleucina-8/genética , Idoso , Carcinogênese/genética , Quimiocina CCL20/sangue , Quimiocina CXCL10/sangue , Chile , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/metabolismo , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/genética , Neoplasias da Vesícula Biliar/patologia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/metabolismo , Cálculos Biliares/patologia , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Índios Sul-Americanos/genética , Inflamação/diagnóstico por imagem , Inflamação/genética , Inflamação/patologia , Interleucina-6/sangue , Interleucina-8/sangue , Estudos Longitudinais , Pessoa de Meia-Idade , Ultrassonografia
9.
Am J Epidemiol ; 190(2): 196-206, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33524121

RESUMO

Gallbladder cancer (GBC) is a highly fatal cancer that can be cured through cholecystectomy if identified early. The presence of gallstones is the primary risk factor for GBC, but few people with gallstones develop GBC. A key question is what drives the development of GBC among persons with gallstones. We initiated the Chile Biliary Longitudinal Study (Chile BiLS) to address this question. From 2016 to 2019, Chile BiLS enrolled 4,726 women aged 50-74 years with ultrasound-detected gallstones from southern-central Chile, accounting for an estimated 36% of eligible women with gallstones in the study area. The median age was 59 years; 25% of the women were Amerindian (Mapuche), 60% were obese, 25% had diabetes, and 6% had cardiovascular disease. Participants will be followed for gallbladder dysplasia or cancer for 6 years. As of April 30, 2020, over 91% of those eligible completed the year 2 follow-up visit. Data being collected include epidemiologic and sociodemographic information, anthropometric measurements, blood pressure, and tooth counts. Biosamples being taken include baseline plasma, buffy coat, red blood cells, serum, blood clot from serum, and PAXgene whole blood (PreAnalytiX GmbH, Hombrechtikon, Switzerland). Complete gallbladder sampling is conducted for most participants undergoing cholecystectomy. The Chile BiLS cohort study will increase our understanding of GBC etiology and could identify potential risk stratification and early detection strategies in high-risk areas.


Assuntos
Neoplasias da Vesícula Biliar/epidemiologia , Cálculos Biliares/epidemiologia , Idoso , Pressão Sanguínea , Pesos e Medidas Corporais , Doenças Cardiovasculares/epidemiologia , Chile , Diabetes Mellitus/epidemiologia , Feminino , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/etnologia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/etnologia , Humanos , Mediadores da Inflamação/sangue , Estudos Longitudinais , Pessoa de Meia-Idade , Obesidade/epidemiologia , Projetos de Pesquisa , Fatores de Risco , Fatores Socioeconômicos , Perda de Dente/epidemiologia
10.
Clin Infect Dis ; 72(1): 90-98, 2021 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-31918439

RESUMO

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) use colon surgical site infection (SSI) rates to rank hospitals and apply financial penalties. The CMS' risk-adjustment model omits potentially impactful variables that might disadvantage hospitals with complex surgical populations. METHODS: We analyzed adult patients who underwent colon surgery within facilities associated with HCA Healthcare from 2014 to 2016. SSIs were identified from National Health Safety Network (NHSN) reporting. We trained and validated 3 SSI prediction models, using (1) current CMS model variables, including hospital-specific random effects (HCA-adapted CMS model); (2) demographics and claims-based comorbidities (expanded-claims model); and (3) demographics, claims-based comorbidities, and NHSN variables (claims-plus-electronic health record [EHR] model). Discrimination, calibration, and resulting rankings were compared among all models and the current CMS model with published coefficient values. RESULTS: We identified 39 468 colon surgeries in 149 hospitals, resulting in 1216 (3.1%) SSIs. Compared to the HCA-adapted CMS model, the expanded-claims model had similar performance (c-statistic, 0.65 vs 0.67, respectively), while the claims-plus-EHR model was more accurate (c-statistic, 0.70; 95% confidence interval, .67-.73; P = .004). The sampling variation, due to the low surgical volume and small number of infections, contributed 74% of the total variation in observed SSI rates between hospitals. When CMS model rankings were compared to those from the expanded-claims and claims-plus-EHR models, 18 (15%) and 26 (22%) hospitals changed quartiles, respectively, and 10 (8.3%) and 12 (10%) hospitals changed into or out of the lowest-performing quartile, respectively. CONCLUSIONS: An expanded set of variables improved colon SSI risk predictions and quartile assignments, but low procedure volumes and SSI events remain a barrier to effectively comparing hospitals.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Medicare , Adulto , Idoso , Colo/cirurgia , Hospitais , Humanos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Estados Unidos/epidemiologia
11.
BMJ Open Sport Exerc Med ; 7(4): e001169, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34987860

RESUMO

OBJECTIVE: To compare femoroacetabular (FA) translation between dancers and athletes with hip pain and between dancers with and without hip pain. METHODS: In this cross-sectional study, 171 female athletes and dancers with hip pain underwent dynamic hip ultrasound (DHUS) of FA translation in three positions: neutral (N), neutral with contralateral hip flexion (NF), apprehension position with contralateral hip flexion (EER-F). Multivariable linear regression analysis was used to assess variation in FA translation between dancers and athletes in the presence of age, Beighton score/hypermobility, BMI, radiographic markers of acetabular dysplasia and femoral version angles. Symptomatic dancers were matched to asymptomatic dancer controls on age, height and BMI, and comparison analyses of FA translation were conducted controlling for matched propensity score and Beighton score. RESULTS: In the symptomatic cohort, dancers were younger, had higher Beighton scores and were more hypermobile than non-dancers. Dancers also showed greater NF, EER-F and max US-min US (delta) compared with non-dancers (mean 5.4 mm vs 4.4 mm, p=0.02; mean 6.3 mm vs 5.2 mm, p=0.01; 4.2 mm vs 3.6 mm, p=0.03, respectively). Symptomatic dancers showed greater NF and EER-F compared with asymptomatic dancers (mean 5.5 mm vs 2.9 mm, p<0.001; mean 6.3 mm vs 4.2 mm, p<0.001, respectively). Comparison of symptomatic dancers with and without hip dysplasia showed no difference in DHUS measurements. CONCLUSION: DHUS measurements of FA translation are greater in female dancers with hip pain relative to female non-dancer athletes with hip pain and asymptomatic female dancers.

13.
J Sports Med Phys Fitness ; 60(10): 1412-1414, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32586080

RESUMO

There are many causes of acute hip pain. Obturator internus (OI) muscle strain is a rare cause of the presentation. We report a case of OI muscle strain in a 15-year-old ski racer who presented with new onset acute right hip pain. Magnetic resonance imaging showed enhancement of the obturator internus muscle indicating muscle injury. Patient was treated conservatively with target physical therapy and NSAIDs for pain management. This case illustrates an atypical diagnosis for a common chief complaint.


Assuntos
Músculo Esquelético/lesões , Esqui/lesões , Entorses e Distensões/diagnóstico por imagem , Adolescente , Artralgia/etiologia , Articulação do Quadril/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Músculo Esquelético/diagnóstico por imagem , Modalidades de Fisioterapia , Entorses e Distensões/terapia
14.
J Hepatol ; 73(4): 863-872, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32437829

RESUMO

BACKGROUND & AIMS: Gallbladder cancer (GBC) is known to have a female predominance while other biliary tract cancers (BTCs) have a male predominance. However, the role of female reproductive factors in BTC etiology remains unclear. METHODS: We pooled data from 19 studies of >1.5 million women participating in the Biliary Tract Cancers Pooling Project to examine the associations of parity, age at menarche, reproductive years, and age at menopause with BTC. Associations for age at menarche and reproductive years with BTC were analyzed separately for Asian and non-Asian women. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models, stratified by study. RESULTS: During 21,681,798 person-years of follow-up, 875 cases of GBC, 379 of intrahepatic bile duct cancer (IHBDC), 450 of extrahepatic bile duct cancer (EHBDC), and 261 of ampulla of Vater cancer (AVC) occurred. High parity was associated with risk of GBC (HR ≥5 vs. 0 births 1.72; 95% CI 1.25-2.38). Age at menarche (HR per year increase 1.15; 95% CI 1.06-1.24) was associated with GBC risk in Asian women while reproductive years were associated with GBC risk (HR per 5 years 1.13; 95% CI 1.04-1.22) in non-Asian women. Later age at menarche was associated with IHBDC (HR 1.19; 95% CI 1.09-1.31) and EHBDC (HR 1.11; 95% CI 1.01-1.22) in Asian women only. CONCLUSION: We observed an increased risk of GBC with increasing parity. Among Asian women, older age at menarche was associated with increased risk for GBC, IHBDC, and EHBDC, while increasing reproductive years was associated with GBC in non-Asian women. These results suggest that sex hormones have distinct effects on cancers across the biliary tract that vary by geography. LAY SUMMARY: Our findings show that the risk of gallbladder cancer is increased among women who have given birth (especially women with 5 or more children). In women from Asian countries, later age at menarche increases the risk of gallbladder cancer, intrahepatic bile duct cancer and extrahepatic bile duct cancer. We did not see this same association in women from Western countries. Age at menopause was not associated with the risk of any biliary tract cancers.


Assuntos
Neoplasias do Sistema Biliar/epidemiologia , Sistema de Registros , Reprodução/fisiologia , Medição de Risco/métodos , Adulto , Idoso , Neoplasias do Sistema Biliar/etiologia , Feminino , Seguimentos , Saúde Global , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida/tendências , Fatores de Tempo , Adulto Jovem
17.
Gene ; 730: 144289, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-31846709

RESUMO

Interferon lambda proteins activate the JAK-STAT signalling pathway, resulting in upregulation of genes with antiviral effects. The interferon lambda family was initially thought to be redundant to the interferon alpha family, which signals through the same pathway, except for the more limited expression of the IFNLR1 receptor. However, recent studies show that interferon lambdas uniquely protect tissue barriers against a wide range of important viral infections. The interferon lambda 4 gene (IFNL4) was discovered in 2013. The IFNL4 protein is determined by the IFNL4-ΔG/TT (rs368234815) variant. The ancestral IFNL4-ΔG allele generates IFNL4, whereas IFNL4-TT causes pre-mature termination of the protein. Surprisingly, although interferons are generally antiviral proteins, the genotypes that generate the IFNL4 protein are strongly linked to impaired clearance of hepatitis C virus (HCV). IFNL4 genotype has also been linked to variation within the HCV genome, as well as risk of hepatic fibrosis, certain cancers and some infectious diseases. There has been very strong evolutionary selection against the ancestral IFNL4-ΔG allele, which is the major form in African populations, but the minor allele in Europeans and Asians. The reason for this selection and the biological mechanisms underlying observed phenotypic associations remain to be explained.


Assuntos
Interleucinas/genética , Interleucinas/metabolismo , Alelos , Evolução Molecular , Frequência do Gene/genética , Variação Genética/genética , Genótipo , Hepacivirus/genética , Hepatite/genética , Humanos , Interleucinas/fisiologia , Fenótipo , Polimorfismo de Nucleotídeo Único/genética , /genética
20.
J Orthop Trauma ; 33(10): 487-496, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31464855

RESUMO

OBJECTIVE: To describe the distribution of femoral neck shortening after internal fixation and to determine whether shortening is associated with inferior hip function at 24 months after a hip fracture in patients 50 years of age or older. DESIGN: Retrospective cohort study. SETTING: A secondary analysis of data from 81 clinical centers included in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial. PARTICIPANTS: Three hundred fifty patients, 50 years of age or older, who had an isolated femoral neck fracture and underwent timely operative fixation of the fracture. INTERVENTION: Femoral neck shortening was measured as a categorical variable and classified into one of the following groups, as determined by the Central Adjudication Committee: no shortening, mild shortening (≤5 mm), moderate shortening (6-10 mm), or severe shortening (>10 mm). MAIN OUTCOME MEASUREMENT: The primary outcome for the current analysis was hip function, as measured by the Western Ontario & McMaster Universities Osteoarthritis Index questionnaire, at 24 months after injury. RESULTS: Two-thirds of patients had no or mild shortening (≤5 mm), whereas one-third of patients had moderate or severe shortening (>5 mm). After adjusting for surgical treatment, a greater amount of femoral neck shortening was found to be associated with poorer hip function (P < 0.01). CONCLUSIONS: We found that increasing femoral neck shortening was associated with inferior hip function. Although internal fixation often results in successful union, patients who heal in a shortened position report poorer functional outcomes. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Colo do Fêmur/patologia , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos
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