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1.
Orthop Surg ; 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31958889

RESUMO

OBJECTIVE: Porous tantalum implantation (PTI) and bone impaction grafting (BIG) through a window at the femoral head neck junction are known as two types of joint-preserving procedures. They provide an alternative option in the treatment of osteonecrosis of the femoral head by providing strong structural support to the subchondral plate. However, when earlier joint-preserving treatments fail, conversion to a total hip arthroplasty seems to be the final treatment of choice. This emphasizes the importance of joint-preserving procedures that do not hinder the clinical results of a subsequent total hip arthroplasty. The results of conversion total hip arthroplasty after failed PTI and BIG are still controversial. The purpose of this study was to compare the clinical and radiological outcomes of total hip arthroplasty after failed PTI or BIG surgery with primary total hip arthroplasty. METHODS: Patients at our institution between 2010 and 2014 who underwent total hip arthroplasty after failed PTI or BIG surgery compared to primary total hip arthroplasty were retrospectively reviewed. A total of 27 patients (30 hips) who underwent total hip arthroplasty after failed PTI surgery (group I) were matched according to age, gender and BMI index with 28 patients (30 hips) who underwent total hip arthroplasty after failed BIG surgery (group II) and 30 patients (30 hips) who underwent primary total hip arthroplasty (group III). The clinical results included preoperative and postoperative Harris Hip score, surgery duration, blood loss volume and clinical complications. Radiological follow-up results included abduction angle and anteversion angle of the acetabular cup, periprosthetic osteolysis, and prosthesis subsidence. RESULTS: There was no significant difference in the preoperative and postoperative Harris Hip score among the three groups at the latest follow-up (P = 0.247). The surgery duration was longer and intra-operative blood loss volume was higher in group I than in group II and group III (P < 0.05, respectively). There was no difference in surgery duration and blood loss volume between group II and group III (P > 0.05). There was no significant difference in radiological follow-up results among the three groups (P > 0.05). Varying degrees of residual tantalum debris were seen on postoperative radiographs of all group I patients. There was no difference in the incidence of complications among the three groups (P > 0.05). CONCLUSIONS: PTI group had higher blood loss volume and surgery duration than BIG group and primary total hip arthroplasty group. BIG group had no significant differences with primary total hip arthroplasty group in clinical and radiological follow-up results. There were no significant differences between the three groups in the Harris Hip score and radiological follow-up results.

2.
Community Dent Oral Epidemiol ; 48(1): 72-80, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31709637

RESUMO

OBJECTIVES: To compare the prevalence of poor self-reported oral health (SROH) and dental service-use in a representative sample of Canadian residents, and to identify associations between SROH and psychosocial determinants of health at baseline of the Canadian Longitudinal Study on Aging. METHODS: Data from baseline interviews from 2010 to 2015 involving 93% of 51 388 adults (n = 47 761) were weighted to compare the prevalence of oral health characteristics adjusted for age, sex, socioeconomics, general health and residence. SROH was assessed as 'excellent', 'very good', 'good', 'fair' or 'poor', and dichotomized as 'fair/poor' and 'good/very good/excellent'. Multivariable logistic regression was used to assess the association of fair/poor oral health with psychosocial determinants of health. RESULTS: Most participants reported 'good/very good/excellent' oral health (92.5%), natural teeth (92.0%) and dental service-use in the previous year (79.6%), yet over 10% had discomfort when eating. Reports of 'fair/poor' oral health were significantly more frequent among participants who had dental concerns, had low socioeconomic status, smoked tobacco or reported poor general health. Dental service-use and tooth loss differed by province. The odds of poor/fair SROH were high (odds ratio ≥1.5) among participants who avoided foods, did not use dental services frequently, had low incomes, smoked tobacco, were depressed, felt unhealthy or had multiple chronic conditions, but by neither sex or age. There were no interprovincial differences. CONCLUSIONS: Most Canadian residents feel in good oral health and use dental services. Oral health inequality is evident between different socioeconomic groups and between healthy and unhealthy people. SROH is strongly associated with socioeconomic and general health status but not with place of residence. However, there were substantial differences in reports of tooth loss and dental service-use across provinces.

3.
Biomed Res Int ; 2019: 1302015, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31828086

RESUMO

The immunologic factors have been implicated in the pathogenesis of osteonecrosis. We aimed to investigate the potential role of immune regulatory cells in the development of osteonecrosis of femoral head (ONFH). Sixty-seven patients diagnosed with ONFH and fifty-eight age-, height-, and weight-matched healthy subjects were included in this retrospective study between September 2015 and September 2018. The flow cytometry was used to test the count, percentage, and ratio of T and B lymphocyte subsets in peripheral blood. The T and B lymphocyte levels were compared among different ARCO stages, CJFH types, and etiology groups. The total lymphocyte count, CD3+T cells, Ts cells (CD3+CD8+), B-1 cell count, and B-1 cells (CD5+CD19+) were significantly higher in the patients with ONFH than those in the control subjects. The percentage of T lymphocytes in the patients with ARCO IV stage was significantly smaller than that in the ONFH patients with ARCO II and III stages. The percentage of inhibitory T lymphocytes in patients with CJFH type L3 was significantly smaller than that in the patients with types L1 and L2. In terms of the different ONFH etiologies, the total lymphocyte count and Ts cells (CD3+CD8+) were significantly lower in the ONFH patients induced by excessive alcohol intake than those in the idiopathic ONFH patients. Our results seem to indicate that immune regulatory cells, such as T and B lymphocytes, play an important role in the pathogenesis of ONFH. The development and progression of ONFH may be associated with immune system imbalance.

4.
JBMR Plus ; 3(9): e10196, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31667453

RESUMO

Giant cell tumors of bone (GCTB) may be difficult to resect because of size or location. We describe two adolescents who were treated with denosumab and followed for tumoral and biochemical responses. Denosumab was effective in achieving sufficient regression to allow surgical resection and in preserving peritumor cortical bone. Reactivation of bone resorption markers was noted while the patients were receiving monthly denosumab. One patient suffered a local tumor recurrence. Denosumab was safe in enabling surgical resection of GCTB. However, the effect was transient, with an escape of resorption markers and tumor recurrence. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

5.
J Gen Intern Med ; 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31713037

RESUMO

BACKGROUND: A clinical practice guideline (CPG) reporting checklist is used to assist CPG developers in recording what content should be provided in a CPG report. Recently, two checklists have become available on the Enhancing the QUAlity and Transparency Of health Research Network website: AGREE (Appraisal of Guidelines, Research and Evaluation) published in 2016 and RIGHT (Reporting Items for practice Guidelines in HealThcare) published in 2017. The objective of this study was to describe the advantages and disadvantages of these two CPG reporting checklists. METHODS: Two epidemiologists who lacked experience using both AGREE and RIGHT but were familiar with evidence-based medicine methodology independently compared AGREE with RIGHT on an item-by-item basis. Their assessments were compiled on a pre-designed data form and any disagreements were resolved through discussion. Three other co-authors independently compared AGREE with RIGHT and decided if they agreed with the results of comparison of the two CPG reporting checklists from the first two co-authors. Finally, another co-author reviewed the comparison results to ensure that the description was clear and understandable. RESULTS: The following six relationships between the two checklists were observed: (1) 11 items from AGREE completely matched with 12 items from RIGHT; (2) four items were listed in AGREE only; (3) 12 items were listed in RIGHT only; (4) three items in AGREE were partially covered by three items in RIGHT; (5) six items in RIGHT were partially covered by three items in AGREE; and (6) two items intersected across AGREE and RIGHT. Based on the comparison results, the potential impact analysis of selecting either checklist is described. DISCUSSION: We recommend that CPG developers use either AGREE plus items unique to RIGHT or RIGHT plus items unique to AGREE.

6.
J Bone Miner Res ; 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31742768

RESUMO

Due to concerns about cumulative radiation exposure in the pediatric population, it is not standard practice to perform spine radiographs in most conditions that predispose to vertebral fracture (VF). In this study we examined the accuracy of two clinical predictors, back pain and lumbar spine bone mineral density (LS BMD), to derive four case-finding paradigms for detection of prevalent VF (PVF). Subjects were 400 children at risk for PVF (leukemia 186, rheumatic disorders 135, nephrotic syndrome 79). Back pain was assessed by patient report, LS BMD was measured by dual-energy X-ray absorptiometry, and PVF were quantified on spine radiographs using the modified Genant semiquantitative method. Forty-four patients (11.0%) had PVF. Logistic regression analysis between LS BMD and PVF produced an odds ratio (OR) of 1.9 (95% confidence interval [CI], 1.5 to 2.5) per reduction in Z-score unit, an area under the receiver operating characteristic curve of 0.70 (95% CI, 0.60 to 0.79), and an optimal BMD Z-score cutoff of -1.6. Case identification using either low BMD alone (Z-score < -1.6) or back pain alone gave similar results for sensitivity (55%, 52%, respectively), specificity (78%, 81%, respectively), positive predictive value (PPV; 24%, 25%, respectively), and negative predictive value (NPV; 93%, 93%, respectively). The paradigm using low BMD plus back pain produced lower sensitivity (32%), higher specificity (96%), higher PPV (47%), and similar NPV (92%). The approach using low BMD or back pain had the highest sensitivity (75%), lowest specificity (64%), lowest PPV (20%), and highest NPV (95%). All paradigms had increased sensitivities for higher fracture grades. Our results show that BMD and back pain history can be used to identify children with the highest risk of PVF so that radiography can be used judiciously. The specific paradigm to be applied will depend on the expected PVF rate and the clinical approach to the use of radiography. © 2019 American Society for Bone and Mineral Research.

7.
Exp Ther Med ; 18(4): 2843-2850, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31555375

RESUMO

The increasing aging of the world population is accompanied by a rise in the incidence of knee osteoarthritis (KOA). There has been a growing interest in shockwave treatment for orthopedic diseases, including KOA. In previous trials, extracorporeal shockwave therapy (ESWT) was compared to physical therapy or placebo in the treatment of KOA. However, the efficacy and safety of ESWT for KOA remains disputed. The present meta-analysis assessed the effects of ESWT in KOA. The PubMed, Medline, Embase, Web of Science, Research Gate and the Cochrane Library were searched to identify comparative studies involving ESWT for patients with KOA. The outcome indicators included the visual analog scale (VAS) score, range of motion (ROM), the Lequesne index (LI) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). In the comparison of the ESWT vs. placebo groups, the primary outcomes included the VAS score and ROM, while the LI was the secondary outcome. In the comparison of the ESWT vs. physical therapy groups, the primary outcomes included the pain score and ROM, while the secondary outcome was the WOMAC index. Relevant data were analyzed using RevMan v5.3. The ESWT group had a lower VAS core, larger ROM and a better LI than the placebo group after 1 month of therapy (P<0.05). Furthermore, at 1 month post-therapy, the ESWT group had a lower VAS score, larger ROM and a better WOMAC than the physical therapy group (P<0.05). The outcomes regarding pain, ROM, LI and WOMAC were significantly different between the two different groups (P<0.05). The present meta-analysis suggested that ESWT may achieve a better therapeutic effect for patients with KOA as compared to physical therapy. However, high-quality trials with large sample sizes are essential to substantiate these results.

8.
Org Lett ; 21(16): 6194-6198, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31373206

RESUMO

CuH-catalyzed diasterospecific synthesis of 3-hydroxyindolines and 2-aryl-3H-indol-3-ones have been developed from o-alkynylnitroarenes in the presence of hydrosilane as the reductant. The protocol employs nitro as both nitrogen and oxygen sources for the intramolecular simultaneous construction of C-N and C-O bonds.

9.
Hip Int ; : 1120700019863036, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296056

RESUMO

BACKGROUND: As a joint-preserving surgery, porous tantalum implantation (PTI) provides an additional treatment option for osteonecrosis of the femoral head (ONFH). However, conversion to a total hip arthroplasty (THA) after failed PTI is considered a challenging procedure. The purpose of this study was to compare the clinical and radiologic outcomes and complications of THA after failed PTI with those of primary THA without any previous surgery for ONFH. METHODS: This retrospective study included 32 patients undergoing THA after failed PTI and 25 age, sex, and body mass index matched patients who underwent primary THA without any previous surgery for ONFH between December 2009 and March 2014. All patients were followed for at least 36 months. The postoperative clinical and radiological evaluations were based on Harris Hip Score (HHS) and plain radiographs. The independent sample test and the chi-square test were used for the statistical analysis. RESULTS: The HHS in the PTI group was similar to that in the primary group at the latest follow-up (p = 0.274), but longer operation time and greater intraoperative blood loss were observed in the PTI group (p < 0.001, respectively). No significant differences in radiological parameters and postoperative complications were found between the 2 groups (p > 0.05). CONCLUSIONS: THA after PTI showed similar clinical and radiological outcomes to primary THA except for longer operation time and greater intraoperative blood loss.

10.
Genomics ; 2019 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-31288068

RESUMO

BACKGROUND: Some previous studies already explored associations of Transcription Factor 7 Like 2 (TCF7L2) polymorphisms with type 2 diabetes mellitus (T2DM), with conflicting findings. Here, we aimed to better analyze the relationship between TCF7L2 polymorphisms and T2DM in a larger combined population by performing a meta-analysis. METHODS: We searched Pubmed, Embase, Web of Science and CNKI for related articles. We calculated odds ratio (OR) and 95% confidence interval (CI) to estimate whether there are genetic associations between TCF7L2 polymorphisms and T2DM. RESULTS: Totally 42 studies were included for this meta-analysis. The meta-analysis results demonstrated that TCF7L2 rs4506565, rs7901695, rs11196205 and rs12255372 polymorphisms were all significantly associated with susceptibility to T2DM in general population. Further subgroup analyses revealed similar significant findings in both Asians and Caucasians. CONCLUSIONS: Our findings supported that these TCF7L2 polymorphisms could be used to identify individuals at high risk of developing T2DM.

11.
J Orthop Surg Res ; 14(1): 101, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971284

RESUMO

BACKGROUND: Both adductor canal block (ACB) and local infiltration analgesia (LIA) are effective procedures for postoperative pain control in total knee arthroplasty (TKA) without motor blockade. However, whether ACB combined with LIA has synergistic effect than ACB alone remains unknown. We hypothesized that ACB combined with LIA would have better postoperative pain control, less rescue opioid consumption and faster rehabilitation than ACB alone, without higher adverse event rate. METHODS: We conducted a meta-analysis to identify relevant articles involving ACB + LIA and ACB alone in patients who underwent TKA from online register databases such as PubMed, Medline, Embase, Web of Science, and the Cochrane Library. The primary outcomes were visual analog scale (VAS) score and morphine consumption. Secondary outcomes were postoperative range of motion (ROM) and adverse event rate. RESULTS: According to the keyword search from online register databases, a total of 879 articles were identified, of which six articles that met the inclusion criteria were determined as eligible. There were three randomized controlled trials (RCTs) and three non-randomized prospective studies. As compared to the ACB alone group, the ACB + LIA group had lower VAS at rest on postoperative day 0 and 1, as well as significantly less morphine consumption on postoperative day 0 and 1 and significantly better postoperative ROM. There were no significant differences in adverse event rate. CONCLUSION: As compared to ACB alone, ACB + LIA provides better analgesia and faster functional rehabilitation in patients who underwent TKA.


Assuntos
Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/métodos , Artroplastia do Joelho/reabilitação , Esquema de Medicação , Humanos , Injeções Intra-Articulares , Morfina/administração & dosagem , Manejo da Dor/métodos , Medição da Dor/métodos , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/métodos
13.
J Clin Endocrinol Metab ; 104(2): 213-222, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30247635

RESUMO

Objective: To assess the effect of vertebral fractures (VF) and glucocorticoid (GC) exposure on height deficits in children during treatment of acute lymphoblastic leukemia (ALL). Methods: Children with ALL treated without cranial radiation therapy (n = 160; median age, 5.1 years; 58.1% male) were followed prospectively for 6 years. Spinal deformity index (SDI) was used to quantify VF status. Results: Baseline height z score ± SD was 0.3 ± 1.2. It fell by 0.5 ± 0.4 in the first 6 months for boys and by 0.4 ± 0.4 in the first 12 months for girls (P < 0.01 for both) and then subsequently recovered. The prevalence of VF peaked at 1 year (17.6%). Among those with VF, median SDI rose from 2 [interquartile range (IQR): 1, 7] at baseline to 8 (IQR: 1, 8) at 1 year. A mixed model for repeated measures showed that height z score declined by 0.13 (95% CI: 0.02 to 0.24; P = 0.02) for each 5-unit increase in SDI during the previous 12 months. Every 10 mg/m2 increase in average daily GC dose (prednisone equivalent) in the previous 12 months was associated with a height z score decrement of 0.26 (95% CI: 0.20 to 0.32; P < 0.01). Conclusions: GC likely plays a major role in the observed height decline during therapy for ALL. Because only a minority of children had VF, fractures could not have contributed significantly to the height deficit in the entire cohort but may have been important among the subset with VF.


Assuntos
Glucocorticoides/efeitos adversos , Transtornos do Crescimento/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Fraturas da Coluna Vertebral/complicações , Adolescente , Antropometria/métodos , Estatura/efeitos dos fármacos , Densidade Óssea/efeitos dos fármacos , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Masculino , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais
14.
J Biomed Mater Res A ; 107(1): 145-153, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30289597

RESUMO

Regenerative medicine has a high demand for the development of scaffold materials combined with other osteogenic inducers to generate bioactive composite materials for bone replacement therapies. Previously, we reported that wedelolactone promoted osteoblastogenesis of bone marrow mesenchymal stem cells (BMSCs). In this study, the effect of hydroxyapatites (HAps), bone composite materials we prepared, and the combined effect of wedelolactone and HAps on osteoblastogenesis differentiation was first evaluated. Three kinds of HAps constructed by a rod-like shape with particle size of 25 nm (HAp-1), 37 nm (HAp-2), and 33 nm (HAp-3) did not affect BMSC survival, but induced activity of alkaline phosphatase(ALP), a marker enzyme for osteoblastogenesis. HAp-1 treatment resulted in a more significant increase in the number of ALP staining-positive BMSC, and maintained an extended time for the increased number of ALP staining-positive BMSC. Moreover, HAp-1 combined with wedelolactone induced a higher ALP activity for a longer time than HAp-2 and HAp-3, and also increased the bone mineralization level. Osteoblastogenesis-related marker genes expression including osteorix, osteocalcin, and runx2 were increased after BMSC were treated with HAp-1 for 6 days. Although three kinds of HAps treatment for 9 days increased osteorix mRNA expression, osteocalcin, and runx2 mRNA expression levels were upregulated only by HAp-1. Similarly, only HAp-1 enhanced wedelolactone-induced osteocalcin, osteorix, and runx2 mRNA expression after 9 days treatment. Together, these results suggested that HAps with different sizes generated different effect on osteoblastogenesis. HAp-1 combined with wedelolacone can exert an enhanced effect on osteoblastogenesis, which has potential for treating osteoporosis. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 145-153, 2019.

15.
Artigo em Inglês | MEDLINE | ID: mdl-31891711

RESUMO

OBJECTIVE: To explore the predictive ability of the Short Physical Performance Battery (SPPB), Late Life Function and Disability Instrument-Function component (LLFDI-function) and frailty phenotype, for falls, hospitalizations, emergency department (ED) visits, and low self-rated health (SRH) over 1 and 2 years in older adults. DESIGN: Secondary analysis of data from a longitudinal study, the Boston Rehabilitative Impairment Study of the Elderly. SETTING: Primary care. PARTICIPANTS: Adults 65 years and older at risk for disability who completed ≥1 follow-up call (N=391). INTERVENTIONS: None. MAIN OUTCOME MEASURES: We computed separate logistic regression models using the SPPB, LLFDI-function, and frailty phenotype as independent variables and falls, hospitalizations, ED visits, and SRH over 1 and 2 years as dependent variables. Receiver operating characteristic curves were constructed and the areas under the curves calculated. RESULTS: Participants had a mean age of 76.5±7.1 years. The SPPB, LLFDI-function, and frailty phenotype all predicted hospitalizations and low SRH over a 1- and 2-year timeframe (odds ratio [OR] min-max, 1.35-1.51 and 1.67-3.07, respectively). Over 2 years, the SPPB predicted ED visits (OR, 1.28), and the LLFDI-function predicted falls (OR, 1.31). The LLFDI-function predicted low SRH better than the frailty phenotype over 1 year. There were no differences between the measures for any of the other outcomes. CONCLUSIONS: The SPPB, LLFDI-function, and frailty phenotype had similar accuracy for predicting falls, hospitalizations, ED visits, and low SRH over 1 and 2 years among older primary care patients at risk for disability. As a result, when considering the optimal screening tool for older adults, the choice between a measure of function and frailty may ultimately depend on clinical preference and context.

16.
Medicine (Baltimore) ; 97(50): e13408, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30557995

RESUMO

Unicompartmental knee arthroplasty (UKA) is one of the effective surgical methods for the treatment of unicompartmental knee arthritis. When UKA fails, a revised surgery to total knee arthroplasty (TKA) is often necessary. The purpose of this study was to compare the clinical outcomes of revision of failed UKAs to TKAs with primary TKAs. The hypothesis was that the TKAs revised from UKAs had inferior clinical outcomes compared with primary TKAs.This meta-analysis was conducted in accordance with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Newcastle-Ottawa Scale (NOS) proposed by the Cochrane Collaboration was used for evaluating the methodological quality of the studies. PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify studies that compared the revision of UKA to TKA with primary TKA. Primary outcomes included Range of motion (ROM); Knee society score (KSS); (re-)revision rate and complications. Secondary outcomes were blood loss and length of hospital stay.A total of 8 eligible retrospective comparative studies were identified from a keyword search. Results revealed that the primary TKAs group has a better ROM (MD = -7.29, 95% CI:-14.03-0.56, P < .05), higher Knee Society Knee scores (MD = -0.54, 95% CI:-1.12-0.04, P < .05), higher Knee Society function score (MD = -0.65,95% CI:-1.25-0.06, P < .05), lower (re-)revision rate (MD = 4.15, 95% CI:2.37-7.25, P < .05) than rUKAs. There was no significant difference in postoperative complications, blood loss and length of stay between the 2 groups.Our meta-analysis revealed that compared with primary TKAs, TKAs revised from UKAs had inferior clinical outcomes.


Assuntos
Artroplastia do Joelho/normas , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Resultado do Tratamento , Artroplastia do Joelho/métodos , Humanos , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/etiologia , Reoperação/normas
17.
Clin Interv Aging ; 13: 1691-1700, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30237705

RESUMO

Background: Mild cognitive impairment (MCI) is known as a transitional stage or phase between normal aging and dementia. In addition, it is associated with an increased risk of dementia. Research has shown that moderate-intensity exercise is associated with a decreased risk of cognitive impairment. Two recent studies demonstrated that dance interventions are associated with improved cognitive function in the elderly with MCI. Purpose: We evaluated the effect of a moderate-intensity aerobic dance routine on the cognitive function in patients with MCI. Patients and methods: This is a single-blind randomized controlled trial. Sixty MCI patients were randomized to receive either treatment (aerobic dance routine + usual care) or control (usual care only) for 3 months. All patients received usual care for an additional 3 months thereafter. The aerobic dance routine was a specially designed dance routine which involved cognitive effort for patients to memorize the complex movements. Wechsler memory scale-revised logical memory (WMS-R LM) and event-related evoked potentials (ERPs) P300 latency were used to assess patients' cognitive function at baseline, 3 months, and 6 months. Results: Twenty-nine patients received exercise therapy and 31 patients received usual care. Patients in the treatment group showed a greater improvement in memory (difference in WMS-R LM changes over 3 months 4.6; 95% CI 2.2, 7.0; p<0.001) and processing speed (difference in P300 latency changes over 6 months -20.0; 95% CI=-39.5, -0.4; p<0.05) compared to control. Conclusion: This dance routine improves cognitive function, especially episodic memory and processing speed, in MCI patients and merits promotion in communities.


Assuntos
Disfunção Cognitiva , Terapia através da Dança/métodos , Demência/prevenção & controle , Exercício/psicologia , Idoso , Idoso de 80 Anos ou mais , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/terapia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Método Simples-Cego , Resultado do Tratamento
18.
CMAJ ; 190(33): E974-E984, 2018 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-30127037

RESUMO

BACKGROUND: Testing for high-sensitivity cardiac troponin (hs-cTn) may assist triage and clinical decision-making in patients presenting to the emergency department with symptoms of acute coronary syndrome; however, this could result in the misclassification of risk because of analytical variation or laboratory error. We sought to evaluate a new laboratory-based risk-stratification tool that incorporates tests for hs-cTn, glucose level and estimated glomerular filtration rate to identify patients at risk of myocardial infarction or death when presenting to the emergency department. METHODS: We constructed the clinical chemistry score (CCS) (range 0-5 points) and validated it as a predictor of 30-day myocardial infarction (MI) or death using data from 4 cohort studies involving patients who presented to the emergency department with symptoms suggestive of acute coronary syndrome. We calculated diagnostic parameters for the CCS score separately using high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT). RESULTS: For the combined cohorts (n = 4245), 17.1% of participants had an MI or died within 30 days. A CCS score of 0 points best identified low-risk participants: the hs-cTnI CCS had a sensitivity of 100% (95% confidence interval [CI] 99.5%-100%), with 8.9% (95% CI 8.1%-9.8%) of the population classified as being at low risk of MI or death within 30 days; the hs-cTnT CCS had a sensitivity of 99.9% (95% CI 99.2%-100%), with 10.5% (95% CI 9.6%-11.4%) of the population classified as being at low risk. The CCS had better sensitivity than hs-cTn alone (hs-cTnI < 5 ng/L: 96.6%, 95% CI 95.0%-97.8%; hs-cTnT < 6 ng/L: 98.2%, 95% CI 97.0%-99.0%). A CCS score of 5 points best identified patients at high risk (hs-cTnI CCS: specificity 96.6%, 95% CI 96.0%-97.2%; 11.2% [95% CI 10.3%-12.2%] of the population classified as being at high risk; hs-cTnT CCS: specificity 94.0%, 95% CI 93.1%-94.7%; 13.1% [95% CI 12.1%-14.1%] of the population classified as being at high risk) compared with using the overall 99th percentiles for the hs-cTn assays (specificity of hs-cTnI 93.2%, 95% CI 92.3-94.0; specificity of hs-cTnT 73.8%, 95% CI 72.3-75.2). INTERPRETATION: The CCS score at the chosen cut-offs was more sensitive and specific than hs-cTn alone for risk stratification of patients presenting to the emergency department with suspected acute coronary syndrome. Study registration: ClinicalTrials.gov, nos. NCT01994577; NCT02355457.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Técnicas de Laboratório Clínico , Miocárdio/química , Troponina I/análise , Troponina T/análise , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Morte , Serviço Hospitalar de Emergência , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo
19.
Chin Med J (Engl) ; 131(21): 2531-2536, 2018 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-30147107

RESUMO

Background:: Identification of the proper femoral intramedullary (IM) access point is an important determinant of final implant position in IM-guided total knee arthroplasty (TKA). The aim of this study was to identify the optimal entry point in Chinese participants using a new three-dimensional method. Methods:: A series of computed tomography scans of 44 femurs in Chinese participants from October 2014 to October 2015 were imported into Mimics 17.0 software to identify the optimal entry point. The apex of the intercondylar notch (AIN) was used as the reference bony anatomical landmark to identify the proper entry point to insert the IM rod. The statistical significance was calculated on the basis of a 5% level (P < 0.05) using the Student's t-test. Results:: For the males, the average ideal entry point was 1.49 mm medial and 13.39 mm anterior to the AIN. The values were 1.77 mm medial and 15.29 mm anterior to the AIN in females. A significant difference was present between males and females (13.39 ± 2.46 mm vs. 15.29 ± 3.44 mm, t = 2.124, P = 0.040). When using the recommended location as the entry point for the IM rod, the mean potential error differed significantly from the femoral trochlear groove (the potential error of IM in males in coronal plane: 0.93° ± 0.24° vs. 1.27° ± 0.32°, t = -4.166, P <0.001; the potential error of IM in males in sagittal plane: 1.40° ± 0.42° vs. 2.79° ± 0.70°, t = 7.155, P < 0.001; the potential error of IM in females in coronal plane: 0.73° ± 0.28° vs. 1.15° ± 0.35°, t = 3.940, P < 0.001; and the potential error of IM in females in sagittal plane: 1.48° ± 0.47° vs. 2.76° ± 0.83°, t =5.574, P < 0.001). A significant difference was present between the recommended point and the point 10 mm anterior to the origin of the posterior cruciate ligament (the potential error of IM in males in coronal plane: 0.93° ± 0.24° vs. 1.53° ± 0.43°, t = 5.948, P < 0.001; the potential error of IM in males in sagittal plane: 1.40° ± 0.42° vs. 2.15° ± 0.75°, t = 3.152, P = 0.003; the potential error of IM in females in coronal plane: 0.73° ± 0.28° vs. 1.28° ± 0.42°, t = -4.632, P < 0.001; and the potential error of IM in females in sagittal plane: 1.48° ± 0.47° vs. 2.40° ± 0.93°, t = 3.763, P = 0.001). Conclusions: The technique described here is an innovative method for swift, easy, and accurate access to the medullary canal during TKA, and it can optimize the position and orientation of the prosthetic components in knee arthroplasty.


Assuntos
Artroplastia do Joelho/métodos , Adulto , Idoso , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Ligamento Cruzado Posterior/cirurgia , Estudos Retrospectivos
20.
PLoS One ; 13(7): e0199672, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29979706

RESUMO

BACKGROUND: Musculoskeletal ultrasound is widely used in diagnosing gout, but its accuracy is debatable. We conducted a systematic review and meta-analysis to quantitatively evaluate the value of ultrasound in the diagnosis of gout. METHODS: We systematically searched for publications using Cochrane Library, PubMed/Medline and Embase and manually screened the references of eligible articles for additional relevant publications. Studies were included in this systematic review if they assessed the diagnostic accuracy of ultrasound in gout compared to that of the gold standard, demonstration of monosodium urate crystals in joint fluid or tophi. We then conducted quantitative analyses by extracting data from each study and calculating the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR). The summary receiver operating characteristic curves (sROCs) were constructed to obtain the Q*-index and the area under the curve (AUC). RESULTS: Thirteen studies were included in this meta-analysis. The diagnostic performances of three distinctive ultrasonographic features of gout, double contour sign (DCS), the presence of tophi and the snowstorm sign, were evaluated. For person-based evaluations, the pooled sensitivity, specificity, DOR, AUC and Q* were as follows: for the DCS, 66% (95% confidence interval (CI) 62%-69%), 92% (95% CI 90%-94%), 25.91 (95% CI 11.80-56.89), 0.8163 and 0.7503, respectively; for the presence of tophi, 56% (95% CI 52%-60%), 94% (95% CI 92%-96%), 21.11 (95% CI 7.84-56.89), 0.8928 and 0.8236, respectively; for the snowstorm sign, 31% (95% CI 27%-36%), 91% (95% CI 88%-93%), 4.54(95% CI 3.13-6.58), 0.5946 and 0.5712, respectively; and for simultaneous consideration of these ultrasonographic features, 80% (95% CI 76%-83%), 83% (95% CI 79%-86%), 19.03 (95% CI 13.97-25.93), 0.889 and 0.8197, respectively. For the joint-/location-based evaluations, the pooled sensitivity, specificity, DOR, AUC and Q* were as follows: for the DCS, 75% (95% CI 68%-80%), 65% (95% CI 59%-70%), 16.90 (95% CI 5.10-56.03), 0.871 and 0.8014, respectively; and for the presence of tophi, 48% (95% CI 40%-57%), 96% (95% CI 91%-99%), 30.20 (95% CI 9.23-98.87), 0.8776 and 0.8081, respectively. CONCLUSIONS: In this meta-analysis, relatively high specificity but modest or low sensitivity were demonstrated in the diagnosis of gout using each of the three ultrasonographic features for person-based evaluations. Simultaneous consideration of these ultrasound findings may improve the diagnostic sensitivity. However, the double contour sign alone is weak in the differentiation of gout and non-gout for joint-/location-based evaluations. Further well-designed studies are still needed to support the current findings.


Assuntos
Gota/diagnóstico , Ultrassonografia , Humanos , Curva ROC , Reprodutibilidade dos Testes , Ultrassonografia/métodos
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