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1.
J Arthroplasty ; 2021 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-33446383

RESUMO

BACKGROUND: Patients with adverse spinopelvic mobility have higher complication rates following total hip arthroplasty (THA). Risk factors include a stiff lumbar spine, standing posterior pelvic tilt ≤ -10°, and a severe sagittal spinal deformity (pelvic incidence minus lumbar lordosis mismatch ≥20°). The purpose of this study is to define the spinopelvic risk factors and quantify the prevalence of risk factors for pathologic spinopelvic mobility. METHODS: A retrospective cohort analysis from January 2014 to February 2020 was performed on a multicenter series of 9414 primary THAs by 168 surgeons, all with preoperative spinopelvic measurements in the supine, standing, and flex-seated positions. All patients were included. The prevalence of adverse spinopelvic mobility and frequency of each spinopelvic risk factor was calculated. RESULTS: The cohort was 52% female, 48% male, with an average age of 65 years. Thirteen percent of patients exhibited adverse spinopelvic mobility and 17% had one or more of the 3 risk factors. Adverse mobility was found in 35% of patients with at least 1 risk factor, 47% with at least 2 risk factors, and 57% with all 3 risk factors. CONCLUSION: Forty-six percent of patients had spinopelvic pathology driven by one or more of the risk factors. Number of risk factors present and risk of adverse spinopelvic mobility were positively correlated, with 57% of patients with all 3 risk factors exhibiting adverse spinopelvic mobility. Although this study defines the prevalence of these risk factors in this highly selected cohort, it does not report incidence in a general THA population. LEVEL OF EVIDENCE: Prognostic Level IV.

2.
J Emerg Med ; 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33451876

RESUMO

BACKGROUND: Total hip arthroplasty (THA) is one of the most successful operations in all of medicine in improving patient pain and restoring function. However, complications do arise after primary and revision THA. Dislocation of a THA, also known as instability, occurs in 1-2% of primary THAs and up to 30% of revision THAs. Most dislocations in the United States are initially managed with closed reduction under procedural sedation in emergency departments (EDs) by on-call orthopedists or emergency medicine specialists. OBJECTIVE: In this review the characteristics of the articulations that may require closed reduction in the ED are described, as well as their radiographic findings prior to reduction. Finally, we present subtle radiographic findings associated with failed closed reductions. DISCUSSION: Due to the different types of implants that have been introduced, closed reduction can be challenging in certain cases. Iatrogenic intraprosthetic dislocations are becoming more common with the increased use of dual-mobility liners. There are also dislocations after staged revision THA cases with the use of spacers. In spacers with semi-constrained articulation, there is the possibility of partial reduction of the spacer. CONCLUSIONS: Dislocation is one of the most common mechanical complications after primary and revision THA. In the majority of the cases, acute closed reduction can be achieved successfully in the ED setting. However, there are specific dislocation types that present unique challenges to acute reduction.

3.
J Am Med Inform Assoc ; 28(1): 193-195, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32584990

RESUMO

Recently, there have been many efforts to use mobile apps as an aid in contact tracing to control the spread of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) (COVID-19 [coronavirus disease 2019]) pandemic. However, although many apps aim to protect individual privacy, the very nature of contact tracing must reveal some otherwise protected personal information. Digital contact tracing has endemic privacy risks that cannot be removed by technological means, and which may require legal or economic solutions. In this brief communication, we discuss a few of these inherent privacy limitations of any decentralized automatic contact tracing system.

4.
J Arthroplasty ; 36(1): 210-216, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32741711

RESUMO

BACKGROUND: Spinal stiffness has been shown to increase risk of dislocation due to impingement and instability. Increasing anteversion of the acetabular component has been suggested to prevent dislocation, but little has been discussed in terms of femoral or global offset restoration. The purpose of this study is to quantify dislocation rates after primary THA using standard versus high-offset femoral components and to determine how differences in offset affect impingement-free range of motion in a stiff spine cohort using a novel impingement model. METHODS: A total of 12,365 patients undergoing THA from 2016 to 2018 were retrospectively reviewed to determine dislocation rates and utilization of standard- versus high-offset stems. For 50 consecutive patients with spinal stiffness, a CT-based computer software impingement modeling system assessed bony or prosthetic impingement during simulated range of motion. The model was run 5 times for each patient with varying offsets. Range of motion was simulated in each scenario to determine the degree at which impingement occurred. RESULTS: There were 51 dislocations for a 0.41% dislocation rate. Total utilization of high-offset stems in the entire cohort was 49%. Of those patients who sustained a dislocation, 49 (96%) utilized a standard-offset stem. The impingement modeling demonstrated 5 degrees of added range of motion until impingement for every 1 mm offset increase. CONCLUSION: In the impingement model, high-offset stems facilitated greater ROM before bony impingement and resulted in lower dislocation rates. In the setting of high-risk THA due to spinal stiffness, surgeons should consider the use of high-offset stems and pay attention to offset restoration.

5.
Am J Med ; 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33316249

RESUMO

Massive animal farming for meat production poses major problems in terms of resource use, environmental impact, and biodiversity. Furthermore, excessive meat consumption has been associated with multiple deleterious health consequences. However, more and better-designed randomized trials are needed to increase the level of evidence on the health impacts of meat. Novel meat alternatives, such as plant- and cell-based meat, are much less impactful to the environment and might replace traditional animal meat in the future, but, despite promising early data, the health consequences of these novel products need further study. This manuscript focuses on the health impacts of meat over 3 main sections: 1) overview of the evidence highlighting the association of meat consumption with health; 2) novel alternatives to meat, including plant-based and cell-based alternatives; and 3) examine the rationale for randomized studies to evaluate the effects of the novel meat alternatives compared with the standard animal meat.

6.
Diabetes Obes Metab ; 2020 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-33269511

RESUMO

AIM: To investigate the ability of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS-HFDM ) to stratify patients with type 2 diabetes mellitus (T2DM) and high cardiovascular risk for heart failure (HF) hospitalization. MATERIALS AND METHODS: We used data from the control group of the Action to Control Cardiovascular Risk in Diabetes Study Group (ACCORD) trial (n = 5123; mean follow-up 4.8 years). The TRS-HFDM includes: prior HF (2 points), atrial fibrillation (1 point), coronary artery disease (1 point), estimated glomerular filtration rate <60 mL/min/1.73 m2 (1 point), and urine albumin-to-creatinine ratio (>300 mg/g: 2 points; 30-300 mg/g: 1 point). We evaluated the discrimination (Harrell's C-index) and calibration (Nam-D'Agostino calibration statistic) of the TRS-HFDM with regard to time to HF hospitalization or death due to HF. RESULTS: The mean age of the participants was 62.8 ± 6.6 years, and 38% were women. The prevalences of TRS-HFDM 0, 1, 2, 3 and ≥4 were 42.1%, 34.9%, 14.6%, 6.0% and 2.5%, respectively. Increasing TRS-HFDM corresponded to an increasing HF risk: 1.3 per 1000 person-years for a TRS-HFDM of 0 to 64.7 per 1000 person-years for TRS-HFDM of ≥4. The TRS-HFDM demonstrated robust discrimination of HF outcomes (C-index 0.78). Furthermore, the score was well calibrated for HF outcomes (calibration statistic P = 0.13). Similar results were seen in participants without baseline HF (C-index 0.75). CONCLUSION: The TRS-HFDM discriminates HF-specific risk among people with T2DM. The use of TRS-HFDM to identify those who would maximally benefit from therapies that reduce HF risk warrants evaluation.

7.
ESC Heart Fail ; 2020 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-33300277

RESUMO

AIMS: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous condition, and tissue congestion manifested by oedema is not present in all patients. We compared clinical characteristics, exercise capacity, and outcomes in patients with HFpEF with and without oedema. METHODS AND RESULTS: This study was a post hoc analysis of pooled data of patients with left ventricular ejection fraction of ≥50% enrolled in the DOSE, CARRESS-HF, RELAX, ATHENA, ROSE, INDIE, and NEAT trials. Patients were dichotomized by the severity of oedema. Cox proportional hazard regression and generalized linear regression models were used to assess associations between oedema, symptoms, and clinical outcomes. The ambulatory cohort included 393 patients (228 with and 165 without oedema), and the hospitalized cohort included 338 patients (249 with ≥moderate oedema and 89 with mild or none). Among ambulatory patients, patients with oedema had a higher body mass index (35.2 kg/m2 [inter-quartile range, IQR 30.5, 41.6] vs. 31.6 kg/m2 [IQR 27.9, 36.3], P < 0.001), greater burden of co-morbidities, higher intravascular pressures estimated on physical examination (elevated jugular venous pressure: 50% vs. 24.7%, P < 0.001), poorer renal function (creatinine: 1.2 mg/dL [IQR 0.9, 1.5] vs. 1 mg/dL [IQR 0.8, 1.3], P = 0.003), and lower peak VO2 (adjusted mean difference -1.04 mL/kg/min, 95% confidence interval [-1.71, -0.37], P < 0.003). Among hospitalized patients, despite greater in-hospital fluid/weight loss in the ≥moderate oedema group, there was no difference in the improvement in dyspnoea by the visual analogue scale or well-being visual analogue scale from baseline to 3-4 days and no statistically significant difference in the rate of 60 day rehospitalization/death (adjusted hazard ratio 1.44, 95% confidence interval [0.87, 2.39], P = 0.156). CONCLUSIONS: Patients with HFpEF and oedema display higher body mass, greater burden of co-morbidities, and more severe exercise intolerance, but clinical responses to treatment appear similar. Further research is required to better understand the nature of volume distribution in different HFpEF phenotypes.

8.
J Am Heart Assoc ; 9(24): e015752, 2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33289458

RESUMO

Background Ultrafiltration is not commonly used because of higher incidence of worsening renal function without improved decongestion. We examined differential outcomes of high versus low fluid removal and preserved versus reduced ejection fraction (EF) in CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure). Methods and Results Baseline characteristics in the ultrafiltration arm were compared according to 24-hour ultrafiltration-based fluid removal above versus below the median. Patients were stratified by EF (≤40% or >40%). We compared clinical parameters of clinical decongestion during the hospitalization based on initial (≤24 hours) response to ultrafiltration. Cox-proportional hazards models were used to identify associations between fluid removal <24 hours and composite of death, hospitalization, or unscheduled outpatient/emergency department visit during study follow-up. The intention-to-treat analysis included 93 patients. Within 24 hours, median fluid removal was 1.89 L (Q1, Q3: 1.22, 3.16). The high fluid removal group had a greater urine output (9.08 versus 6.23 L, P=0.027) after 96 hours. Creatinine change from baseline to 96 hours was similar in both groups (0.10 mg/dL increase, P=0.610). The EF >40% group demonstrated larger increases of change in creatinine (P=0.023) and aldosterone (P=0.038) from baseline to 96 hours. Among patients with EF >40%, those with above median fluid removal (n=17) when compared with below median (n=17) had an increased rate of the combined end point (87.5% versus 47.1%, P=0.014). Conclusions In patients with acute heart failure, higher initial fluid removal with ultrafiltration had no association with worsening renal function. In patients with EF >40%, ultrafiltration was associated with worsening renal function irrespective of fluid removal rate and higher initial fluid removal was associated with higher rates of adverse clinical outcomes, highlighting variable responses to decongestive therapy.

9.
Soft Matter ; 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33313625

RESUMO

Equilibrium properties of a system of passive diffusing particles in an external magnetic field are unaffected by Lorentz force. In contrast, active Brownian particles exhibit steady-state phenomena that depend on both the strength and the polarity of the applied magnetic field. The intriguing effects of the Lorentz force, however, can only be observed when out-of-equilibrium density gradients are maintained in the system. To this end, we use the method of stochastic resetting on active Brownian particles in two dimensions by resetting them to the line x = 0 at a constant rate and periodicity in the y direction. Under stochastic resetting, an active system settles into a nontrivial stationary state which is characterized by an inhomogeneous density distribution, polarization and bulk fluxes perpendicular to the density gradients. We show that whereas for a uniform magnetic field the properties of the stationary state of the active system can be obtained from its passive counterpart, novel features emerge in the case of an inhomogeneous magnetic field which have no counterpart in passive systems. In particular, there exists an activity-dependent threshold rate such that for smaller resetting rates, the density distribution of active particles becomes non-monotonic. We also study the mean first-passage time to the x axis and find a surprising result: it takes an active particle more time to reach the target from any given point for the case when the magnetic field increases away from the axis. The theoretical predictions are validated using Brownian dynamics simulations.

10.
J Trop Pediatr ; 2020 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-33221859

RESUMO

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-19) has emerged as a public health emergency in recent times. The reported data on the mode of transmission of coronavirus disease 2019 (COVID-19) are largely through contact, droplet, airborne and fomite transmission methods with vertical transmission being a rare entity. We hereby report a case of a probable vertical transmission of SARS-CoV-19 from an infected pregnant female to her neonate. The transmission has been confirmed by a positive RT-PCR at 16 h of life along with a positive IgG antibody test for SARS-CoV-19 in the baby and after excluding the possible environmental contamination of the sample. The baby was asymptomatic during the course of hospital stay and was discharged from the facility on Day 9 of life.

11.
Sci Rep ; 10(1): 18403, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33110237

RESUMO

Despite the reported benefits of intravenous iron therapy (IVIT) for correcting iron deficiency anemia (IDA) before any major surgery and the evidence thereof, perioperative allogenic blood transfusion (ABT) practice is still considered as the only viable option by some clinicians worldwide. As ABT increases the likelihood of infections, cardiac complications, longer hospital stays and mortality among the patients, the practice of ABT should only be reserved for critical cases (Hb level < 7 g/dl). Timely iron studies and iron replenishment (oral/IV) of prospective surgical patients could help decrease the ABT practice, and prove beneficial from both the clinical and economic standpoint. Evidence based patient blood management guidelines should be developed and standardized for use by clinicians worldwide. These guidelines should include specific instructions on timely assessment of surgical patients for correction of their IDA by either oral iron supplementation, if time permits, or by using IVIT such as ferric carboxymaltose (FCM) in emergency surgeries and in patients with functional ID. This study was conducted to explore the clinical benefits of the timely administration of IV-FCM in iron-deficient preoperative patients during 2017-2018 and compare the results thereof with that of the ABT. Based on the IDA treatment plan of 2953 patients, 11.14% cases were administered IV FCM (Group 1), 11.58% cases received ABT (Group 2), while the remaining 77.27% of anemic cases received neither ABT nor IV FCM (Group 3). The results indicate that the IV FCM administration reduces the need for ABT and thus minimizes its associated side effects. The findings of our study concur with the favorable outcomes reported by the other similar studies.

12.
J Orthop ; 21: 432-437, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32968337

RESUMO

Background: Dual mobility (DM) constructs effectively reduce the risk of dislocation in revision and high risk primary total hip arthroplasty. However, modular DM designs require the use of a cobalt-chrome liner against a titanium cup which may induce corrosion, metal ions release, and associated biologic response. The purpose of this systematic review study was to collect all reported cases of serum metal ions after DM in the literature and ask the following questions: 1) what is the overall rate of significantly elevated Cobalt and Chromium metal ions and how do these levels change over time? 2) Does femoral head material composition influence serum metal ion levels? and 3) were there any atypical lymphocytic associated lesions after modular DM that required revision surgery? Methods: A systematic review was performed according to PRISMA guidelines. In addition to patient demographics, information specific to the performance of the DM implant were recorded including: cobalt and chromium serum ion levels and all reported timepoints, the material composition of the femoral head, all revision and reoperations and any failure related to corrosion of the DM bearing. A significant elevation in cobalt or chromium was defined as >1.0 or >1.6 mcg/L. Results: 248 modular DM THAs were analyzed. The cumulative mean cobalt and chromium levels for all included studies was 0.47mcg/L and 0.53mcg/L, respectively. At final follow-up 13 patients (5.2%) had elevated cobalt ion levels and 4 patients (1.6%) had elevated chromium ion levels. Femoral head material composition trended towards but did not significantly increase serum ion levels. Ceramic heads had elevated cobalt and chromium ions in 4/135 (3%) of patients compared to metal heads which had elevated cobalt ions in 9/113 (8%) and elevated chromium ions in 0/113 (0%), (p = 0.09). There were no reoperations or revisions for metal related reactions at final follow-up (mean 27.4 months). Conclusion: In this systematic review including 248 modular DM THAs, elevated serum cobalt ions were present in 5.2% of patients at a mean follow-up of 27.4 months. While a trend towards increased Cobalt serum ions with the use of cobalt chrome femoral heads, femoral head composition was not significantly associated with increased serum metal ion levels. At final follow-up, metal ion levels appear to decrease in the majority of patients between 1 and 2 years and no patient was revised for metal ion related complications. Continued serum metal ion surveillance is recommended to ensure the safety of DM constructs in THA with longer term follow-up.

13.
Am Heart J ; 229: 40-51, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32916607

RESUMO

BACKGROUND: The timing of enrolment following an acute coronary syndrome (ACS) may influence cardiovascular (CV) outcomes and potentially treatment effect in clinical trials. Understanding the timing and type of clinical events after an ACS will allow for clinicians to better tailor evidence-based treatments to optimize therapeutic effect. Using a large contemporary trial in patients with type 2 diabetes mellitus (T2DM) post-ACS, we examined the impact of timing of enrolment on subsequent CV outcomes. METHODS: EXAMINE was a randomized trial of alogliptin versus placebo in 5,380 patients with T2DM and a recent ACS from October 2009 to March 2013. The primary outcome was a composite of CV death, nonfatal myocardial infarction (MI), or nonfatal stroke. The median follow-up was 18 months. In this post hoc analysis, we examined the occurrence of subsequent CV events by timing of enrollment divided by tertiles of time from ACS to randomization: 8-34, 35-56, and 57-141 days. RESULTS: Patients randomized early (compared to the latest times) had less comorbidities at baseline including a history of heart failure (HF; 24.7% vs 33.0%), prior coronary artery bypass graft (9.6% vs 15.9%), or atrial fibrillation (5.9% vs 9.4%). Despite the reduced comorbidity burden, the risk of the primary outcome was highest in patients randomized early compared to the latest time (adjusted hazard ratio 1.47; 95% CI 1.21-1.74). Similarly, patients randomized early had an increased risk of recurrent MI (adjusted hazard ratio 1.51; 95% CI 1.17-1.96) and HF hospitalization (1.49; 95% CI 1.05-2.10). CONCLUSIONS: In a contemporary cohort of T2DM with a recent ACS, the risk for recurrent CV events including MI and HF hospitalization is elevated early after an ACS. Given the emergence of antihyperglycemic therapies that reduce the risk of MI and HF among patients with T2DM at high CV risk, future studies evaluating the initiation of these therapies in the early period following an ACS are warranted given the large burden of potentially modifiable CV events.


Assuntos
Síndrome Coronariana Aguda , Diabetes Mellitus Tipo 2 , Infarto do Miocárdio , Seleção de Pacientes , Piperidinas , Distribuição Aleatória , Acidente Vascular Cerebral , Fatores de Tempo , Uracila/análogos & derivados , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/terapia , Comorbidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/normas , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Piperidinas/administração & dosagem , Piperidinas/efeitos adversos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Uracila/administração & dosagem , Uracila/efeitos adversos
14.
Appl Clin Inform ; 11(4): 606-616, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32937677

RESUMO

BACKGROUND: Incidental radiographic findings, such as adrenal nodules, are commonly identified in imaging studies and documented in radiology reports. However, patients with such findings frequently do not receive appropriate follow-up, partially due to the lack of tools for the management of such findings and the time required to maintain up-to-date lists. Natural language processing (NLP) is capable of extracting information from free-text clinical documents and could provide the basis for software solutions that do not require changes to clinical workflows. OBJECTIVES: In this manuscript we present (1) a machine learning algorithm we trained to identify radiology reports documenting the presence of a newly discovered adrenal incidentaloma, and (2) the web application and results database we developed to manage these clinical findings. METHODS: We manually annotated a training corpus of 4,090 radiology reports from across our institution with a binary label indicating whether or not a report contains a newly discovered adrenal incidentaloma. We trained a convolutional neural network to perform this text classification task. Over the NLP backbone we built a web application that allows users to coordinate clinical management of adrenal incidentalomas in real time. RESULTS: The annotated dataset included 404 positive (9.9%) and 3,686 (90.1%) negative reports. Our model achieved a sensitivity of 92.9% (95% confidence interval: 80.9-97.5%), a positive predictive value of 83.0% (69.9-91.1)%, a specificity of 97.8% (95.8-98.9)%, and an F1 score of 87.6%. We developed a front-end web application based on the model's output. CONCLUSION: Developing an NLP-enabled custom web application for tracking and management of high-risk adrenal incidentalomas is feasible in a resource constrained, safety net hospital. Such applications can be used by an institution's quality department or its primary care providers and can easily be generalized to other types of clinical findings.

15.
Infect Genet Evol ; 85: 104550, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32920193

RESUMO

Human tuberculosis (TB) is caused by members of the Mycobacterium tuberculosis complex (MTBC), including Mycobacterium tuberculosis var. tuberculosis (MTB) and Mycobacterium tuberculosis var. africanum (MAF). While MTB is isolated worldwide, MAF is almost completely restricted to the African continent, and despite the historical proximity between Brazil and Africa during the slave trade, no case of TB being caused by MAF has been reported in Brazil to date. We hereby describe the first case of TB caused by MAF in Brazil comparing its genome against the published ones. A female patient who had never visited Africa presented with clinical symptoms typical of pulmonary TB. Based on 16S rRNA gene sequencing, the cultured isolate was identified as belonging to MTBC and partial sequence of the hsp65 gene was identical to that of MAF. This was confirmed by genotyping based on detection of Single Nucleotide Polymorphism (SNP), Region of Difference (RD) and spoligotyping. The isolate presented the Shared International Typing (SIT) 181. In the whole-genome comparison against MAF genomes available on published EMBL-EBI European Nucleotide Archive (ENA), the Brazilian genome (MAFBRA00707) was identified as belonging to Lineage 6 and clustered with isolates from The Gambia. This is the first report of the isolation of MAF from a patient from Brazil, without evidence of having any contact with an African index case.

16.
Arthroplast Today ; 6(4): 770-776, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32964085

RESUMO

Background: Total hip arthroplasty (THA) is an effective operation for patients with hip osteoarthritis; however, patients with hip dysplasia present a particular challenge. Our novel study examined the effect of robot-assisted THA in patients with hip dysplasia. Methods: We retrospectively reviewed patients with developmental dysplasia of the hip undergoing primary THA using robotic arm assistance at 2 institutions from January 2010 to January 2017. Patients undergoing revision arthroplasty were excluded. Preoperatively, all patients underwent a computed tomography scan so that 3-dimensional templating could be performed. Hip range of motion (ROM) and clinical leg length discrepancy were recorded preoperatively. Two independent observers calculated Crowe and Hartofilakidis grades for each operative hip. At the final follow-up, hip ROM, postoperative complications, and modified Harris Hip scores were obtained. Results: Seventy-nine patients underwent THA because of degenerative joint disease in the setting of developmental dysplasia of the hip. There were 56 females and 23 males with a mean age of 45 years (range: 26-64 years). We found that components were placed according to the preoperative plan, that there was an improvement in the modified Harris hip score from 29 to 86 (P < .001), an improvement in the hip ROM (flexion improvement from 66° to 91°, P < .0001), and a correction of leg length discrepancy (17.1 vs 4 mm, P < .0002). There were no complications during the short-term interim follow-up (mean: 3.1 years). Conclusions: Robot-assisted THA can be a useful method to ensure adequate component positioning and excellent outcomes in patients with hip dysplasia. Level of Evidence: Level III, Retrospective.

19.
Clin Res Cardiol ; 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32789678

RESUMO

BACKGROUND: Patients with diabetes who had a recent myocardial infarction (MI) are at high risk of cardiovascular events. Therefore, risk assessment is important for treatment and shared decisions. We used data from EXAMINE trial to investigate whether a multi-proteomic approach would provide specific proteomic signatures and also improve the prognostic capacity for determining the risk of cardiovascular death, MI, stroke, heart failure [HF], all-cause death, and combinations of these outcomes. METHODS: 93 circulating proteins (92 from the Olink® CVDII plus troponin) were assessed in 5131 patients. Cox, competing risks, and reclassification measures were applied. RESULTS: The clinical model showed good discrimination and calibration for all outcomes. On top of the clinical model that included age, sex, smoking, diabetes duration, history of MI (prior to the index MI of inclusion), history of HF hospitalization, history of stroke, atrial fibrillation, hypertension, systolic blood pressure, statin therapy, estimated glomerular filtration rate, and study treatment (alogliptin or placebo), troponin and BNP added prognostic information to the composite of cardiovascular death, MI, or stroke (∆C-index + 5%) and cardiovascular death alone (∆C-index + 7%). Troponin, BNP, and TRAILR2 added prognostic information on all-cause death and the composite of cardiovascular death or HF hospitalization. HF hospitalization alone was improved by adding BNP and Gal-9. For MI, troponin, FGF23, and AMBP added prognostic value; whereas for stroke, only troponin added prognostic value (multi-proteomics improved C-index > 3% [p < 0.001] for all the studied outcomes). The addition of the final biomarker selection to the clinical model improved event reclassification (cNRI from + 23% to + 64%). Specifically, the addition of the biomarkers allowed a better classification of patients at low risk (as having "true" low risk) and patients and high risk (as having "true" high risk). These results were consistent for all the studied outcomes with even more marked differences in the fatal events. CONCLUSIONS: The addition of multi-proteomic biomarkers to a clinical model in this population with diabetes and a recent MI allowed a better risk prediction and event reclassification, potentially helping for better risk assessment and targeted treatment decisions. T2D type 2 diabetes, MI myocardial infarction, CV cardiovascular, HFH heart failure hospitalization, Δ delta, cNRI continuous net reclassification index, BNP brain natriuretic peptide, TRAILR2 trail receptor 2 (or death receptor 5), Gal-9 galectin-9, FGF23 fibroblast growth factor 23.

20.
J Am Heart Assoc ; 9(12): e012405, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32476539

RESUMO

Background There are conflicting data regarding the benefit of primary prevention implantable cardioverter-defibrillators (ICDs) in patients with diabetes mellitus and heart failure (HF) with reduced ejection fraction. We aimed to assess the comparative effectiveness of ICD placement in patients with diabetes mellitus and HF with reduced ejection fraction. Methods and Results Data were obtained from the Get With the Guidelines-Health Failure registry, linked with claims from the Centers for Medicare & Medicaid Services. We used a Cox proportional hazards model censored at 5 years with propensity score matching. Of the 17 186 patients with HF with reduced ejection fraction from the Centers for Medicare & Medicaid Services claims database (6540 with diabetes mellitus; 38%), 1677 (646 with diabetes mellitus; 39%) received an ICD during their index HF hospitalization or were prescribed an ICD at discharge. Patients with diabetes mellitus and an ICD (n=646), as compared with those without an ICD (n=1031), were more likely to be younger (74 versus 78 years of age) and have coronary artery disease (68% versus 60%). After propensity matching, ICD use among patients with diabetes mellitus, as compared with those without an ICD, was associated with a reduced risk of all-cause mortality at 5 years after HF discharge (54% versus 59%; multivariable hazard ratio, 0.73; 95% CI, 0.64-0.82; P<0.0001). Ischemic heart disease did not modify the association between ICD use and all-cause mortality (P=0.95 for interaction). Similar results were seen in patients without diabetes mellitus. Conclusions Primary prevention ICD use among older patients with HF with reduced ejection fraction and diabetes mellitus was associated with a reduced risk of all-cause mortality. Our analysis supports current guideline recommendations for implantation of primary prevention ICDs among older patients with diabetes mellitus and HF with reduced ejection fraction.

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