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1.
Clin Interv Aging ; 16: 1215-1222, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34211270

RESUMO

Purpose: Ultrasound-based prediction methods for the detection of low muscle mass for sarcopenia in older adults have been explored previously; however, the muscle that most accurately predicts it is unclear. This study aimed to clarify prediction accuracy and cut-off values for ultrasound-derived thigh and lower leg muscle thickness (MT) to detect low skeletal muscle mass index (SMI) in older adults and to estimate cut-off values based on two standard deviations (SD) below younger adult means for the corresponding muscles as an early detection tool for site-specific low muscle mass. Methods: This study included 204 community-dwelling older (64 males, 140 females, mean age: 75.4 years) and 59 younger (31 males, 28 females, mean age: 22.3 years) adults. The MT of the rectus femoris, vastus intermedius, gastrocnemius, and soleus muscles was measured using ultrasound; SMI was measured using bioelectrical impedance analysis. Results: The prevalence of a low SMI among older adults was 20.3% (n=13) for males and 21.4% (n=30) for females. The receiver operating characteristic analysis revealed that the total MT for the four muscles measured presented the highest area under the curve (AUC) value to predict low SMI for males (0.849) and females (0.776). The AUC value was the highest for the total MT of the gastrocnemius and soleus muscles for males and the gastrocnemius for females (0.836, 0.748; cut-off value: 5.67 cm, 1.42 cm, respectively). Muscle-specific differences between the low SMI-predicting and SD-based cut-off values were observed. The SD-based value for the rectus femoris (1.85 cm) was substantially higher than the low SMI-predicting value (1.51 cm) in males. Conclusion: Ultrasound measurement of lower leg muscles may be a simple, robust measure to detect low muscle mass for sarcopenia. Additionally, cut-off values for site-specific muscle mass loss may not always agree with those for whole-limb muscle mass loss.


Assuntos
Extremidade Inferior/patologia , Músculo Esquelético/patologia , Sarcopenia/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos Transversais , Impedância Elétrica , Feminino , Humanos , Vida Independente , Masculino , Músculo Esquelético/diagnóstico por imagem , Prevalência , Músculo Quadríceps/patologia , Curva ROC , Valores de Referência , Sarcopenia/epidemiologia , Fatores Sexuais , Ultrassonografia
2.
Eur J Vasc Endovasc Surg ; 62(3): 439-449, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34330647

RESUMO

OBJECTIVE: The aim of this study was to examine the external applicability of the COMPASS and the VOYAGER-PAD trials in patients with lower extremity artery disease (LEAD) in the real world. METHODS: This was a multicentre retrospective analysis of prospectively collected COPART data, a French multicentre registry of patients hospitalised for symptomatic LEAD. The proportion of patients eligible for the combination of rivaroxaban 2.5 mg twice daily plus aspirin based on either COMPASS or VOYAGER-PAD criteria is reported. The one year cumulative incidence of outcomes between eligible and non-eligible patients, as well as eligible patients vs. control arms of the COMPASS (LEAD patient subgroup) and the VOYAGER-PAD trials were compared. Analyses were performed using Cox models. RESULTS: Of 2 259 evaluable patients, only 679 (30.1%) were eligible for a low dose rivaroxaban plus aspirin regimen. Others were not eligible because of the need for anticoagulant (48.5% and 38.9% of patients meeting COMPASS and VOYAGER-PAD exclusion criteria, respectively) or dual antiplatelet therapy use (15.7% and 16.5%, respectively), high bleeding risk (14.4% and 11.6%, respectively), malignancy (26.1% and 21.0%, respectively), history of ischaemic/haemorrhagic stroke (21.1% and 19.8%, respectively), and severe renal failure (13.2% and 10.5%, respectively). COMPASS and VOYAGER-PAD eligible and ineligible patients were at higher risk of ischaemic events than participants in these trials. The one year cumulative incidences were 6.0% (95% CI 4.3 - 8.1) in the COMPASS eligible subset vs. 3.5% (95% CI 2.9 - 4.3) in the COMPASS control arm for major adverse cardiovascular events, and 27.9% (95% CI 19.9 - 38.3) in the VOYAGER-PAD eligible subset vs. 6.0% (95% CI 5.3 - 6.9) in the VOYAGER-PAD control arm for major adverse limb events. CONCLUSION: Many patients hospitalised for symptomatic LEAD in France are not eligible for the low dose rivaroxaban plus aspirin combination. In turn, those eligible may potentially have greater absolute benefit because of higher risk than those enrolled in the trials.


Assuntos
Aspirina/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Isquemia/prevenção & controle , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Rivaroxabana/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Quimioterapia Combinada , Feminino , França , Hospitalização , Humanos , Incidência , Isquemia/epidemiologia , Isquemia/etiologia , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/fisiopatologia , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
Medicine (Baltimore) ; 100(22): e26191, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087886

RESUMO

ABSTRACT: Case-control studies by examining the lumbar spine computed tomography (CT) findings focusing on the spinous processes."Passing spine" was defined as a lumbar degenerative change observed on CT images. In contrast, kissing spine, which is also an image finding, has been acknowledged as an established clinical condition. Therefore, we compared the passing spine group and the kissing spine group to investigate whether the 2 groups belong to a similar disease group; this would help explain the clinical and imaging characteristics of patients with passing spine.Previous studies have described the gradual increase in the height and thickness of the lumbar vertebral spinous processes that can occur in individuals aged >40 years, and reported that this progressive degeneration can lead to a condition termed "kissing spine."We examined the CT imaging of 373 patients with lumbar spinal disease and divided patients into 2 groups, the kissing spine (K) group and the passing spine (P) group, and compared the clinical (age, sex, presence/absence of lower extremity pain) and imaging data (localization of kissing or passing spine, intervertebral disc height at the level of kissing or passing spine, lumbar lordosis (LL) angle, presence/absence of vacuum phenomenon (VP) in the intervertebral discs and spondylolisthesis at the level of kissing or passing spine between the 2 groups.Compared with patients with kissing spine, patients with passing spine had an increased incidence of lower extremity pain, lower intervertebral disc height at the level of passing spine, relatively static LL, and VP commonly observed in the intervertebral discs at the level of passing spine.Because the clinical and imaging characteristics of patients with passing spine are different from those of patients with kissing spine, passing spine might be a pathological condition distinct from kissing spine.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Corpo Vertebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Disco Intervertebral/patologia , Lordose/diagnóstico por imagem , Extremidade Inferior/patologia , Vértebras Lombares/patologia , Região Lombossacral/patologia , Masculino , Pessoa de Meia-Idade , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/epidemiologia , Espondilolistese/diagnóstico por imagem , Corpo Vertebral/patologia
4.
Med Clin North Am ; 105(4): 663-679, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059244

RESUMO

Lower extremity ulcerations contribute to significant morbidity and economic burden globally. Chronic wounds, or those that do not progress through healing in a timely manner, are estimated to affect 6.5 million people in the United States alone causing, significant morbidity and economic burden of at least an estimated $25 billion annually. Owing to the aging population and increasing rates of obesity and diabetes mellitus globally, chronic lower extremity ulcers are predicted to increase. Here, we explore the pathophysiology, diagnosis, and management of the most (and least) commonly seen lower extremity ulcers.


Assuntos
Úlcera da Perna/diagnóstico , Úlcera da Perna/economia , Úlcera da Perna/terapia , Extremidade Inferior/patologia , Adulto , Idoso , Envelhecimento/fisiologia , Aterosclerose/complicações , Doença Crônica , Comorbidade , Efeitos Psicossociais da Doença , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Úlcera da Perna/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Fatores de Risco , Estados Unidos/epidemiologia , Cicatrização/fisiologia
5.
Sci Rep ; 11(1): 13412, 2021 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-34183729

RESUMO

We previously identified the inhibitory serpin protease nexin-1 (PN-1) as an important player of the angiogenic balance with anti-angiogenic activity in physiological conditions. In the present study, we aimed to determine the role of PN-1 on pathological angiogenesis and particularly in response to ischemia, in the mouse model induced by femoral artery ligation. In wild-type (WT) muscle, we observed an upregulation of PN-1 mRNA and protein after ischemia. Angiography analysis showed that femoral artery perfusion was more rapidly restored in PN-1-/- mice than in WT mice. Moreover, immunohistochemistry showed that capillary density increased following ischemia to a greater extent in PN-1-/- than in WT muscles. Moreover, leukocyte recruitment and IL-6 and MCP-1 levels were also increased in PN-1-/- mice compared to WT after ischemia. This increase was accompanied by a higher overexpression of the growth factor midkine, known to promote leukocyte trafficking and to modulate expression of proinflammatory cytokines. Our results thus suggest that the higher expression of midkine observed in PN-1- deficient mice can increase leukocyte recruitment in response to higher levels of MCP-1, finally driving neoangiogenesis. Thus, PN-1 can limit neovascularisation in pathological conditions, including post-ischemic reperfusion of the lower limbs.


Assuntos
Artéria Femoral/metabolismo , Membro Posterior/metabolismo , Isquemia/metabolismo , Neovascularização Patológica/metabolismo , Neovascularização Fisiológica/fisiologia , Serpina E2/metabolismo , Animais , Capilares/metabolismo , Citocinas/metabolismo , Modelos Animais de Doenças , Extremidade Inferior/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Músculo Esquelético/metabolismo , Perfusão/métodos , Fluxo Sanguíneo Regional/fisiologia
7.
J Pediatr Orthop ; 41(Suppl 1): S24-S32, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096534

RESUMO

INTRODUCTION: Limb length discrepancy (LLD) is common in both the pediatric and adult population. Length inequalities can be due to a multitude of etiologies including congenital, developmental, and acquired causes. There has been little consensus on the morbidity of LLD and, as a result, the threshold necessary for treatment of LLD to prevent morbidity. Advances in magnetically controlled lengthening devices achieve greater accuracy and patient satisfaction and create an opportunity to lower the threshold for limb lengthening. DISCUSSION: Asymptomatic LLD is relatively common in both pediatric and adult populations. Only ~10% of the population has equal leg length. LLD of <5 cm may lead to long-term morbidities such as scoliosis, lower back pain, gait abnormalities, stress on hip or knee joint, and lower extremity symptomatic versus asymptomatic osteoarthritis. The teaching in most orthopaedic textbooks is to adjust the shoe if symptomatic for discrepancies up to 2 cm; consider an orthotic, epiphysiodesis, or skeletal shortening for 2.5 to 5 cm; and possible limb reconstruction for >5 cm. The assumption is that there are no long-term consequences of mild LLD. However, data in recent literature show that small discrepancies may contribute to pathologic changes such as pain, gait abnormalities, and osteoarthritis. Major advances have been made in limb lengthening over the past 40 years. The increased accuracy and superior patient satisfaction of the magnetically controlled lengthening nail versus external fixation methods argue for including lengthening for LLD of <5 cm. CONCLUSION: If mild LLD can cause long-term pathology, it is important to counsel families on the full range of options for limb equalization no matter the size of the discrepancy. The evolution in technology and understanding of limb lengthening has provided additional safe surgical options. Therefore, the historic treatment protocol for addressing limb differences may need to include lengthening for smaller discrepancies even <2 cm.


Assuntos
Artrodese , Alongamento Ósseo , Pinos Ortopédicos , Desigualdade de Membros Inferiores/cirurgia , Extremidade Inferior , Imãs , Osteotomia , Adolescente , Algoritmos , Artrodese/efeitos adversos , Artrodese/instrumentação , Artrodese/métodos , Alongamento Ósseo/efeitos adversos , Alongamento Ósseo/instrumentação , Alongamento Ósseo/métodos , Criança , Humanos , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/prevenção & controle , Extremidade Inferior/crescimento & desenvolvimento , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Medição de Risco
8.
PLoS One ; 16(5): e0252030, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34043672

RESUMO

PURPOSE: Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI. MATERIALS AND METHODS: We retrospectively enrolled consecutive CLI patients between 1/1/2013 and 12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality; major adverse cardiovascular events (MACEs); and major adverse limb events (MALEs). RESULTS: Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; body mass index, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P = 0.008), and MALE (28.1% vs. 13.0%, P = 0.021) rates than those with NLR<8. In multivariate logistic regression, NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075-13.47, P<0.001) mortality, and NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292-6.088, P = 0.009). Each increase in the NLR was associated with increases in all-cause (adjusted HR: 1.028, 95% CI: 1.008-1.049, P = 0.007) and cardiac-related (adjusted HR:1.027, 95% CI: 0.998-1.057, P = 0.073) mortality but not in-hospital mortality or MACEs. CONCLUSION: CLI patients with high NLRs had significantly higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.


Assuntos
Amputação/mortalidade , Fibrilação Atrial/diagnóstico , Insuficiência Cardíaca/diagnóstico , Isquemia/diagnóstico , Linfócitos/patologia , Infarto do Miocárdio/diagnóstico , Neutrófilos/patologia , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Fibrilação Atrial/imunologia , Fibrilação Atrial/mortalidade , Fibrilação Atrial/patologia , Biomarcadores/análise , Índice de Massa Corporal , Feminino , Insuficiência Cardíaca/imunologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/patologia , Humanos , Isquemia/imunologia , Isquemia/mortalidade , Isquemia/patologia , Contagem de Leucócitos , Extremidade Inferior/patologia , Linfócitos/imunologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/imunologia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/patologia , Neutrófilos/imunologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
9.
Sci Rep ; 11(1): 10388, 2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001969

RESUMO

To investigate the change trends of plasma D-dimer during catheter-directed thrombolysis (CDT) in acute lower limb ischemia (ALI) patients and their clinical value. A retrospective review of patients with ALI who received CDT was carried out. The repeated measurements of plasma D-dimer were analyzed by generalized estimating equations (GEEs) and the change trends of D-dimer were analyzed by spline regression approach. A total of 150 patients were included. Among them, 3 days of CDT was ineffective in 41 cases, effective in 33 cases and markedly effective in 76 cases. The results of GEEs analysis showed that serum D-dimer changed significantly with time (time effect, P < 0.001). Serum D-dimer levels of patients with different treatment outcomes were different after treatment (group effect, P < 0.001), and serum D-dimer levels in these three groups showed different trends over time (group*time effect, P < 0.001). The different trends in serum D-dimer level with time after treatment in the three groups could be directly seen in the spline regression curve (P < 0.001). The plasma D-dimer changes regularly during CDT for ALI. We can predict the efficacy of CDT and guide adjustments of the therapeutic regimen according to the trend of D-dimer changes during thrombolysis.


Assuntos
Arteriopatias Oclusivas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Isquemia/terapia , Trombose/terapia , Idoso , Arteriopatias Oclusivas/patologia , Arteriopatias Oclusivas/cirurgia , Arteriopatias Oclusivas/terapia , Cateteres/efeitos adversos , Feminino , Fibrinólise/fisiologia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/patologia , Isquemia/cirurgia , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Trombectomia , Terapia Trombolítica , Trombose/diagnóstico por imagem , Trombose/patologia , Trombose/cirurgia , Resultado do Tratamento
10.
Acta Orthop Traumatol Turc ; 55(2): 147-153, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33847577

RESUMO

OBJECTIVE: The study was aimed to determine the survivorship and functional outcomes of modular endoprosthetic reconstruction in the management of primary and metastatic bone tumors of the lower limbs and to investigate the rate and causes of implant failure. METHODS: A total of 84 limbs of 82 patients (49 male, 33 female; mean age=48 years, age range=13-78 years) with a minimum follow-up of 12 months in whom resection and modular endoprosthetic reconstructions were performed for primary or metastatic bone tumors of the lower extremity were retrospectively reviewed and included in the study. The mean follow-up was 43 (range=13-119) months. Functional status was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system at the final follow-up. Implant survival was defined as the time from implantation until partial or complete exchange of the prosthesis secondary to mechanical or nonmechanical causes or amputation. The effects of the anatomical site on functional scores and implant survival were statistically analyzed. Additionally, the effects of diagnosis and adjuvant treatments on functional scores, implant survival, and failure rates were investigated. RESULTS: At the time of the study, 55 patients were still alive with a mean follow-up of 48 (range=15-119) months. The mean MSTS scores resulting from the final follow-up of all patients and of those surviving were 87.9% (range=16%-100%) and 86.8% (range=16%-100%), respectively. Overall implant survival was 95.2%, 89.2%, 87%, and 87% at 1, 2, 3, and 4 years, respectively. Statistically, both functional scores and implant survival analysis in different anatomical sites were found similar. In 15 of the patients (17.8%), endoprosthetic reconstructions had failed. The causes of failure were soft tissue failure (dislocation) in 5 patients, infection in 5, structural/mechanical failure in 2, local recurrence in two, and aseptic loosening in one. The diagnosis and receiving preoperative and/or postoperative adjuvant treatment did not affect functional scores, implant survival or failure rates. CONCLUSION: The results of this study have shown that modular endoprosthetic replacement can provide satisfactory functional results and a durable mid-term limb salvage option in the management of patients with primary and metastatic bone tumors of the lower limbs. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Amputação , Neoplasias Ósseas , Salvamento de Membro , Extremidade Inferior , Próteses e Implantes , Implantação de Prótese , Amputação/métodos , Amputação/reabilitação , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Feminino , Estado Funcional , Humanos , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Salvamento de Membro/psicologia , Salvamento de Membro/reabilitação , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Falha de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Estudos Retrospectivos , Risco Ajustado/métodos , Sobrevivência
11.
Clin Nucl Med ; 46(7): 549-555, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33826571

RESUMO

PURPOSE: This study was performed to evaluate the usefulness of lymphoscintigraphy in predicting the surgical outcomes of lymphaticovenous anastomosis (LVA) in a patient with extremity lymphedema. PATIENTS AND METHODS: We retrospectively evaluated 133 patients with extremity lymphedema who underwent lymphoscintigraphy followed by LVA surgery from February 2018 to March 2020. Lymphoscintigraphic findings were evaluated on the following parameters: the extent of dermal backflow (small/large), lymphatic flow patterns (trunk flow pattern/proximal-restricted pattern/distal-restricted pattern), visualization of lymph nodes, and collateral lymphatic vessels. The mean circumferential difference change before and after surgery, circumferential reduction (CR) rate (%), was used as the clinical outcome variables. RESULTS: A decrease in circumference was observed in 93 (69.9%) of 133 patients after LVA. The extent of dermal backflow and lymphatic flow patterns was significantly correlated with improved clinical outcomes after LVA. The large extent of the dermal backflow group showed a more significant CR rate than the small extent (19.27% vs 1.24%, P = 0.005). The TP group showed the most significantly decreased CR rate to 21.46%, and the proximal-restricted pattern and distal-restricted pattern groups were -2.49% and -5.33%, respectively (P < 0.001). Multivariate analysis revealed that dermal backflow and lymphatic flow patterns were independent predictors of therapeutic outcome (P < 0.001). CONCLUSIONS: Our study demonstrates that pretreatment lymphoscintigraphy may help predict the therapeutic effect of LVA in patients with extremity lymphedema. Furthermore, dermal backflow and lymphatic flow patterns are independent predictors of CR rate after LVA surgery for extremity lymphedema.


Assuntos
Extremidade Inferior/patologia , Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Linfocintigrafia , Adulto , Idoso , Anastomose Cirúrgica , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
Int J Mol Sci ; 22(6)2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33801150

RESUMO

Several human tissues are investigated in studies of molecular biomarkers associated with diseases development. Special attention is focused on the blood and its components due to combining abundant information about systemic responses to pathological processes as well as high accessibility. In the current study, transcriptome profiles of peripheral blood mononuclear cells (PBMCs) were used to compare differentially expressed genes between patients with lower extremities arterial disease (LEAD), abdominal aortic aneurysm (AAA) and chronic venous disease (CVD). Gene expression patterns were generated using the Ion S5XL next-generation sequencing platform and were analyzed using DESeq2 and UVE-PLS methods implemented in R programming software. In direct pairwise analysis, 21, 58 and 10 differentially expressed genes were selected from the comparison of LEAD vs. AAA, LEAD vs. CVD and AAA vs. CVD patient groups, respectively. Relationships between expression of dysregulated genes and age, body mass index, creatinine levels, hypertension and medication were identified using Spearman rank correlation test and two-sided Mann-Whitney U test. The functional analysis, performed using DAVID website tool, provides potential implications of selected genes in pathological processes underlying diseases studied. Presented research provides new insight into differences of pathogenesis in LEAD, AAA and CVD, and selected genes could be considered as potential candidates for biomarkers useful in diagnosis and differentiation of studied diseases.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/genética , Perfilação da Expressão Gênica , Leucócitos Mononucleares/metabolismo , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/genética , Transcriptoma , Idoso , Biomarcadores , Estudos de Casos e Controles , Comorbidade , Biologia Computacional , Diagnóstico Diferencial , Feminino , Redes Reguladoras de Genes , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Veias
13.
JAMA ; 325(13): 1266-1276, 2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33821898

RESUMO

Importance: Supervised high-intensity walking exercise that induces ischemic leg symptoms is the first-line therapy for people with lower-extremity peripheral artery disease (PAD), but adherence is poor. Objective: To determine whether low-intensity home-based walking exercise at a comfortable pace significantly improves walking ability in people with PAD vs high-intensity home-based walking exercise that induces ischemic leg symptoms and vs a nonexercise control. Design, Setting, and Participants: Multicenter randomized clinical trial conducted at 4 US centers and including 305 participants. Enrollment occurred between September 25, 2015, and December 11, 2019; final follow-up was October 7, 2020. Interventions: Participants with PAD were randomized to low-intensity walking exercise (n = 116), high-intensity walking exercise (n = 124), or nonexercise control (n = 65) for 12 months. Both exercise groups were asked to walk for exercise in an unsupervised setting 5 times per week for up to 50 minutes per session wearing an accelerometer to document exercise intensity and time. The low-intensity group walked at a pace without ischemic leg symptoms. The high-intensity group walked at a pace eliciting moderate to severe ischemic leg symptoms. Accelerometer data were viewable to a coach who telephoned participants weekly for 12 months and helped them adhere to their prescribed exercise. The nonexercise control group received weekly educational telephone calls for 12 months. Main Outcomes and Measures: The primary outcome was mean change in 6-minute walk distance at 12 months (minimum clinically important difference, 8-20 m). Results: Among 305 randomized patients (mean age, 69.3 [SD, 9.5] years, 146 [47.9%] women, 181 [59.3%] Black patients), 250 (82%) completed 12-month follow-up. The 6-minute walk distance changed from 332.1 m at baseline to 327.5 m at 12-month follow-up in the low-intensity exercise group (within-group mean change, -6.4 m [95% CI, -21.5 to 8.8 m]; P = .34) and from 338.1 m to 371.2 m in the high-intensity exercise group (within-group mean change, 34.5 m [95% CI, 20.1 to 48.9 m]; P < .001) and the mean change for the between-group comparison was -40.9 m (97.5% CI, -61.7 to -20.0 m; P < .001). The 6-minute walk distance changed from 328.1 m at baseline to 317.5 m at 12-month follow-up in the nonexercise control group (within-group mean change, -15.1 m [95% CI, -35.8 to 5.7 m]; P = .10), which was not significantly different from the change in the low-intensity exercise group (between-group mean change, 8.7 m [97.5% CI, -17.0 to 34.4 m]; P = .44). Of 184 serious adverse events, the event rate per participant was 0.64 in the low-intensity group, 0.65 in the high-intensity group, and 0.46 in the nonexercise control group. One serious adverse event in each exercise group was related to study participation. Conclusions and Relevance: Among patients with PAD, low-intensity home-based exercise was significantly less effective than high-intensity home-based exercise and was not significantly different from the nonexercise control for improving 6-minute walk distance. These results do not support the use of low-intensity home-based walking exercise for improving objectively measured walking performance in patients with PAD. Trial Registration: ClinicalTrials.gov Identifier: NCT02538900.


Assuntos
Terapia por Exercício/métodos , Doença Arterial Periférica/terapia , Caminhada , Idoso , Biópsia , Feminino , Humanos , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Masculino , Músculo Esquelético/patologia , Doença Arterial Periférica/patologia , Doença Arterial Periférica/fisiopatologia , Teste de Caminhada
14.
Biomed Res Int ; 2021: 6653579, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33884268

RESUMO

Considering the increasingly incidence rate of lower extremity arterial occlusive disease and difficult to distinguish from lumbar disc herniation, it is very necessary to exclude lower extremity arterial occlusive disease resulting in lower limb symptoms from lumbar disc herniation. More importantly, who have a higher risk of combining with lower extremity arterial occlusive disease and misdiagnosed as lumbar disc herniation? Why those patients are easy to be misdiagnosed as lumbar disc herniation? It is worth analyzing and discussing. The risk factors including age, gender, the medical history of high blood pressure, diabetes, smoking and coronary, pulse pressure, lumbar disc herniation segment and type, ankle-brachial index, and straight leg raising test were observed. The Oswestry disability index and the Japanese Orthopedic Association score were collected preoperative, six months after posterior lumbar interbody fusion and six months after vascular interventional treatment to evaluate the symptoms relief and surgical efficacy. There was a statistically significant difference (P < 0.01) in pulse pressure, ankle-brachial index, central disc herniation, and straight leg raising test between two groups. There was a high risk to missed diagnosis of lower extremity arterial occlusive disease and misdiagnosed as lumbar disc herniation when patients are with a mild central lumbar disc herniation, higher pulse pressure, lower ankle-brachial index, and straight leg raising test negative. Therefore, sufficient history-taking and cautious physical examinations contributed to find risk factors and attach importance to such patients and, further, to exclude lower extremity arterial occlusive disease from lumbar disc herniation using lower extremity vascular ultrasound examination.


Assuntos
Arteriopatias Oclusivas/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Extremidade Inferior/patologia , Vértebras Lombares/patologia , Arteriopatias Oclusivas/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fusão Vertebral , Resultado do Tratamento
15.
Gait Posture ; 86: 33-37, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33677176

RESUMO

BACKGROUND: Trunk control during gait in children with cerebral palsy (CP) is known to be impaired. While differentiation of trunk movement between CP subtypes (unilateral/bilateral) has been examined, differentiation of lower lumbar spinal loading has not been considered. Furthermore, the relationship between lower lumbar loading and lower limb pathology has not been reported. RESEARCH QUESTION: How do lower lumbar spinal kinetics differ during unilateral and bilateral CP gait and what is the relationship between trunk kinematics and L5/S1 kinetics with lower limb pathology? METHODS: Three-dimensional thorax kinematics and L5/S1 kinetics were measured during gait with children divided into 3 groups (unilateral CP (n = 21), bilateral CP (n = 31) and typical development (TD) (n = 26)). Differences in thorax kinematics and reactive forces and moments at L5/S1 between groups were analysed using Statistical Parametric Mapping. Correlation coefficients were calculated between Gait Profile Score (GPS) and kinematic measures of the thorax and kinetics at L5/S1. RESULTS: An increased ipsilateral bending moment was present for unilateral CP in the coronal plane (55-70% Gait Cycle (GC), p < 0.001), while children with bilateral CP demonstrated two distinct increased peaks during mid-stance (10-30 % GC, p < 0.001) and mid-swing (60-80% GC, p = 0.004) compared to TD. RMS and RoM thorax flexion, side flexion and L5/S1 lateral bend moment demonstrated significant moderate correlations with GPS. SIGNIFICANCE: This study confirmed an increased involvement at the trunk and of lower lumbar spinal loading for children with bilateral CP compared to unilateral CP. It has been suggested that altered trunk movement in CP gait may be a combination of both a compensation for lower limb pathology and an underlying deficit. Our result of positive yet moderate correlations between GPS and trunk movement and lower spinal loading support this theory.


Assuntos
Paralisia Cerebral/fisiopatologia , Marcha/fisiologia , Extremidade Inferior/patologia , Tronco/fisiologia , Fenômenos Biomecânicos , Criança , Feminino , Humanos , Cinética , Masculino
16.
Clin Nucl Med ; 46(7): 577-578, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33782309

RESUMO

ABSTRACT: In July 2017, an 84-year-old woman was treated for grade III, RH+, HER2- infiltrative ductal carcinoma breast cancer by right mastectomy, adjuvant radiotherapy, and hormone therapy. In April 2020, moderated elevation of the CA-15.3 tumor marker was observed at 53 UI/mL (normal, <25.5 UI/mL). Clinical examination and CT TAP scan showed no argument for relapse. In August 2020, patient presented pain in her left foot. 99mTc-DPD bone scintigraphy showed multiple uptakes regarding osteolytic lesion of the left lower limb with no other pathological uptake. Echo-guided tibial biopsies confirmed breast origin adenocarcinoma, in favor of relapse of the originally treated cancer.


Assuntos
Neoplasias da Mama/patologia , Extremidade Inferior/patologia , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/metabolismo , Neoplasias da Mama/terapia , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Mastectomia , Recidiva , Tomografia Computadorizada por Raios X
17.
Clin Appl Thromb Hemost ; 27: 10760296211002900, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33754840

RESUMO

OBJECTIVE: The objective of this work is to discuss and analyze the related factors of lower extremity fracture complicated by preoperative deep vein thrombosis (DVT). METHODS: A total of 11,891 patients with closed fractures of lower extremities were selected. By analyzing each patient's gender, age, presence or absence of diabetes and hypertension, preoperative plasma D-dimer level, and color Doppler ultrasound of the lower extremity vein, the pertinent factors of the patients with lower extremity fractures complicated by preoperative DVT were analyzed. RESULTS: A total of 578 with preoperative DVT were detected, displaying a total incidence of 4.86%. All patients were categorized into either the DVT group or non-DVT group. The results demonstrate that there were statistically significant differences between the 2 groups in age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level (P < 0.05). Logistic multivariate analysis revealed that age, the presence of diabetes, and the preoperative plasma D-dimer level of patients were independent risk factors for lower extremity fracture complicated by DVT. CONCLUSION: Age, the presence of diabetes, the fracture site, and increased D-dimer levels were found to be potential risk factors and indicators for preoperative DVT in patients with lower extremity fractures. In addition, the preoperative plasma D-dimer level has certain guiding significance for the prediction of venous thrombosis after lower extremity fracture, which is conducive to the early prediction and diagnosis of DVT, but it often must be followed with good clinic acumen and examinations.


Assuntos
Fraturas Ósseas/complicações , Extremidade Inferior/patologia , Trombose Venosa/etiologia , Adolescente , Adulto , Feminino , Fraturas Ósseas/cirurgia , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trombose Venosa/fisiopatologia , Adulto Jovem
18.
BMJ Case Rep ; 14(3)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653867

RESUMO

A previously healthy 53-year-old man was hospitalised for 12 days due to COVID-19 with shortness of breath. A few days after discharge from hospital, the patient developed fever and severe pain in several joints in the lower extremities. The pain was so severe that the patient was unable to stand on his feet. Synovial fluid from the right-side knee contained a high number of polynuclear cells and a few mononuclear cells. Microscopy, culture and PCR tests for bacterial infection were all negative. Furthermore, the patient tested negative for rheumatoid factor, anti-cyclic citrullinated peptide and human leukocyte antigen (HLA)-B27. Thus, the condition was compatible with reactive arthritis. The condition improved markedly after a few days' treatment with non-steroid anti-inflammatory drugs and prednisolone.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Artrite Reativa , Artrite , COVID-19 , Prednisolona/administração & dosagem , Líquido Sinovial , Anti-Inflamatórios/administração & dosagem , Artralgia/diagnóstico , Artralgia/etiologia , Artrite/tratamento farmacológico , Artrite/etiologia , Artrite/fisiopatologia , Artrite Reativa/diagnóstico , Artrite Reativa/tratamento farmacológico , Artrite Reativa/fisiopatologia , Artrite Reativa/virologia , Artrite Reumatoide/diagnóstico , Autoanticorpos/análise , COVID-19/complicações , COVID-19/fisiopatologia , COVID-19/terapia , Diagnóstico Diferencial , Humanos , Articulação do Joelho/diagnóstico por imagem , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Líquido Sinovial/citologia , Líquido Sinovial/imunologia , Resultado do Tratamento
19.
Medicine (Baltimore) ; 100(6): e24696, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578604

RESUMO

RATIONAL: Chromobacterium violaceum is a motile gram-negative bacterium. This bacterium commonly grows in tropical or subtropical areas in sewage and can cause opportunistic infections. PATIENT CONCERNS: A 50-year-old Chinese man had a skin ulcer in the middle of his left leg in front of the tibia. The diameter of the wound was 3.0 cm, the exudation was obvious, and necrotic tissue was attached to the wound. One week previously, he was working in a field where he accidentally punctured his left leg. DIAGNOSIS: C violaceum infection was diagnosed as per the results of pathogen culture from the infection site. INTERVENTIONS: He was treated with piperacillin/tazobactam (3.375 g/12 h iv) and levofloxacin (0.5 g/24 h iv) for 5 days. OUTCOMES: The patient showed good response to therapy and was discharged on day 18 after wound healing. LESSONS: C violaceum rarely infects humans. When an infection is suspected, samples should be immediately sent for microbial culture. Timely treatment on the basis of drug sensitivity test results can prevent further complications.


Assuntos
Chromobacterium/isolamento & purificação , Infecções por Bactérias Gram-Negativas/microbiologia , Extremidade Inferior/microbiologia , Úlcera Cutânea/tratamento farmacológico , Pele/microbiologia , Administração Intravenosa , Quimioterapia Combinada , Humanos , Levofloxacino/administração & dosagem , Levofloxacino/uso terapêutico , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/complicações , Combinação Piperacilina e Tazobactam/administração & dosagem , Combinação Piperacilina e Tazobactam/uso terapêutico , Pele/patologia , Resultado do Tratamento
20.
Brasília; CONITEC; fev. 2021.
Não convencional em Português | BRISA/RedTESA | ID: biblio-1255176

RESUMO

INTRODUÇÃO: O linfedema é uma doença crônica progressiva, ocasionada por insuficiência do processo de drenagem linfática, que causa edema tecidual. Não há nenhum tratamento curativo para o linfedema e no âmbito do Sistema Único de Saúde (SUS), estão listados dois procedimentos de manejo do linfedema: o atendimento fisioterapêutico e o tratamento cirúrgico do linfedema. As meias elásticas de compressão seriam uma opção de tratamento autogerido, o que pode reduzir a sobrecarga do sistema por procedimentos eletivos. PERGUNTA: O uso de meias elásticas de compressão é eficaz, efetivo, seguro e custo-efetivo para o tratamento de pacientes com linfedema primário ou secundário? EVIDÊNCIAS CIENTÍFICAS: A busca recuperou duas coortes prospectivas. O estudo de Brambilla et al., 2006 demonstrou diferença estatisticamente significante na redução do volume dos membros inferiores (mensurada por uso de fita métrica em vários pontos dos membros inferiores) entre os pacientes que utilizaram as meias elásticas de compressão em relação aos pacientes do grupo controle (que não usaram as meias). Contudo, as circunferências dos membros inferiores foram reduzidas de maneira irregular, 40% dos pacientes tratados com as meias elásticas de compressão apresentaram aumento do volume do membro e apenas 16,67% das reduções foram consideradas satisfatórias. Já o estudo de Godoy et al., 2017, uma coorte do tipo antes e depois, demonstrou diferença estatisticamente significante entre as meias de compressão de 30/40 mmHg e as de 20/30 mmHg, sendo esta última não efetiva na manutenção do volume dos membros após quatro semanas em relação a linha de base. Porém, nessa última coorte, as meias elásticas de compressão foram utilizadas para manutenção do volume dos membros após redução completa do edema por outros procedimentos terapêuticos. Não foram encontrados estudos referentes à adesão das meias elásticas de compressão na população com linfedema. Nenhum dos estudos incluídos relatou dados de segurança. As duas coortes apresentaram baixa qualidade metodológica, uma vez que receberam 5 estrelas ou menos nas ferramentas de Newcastle-Ottawa. A certeza da evidência de todos os desfechos, avaliada pelo Grading of Recommendations Assessment, Development and Evaluation, foi muito baixa. ANÁLISE DE IMPACTO ORÇAMENTÁRIO: Para um horizonte temporal de 5 anos, a incorporação das meias elásticas de compressão para linfedema ocasionaria um aumento de gastos estimados, em cinco anos, de R$117.900.922,59 a R$136.039.526,07, a depender da prevalência. CONSIDERAÇÕES FINAIS: As evidências disponíveis acerca da efetividade das meias elásticas de compressão em indivíduos com linfedema de membros inferiores são escassas e, de forma geral, de qualidade baixa. A avaliação econômica estimou uma RCEI R$ 2.155,87, ao passo que análise de impacto orçamentário estima um custo acumulado em cinco anos de até R$ 136 milhões no cenário de incorporação das meias elásticas de compressão. Não foram identificadas recomendações sobre o uso de meias elásticas no tratamento do linfedema em agências internacionais de ATS. Dessa forma, recomendações sobre o uso da tecnologia são permeadas de incertezas e devem ser realizadas com cautela. RECOMENDAÇÃO PRELIMINAR DA CONITEC: A Conitec, em sua 92ª reunião ordinária, realizada nos dias 04 de novembro de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar não favorável à incorporação no SUS das meias elásticas de compressão como parte do tratamento de pacientes com linfedema de membros inferiores. Considerou-se, entre outros fatores, que, há escassez de evidências sobre o uso das meias elásticas de compressão no tratamento do linfedema de membros inferiores. Além disso, as poucas evidências disponíveis foram consideradas frágeis, com baixo número amostral e baixa qualidade, sendo, portanto, insuficientes para determinar com robustez a efetividade, a segurança, a custo-efetividade e o impacto orçamentário decorrente da incorporação das meias de compressão. CONSULTA PÚBLICA: O relatório de recomendação inicial da CONITEC foi disponibilizado para contribuições por meio da consulta pública nº 64/2020 entre os dias 25/11/2020 e 14/12/2020. Foram recebidas 163 contribuições, sendo 93 contribuições de cunho técnico-científico e 70 contribuições de experiência pessoal ou opinião, destas 84,7% discordavam com a recomendação preliminar da Conitec. RECOMENDAÇÃO FINAL: Os membros da Conitec presentes na 94ª reunião ordinária, no dia 03 de janeiro de 2021, deliberaram por unanimidade recomendar a não incorporação das meias elásticas de compressão para o tratamento de pacientes com linfedema. Os membros presentes entenderam que não houve argumentação suficiente para alterar a recomendação inicial. Foi assinado o registro de deliberação nº 585. DECISÃO: Não incorporar as meias elásticas de compressão como parte do tratamento de pacientes com linfedema de membros inferiores, do Sistema Único de Saúde - SUS, conforme Portaria nº 03, publicada no Diário Oficial da União nº 34, seção 1, página 93, em 22 de fevereiro de 2021.


Assuntos
Humanos , Extremidade Inferior/patologia , Meias de Compressão/provisão & distribuição , Linfedema/terapia , Avaliação da Tecnologia Biomédica , Análise Custo-Eficiência , Sistema Único de Saúde
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