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1.
Tristan Maerz Michael Newton Abigail A. Marek Michael Planalp Kevin Baker 《The spine journal》2018,18(11):2091-2101
Background Context
Degenerative disc disease (DDD) is associated with longitudinal remodeling of paravertebral tissues. Although chronic vertebral changes in advanced stages of DDD are well-studied, very little data exists on acute vertebral bone remodeling at the onset and progression of DDD.Purpose
To longitudinally characterize bony remodeling in a rodent model of disc injury-induced DDD.Study Design
In vivo animal study involving a rat annulus fibrosus injury model of DDD.Methods
Eight female Lewis rats were assigned to intervertebral disc (IVD) injury (Puncture) or sham surgery (Sham). All rats underwent anterior, transperitoneal approach to the lumbar spine, and Puncture rats underwent annulus fibrosus injury at the L3-L4 and L5-L6 IVDs (n?=?8 per group). Live micro computed tomography imaging (10-μm voxel size) was performed 1 week before surgery and postoperatively at 2-week intervals up to a 12-week endpoint. Bone morphology and densitometry of the cranial vertebral body and bony endplate were analyzed and reported with respect to the preoperative baseline scan. Sagittal Safranin-O/Fast-Green and Toluidine Blue histology evaluated using the Rutges IVD score and a custom vertebral endplate score.Results
Vertebral trabecular tissue mineral density (TMD), vertebral trabecular spacing, endplate TMD, and endplate apparent bone mineral density were all significantly greater in Puncture compared with Sham at 4 weeks and each subsequent timepoint. Puncture rats exhibited marginally lower endplate total volume. Anterior endplate osteophyte formation and central physeal ossification were observed in Puncture rats. Endpoint histological analysis demonstrated moderate evidence of IVD degeneration, indicating that vertebral bone adaptation occurs in the acute phases of DDD onset and progression.Conclusions
Annulus injury-induced DDD leads to acute and progressive changes to the morphology and densitometry of bone in the adjacent vertebral bodies and endplates. 相似文献2.
Jeremiah Easley Christian M. Puttlitz Howard Seim Nicole Ramo Celeste Abjornson Frank P. Cammisa Kirk C. McGilvray 《The spine journal》2018,18(12):2302-2315
BACKGROUND CONTEXT
Screw loosening is a prevalent failure mode in orthopedic hardware, particularly in osteoporotic bone or revision procedures where the screw-bone engagement is limited.PURPOSE
The objective of this study was to evaluate the efficacy of a novel screw retention technology (SRT) in an ovine lumbar fusion model.STUDY DESIGN/SETTING
This was a biomechanical, radiographic, and histologic study utilizing an ovine lumbar spine model.METHODS
: In total, 54 (n=54) sheep lumbar spines (L2–L3) underwent posterior lumbar fusion (PLF) via pedicle screw fixation, connecting rod, and bone graft. Following three experimental variants were investigated: positive control (ideal clinical scenario), negative control (simulation of compromised screw holes), and SRT treatments. Biomechanical and histologic analyses of the functional spinal unit (FSU) were determined as a function of healing time (0, 3, and 12 months postoperative).RESULTS
Screw pull-out, screw break-out, and FSU stability of the SRT treatments were generally equivalent to the positive control group and considerably better than the negative control group. Histomorphology of the SRT treatment screw region of interest (ROI) observed an increase in bone percentage and decrease in void space during healing, consistent with ingrowth at the implant interface. The PLF ROI observed similar bone percentage throughout healing between the SRT treatment and positive control. Less bone formation was observed for the negative control.CONCLUSIONS
The results of this study demonstrate that the SRT improved screw retention and afforded effective FSU stabilization to achieve solid fusion in an otherwise compromised fixation scenario in a large animal model. 相似文献3.
Bong Gun Lee Jung-Hwan Choi Dong-Yun Kim Won Rak Choi Seung Gun Lee Chang-Nam Kang 《The spine journal》2019,19(2):301-305
Background context
It has been reported that newly developed osteoporotic vertebral compression fractures (OVCFs) occur at a relatively high frequency after treatment. While there are many reports on possible risk factors, these have not yet been clearly established.Purpose
The purpose of this study was to investigate the risk factors for newly developed OVCFs after treatment by vertebroplasty (VP), kyphoplasty (KP), or conservative treatment.Study design/setting
A retrospective comparative study.Patient sample
One hundred thirty-two patients who had radiographic follow-up data for one year or longer among 356 patients who were diagnosed with OVCF and underwent VP, KP or conservative treatment between March 2007 and February 2016.Outcome measures
All records were examined for age, sex, body mass index (BMI), rheumatoid arthritis and other medical comorbidities, osteoporosis medication, bone mineral density (BMD), history of vertebral and nonvertebral fractures, treatment methods used, level of fractures, and presence of multiple fracture sites.Methods
Patients were divided into those who manifested new OVCF (Group A) and those who did not (Group B). For the risk factor analysis, student's t-tests and chi-square tests were used in univariate analysis. Multivariate logistic regression analysis was carried out on variables with a p<.1 in the univariate analysis.Results
Newly developed OVCFs occurred in 46 of the 132 patients (34.8%). Newly developed OVCF increased significantly with factors such as average age (p=.047), low BMD T-score of the lumbar spine (p=.04) and of the femoral neck (p=.046), advanced age (>70 years) (p=.011), treatment by cement augmentation (p=.047) and low compliance with osteoporosis medication (p=.029). In multivariate regression analysis, BMD T-score of the lumbar spine (p=.009) and treatment by cement augmentation (p=.044) showed significant correlations with the occurrence of new OVCFs with a predictability of 71.4%.Conclusion
Osteoporotic vertebral compression fracture patients with low BMD T-score of the lumbar spine and those who have been treated by cement augmentation have an increased risk of new OVCFs after treatment and, therefore, require especially careful observation and attention. 相似文献4.
Victoria E. Sanborn Mary-Beth Spitznagel Ross Crosby Kristine Steffen James Mitchell John Gunstad 《Surgery for obesity and related diseases》2018,14(9):1396-1401
Background
Both poor quality of life (QoL) and cognitive impairment are common in persons with severe obesity. Work in other patient populations show that cognitive impairment is associated with poorer QoL, though this possibility has not been examined in bariatric surgery candidates.Objectives
We sought to determine the association between cognitive performance and QoL, both total and work related, in a sample of bariatric surgery candidates.Setting
Three sites were used for data collection, including the Neuropsychiatric Research Institute in Fargo, North Dakota, Columbia University in New York, and Cornell University in New York.Methods
Sixty participants from the Longitudinal Assessment of Bariatric Surgery project were assessed at preoperative baseline.Results
Hierarchical regression analyses showed that poorer cognitive function was independently associated with lower total QoL and that both reported and objectively measured cognitive impairment were associated with poorer work-related QoL.Conclusions
These preliminary findings suggest that cognitive impairment may contribute to poorer total and work-related QoL in bariatric surgery candidates. Future studies should examine whether interventions to improve cognitive function can improve QoL and other outcomes in this population. 相似文献5.
Mahdieh Khodaei Camila Pachêco-Pereira Suzana Trac Andrew Chan Lawrence H Le Edmond Lou 《The spine journal》2018,18(11):2128-2139
BACKGROUND CONTEXT
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity recognized with lateral curvature of the spine as well as axial vertebral rotation. Surgical interventions are recommended when patients with AIS have severe curvature (Cobb angle >45o). Spinal flexibility is one of important parameters for surgeons to plan surgical treatment. Few radiographic methods have been developed to assess spinal flexibility.PURPOSE
A systematic review was performed to evaluate which preoperative radiographic methods should be used to estimate spinal flexibility based on the postoperative outcomes.STUDY DESIGN
Studies which included any of the five radiographic methods: (1) supine side-bending (SBR), (2) fulcrum-bending (FBR), (3) traction, (4) push-prone, and (5) suspension were reviewed and compared to determine which method provided the most accurate estimation of the postoperative outcomes.PATIENT SAMPLE
Seven case series, one case control, and multiple cohort studies reported the flexibility assessment methods with the estimations of postoperative outcomes on patients with AIS.OUTCOME MEASURES
The flexibility index defined as a correction rate relative to flexibility rate was used to estimate the immediate and final follow-up postoperative outcomes.METHODS
Seven databases searched included MEDLINE, CENTRAL, EMBASE, CINAHL, Web of Science, LILACS, and Google Scholar. Three independent reviewers were involved for abstracts and full-texts screening as well as data extraction. The Quality in Prognostic Studies quality appraisal tool was used to assess the risk of bias within the studies. Also, the GRADE system rate was used to assess the evidence level across the studies.RESULTS
Forty-six articles were included. The distribution of the five flexibility methods in these 46 studies were SBR 38/46 (83%), fulcrum bending radiograph (FBR) 16/46 (35%), traction radiograph 5/46 (11%), push-prone 1/46 (2%), and suspension 1/46 (2%). Based on the overall assessment of flexibility indices, FBR had the best estimation of postoperative correction among the five methods. FBR method provided the best estimations of immediate and final follow-up postoperative outcomes for moderate (25°–45°) and severe (>45°) curves, respectively. For main thoracic and thoracolumbar/lumbar curves, the best estimations were traction, and FBR. However, in the reviewed articles, the risk of bias was rated moderate and the quality of evidence was rated very low to low so that a strong conclusive statement cannot be made.CONCLUSIONS
SBR method was the most commonly used method to assess the spinal flexibility. The FBR method was the most accurate method to estimate the postoperative outcomes based on the limited evidence of the 46 articles. 相似文献6.
Michael F. Knox Lucy S. Chipchase Siobhan M. Schabrun Rick J. Romero Paul W.M. Marshall 《The spine journal》2018,18(10):1934-1949
Background context
Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting.Purpose
This systematic review aimed to determine whether APAs or CPAs are altered in the presence of acute and chronic LBP.Study design
A systematic review of studies was carried out.Patient sample
No patient sample was required.Outcome measures
Between group standardized mean differences and 95% confidence intervals for APAs ad CPAsMethods
A comprehensive search was conducted for articles comparing people with LBP (acute or chronic) to healthy controls for the onset or amplitude of muscle activity, center of pressure (COP), or kinematic responses to expected or unexpected perturbations. Two independent reviewers extracted data and assessed the methodological quality of relevant studies. Differences between people with and without LBP were calculated as standardized mean differences, and included in a meta-analysis if outcomes were homogeneous. Otherwise, a narrative synthesis was conducted.Results
Twenty-seven studies were included, of which the majority examined muscle onsets in response to expected and unexpected perturbations. Only two studies compared people with and without acute LBP, and results for these studies were conflicting. The results show delayed muscle onsets in response to expected and unexpected perturbations for people with chronic LBP when compared with healthy controls. No conclusive evidence for differences between people with and without chronic LBP for COP or kinematic responses.Conclusions
There is currently no convincing evidence of differences between people with and without acute LBP for APAs or CPAs. Conversely, delayed muscle onsets in people with chronic LBP suggest APAs and CPAs are altered in this population. However, the functional relevance of these delayed muscle onsets (eg, COP and kinematics) is unknown. 相似文献7.
8.
Omar A. Khan Emma Rose McGlone William Maynard James Hopkins Simon Dexter Ian Finlay David Hewin Peter Sedman Peter Walton Shaw Somers Marcus Reddy Peter Small Marco Adamo Richard Welbourn 《Surgery for obesity and related diseases》2018,14(10):1516-1520
Background
For patients in whom laparoscopic adjustable gastric band has failed, conversion to Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy are both options for further surgical treatment. There are limited data comparing these 2 procedures. The National Bariatric Surgery Registry is a comprehensive United Kingdom–wide database of bariatric procedures, in which preoperative demographic characteristics and clinical outcomes are prospectively recorded.Objectives
To compare perioperative complication rate and short-term outcomes of patients undergoing single-stage conversion of gastric band to Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy.Setting
United Kingdom national bariatric surgery database.Methods
From the National Bariatric Surgical Registry data set, we identified 141 patients undergoing single-stage conversion from gastric band to either gastric bypass (113) or sleeve gastrectomy (28) between 2009 and 2014, and analyzed their clinical outcomes.Results
With respect to perioperative outcomes gastric bypass was associated with a higher incidence of readmission or reintervention postoperatively (16 versus 0; P?=?.04). There was no difference in percentage excess weight loss between sleeve gastrectomy and gastric bypass at final follow-up at 1 year (52.1% versus 57.1% respectively; P?=?.4).Conclusions
Conversion from band to sleeve or bypass give comparable good early excess weight loss; however, conversion to sleeve is associated with a better perioperative safety profile. 相似文献9.
Jung Hwan Lee Kyoung-ho Shin Sung Jin Bahk Goo Joo Lee Dong Hwan Kim Chang-Hyung Lee Du Hwan Kim Hee Seung Yang Sang-Ho Lee 《The spine journal》2018,18(12):2343-2353
BACKGROUND CONTEXT
Epidural steroid injection has been used to treat back or radicular pain from lumbar and lumbosacral disc herniation (LDH). However, the superiority of transforaminal injection (TFESI) to caudal injection (CESI) remains controversial.PURPOSE
This systematic review and meta-analysis aimed to investigate whether TFESI was more useful than CESI for achieving clinical outcomes in patients with LDH.STUDY DESIGN/SETTING
A systematic review and/or is not appropriate. A systematic review and meta-analysis. Spine hospital and tertiary care hospital.PATIENT SAMPLE
Articles were chosen that compared the clinical efficacy of TFESI and CESI for treatment of low back and radicular leg pain caused by LDH.OUTCOMES MEASURES
Visual analogue scale, numeric rating scale, and Oswestry disability index.METHODS
A literature search was performed using MEDLINE, EMBASE, Cochrane review, and KoreaMed databases for studies published until July 2017. After reviewing titles, abstracts, and full-texts of 6,711 studies after initial database search, six studies were included in a qualitative synthesis. Data including pain score, functional score, and follow-up period were extracted from four studies and were analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the grading of recommendations assessment, development and evaluation methodology.RESULTS
Among six studies, four articles supported the superiority of TFESI to CESI, one article showed no significant difference, and one article supported the superiority of CESI to TFESI. To obtain compatible or superior clinical results to TFESI, CESI might need to inject a larger amount of medication than was usually used. A meta-analysis showed short-term and long-term trends toward better clinical efficacy with TFESI than with CESI without statistical significance. The evidence level was low because of inconsistency and imprecision.CONCLUSIONS
Comprehensive reviews of selected articles revealed better clinical benefits with TFESI than with CESI, possibly because TFESI had the ability to deliver medication directly into the target area. Because of a low level of evidence and no significant results on meta-analysis, TFESI could be weakly recommended over CESI. 相似文献10.
Ryan J. Marek Kristine J. Steffen David R. Flum Alfons Pomp Walter J. Pories J. Peter Rubin Bruce M. Wolfe James E. Mitchell 《Surgery for obesity and related diseases》2018,14(11):1740-1747
Background
Bariatric surgery usually results in substantial weight loss and a reduction in medical comorbidities. Many patients, as a consequence of the weight loss, subsequently evidence loose, redundant skin.Objectives
This investigation seeks to examine the prevalence of body contouring surgery (BCS) by patients approximately 4 to 5 years after Roux-en-Y gastric bypass surgery. Demographics, change in BMI, and psychosocial variables were also used to predict body dissatisfaction, desire for BCS, and patients who reported obtaining BCS.Setting
The clinical sites involved in the Longitudinal Assessment of Bariatric Surgery project, which included 10 hospitals across the United States.Methods
The sample comprised 1159 patients who underwent Roux-en-Y gastric bypass and were enrolled in the Longitudinal Assessment of Bariatric Surgery-2 study. Participants were surveyed using the Excessive Skin Survey and other psychosocial measures at their 4- or 5-year postoperative outcome. The participants were predominately women (80.5%), Caucasian (88.3%), and middle-aged (mean?=?46.1 yr, standard deviation?=?11.11 yr).Results
Participants reported modest degrees of being bothered by excessive skin, primarily in their waist/abdomen, thighs, and chest/breasts body areas. Only 11.2% of the sample had undergone any BCS procedure, and a majority of those participants paid “out of pocket” for BCS. Desire for BCS and body dissatisfaction 4 to 5 years postsurgery was associated with higher depression scores and poorer quality of life scores.Conclusions
Excessive skin is associated with poorer psychosocial functioning. Despite reporting modest levels of being bothered by excessive skin and body dissatisfaction, only a small fraction of participants underwent BCS. Cost of BCS was reported to be a primary barrier for not obtaining BCS. All rights reserved. 相似文献11.
Adrian Mancini Anne-Laure Borel Sandrine Coumes Nelly Wion Catherine Arvieux Fabian Reche 《Surgery for obesity and related diseases》2018,14(11):1700-1704
Background
Beyond medical complications, people with obesity experience dramatic impairment of quality of life, including adverse workplace effects. Obesity results in weight-based discrimination and a high rate of unemployment because of work disability, absenteeism, loss of productivity, and cost. A few studies have been performed to assess the relationship between obesity surgery and the workplace, finding an improvement in weekly working hours and productivity and a decrease in absenteeism, days of sick leave, and state benefit claims. However, the results are still controversial concerning the overall employment rate.Objectives
This study aimed to compare the employment rate before and 2 years after obesity surgery and to evaluate the difference in weight loss between worker and nonworker patients.Setting
Participants were recruited from a tertiary care university hospital in France.Methods
The 2-year outcomes of all patients who underwent obesity surgery between 2010 and 2015 were retrospectively reviewed. The employment status was recorded preoperatively and postoperatively. Retired or permanently disabled patients were excluded from the analysis.Results
Preoperatively, 158 of 238 patients were employed compared with 199 of 238 postoperatively (P < .0001). There was no difference in weight loss between the worker and nonworker patients regarding the percentage of excess weight loss and the change in body mass index.Conclusion
This study supports the finding that bariatric surgery also has a positive impact on the professional sphere, providing the opportunity for unemployed patients to return to work. 相似文献12.
BACKGROUND CONTEXT
Intervertebral disc degeneration has been subject to numerous in vivo and in vitro investigations and numerical studies during recent decades, reporting partially contradictory findings. However, most of the previous studies were limited in the number of specimens investigated and, therefore, could not consider the vast variety of the specimen geometries, which are likely to strongly influence the mechanical behavior of the spine.PURPOSE
To complement the understanding of the mechanical consequences of disc degeneration, whereas considering natural variations in the major spinal geometrical parameters.DESIGN/SETTING
A probabilistic finite element study.METHODS
A parametric finite element model of a human L4–L5 motion segment considering 40 geometrical parameters was developed. One thousand individual geometries comprising four degeneration grades were generated in a probabilistic manner, and the influence of the severity of disc degeneration on the mechanical response of the motion segment to different loading conditions was statistically evaluated.RESULTS
Variations in the individual structural parameters resulted in marked variations in all evaluated parameters within each degeneration grade. Nevertheless, the effect of degeneration in almost all evaluated response values was statistically significant. With degeneration, the intradiscal pressure progressively decreased. At the same time, the facet loads increased and the ligament tension was reduced. The initially nonlinear load-deformation relationships became linear whereas the segment stiffness increased.CONCLUSIONS
Results indicate significant stiffening of the motion segment with progressing degeneration and gradually increasing loading of the facets from nondegenerated to moderately degenerated conditions along with a significant reduction of the ligament tension in flexion. 相似文献13.
Shinban Liu Christine J. Ren-Fielding Bradley Schwack Marina Kurian George A. Fielding 《Surgery for obesity and related diseases》2018,14(10):1501-1506
Background
Studies reporting revisionary options for weight loss failure after Roux-en-Y gastric bypass (RYGB) have been underpowered and lacking long-term data. We have previously shown that short-term (12 mo) and midterm (24 mo) weight loss is achievable with laparoscopic adjustable gastric banding (LAGB) for failed RYGB. The present study represents the largest published series with longest postoperative follow-up of patients receiving salvage LAGB after RYGB failure.Objective
To investigate long-term results of salvage gastric banding.Setting
University Hospital, New York, United States.Methods
Data were prospectively collected with retrospective review. Baseline characteristics were evaluated and weights at multiple time intervals (before RYGB, before LAGB, each year of follow-up). Additional data included approach (open or laparoscopic), operative time, hospital length of stay, and postoperative complications.Results
A total of 168 patients underwent statistical analysis with 86 patients meeting inclusion for RYGB failure. The mean body mass index before RYGB was 48.9 kg/m2. Before LAGB, patients had an average body mass index of 43.7 kg/m2, with 10.4% total weight loss and 21.4% excess weight loss after RYGB. At 5-year follow-up, patients (n?=?20) had a mean body mass index of 33.6 kg/m2 with 22.5% total weight loss and 65.9% excess weight loss. The long-term reoperation rate for complications related to LAGB was 24%, and 8% of patients ultimately had their gastric bands removed.Conclusion
The results of our study have shown that LAGB had good long-term data as a revisionary procedure for weight loss failure after RYGB. 相似文献14.
Ahmad Assalia Anat Ilivitzki Amos Ofer Alain Suissa Elias Manassa Iyad Khamaysi Ahmad Mahajna 《Surgery for obesity and related diseases》2018,14(8):1093-1098
Background
Laparoscopic sleeve gastrectomy (LSG) is considered as a first line treatment for morbid obesity around the globe. Leakage and subsequent gastric fistula is the most dreadful complication, which may lead to serious morbidity and even mortality.Objectives
To assess the safety and efficacy of fibrin glue application in the setting of gastric fistula after LSG.Setting
University hospital, Israel.Methods
Twenty-four morbidly obese patients (mean age?=?42.2 yr, mean body mass index?=?42 kg/m2) developed gastric fistula after LSG. The fistula was acute in 10 patients, subacute in 9, and chronic in 5. Sixteen patients (67%) have had previous failed endoscopic interventions. Fibrin glue was applied percutaneously with fluoroscopic guidance, under endoscopic visualization. A pigtail drain was left in the distal tract to monitor and manage possible continuous leakage.Results
There were no complications except abdominal pain in 2 patients associated with fever in 1. Both resolved within 1 to 2 days. Fistula closure was achieved in all patients but 1 (95.8%). Closure was accomplished after a single application in 9 patients (39%), 2 applications in 8, 3 applications in 3, 5 applications in 2, and 6 applications in 1. All patients were followed with a mean time of 42.3 months (range, 20–46).Conclusions
Although in most patients there was a need for multiple applications, our experience indicates that percutaneous fluoroscopic application of Fibrin glue under endoscopic visualization proved to be a simple, tolerable, and highly effective method for the treatment of selected patients with gastric fistula after LSG. 相似文献15.
Nianye Zheng Xiaodong Liu Ri Zhang Idy Ho Shihui Chen Jiankun Xu Hao Yao Jiali Wang Jiang Yue Xinluan Wang Ling Qin 《The spine journal》2018,18(11):2112-2118
16.
Katherine J.P. Schwenger Sandra E. Fischer Timothy Jackson Allan Okrainec Johane P. Allard 《Surgery for obesity and related diseases》2018,14(9):1233-1239
Background
In obese individuals undergoing Roux-en-Y gastric bypass (RYGB), nonalcoholic fatty liver disease (NAFLD) is seen in 75% to 100% of cases. This improves postsurgery, but some patients continue to have persistent NAFLD.Objective
The purpose of this study was to determine the factors associated with persistent NAFLD at 12 months post-RYGB.Setting
University Hospital, Canada, bariatric clinic.Methods
This is a prospective cohort study of 42 patients who underwent RYGB. Liver biopsy, biochemical and clinical parameters were collected pre- and 12 months post-RYGB. Based on histology at 12 months, patients were separated in 2 groups, normal liver (NL) and persistent NAFLD.Results
At baseline, NAFLD was diagnosed in 85.7% of patients and at 12 months post-RYGB, NAFLD was present in 19.1% of patients. Patients who had an NL at baseline remained with NL. RYGB resulted in significant decreases in body mass index, waist circumference, blood pressure, aspartate aminotransferase, alanine aminotransferase, fasting glucose and insulin, glycated hemoglobin, and triglycerides and significant increases in high-density lipoprotein cholesterol. Changes were similar in both groups except for waist circumference, which showed lower changes in those with persistent NAFLD. These patients also had significantly higher (P < .05) fasting glucose and insulin with a higher proportion of patients having insulin resistance compared with those with NL.Conclusions
RYGB resulted in significant improvements in liver histology, biochemical, and clinical parameters. However, despite similar weight loss, persistent NAFLD was associated with less improvement in waist circumference and worse glycemic control. 相似文献17.
Joshua A. Hirsch Douglas P. Beall M. Renée Chambers Thomas G. Andreshak Allan L. Brook Brian M. Bruel H. Gordon Deen Peter C. Gerszten D. Scott Kreiner Charles A. Sansur Sean M. Tutton Peter van der Meer Herman J. Stoevelaar 《The spine journal》2018,18(11):2152-2161
BACKGROUND CONTEXT
Vertebral fragility fractures (VFFs), mostly due to osteoporosis, are very common and are associated with significant morbidity and mortality. There is a lack of consensus on the appropriate management of patients with or suspected of having a VFF.PURPOSE
This work aimed at developing a comprehensive clinical care pathway (CCP) for VFF.STUDY DESIGN/SETTING
The RAND/UCLA Appropriateness Method was used to develop patient-specific recommendations for the various components of the CCP. The study included two individual rating rounds and two plenary discussion sessions.METHODS
A multispecialty expert panel (orthopedic and neurosurgeons, interventional [neuro]radiologists and pain specialists) assessed the importance of 20 signs and symptoms for the suspicion of VFF, the relevance of 5 diagnostic procedures, the appropriateness of vertebral augmentation versus nonsurgical management for 576 clinical scenarios, and the adequacy of 6 aspects of follow-up care.RESULTS
The panel identified 10 signs and symptoms believed to be relatively specific for VFF. In patients suspected of VFF, advanced imaging was considered highly desirable, with MRI being the preferred diagnostic modality. Vertebral augmentation was considered appropriate in patients with positive findings on advanced imaging and in whom symptoms had worsened and in patients with 2 to 4 unfavorable conditions (eg, progression of height loss and severe impact on functioning), dependent on their relative weight. Time since fracture was considered less relevant for treatment choice. Follow-up should include evaluation of bone mineral density and treatment of osteoporosis.CONCLUSIONS
Using the RAND/UCLA Appropriateness Method, a multispecialty expert panel established a comprehensive CCP for the management of VFF. The CCP may be helpful to support decision-making in daily clinical practice and to improve quality of care. 相似文献18.
Valerie M. Monpellier Evangelia E. Antoniou Sandra Mulkens Ignace M.C. Janssen Aebele B. Mink van der Molen Anita T.M. Jansen 《Surgery for obesity and related diseases》2018,14(10):1507-1515
Background
Overhanging skin in postbariatric patients leads to a negative body image. In patients with obesity, negative body image is related to more depressive symptoms and a higher weight. This relationship might also be important in postbariatric patients, because improvement of body image via body contouring surgery (BCS) could lead to better weight loss results.Objectives
To evaluate the relationship between body image, depressive symptoms, and weight loss in a postbariatric population, focusing on desire for BCS.Setting
Outpatient clinic.Methods
One thousand twenty-four primary bariatric surgery patients were contacted, and 590 patients agreed to participate and filled in online questionnaires regarding body image (Body Shape Questionnaire and Multidimensional Body-Self Relations Questionnaire-Appearance Scales) and depression (Beck Depression Inventory-II). Differences between patients who had BCS, patients who desired BCS, and patients who did not desire BCS were studied. The mediating role of body image in the association between percentage total weight loss and depressive symptoms was assessed via a 2-mediator model.Results
There was a desire for BCS in 368 patients (62.4%); these patients had significantly lower scores on appearance evaluation and body image satisfaction scales and showed more depressive symptoms. Patients without a desire (n?=?157, 26.6%) had lowest rates of depressive symptoms and a more positive body image. Sixty-five patients (11.0%) had undergone BCS. In the patients who desired BCS, percentage total weight loss was negatively affected by depressive symptoms via appearance evaluation and body-area satisfaction.Conclusions
There are striking differences regarding body image satisfaction and depressive symptoms when comparing postbariatric patients and without desire for BCS. Body image satisfaction is associated with less depressive symptoms in all postbariatric patients. In patients who desired BCS, body image is one of the mediators of the relationship between percentage total weight loss and depressive symptoms. Therefore, body image should be taken seriously and be part of outcome assessment in postbariatric patients. 相似文献19.
Chun Hai Tan Nawaf Al-Kalifah Kong-Han Ser Yi-Chih Lee Jung-Chien Chen Wei-Jei Lee 《Surgery for obesity and related diseases》2018,14(10):1600-1606
Background
Nonalcoholic steatohepatitis (NASH) is an important etiology of end-stage liver disease. Long-term effect of bariatric surgery in improvement of NASH is not clear.Objectives
To validate a scoring system for predicting NASH in morbidly obese patients and using it to evaluate the long-term effect of bariatric surgery on NASH.Setting
Tertiary referral hospital, Taiwan.Methods
A new 5-point clinical NASH (C-NASH) score incorporating body mass index, alanine aminotransferase, and triglyceride was validated in a group of 307 bariatric patients (mean age 30.2 years, incorporating body mass index 45.0 kg/m2) with concurrent liver biopsy from 2003 to 2008. Remission of NASH in 5741 obese patients undergoing bariatric/metabolic surgery with long-term follow-up was then evaluated using the C-NASH score.Results
Among 307 patients with liver biopsy, the prevalence of NASH was 44.0%. At baseline, the NASH group had significantly worse fasting glucose levels, triglycerides, uric acid, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transferase, and glycated hemoglobin. The diagnostic sensitivity of C-NASH score was 84.4%, and the accuracy was 68.4%. Among 5741 bariatric patients, the prevalence of high risk for NASH evaluated by C-NASH score was 40.9%. Postoperative follow-up showed good weight loss and almost complete remission of high risk for NASH up to 10 years. Patients with gastric banding had less weight loss, higher mean level of C-NASH score, and a higher incidence of high risk for NASH compared with other procedures at follow-up.Conclusion
This study demonstrated that improvement in C-NASH score suggesting remission of NASH is durable up to 10 years in all kinds of bariatric procedures. 相似文献20.
Helena Dreber Anders Thorell Jarl Torgerson Signy Reynisdottir Erik Hemmingsson 《Surgery for obesity and related diseases》2018,14(9):1319-1326