Reamed or unreamed intramedullary nailing for tibial fractures: a meta-analysis

Objective：To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults.Methods：Literature reports in both Chinese and English languages were retrieved （from the earliest available records to October 1,2013） from the PubMed,FMJS,CNKI,Wanfang Data using randomized controlled trials （RCTs） to compare reamed and unreamed intramedullary nailing for treatment of tibial fractures.Methodological quality of the trials was critically assessed,and relevant data were extracted.Statistical software Revman 5.0 was used for data-analysis.Results：A total of 12 randomized controlled trials,comprising 985 patients （475 in the unreamed group and 510 in the reamed group）,were eligible for inclusion in this meta-analysis.The results of metaanalysis showed that there were no statistically significant differences between the two methods in the reported outcomes of infection （RR=0.64; 95％CI,0.39 to 1.07;P=0.09）,compartment syndrome （RR=1.44; 95％CI,0.8to 2.41; P=0.16）,thrombosis （RR=1.29; 95％CI,0.43to 3.87; P=0.64）,time to union （WMD=5.01; 95％CI,-1.78 to 11.80; P=0.15）,delayed union （nonunion）（RR=1.56; 95％CI,0.97 to 2.49; P=0.06）,malunion （RR=1.75; 95％CI,1.00 to 3.08; P=0.05） and knee pain （RR=0.94; 95％CI,0.73 to 1.22; P=0.66）.But there was a significantly higher fixation failure rate in the unreamed group than in the reamed group （RR=4.29; 95％CI,2.58to 7.14; P＜0.00001）.Conclusion：There is no significant difference in the reamed and unreamed intramedullary nailing for the treatment of tibial fractures,but our result recommends reamed nails for the treatment of closed tibial fractures for their lower fixation failure rate.     

A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia after accidental dural puncture in labour

BackgroundAfter accidental dural puncture in labour it is suggested that inserting an intrathecal catheter and converting to spinal analgesia reduces postdural puncture headache and epidural blood patch rates. This treatment has never been tested in a controlled manner.MethodsThirty-four hospitals were randomised to one of two protocols for managing accidental dural puncture during attempted labour epidural analgesia: repeating the epidural procedure or converting to spinal analgesia by inserting the epidural catheter intrathecally. Hospitals changed protocols at six-month intervals for two years.ResultsOne hundred and fifteen women were recruited but 18 were excluded from initial analysis because of practical complications which had the potential to affect the incidence of headache and blood patch rates. Of the remaining 97 women, 47 were assigned to the repeat epidural group and 50 to the spinal analgesia group. Conversion to spinal analgesia did not reduce the incidence of postdural puncture headache (spinal 72% vs. epidural 62%, P = 0.2) or blood patch (spinal 50% vs. epidural 55%, P = 0.6). Binary logistic analysis revealed the relative risk of headache increased with 16-gauge vs. 18-gauge epidural needles (RR = 2.21, 95% CI 1.4–2.6, P = 0.005); anaesthetist inexperience (RR = 1.02 per year difference in experience, 95% CI 1.001–1.05, P = 0.043), and spontaneous vaginal compared to caesarean delivery (RR = 1.58, 95% CI 1.14–1.79, P = 0.02). These same factors also increased the risk of a blood patch: 16-gauge vs. 18-gauge needles (RR = 2.92, 95% CI 1.37–3.87, P = 0.01), anaesthetist inexperience (RR = 1.06 per year difference in experience, 95% CI 1.02–1.09, P = 0.006), spontaneous vaginal versus caesarean delivery (RR = 2.22, 95% CI 1.47–2.63, P = 0.002). When all patients were included for analysis of complications, there was a significantly greater requirement for two or more additional attempts to establish neuraxial analgesia associated with repeating the epidural (41% vs. 12%, P = 0.0004) and a 9% risk of second dural puncture.ConclusionsConverting to spinal analgesia after accidental dural puncture did not reduce the incidence of headache or blood patch, but was associated with easier establishment of neuraxial analgesia for labour. The most significant factor increasing headache and blood patch rates was the use of a 16-gauge compared to an 18-gauge epidural needle.     

Impact of knee flexion on patella length in osteoarthritic patients undergoing total knee arthroplasty

PurposeThis study used magnetic resonance imaging (MRI) to evaluate in vivo preoperative changes in the length of the patellar tendon (LPT) in patients undergoing total knee arthroplasty (TKA). We sought to answer two questions: first, does the LPT change with flexion? Second, does the LPT show a gender-specific pattern?MethodsEighty-five knees in 76 consecutive osteoarthritic patients were evaluated. The age range was 56–90 years (mean 70). The study included 62 females and 14 males. MRI was performed at full extension and at 30°, 60°, 90°, and full flexion.ResultsThere were significantly different patterns between genders (p < 0.001). The main shortenings occurred earlier, at 30°, in females and later, at 60°, in males. In females, LPT values in full extension were significantly longer than those measured at other flexion angles. In male subjects, significant differences in LPT values were found between full extension versus 90° (p < 0.001) and full flexion (p < 0.001), and between 60° versus 90°(p = 0.030) and full flexion (p = 0.030).ConclusionThese differences might influence the gender-specific complications related to the extensor mechanism after TKA. These data provide useful information for surgeons attempting to achieve a satisfactory balance between joint gaps in the patellar reduced position intraoperatively.     

Cardiovascular profile in osteoarthritis: a meta-analysis of cardiovascular events and risk factors

IntroductionHigher cardiovascular risk found in rheumatoid arthritis or psoriatic arthritis is largely due to systemic inflammation. In osteoarthritis (OA), occurrence of systemic inflammation has already been sometimes reported, but the possible association between OA and increased cardiovascular risk remains unclear. In this meta-analysis, we aimed to assess the incidences of myocardial infarction (MI) and stroke, and the cardiovascular risk factors in OA patients.MethodsWe searched PubMed, EMBase, and the Cochrane Library to find references of interest up to June 2018. MI and stroke incidence were calculated using meta-proportion analysis. Differences in cardiovascular risk factors between OA patients and controls were expressed as standardized mean differences using the inverse of variance method.ResultsThe reviewed studies reported 227 MIs in 3550 OA patients (incidence, 7.5%; 95% CI: 3.0–13.8%) and 616 MIs among 12,444 control subjects (incidence, 6.0%; 95% CI: 2.8–10.3%). Meta-analysis of the three longitudinal studies revealed a significantly increased MI risk among OA patients (RR = 1.22; 95% CI: 1.02–1.45). We also found a significantly increased stroke risk in OA patients (RR = 1.43; 95% CI: 1.38–1.48). Concerning cardiovascular risk factors, OA patients exhibited a pro-atherogenic lipid and glycemic profile including high levels of fasting glucose, total cholesterol, and LDL cholesterol and a high body mass index. Concerning atherosclerosis markers, OA patients exhibited a higher risk of metabolic syndrome, and increased pulse wave velocity.ConclusionOur meta-analysis results revealed higher cardiovascular risk in OA patients. This highlights the importance of cardiovascular risk factor management in OA.     

Association of nocturnal penile rigidity with testosterone, metabolic syndrome, and other variables: a prospective cross-sectional pilot study

Introduction: The aim was to study whether nocturnal penile rigidity (NPTR) correlates with metabolic syndrome (MetS) and testosterone in men consulting for erectile dysfunction (ED).Material and methods: 234 men were included in a prospective, cross-sectional pilot study. Serum total and bioavailable testosterone and other biochemical constituents were measured and compared with NPTR. Patients were classified by normal or low/abnormal penile rigidity (abnormal meaning predominant organic component of ED) and presence or absence of MetS to test the hypothesized correlations.Results: Application of the logistic regression model to rigidity as the dependent variable showed the risk of low penile rigidity to be significantly lower for patients with higher total (OR = 0.96, 95% CI = 0.92-0.99) or bioavailable testosterone (OR = 0.91, 95% CI = 0.84-0.99). Patients with testosterone levels between 8 and 12 mmol/L had a quadrupled risk of low penile rigidity compared with patients with higher levels (>12 mmol/L) (OR = 3.96, 95% CI = 1.89-8.31). Considering men without MetS, age and body mass index were associated as significant factors for low penile rigidity: age increased risk by 8% (OR = 1.08, 95% CI = 1.03-1.13) and BMI increased it by 18% (OR = 1.18, 95% CI = 1.01-1.38).Conclusion: Testosterone levels are weakly associated with penile rigidity and disappear when associated with MetS.     

Association between family history of cancers and risk of prostate cancer

IntroductionFamily history of prostate cancer is an established risk factor for prostate cancer. However, the relationship between family history of cancers other than prostate cancer and prostate cancer risk is inconclusive. This study sought to examine the association between family history of cancers and prostate cancer.MethodsA case–control study was conducted in which cases and controls were randomly selected from a large urology clinic in Central Virginia. Cases were 600 histologically confirmed prostate cancer patients who were diagnosed between January 2000 and December 2005, and controls were 686 patients who visited the clinic during the same period and were diagnosed with urological illnesses other than cancers and prostate-related problems. Data on family history of cancers, lifestyle and demographic factors were collected through mail survey utilizing the method suggested by Dillman. Unconditional logistic regression analysis was used to estimate the odds ratios (OR) and the corresponding 95% confidence intervals (CI) after adjustment for potential confounding factors including body mass index (BMI), alcohol intake, physical activity, smoking, diet, history of vasectomy and sexually transmitted disease (STD), age, race, marital history, education, and income. Multiple comparisons adjustments were made using the Bonferroni adjustment.ResultsMen with a family history of any cancer in first-degree relatives including parents (OR = 2.42, 95% CI = 1.53–3.84) and parents only (OR = 1.90, 95% CI = 1.23– 2.94) were at increased risk of developing prostate cancer. Significant increased risk was also observed with family history of prostate cancer in first-degree relatives (OR = 2.68, 95% CI = 1.53–4.69) and parents only (OR = 3.26, 95% CI = 1.71–6.24). Even after adjustments for multiple comparisons, the significance persisted both in first-degree relatives (OR = 2.68, 95% CI = 1.16–6.21) and parents alone (OR = 3.26, 95% CI = 1.24– 8.63).ConclusionThis study demonstrated an increased prostate cancer risk for men with a family history of any cancer or prostate cancer in first-degree relatives and parents alone. Health care providers need to be aware of the potential risk of family history of cancers on prostate cancer.     

Serum resistin level is associated with radiographic changes in hand osteoarthritis: cross-sectional study

ObjectiveThe aim of this study was to determine whether adipokines such as adiponectin and resistin were related to radiographic outcomes in patients with hand osteoarthritis (OA).MethodsA total of 156 female subjects (46 controls, 60 non-radiographic hand OA, and 50 radiographic hand OA) were enrolled. We measured serum adiponectin and resistin concentrations using an enzyme-linked immunosorbent assay (ELISA). Radiographic hand OA was defined by the presence of a ≥ 2 Kellgren-Lawrence radiological grade after assessment for 20 joints of both hands. The association between radiographic hand OA and each adipokine was assessed using multivariate logistic regression models controlling for confounding clinical parameters.ResultsSerum resistin levels in radiographic hand OA patients were higher than in non-radiographic hand OA and controls (p_adj = 0.020 and p_adj = 0.019, respectively), whereas there were no significant differences in serum adiponectin levels. The presence of radiographic changes in hand OA was shown to be dependent on serum resistin levels (p_adj = 0.028). Specifically, subchondral erosion in radiographic hand OA was associated with serum resisitin (p_adj = 0.028). However, there were no associations of serum adipokines with joint space narrowing, bony ankylosis, and cortical destruction.ConclusionsThis study suggests that resistin is involved in radiographic changes in hand OA, and that adipokines contribute to pathogenesis in radiographic outcomes in hand OA.     

The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis

ObjectivesKnee osteoarthritis (OA) is a common chronic degenerative disorder. There are various treatment modalities. This study was planned to investigate the efficacy of balneotherapy, mud-pack therapy in patients with knee OA.MethodsA total of 80 patients with knee OA were included. Their ages ranged between 39–78. The patients were separated in to three groups. Group I (n = 25) received balneotherapy, group II (n = 29) received mud-pack therapy and group III (n = 26) was hot-pack therapy group. The therapies were applied for 20 min duration, once a day, five times per week and a total of 10 session. Patients were assessed according to pain, functional capacity and quality of life parameters. Pain was assessed by using Visuel Analogue Scale (VAS) and Western Ontario McMaster Osteoarthritis Index (WOMAC) pain scale (0–4 likert scale). Functional capacity was assessed by using WOMAC functional capacity and WOMAC global index. Quality of life was evaluated by Nottingham Health Profile (NHP) self-administered questionnaire. Also physician's global assessment and the maximum distance that patient can walk without pain, were evaluated. The assessment parameters were evaluated before and after three months.ResultsThere were statistically significant improvement in VAS and WOMAC pain scores in group I (p < 0.001), group II and III (p < 0.05). The WOMAC functional and global index also decreased in group I (p < 0.05), group II (p < 0.001) and hot-pack group (p < 0.05). Quality of life results were significantly improved in balneotherapy and mud-pack therapy groups (p < 0.05). No difference was observed in hot-pack therapy group (p > 0.05). The maximum distance was improved both in group I and II (p < 0.05) but not in group III. Also physician's global assessment was found to be improved in all groups (p < 0.05).ConclusionsBalneotherapy and mud-pack therapy were effective in treating patients with knee OA.     

The KHOALA cohort of knee and hip osteoarthritis in France

ObjectivesThis study aimed to describe the prevalence of symptomatic knee and hip osteoarthritis (OA) and its course over time, as well as identify prognostic factors of OA course and determinants of costs and access to care in France in a patient cohort.MethodsSubjects aged 40 to 75 years, with uni- or bilateral symptomatic hip and/or knee OA (ACR criteria), Kellgren and Lawrence (KL) stage 2 or greater, were recruited from a French national prevalence survey for the multicenter KHOALA cohort study. Data collected at baseline included sociodemographic and clinical data; WOMAC, IKS and Harris scores for pain and function; MAQ score for physical activity; functional comorbidity index; GHQ28 score for psychological status; and SF-36 (generic) and OAKHQOL (specific) scores for quality of life. Blood and urine samples were collected.ResultsEight hundred and seventy-eight subjects were included, 222 with OA of the hip (mean age 61.2 ± 8.8 years), 607 knee (mean age 62.0 ± 8.5 years) and 49 both hip and knee (mean age 64.9 ± 7.9 years). Mean body mass index was 26.9 ± 4.5 for hip OA and 30.3 ± 6.3 for knee OA. Hip and knee OA patients had 1.99 and 2.06 comorbidities, on average, respectively. Disease severity on X-rays for KL stages 2, 3 and 4 for hip OA was 69.8, 26.1 and 4.1%, respectively, and for knee OA, 44.5, 30.3, and 25.2%. As compared with population norms, age- and sex-standardized SF-36 scores were greatly decreased for both knee and hip OA in all dimensions, particularly physical and emotional dimensions.PerspectivesPatients will be followed up annually, alternately by mail and clinical visit. This cohort of representative patients with knee and hip OA will be an opportunity for future collaborative research.     

Oral health-related quality of life in Iranian patients with spinal cord injury: A case–control study

IntroductionThe study aimed to compare the oral health variables, general, and oral health-related quality of life (QoL), depression, and anxiety between spinal cord injury (SCI) patients and healthy controls and also to determine the key factors related to the oral health-related quality of life (OHRQoL) in the SCI patients.MethodsA total of 203 SCI patients and 203 healthy controls were enrolled. Patients and healthy adults were invited to attend a dental clinic to complete the study measures and undergo oral clinical examinations. OHRQoL was assessed by the 14-item Oral Health Impact Profile (OHIP-14), and the general health-related quality of life (GHRQoL) was evaluated by SF-36. In SCI patients, depression and anxiety were recorded using the Hospital Anxiety and Depression Scale (HADS), while Functional Assessment Measure (FAM) was used to assess dependence and disability. All the subjects were examined for caries which was quantified using the decayed, missing, and filled Teeth (DMFT) index, gingival bleeding index (GI), plaque index, and periodontal status by community periodontal index (CPI).ResultsThe analysis of covariance (ANCOVA) revealed significant differences between the two groups in terms of oral health expressed in DMFT, oral hygiene, and periodontal status, controlled for age, gender, family income, and occupational status (p < 0.001). Using the hierarchical linear regression analyses, in the final model, which accounted for 18% of the total variance (F(126.7), p < 0.01), significant predictors of OHRQoL were irregular tooth brushing (β = 1.23; 95% CI = 1.06; 1.41), smoking (β = 0.82; 95% CI = 0.66; 0.97), dry mouth (β = 0.37; 95% CI = −0.65 to 0.10) functional and motor functioning (β = 0.32; 95% CI = −0.45 to 0.17), DMFT (β = 0.06; 95% CI = 0.02; 0.09), CPI (β = 0.22; 95% CI = 0.04; 0.04), physical component measure of GHRQoL (β = −0.275; 95% CI = −0.42 to 0.13), lesion level at the lumbar–sacral (β = −0.18; 95% CI = −0.29 to −0.06) and thoracic level (β = −0.09; 95% CI = −0.11 to −0.06).ConclusionSCI patients had poor oral hygiene practices, greater levels of plaque, gingival bleeding, and caries experience than the healthy controls. In addition, more number of SCI patients had periodontal pockets and dry mouth than the comparative group. SCI patients experienced more depression and anxiety, poor GHRQoL, and OHRQoL than the healthy control group. The factors that influenced OHRQoL in SCI patients were age, toothbrushing frequency, smoking, oral clinical status, depression, physical component of GHRQoL, and level of lesion.     

The efficacy of dendritic cell vaccine for newly diagnosed glioblastoma: A meta-analysis of randomized controlled studies

IntroductionThe efficacy of dendritic cell vaccine to treat glioblastoma remained elusive and therefore we conducted a meta-analysis to explore the influence of dendritic cell vaccine on treatment efficacy of glioblastoma.MethodsPubMed, EMbase, Web of science, EBSCO and Cochrane library databases have been searched through October 2020, and we included randomized controlled trials (RCTs) assessing the efficacy of dendritic cell vaccine for glioblastoma.ResultsFour RCTs and 267 patients were included in the meta-analysis. Compared to control group for glioblastoma, dendritic cell vaccine demonstrated no obvious impact on overall survival (HR = 0.59; 95% CI = 0.34 to 1.04; P = 0.07), progression-free survival (PFS, HR = 0.72; 95% CI = 0.52 to 1.00; P = 0.05), nervous system disorders (OR = 0.61; 95% CI = 0.29 to 1.29; P = 0.20), or adverse events (OR = 1.44; 95% CI = 0.82 to 2.50; P = 0.20).ConclusionsDendritic cell vaccine may be not effective to treat glioblastoma.     

The associations between interleukin-1 polymorphisms and susceptibility to ankylosing spondylitis: a meta-analysis

ObjectiveThe aim of this study was to determine whether polymorphisms of interleukin-1 (IL-1) confer susceptibility to ankylosing spondylitis (AS).MethodsThe authors conducted meta-analyses on associations between IL-1 polymorphisms and AS susceptibility, using fixed or random effects models. In order to avoid duplications and data previously subjected to meta-analysis, we performed meta-analysis on studies if new data on IL-1 polymorphisms in AS were reported.ResultsA total of nine studies consisting of 20 separate comparisons of association between IL-1 polymorphisms and AS susceptibility were included in this meta-analysis. These were performed on European, Asian, and Latin American population samples. Meta-analysis revealed a significant association between the 2 allele of the IL-1F10.3 polymorphism (rs3811581) and the risk of developing AS in Europeans (OR = 0.775, 95% CI = 0.605–0.992, P = 0.043). Furthermore, the OR of the 2 allele of IL-1A + 889 (rs1800587) was found to be significantly increased in Europeans with AS (OR = 1.357, 95% CI = 1.085–1.697, P = 0.007). However, meta-analyses of the IL-1B-511, IL-1B + 3953, and ILF7.1 polymorphisms and of the variable numbers of tandem repeats of the IL-1 receptor antagonist gene (IL-1RN VNTR) revealed no association between AS and these polymorphisms.ConclusionsIn addition to the three known IL-1 polymorphisms, rs2856836, rs17561, and rs1894399, found in previous meta-analysis, this meta-analysis shows that the IL-1F10.3 and IL-1A + 889 polymorphisms are associated with the development of AS in Europeans but not in Asians.     

Outcome of periprosthetic distal femoral fractures following knee arthroplasty

IntroductionThe majority of periprosthetic fractures around the knee occur at the supracondylar region of the distal femur. Fixation of distal femoral fractures in osteoporotic bone with short segment remains a challenge, especially after total knee arthroplasty (TKA). Internal fixation of these fractures using locking plates has become popular. The purpose of this study was to evaluate a consecutive series of periprosthetic supracondylar femoral fractures treated with locked periarticular plate fixation with regard to surgical procedure, complications and clinical outcome.Materials and methodsFrom two academic trauma centres, 55 consecutive periprosthetic distal femoral fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association, AO/OTA 33) were retrospectively identified as having been treated with locked plate fixation. Of these, 36 fractures in 35 patients (86.1% female) met the inclusion criteria. Patients had an average age of 73.2 years (range 54–95 years). Fixation constructs for plate length and working length were delineated. Nonunion, infection and implant failure were used as complication variables. Demographics were assessed. Outcome was addressed radiographically and clinically according to Kristensen et al.¹ by range of motion and pain.ResultsTwenty-five of 36 fractures (69.4%) healed after the index procedure. Eight of 36 fractures (22.2%) developed a nonunion with three fractures (8.3%) leading to hardware failure. Nine of the 36 patients (25%) were radiographically diagnosed with notching of the anterior femoral cortex. Regarding technical aspects, distance from the anterior flange of the femoral component to fracture was significantly shorter in patients with compared to without anterior notching (t = 3.68, p = 0.02). Patients who underwent submuscular plate insertion compared to an extensive lateral approach had a reduced nonunion risk (χ² = 0.05). No difference in infection rate was found for submuscular procedures compared with open procedures (χ² = 0.85). Range of motion was reduced in most of the patients and 13.5% had a persistent loss of extension of 5°. More than 77% of the patients reported no or only mild pain during the last office visit. Range of motion loss did not influence pain. Successful treatment according to Cain et al.² was achieved in 83%. Using Kristensen's¹ criteria, 56% of the knees had acceptable flexion.ConclusionOperative fixation of periprosthetic distal femoral fractures after TKA continues to be challenging. Notching of the anterior femoral cortex should be avoided. Loss of reduction and high failure rates still occur with locked plating and may be related to underlying factors. Indirect reduction and submuscular plate insertion technique reduce nonunion risk.     

Outcomes of partial and total calcanectomies for the treatment of diabetic heel ulcers complicated with osteomyelitis. A systematic review and meta-analysis

BackgroundInfected diabetic foot ulcers (DFU) complicated with calcaneal osteomyelitis are a real challenge for limb preservation. Very few alternatives to amputation are available, mainly the resection of a part or the totality of the calcaneal bone. Calcanectomies were advanced as limb-sparing procedures in patients with heel osteomyelitis. However, there is a lack of pooled quantitative evidence on their efficacy and complications.ObjectivesThe present systematic review and meta-analysis was conducted to determine the primary outcome of healing rates following partial (PC) and total calcanectomies (TC) in treating calcaneal osteomyelitis due to diabetic heel ulcers. Additionally, secondary outcomes such as secondary TC following PC, secondary below knee amputation (BKA), mortality and the change in the ambulation status were analyzed.MethodsMedline, Scopus, Web of science, Cochrane Library and Google Scholar were searched since inception. All types of study design were included. Single case report studies and studies reporting osteomyelitis due to other etiologies than DFU were excluded.ResultsTwenty studies met the inclusion criteria comprising 295 patients with 300 calcanectomies (270 PC and 30 TC). With a mean follow-up period of 29.3 ± 17.7 months, the weighted results were as follows: a) the osteomyelitis healing rate was of 80% (95% CI = 0.728 to 0.861, I² = 48.3%), b) the rate of secondary total calcanectomy was of 5.4% (95% CI = 0.022 to 0.097, I² = 7.5%), c) the rate of secondary BKA was of 17.1% (95% CI = 0.111 to 0.241, I² = 50.6%) with no difference between subgroups of TC and PC, and d) the combined mortality rate of both calcanectomies was of 13.4% (95% CI = 0.064 to 0.224, I² = 73.6%); however, significant higher mortality was found following TC compared to PC (p < 0.0001).ConclusionPartial and total calcanectomies were found to yield very good healing rates with acceptable complication frequencies. When compared to the reported outcomes of below and above-knee amputations in the literature, calcanectomies could be fairly considered as good alternatives to above ankle amputations.     

Early attained weight and length predict growth faltering better than velocity measures in infants with CF

BackgroundCF infants often do not grow as expected which adversely affects later clinical outcomes, thus sensitive early measures of growth deficiency are important. This study compared attained growth for age with velocity standards to determine which better predicts growth deficits at 24 months of age.MethodsGrowth deficiency in infancy based on weight and length velocity, and attained growth was calculated for 1992 infants in the US CF Foundation National Registry using the World Health Organization (WHO) and US growth standards. One, two and three month increments were used for calculating velocity and pooled for each age interval. Sensitivity and specificity of early indicators to predict growth deficiency at 24 months were calculated.ResultsObserved prevalence of weight deficiency (< 10th percentile) during the first year of life was 26.8% higher (95% CI = (25.6, 28.1%), p < 0.001) on average when measured by attained weight for age than velocity. Attained weight for age at four months was a more sensitive predictor of diminished weight for age (< 10th percentile) at 24 months (sensitivity = 100%, 95% CI = (87, 100%)) than weight velocity (sensitivity = 40%, 95% CI = (23, 59%)). Attained length at four months was more sensitive to detecting subsequent stunting (< 10th percentile length for age) (77%, 95% CI = (62, 87%)) than length velocity (30%, 95% CI = (19, 45%)).ConclusionsIn CF infancy, attained weight or length is more sensitive than velocity-based definitions for predicting subsequent diminished growth.     

Time-influencing factors for biochemical progression following radical prostatectomy

IntroductionWe assessed the time-influencing clinical-pathological factors for biochemical progression of an equal series of patients from a single institution.Materials and methodsRetrospective analysis of 278 patients with biochemical progression following prostatectomy. We considered biochemical progression to be PSA>0.4 ng/ml. We performed the trial using the Cox model (univariate and multivariate) and using the Student's t-test to compare averages.ResultsWith a mean follow-up of 4 (±3 DE) years, the univariate study showed a mean until progression for the Gleason score 2-6 in the biopsy of 824 days and 543 for the Gleason score 7-10 (p = 0.003). For negative surgical margins, the mean was 920 days and 545 for positive margins (p = 0.0001). In the case of a Gleason score 2-7 in the specimen, the mean was 806 days and 501 for a Gleason score 8-10 (p = 0.001). Lastly, the mean for the cases with Ki-67 negative in the specimen (< 10%) was 649 days and 345 for Ki-67 positive (> 10%) (p = 0.003). In the multivariate study, Ki-67 (OR 1.028; IC 95% 1-1.01; p = 0.0001) and Gleason score 8-10 (OR 1.62; IC 95% 1.5-2.45; p = 0.026) in the specimen, and initial PSA >10 ng/ml (OR 1.02; IC 95% 1.01-1.04; p = 0.0001) were independent variables. Using these variables, we designed a predictive model with three groups. The time until the progression of each group was 1,081, 551 and 218 days respectively.ConclusionThe Gleason score 7-10 in the prostate biopsy, the presence of Ki-67, the positive margins and the Gleason score 8-10 in the specimen, and the initial PSA > 10 ng/ml are time-influencing factors until biochemical progression. Pathological Gleason score 8-10, PSA > 10 ng/ml and Ki-67 are independent factors.     

Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis

AimsThe aim of this retrospective study was to investigate the correlation between MPV and the clinical disease activity indices of rheumatoid arthritis and ankylosing spondylitis.MethodsThe study consisted of 32 active RA patients (males/females: 7/25, mean age: 49 ± 13) and 30 active AS patients (males/females: 15/15, mean age: 36 ± 12) along with 26 osteoarthritis (OA) patients (males/females: 4/22, mean age: 52 ± 8) and 29 age-matched healthy subjects (males/females: 5/24, mean age: 41 ± 7) as control groups for RA and AS, respectively.ResultsMPV was significantly lower in both AS patients and RA patients with active disease as compared to controls (RA vs OA p < 0.001, AS vs healthy subjects p < 0.001). After treatment MPV values significantly increased in AS and RA (p < 0.001 for all). However, MPV values remained somewhat lower in RA patients than OA patients (p = 0.019). There was a negative correlation between MPV values and BASDAI scores in AS patients after two months of treatment (r = ?0.507; p = 0.004).ConclusionOur results suggest that assessment of MPV may provide additional information about inflammation in AS and RA.