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1.
Background
The purpose of this study was to evaluate the influence of anterolateral ligament (ALL) injuries on stability and second-look arthroscopic findings after anterior cruciate ligament (ACL) reconstruction.Methods
One-hundred and nineteen consecutive patients underwent a second-look arthroscopic surgery after ACL reconstruction and magnetic resonance imaging (MRI) examination of the ALL. The patients were divided into an ALL intact group (n?=?39) and ALL injured group (n?=?80). The ALL injuries were divided according to the three anatomical parts of the ALL (femoral, meniscal, and tibial) using MRI evaluation. Stability and clinical results were evaluated using the Lachman test, pivot-shift test, KT-2000 arthrometer, and Lysholm score. On second-look arthroscopy, graft tension and synovial coverage were evaluated.Results
The clinical evaluation revealed no significant differences in ALL injury. Although the synovial coverages showed no significant difference (P?=?0.113), the second-look arthroscopic findings indicated that tension was statistically significantly dependent on the ALL injury (P?<?0.001). In addition, according to the location of the ALL injury, femoral, tibial, and combined ALL injuries showed significant differences in graft tension as compared with the ALL intact group; only the meniscal injuries had no effect on graft tension.Conclusion
Combined ACL and ALL injuries showed poor graft tension in the second-look arthroscopic findings after allograft transtibial ACL reconstruction, even though no significant differences in clinical outcomes and stability were observed. 相似文献2.
Background
Double hamstring autograft for anterior cruciate ligament (ACL) reconstruction is a well-established graft option; however, a major concern with this method arises when the prepared graft is too small. Resorting to allograft can be a solution to this problem, but some surgeons prefer to use autograft in particular situations and some patients may refuse allograft. We investigate the merits of using autogenous quadriceps tendons to augment the insufficient hamstrings and compare the autograft composite graft to a standard hamstrings graft of equal size.Methods
Semitendinosus, gracilis, and quadriceps tendons were harvested from 10 matched pairs of human cadaver lower extremities. Within each pair, a routine hamstring ACL graft (control) consisting of the semitendinosus and gracilis tendons, and an quadriceps augmented hamstrings graft of equal size comprised of the semitendinosus and quadriceps tendons, were prepared. A freeze-clamp mount was used to biomechanically test each graft construct. Tensile failure load, displacement, energy absorbed, and stiffness were determined and statistically compared within each pair and mode of graft failure was established.Results
No statistically significant differences were found between the quadriceps augmented hamstrings graft versus standard control grafts. Average values for peak failure load and graft displacement at the point of first failure were nearly identical. All ACL graft constructs failed at the mid-substance.Conclusions
This study demonstrates no statistical difference in the biomechanical properties of an isolated hamstring ACL autograft versus a quadriceps augmented ACL autograft of equal size at time zero.Clinical relevance
This is a potentially new and reliable method for quadriceps tendon autograft augmentation of hamstring autograft for ACL reconstruction. 相似文献3.
Kristoffer W. Barfod Julian A. Feller Taylor Hartwig Brian M. Devitt Kate E. Webster 《The Knee》2019,26(1):149-154
Background
Knee extensor strength and single limb hop for distance have been suggested as useful measures to evaluate readiness to return to sport after anterior cruciate ligament (ACL) reconstruction.The aim of the study was to examine the association between knee extensor strength and single leg hop for distance following ACL reconstruction and to determine the proportion of patients with knee extensor strength symmetry deficits at six and 12 months.Methods
From December 2013 to December 2015 69 patients aged 14 to 45 undergoing primary ACL reconstruction were recruited. Isokinetic concentric knee extensor strength testing and single limb hop for distance were performed six and 12 months postoperatively. Satisfactory knee extensor strength was defined as a leg symmetry index (LSI) ≥85%.Results
At six months 27.5% (19/69) of patients had recovered satisfactory knee extensor strength in the injured leg, improving to 46.4% (32/69) at 12 months. Recovery of satisfactory strength was associated with hopping distance. Hop symmetry was achieved considerably faster than knee extensor symmetry, with 66.7% (46/69) of patients demonstrating satisfactory hopping symmetry at six months, 89.9% (62/69) at 12 months. Recovery of hopping distance was not associated with knee extensor strength.Conclusions
Single leg hop test cannot be used as a surrogate measure for knee extensor strength as no association was found between hop tests and knee extensor strength. Less than one in three patients at six months and one in two at 12 months had recovered satisfactory knee extensor strength. 相似文献4.
Tiana Raoul Shahnaz Klouche Baptiste Guerrier Badr El-Hariri Serge Herman Antoine Gerometta Nicolas Lefevre Yoann Bohu 《The Knee》2019,26(1):155-164
Background
The decision to return to sport following anterior cruciate ligament (ACL) reconstruction should not only be based on time since surgery. This study aimed to assess, using isokinetic and neuromuscular (hops) testing in a large group, postoperative objective functional recovery of the knee. The secondary objective was to determine the relationship between psychological, functional scores, and these postoperative tests.Methods
This prospective study included athletes who underwent surgery between 2013 and 2016 for an isolated full-thickness ACL tear. They received a complete evaluation of functional performance of the knee by isokinetic tests performed on a dynamometer to measure quadriceps and hamstring strength, and neuromuscular assessment based on single-leg hop tests. The main judgment criterion was satisfactory functional recovery (yes/no) defined as a difference of ≤ 10% both in the quadriceps 60°/s and the single hop at a minimum of four months of follow-up.Results
A total of 234 athletes were analyzed. The mean age was 28.4?±?8.6?years. At 6.5?±?1.7?months mean follow-up, 44 (18.5%) patients had satisfactory functional recovery of the knee. The correlations between isokinetic/hop tests and the different scores were variable. During follow-up, two patients presented with a graft tear and two with a contralateral ACL tear, all in the group with unsatisfactory functional recovery.Conclusion
At a mean of six months after ACL reconstruction, objective functional recovery of the knee was generally unsatisfactory and this seemed to be a risk factor for recurrent tears.Level of evidence
IV; case series. 相似文献5.
Salman Nazary-Moghadam Mahyar Salavati Ali Esteki Behnam Akhbari Sohrab Keyhani Afsaneh Zeinalzadeh 《The Knee》2019,26(1):88-96
Background
Several investigations have studied gait variability of individuals with anterior cruciate ligament (ACL) deficiency; however, the effect of dual-tasking on the gait variability of these individuals remained unclear. The aim of the present study was to determine the effect of gait speed and dual-tasking on knee flexion–extension variability in subjects with and without ACL deficiency.Methods
The knee flexion–extension Lyapunov exponent (LyE) was measured in 22 ACL-deficient (Mean±SD) (25.95?±?4.69?years) and 22 healthy subjects (24.18?±?3.32?years). They walked at three levels of gait speed in isolation or concurrently with a cognitive task.Results
Repeated-measure analyses of variance (ANOVAs) demonstrated that the interaction of group by gait speed was statistically significant. As the gait speed increased from low to high, the knee flexion–extension LyE significantly decreased for the subjects with ACL deficiency (effect size: 0.57, P?=?0.01). The interaction of group by cognitive load was not statistically significant (P?=?0.07). In addition, the ACL-deficient subjects had statistically slower reaction times than healthy subjects during the dual-task compared with the single-task condition.Conclusions
The ACL-deficient and healthy individuals had a tendency to maintain safe gait. It seems that the ACL-deficient subjects sacrificed the cognitive task more than the healthy individuals to pay more attention toward gait. Additionally, it seems that the gait speed was more challenging than cognitive load on the stride-to-stride variability in the individuals with ACL deficiency. 相似文献6.
Background
A large majority of anterior cruciate ligament (ACL) injuries are non-contact, most often occurring during a landing or change of direction. Recent research indicates that cognitive factors may be involved in non-contact ACL injuries. The aim of this study was to determine if a game-situation perceptual–cognitive load leads to altered landing kinematics in physically fatigued female athletes.Methods
Nineteen female recreational athletes were recruited to perform a series of jumping and landing trials. In a first phase, eight trials were performed in an isolated condition and eight were performed while participants performed a perceptual–cognitive task. Before a second identical phase, participants underwent a muscular fatigue protocol. Knee-joint kinematics were recorded and compared between conditions using paired t-tests.Results
Muscle fatigue led to statistically significant increases in peak knee abduction and peak internal knee rotation as well as a decrease in maximum knee flexion, when comparing conditions without the perceptual–cognitive task. The perceptual–cognitive task had no statistically significant effect on any knee rotations, either pre- or post-fatigue. However, a subgroup of 12 athletes showed a significant increase in knee abduction in the presence of the perceptual–cognitive task, only in the fatigued condition.Conclusion
A perceptual–cognitive task combined with muscle fatigue alters knee kinematics of landing for a subset of recreational athletes, potentially increasing the risk of ACL rupture. Further studies are necessary to confirm this finding and to identify characteristics of at-risk individuals to target them for injury prevention protocols. 相似文献7.
Annemie Smeets Bart Malfait Bart Dingenen Mark A. Robinson Jos Vanrenterghem Koen Peers Stefaan Nijs Styn Vereecken Filip Staes Sabine Verschueren 《The Knee》2019,26(1):40-51
Background
There is limited evidence on neuromuscular risk factors for anterior cruciate ligament (ACL) injuries, with most work mainly focusing on hamstrings and quadriceps muscle strength. This prospective pilot study explored if neuromuscular activation patterns of the quadriceps and hamstrings during a drop vertical jump influence ACL injury risk.Methods
Forty-six female athletes performed a drop vertical jump at baseline. Injuries were monitored throughout a one-year follow-up. Neuromuscular activation patterns of the vastus medialis, vastus lateralis, hamstrings medialis and hamstrings lateralis, and selected landing kinematic and kinetic profiles (knee flexion, knee abduction and hip flexion angles, and knee abduction moments), were compared between athletes who sustained a non-contact ACL injury and those who remained injury free. Electromyogram vector fields were created to represent neuromuscular activation patterns of muscle pairs around the knee joint rather than only considering individual muscle activations, and compared using Statistical Parametric Mapping.Results
Four athletes sustained an ACL injury. Significantly greater {hamstrings medials, hamstrings lateralis}, {vastus lateralis, hamstrings lateralis} and {hamstrings lateralis, vastus medialis} activations, mainly due to greater hamstrings lateralis activation, were found in the injured group around peak loading and just before take-off (P?<?0.001). No group differences were found in knee flexion, knee abduction and hip flexion angles, or knee abduction moments.Conclusions
This pilot study revealed initial evidence that athletes already showed altered neuromuscular activation patterns prior to sustaining an ACL injury, namely increased lateral and posterior muscle activations. 相似文献8.
Mai Katakura Masafumi Horie Toshifumi Watanabe Hiroki Katagiri Koji Otabe Toshiyuki Ohara Kaori Nakamura Kenta Katagiri Hiroko Ueki Stefano Zaffagnini Ichiro Sekiya Takeshi Muneta Hideyuki Koga 《The Knee》2019,26(1):124-131
Background
Some types of meniscus tear, especially lateral meniscus tear, have been reported to be associated with rotatory knee laxity. However, precise information regarding the effect of meniscus repair on rotatory laxity is limited. The purpose of this study was to investigate the effects of lateral and medial meniscus repair on rotatory laxity in anterior cruciate ligament (ACL) injured knees.Methods
Forty-one patients who underwent ACL reconstruction were included in the study. The tibial acceleration during the pivot shift test was measured using a triaxial accelerometer preoperatively under anesthesia and intraoperatively before and after medial and lateral meniscus repair and ACL reconstruction during surgery. Effects of meniscus tear and its repair on rotatory laxity were analyzed.Results
Preoperative measurements revealed that patients with lateral meniscus tear showed significantly higher tibial acceleration compared to the patients without meniscus tear (P?=?0.006). Intraoperative measurements revealed that medial and lateral meniscus repair significantly reduced tibial acceleration by 1.46?m/s2 (P?=?0.002) and 1.91?m/s2 (P?<?0.001), respectively.Conclusion
In ACL injured knees, knees with lateral meniscus tear showed greater rotatory laxity compared to the knees without meniscus tear. In addition, lateral meniscus repair, and to a lesser degree medial meniscus repair, reduced rotatory laxity during ACL reconstruction surgery. Therefore, the meniscus should be repaired as much as possible for its role as a secondary stabilizer of rotatory laxity. Besides, the effect of meniscus repair on rotatory laxity should be considered when the indication of anterolateral augmentation is determined. 相似文献9.
Sophie Heywood Jodie McClelland Paula Geigle Ann Rahmann Elizabeth Villalta Benjamin Mentiplay Ross Clark 《The Knee》2019,26(1):61-72
Background
Closed kinetic chain and plyometric exercises are commonly used in aquatic rehabilitation because they are believed to reduce joint loading whilst replicating functional tasks. However, the forces and relationship to land-based functional movement is unknown. This study aims to compare vertical ground reaction force during squats, calf raises and jumping in older adults with and without knee osteoarthritis on land and in water.Methods
Forty one participants (Healthy n?=?21; Knee osteoarthritis n?=?20; Age 68.5 (4.4) years) completed squats and calf raises at slow, medium and maximal speeds and jumping at maximal speed on land and in waist and chest depth water. Vertical ground reaction force and pain rating was measured in each environment.Results
Force in all exercises was significantly greater on land than in chest depth water (p?<?0.005). Peak force was significantly greater at maximal speed compared to slow speed (p?<?0.001). The pattern of force in squats at slow speed in water was different to on land, with force highest at the start and end of the exercise and decreasing in the central phase. Pain ratings were significantly lower (p?<?0.001) in water compared to on land in squats.Conclusions
Closed kinetic chain exercises offer inherently different loading in an aquatic environment. Body weight squats and calf raises in water could be defined as either neuromotor or low load, high velocity training. Maximal speed exercise in water produces higher relative load compared to slow speed and minimal pain providing an opportunity for clinicians to use greater speed to address power deficits. 相似文献10.
Alireza Motealleh Amin Kordi Yoosefinejad Mahdieh Ghoddosi Negar Azhdari Soraya Pirouzi 《The Knee》2019,26(1):26-32
Background
Patellofemoral pain syndrome (PFPS) is a common orthopedic problem with a high prevalence among young women. Patients with PFPS have altered trunk muscle activity, impaired postural control and greater displacement of the center of pressure (COP) while standing. Training in unstable sitting, by putting more emphasis on trunk sensory receptors, may improve trunk proprioception by minimizing the role of the lower extremities. The aim of this study was to compare trunk postural control in healthy persons and in patients with PFPS.Methods
Twenty-one women diagnosed with PFPS and 21 healthy women volunteered to participate in this cross-sectional study. The participants were asked to maintain trunk postural balance on an unstable sitting device, and COP indices of trunk postural control were compared between groups.Results
All COP indices (e.g., mean anterior–posterior and lateral COP displacement, mean COP velocity and mean area of COP displacement) were significantly increased in participants with PFPS in comparison to healthy controls (P?<?0.001). The effect sizes of all the indices were greater than 0.80.Conclusions
Trunk postural control is impaired in patients with PFPS, and this finding has clinical implications for rehabilitation in patients with PFPS. Adding seated postural control training to conventional physical therapy management in patients with PFPS may have beneficial effects by emphasizing trunk proprioception while minimizing the role of the lower extremities. 相似文献11.
N.D. Clement L.C. Walker K. Merrie M. Bardgett D. Weir J. Holland D.J. Deehan 《The Knee》2019,26(1):258-266
Background
The primary aim of this study was to assess whether patients dissatisfied with both recreational activities and overall outcome were different to those dissatisfied with recreational activities but satisfied with their overall outcome one year after total knee arthroplasty (TKA).Methods
A retrospective cohort consisting of 3324 primary TKA were identified from an established arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form (SF) 12 scores were collected pre-operatively and one year post-operatively. Overall patient satisfaction and satisfaction with recreational activities were assessed at one year.Results
The rate of patient satisfaction with recreational activities (n?=?2672, 80.4%) was significantly (odds ratio (OR) 0.47, 95% confidence intervals (CI) 0.41 to 0.54, p?<?0.001) lower than satisfaction with the overall outcome (n?=?2982, 89.7%). When adjusting for confounding variables older age (OR 1.03, p?=?0.008), increasing BMI (OR 1.05, p?=?0.01) and absence of hypertension (OR 0.66, p?=?0.02) were independent predictors of being dissatisfied with recreational activities in isolation. The one-year components and total WOMAC scores were significant (p?<?0.001) predictors of satisfaction with recreational activities and were reliable with an area under the curve of ≥ 0.82Conclusion
Patients of older age, higher BMI and without hypertension are more likely to be dissatisfied with recreational activities despite being satisfied with their overall outcome. 相似文献12.
Andrea M. Russell Deesha A. Patel Laura M. Curtis Kwang-Youn A. Kim Michael S. Wolf Megan E. Rowland Danielle M. McCarthy 《Patient education and counseling》2019,102(4):749-752
Objective
To determine the reliability of the Newest Vital Sign (NVS) administered via telephone by examining test-retest properties of the measure.Methods
Data were obtained from a randomized controlled trial promoting opioid safe use. Participants were 18 or older and English-speaking. NVS assessment occurred in-person at baseline and in-person or via telephone at follow-up. Intraclass correlation coefficients (ICCs) were used to assess the test-retest reliability using raw NVS scores by mode of administration of the second NVS assessment. Kappa statistics were used to examine test-retest agreement based on categorized NVS score. Internal consistency was measured with Cronbach’s alpha.Results
Data from 216 patients (70 completing follow-up in-person and 146 via telephone) were included. Reliability was high (ICCs: in-person?=?0.81, phone?=?0.70). Agreement was lower for three category NVS score (Kappas: in-person?=?0.58, 95% CI [0.39-0.77]; phone?=?0.52, 95% CI [0.39-0.65]) compared to two category NVS (Kappas: in-person?=?0.65, 95% CI [0.46-0.85]; phone?=?0.64, 95% CI [0.51-0.78]). Correlations decreased as time between administrations increased. Internal consistency was moderately high (baseline NVS in-person (α?=?0.76), follow-up NVS in-person (α?=?0.76), and phone follow-up (α?=?0.78).Conclusion
The test-retest properties of the NVS are similar by mode of administration.Practice implications
This data suggests the NVS measure is reliably administered by telephone. 相似文献13.
Cedric Maillot Anthony Leong Ciara Harman Alberto Morelli Richard Mospan Justin Cobb Charles Rivière 《The Knee》2019,26(1):106-114
Background
The kinematic alignment (KA) technique for total knee arthroplasty (TKA) is an emerging implant positioning philosophy that aims to restore constitutional knee anatomy to improve knee kinematics. At present, the KA technique aims to reconstruct native femorotibial (FT) joint alignment, however there is still insufficient consideration towards the inter-individual trochlear anatomy variability. Poor trochlear restoration may compromise clinical outcomes. Our study aimed at assessing the anatomical relationship between the native trochlea and other FT anatomical parameters.Methods
Fifty-eight preoperative CT scans of low-grade knee arthritic patients were segmented to create 3D bone models. The FT and the PF anatomical parameters were measured using in-house software. Values were compared between different groups of lower limb and FT joint line (JL) orientation, and correlations between FT and PF anatomical parameters were assessed.Results
We were unable to detect any significant correlation between groove orientation (frontal and axial) or groove radius and either the hip–knee–ankle (HKA), or the lateral distal femoral (LDFA), or the medial proximal tibial (MPTA), or the FTJL-mechanical axis (FTJLMAA) Angles. When considering the correlation within sub-groups of limb or JL orientation, we only found a positive correlation (r?=?0.464, p?=?0.022) in the varus lower limb (HKA?≤?180°) sub-group between groove frontal orientation and LDFA.Conclusion
Our study shows that the determination of several limb, knee, and JL parameters is of poor value to predict individual trochlea anatomy. This raises the issue of how to improve femoral component design to achieve individualised FT and PF anatomical restoration with KATKA.Level of evidence
Level 1 – computational study. 相似文献14.
Kathryn A. Barth Cort D. Lawton Daniel C. Touhey Ryan S. Selley Daniel D. Li Earvin S. Balderama Gordon W. Nuber Wellington K. Hsu 《The Knee》2019,26(1):142-148
Background
Soccer is one of the most common international sports in which ACL injuries occur, with previous studies reporting high return-to-play rates following ACL reconstruction (ACLR). Return-to-play analysis fails to take into consideration how effective a player remains once returning to competition. The aims of this study are to provide a large-scale international analysis of return-to-play and player performance statistics among professional soccer athletes following ACLR.Methods
Using publicly available sources, professional soccer athletes who have undergone ACLR between the 1996 and 2015 seasons were identified. Player metrics including statistical performance, recovery time, and return-to-play rates were analyzed both before and after reconstruction. Furthermore, player performance statistics during each of three consecutive seasons post-ACLR were compared.Results
A total of 176 athletes who underwent ACLR were included in this study. The return-to-play rate was 93.2% (164 athletes). Cumulative post-surgical statistical analysis of ACLR players demonstrated fewer games/season, minutes/season, minutes/game, goals/season, and more fouls/season following ACLR (p?<?0.04). Analysis of player performance statistics suggests that athletes do not return to their baseline number of games/season and minutes/game until two and three seasons post-ACLR, respectively. At three seasons post-ACLR, athletes are still starting fewer games/season and scoring fewer goals/90?min (p?<?0.04).Conclusion
Return-to-play rate is high following ACLR; however, athletes exhibit poorer statistical performance, especially in the first few seasons upon return. Our data shows that athletes continue to start fewer games/season and score fewer goals/90?min at three seasons post-ACLR. 相似文献15.
Allison A. Marshall Alessandra Zaccardelli Zhi Yu Maria G. Prado Xinyi Liu Rachel Miller Kroouze Sarah S. Kalia Robert C. Green Nellie A. Triedman Bing Lu Kevin D. Deane Maura D. Iversen Elizabeth W. Karlson Jeffrey A. Sparks 《Patient education and counseling》2019,102(5):976-983
Objective
To investigate the effect of providing comprehensive personalized risk information on concern for chronic disease development.Methods
Unaffected first-degree relatives (FDRs) of rheumatoid arthritis (RA) patients (n?=?238) were randomly allocated to: 1) disclosure of RA risk personalized to demographics, genetics, biomarkers, and behaviors using a web-based tool (PRE-RA arm, n?=?78); 2) PRE-RA with interpretation by a health educator (PRE-RA Plus arm, n?=?80); and 3) standard RA education (Comparison arm, n?=?80). Concern for developing RA was assessed at baseline and immediately, 6 weeks, 6 months, and 12 months post-intervention.Results
FDRs randomized to PRE-RA arms were less concerned about developing RA than the Comparison arm at all post-intervention assessments (p?<?0.05). Among those concerned about RA risk at baseline, the PRE-RA (OR?=?4.7, 95%CI 1.5–14.4) and PRE-RA Plus (OR?=?5.2, 95%CI 1.6–17.3) arms were more likely to have reassurance 6 months post-intervention than the Comparison arm.Conclusion
A comprehensive tool provided reassurance to those at risk for developing a chronic disease, with or without interpretation from a health educator, compared to standard education.Practice implications
Individuals may be more likely to be reassured using a personalized chronic disease risk disclosure tool than a standard non-personalized approach. 相似文献16.
Scott A. Davis Delesha M. Carpenter Susan J. Blalock Donald L. Budenz Charles Lee Kelly W. Muir Alan L. Robin Betsy Sleath 《Patient education and counseling》2019,102(5):937-943
Objective
To determine the effectiveness of an online video intervention in improving self-efficacy and eye drop application technique in glaucoma patients.Methods
We randomized ninety-two patients with primary open-angle glaucoma, all who self-administer their eye drops, to either watch the 4-minute Meducation® eye drop technique video in the intervention group, or a nutrition video in the control group. We assessed five eye drop technique steps using objective video recordings at baseline, immediately after watching the video, and 1 month later. We used linear regression models to determine whether the intervention group had better self-efficacy and technique than the control group.Results
Adjusted for baseline technique and other covariates, eye drop technique averaged 0.73 steps better in intervention patients than controls immediately after the video (p?=?0.003) and 0.63 steps better at 1 month (p?=?0.01). Adjusted for baseline self-efficacy, intervention patients had better eye drop technique self-efficacy than controls immediately after the video (p?=?0.02) and at 1 month (p?=?0.02).Conclusion
A short educational video can significantly improve glaucoma patients’ short-term self-efficacy and eye drop technique.Practice implications
Videos may provide an inexpensive, convenient way to deliver eye drop technique education in any provider’s office or online. 相似文献17.
Nahed A. Soliman Shaimaa M. Yussif Abdelhadi M. Shebl 《Pathology, research and practice》2019,215(5):977-982
Introduction
Syndecan-1 is heparan sulfate proteoglycans (HSPGs) that is used as coreceptors for signaling of growth factors. The comprehensive effect of syndecan-1 is to augment receptor stimulation at little ligand concentrations.The goal of this research
is to study syndecan-1 expression in breast carcinoma and its value in predicting the prognosis in comparison to other clinicopathological parameters.Material &methods
immunohistochemistry study for syndecan-1 is done on 103 cases of invasive breast carcinoma. Its expression is assessed and correlated to other clinicopathological parameters and prognosis.Results
overexpression was significantly related to high histologic grade (p?=?0.001), large tumor size (p?=?0.043), HER2-positive status (p?=?0.001), and ER&PR-negative status (p?=?0.001). It was also have a negative impact on the overall survival (p=0.012) and disease free survival (p?=?0.009). Syndecan-1 expression showed weak positive correlation with Her 2 expression (Correlation Coefficient (co): 0.332, p?=?0.001).Conclusion
syndecan-1 is a good predictor of poor overall survival and recurrence/ metastasis free survival. It is associated with aggressive phenotype as HER2 enriched and Triple negative rather than luminal subtypes of breast carcinoma. So it can be added to the hormonal receptors and HER 2 assay in the routine management of invasive breast cancer after confirmation on a more larger study. 相似文献18.
Megan Jarman Laura Adam Wendy Lawrence Mary Barker Rhonda C. Bell 《Patient education and counseling》2019,102(5):924-931
Objective
In a pilot RCT we assessed training a dietitian in “Healthy Conversation Skills” (HCS) to support behavior change. This study describes the acceptability of the intervention from the participant and practitioner perspective.Methods
Seventy pregnant women participated (intervention?=?33; control?=?37). The evaluation included: i)audio-recording sessions to assess use of HCS from the intervention dietitian; ii)semi-structured interview with the intervention dietitian to assess experiences of using HCS; iii)Quality of Prenatal Care Questionnaire and focus groups to assess participants’ views of study experience.Results
Intervention sessions involved conversations where the dietitian used HCS. The dietitian reflected on the simplicity of learning HCS in training but the challenges of embedding these new skills in practice and highlighted the need to review and reflect on practice as an ongoing process. Intervention participants were more satisfied with the study (p?=?0.05) and more likely to agree that the dietitian took time to ask about things that were important to them (p?=?0.04) than control participants.Conclusion
Use of HCS by practitioners is an acceptable way to support lifestyle changes in pregnancy.Practice implications
Use of HCS provide opportunities to support behaviour change. Review of and reflecting on practice may facilitate the application of new skills in practice. 相似文献19.
Marleen Kunneman Michael R. Gionfriddo Freddy J.K. Toloza Fania R. Gärtner Gabriela Spencer-Bonilla Ian G. Hargraves Patricia J. Erwin Victor M. Montori 《Patient education and counseling》2019,102(3):452-466
Objective
To assess the extent to which evaluations of shared decision making (SDM) assess the extent and quality of humanistic communication (i.e., respect, compassion, empathy).Methods
We systematically searched Web of Science and Scopus for prospective studies published between 2012 and February 2018 that evaluated SDM in actual clinical decisions using validated SDM measures. Two reviewers working independently and in duplicate extracted all statements from eligible studies and all items from SDM measurement instruments that referred to humanistic patient-clinician communication.Results
Of the 154 eligible studies, 14 (9%) included ≥1 statements regarding humanistic communication, either in framing the study (N?=?2), measuring impact (e.g., empathy, respect, interpersonal skills; N?=?9), as patients’/clinicians’ accounts of SDM (N?=?2), in interpreting study results (N?=?3), and in discussing implications of study findings (N?=?3). Of the 192 items within the 11 SDM measurement instruments deployed in the included studies, 7 (3.6%) items assessed humanistic communication.Conclusion
Assessments of the quality of SDM focus narrowly on SDM technique and rarely assess humanistic aspects of patient-clinician communication.Practice implications
Considering SDM as merely a technique may reduce SDM’s patient-centeredness and undermine its’ contribution to patient care. 相似文献20.
Jesse C. Christensen Ryan L. Mizner K. Bo Foreman Paul C. LaStayo Christopher L. Peters Christopher E. Pelt 《The Knee》2019,26(1):79-87