Effect of weight-bearing wrist movement with carpal-stabilizing taping on pain and range of motion in subjects with dorsal wrist pain: A randomized controlled trial

Study DesignRandomized control trial.IntroductionDuring weight-bearing wrist movement, potential stabilizing forces caused by carpal stabilizing taping (CST) may restrict movement of the carpal bones, allowing greater wrist joint extension.Purpose of the StudyThe purpose of study was to investigate the effect of CST during weight-bearing wrist movement on pain intensity and range of motion (ROM) of wrist extension in subjects with dorsal wrist pain.MethodsThirty participants with dorsal wrist pain when weight bearing through the hand were randomly allocated into 2 groups: (1) a CST group using rigid tape and (2) placebo taping (PT) group using elastic tape. Subjects performed weight-bearing wrist movements with CST or PT in 6 sessions for 1 week. Active and passive ROM (AROM and PROM), and the visual analog scale (VAS) were assessed at baseline and after the intervention.ResultsThe AROM and PROM of wrist extension increased significantly in both groups compared with preintervention values (P < .01). Comparing the PT and CST groups, the differences between preintervention and postintervention AROM (mean difference [MD] = +8.6°) and PROM (MD = +6.8°) were significantly greater in the CST group than in the PT group (P < .01). The CST group also showed greater improvement in VAS compared with the PT group (MD = −18 mm) (P < .01).ConclusionWe recommend CST during weight-bearing wrist movement as an effective intervention for both increasing wrist extension ROM and decreasing pain in patients with dorsal wrist pain during weight bearing through the hand.     

Histopathological Evaluation of Gallbladder Specimens Obtained From Living Liver Donors

BackgroundCholecystectomy is routinely performed during living donor hepatectomy both to see the structure of the biliary tract and to determine the demarcation line based on the biliary tract junction. This study aims to present the general histopathological features of the gallbladder specimen obtained from living liver donors (LLD).MethodsData from 2577 LLDs who underwent living donor hepatectomy (n = 2511) or aborted living donor hepatectomy (n = 66) in our Liver Transplantation Institute between September 2005 and June 2021 were analyzed retrospectively. Age, gender, macroscopic (length, diameter, and wall thickness), and microscopic (histopathological) features of the gallbladder of the LLDs were recorded for use in this study.ResultsA total of 2493 LLDs (men: 1486, women: 1007) with a median age of 29 years (interquartile range [IQR]: 13) met the inclusion criteria in this study. The median length, width and wall thickness of the gallbladder specimens were measured as 70 mm (IQR: 20), 50 mm (IQR: 20), and 2 mm (IQR: 1), respectively. The most common histopathological findings are normal structure (2026; 81.3%), chronic cholecystitis (n = 446; 17.9%), adenomyomatosis (n = 9), and papillary hyperplasia (n = 6), respectively. The most common pathologic findings in the gallbladder lumen are cholesterolosis (n = 207; 0.4%), cholelithiasis (n = 53), cholesterol polyp (n = 31), and noncholesterol polyp (n = 19), respectively. Significant differences were detected between the male and female genders in terms of age (P < .001), height (P < .001), weight (P < .001), body mass index (P < .001), gallbladder width (P = .001), gallbladder length (P < .001), histopathological finding (content) (P < .001), and lymph node around the gallbladder (P = .015).ConclusionsThe results we obtained in this study are true gallbladder pathologies that can be detected in healthy people. In this study, it was shown that the diameter and size of the gallbladder were larger in men, whereas the incidence of cholesterolosis and cholelithiasis was higher in women.     

Self-identified functional limitations improve in patients with degenerative wrist arthritis after surgery

Study DesignThis is a prospective cohort pilot study.BackgroundDegenerative wrist arthritis leads to pain, loss of strength, mobility, function, and impairments in psychological well-being. Accurate assessment of functional limitations that are unique to the individual is essential for successful treatment that best meets those specific needs.Purpose of the StudyTo identify and determine if self-identified functional limitations improve in patients who underwent surgery for degenerative wrist arthritis.MethodsPatients with degenerative wrist arthritis who were scheduled for surgery were prospectively recruited (n = 14, mean age + SD = 42 + 16, 10 males, 4 females) into a pilot study that measured self-identified functional limitations and outcomes. Inclusion criteria included a diagnosis of scapholunate advanced collapse, scaphoid nonunion advanced collapse, scapholunate interosseous ligament tear, or Kienböck disease. Exclusion criteria included a history of neuromuscular disease or concomitant ipsilateral musculoskeletal injury. Data were collected during two 20-minute sessions, preoperatively and one year postoperatively, utilizing the Patient-Rated Wrist Evaluation and the Canadian Occupational Performance Measure.ResultsAll patients reported significant decreases (P < .001) in total pain (mean change = 17.6, SD = 8.5) and total disability (mean = 17.8, SD = 9.1) on the Patient-Rated Wrist Evaluation from presurgery to postsurgery, with a large effect size of d > 0.8. Patients also reported significant improvements (P < .001) in mean performance (mean = 3.5, SD = 1.5) and mean satisfaction (mean = 4.0, SD = 2.1) with self-identified activities on the Canadian Occupational Performance Measure, with an effect size of d > 0.8.ConclusionPatients with degenerative wrist arthritis reported significant postoperative improvement in both performance and satisfaction in self-identified activities. Consideration of patient-specified goals can inform both patients and clinicians during the surgical decision-making process and allow for more individualized care.     

Ultrasound assessment of extensor pollicis brevis tendon excursion in different wrist positions in healthy people

Study DesignCross-sectional, observational study.IntroductionThere is little reported on the in vivo mechanics and behavior of extensor pollicis brevis (EPB) in relation to wrist position. Wrist position is known to significantly influence tendon excursion and therefore function of the digits. Ultrasound imaging (USI) can be used to assess in vivo tendon behavior and excursion. An improved knowledge of the excursion of the EPB tendon is important in understanding normal tendon mechanics and potentially pathological tendon disorders such as de Quervains tenosynovitis.Purpose of the StudyTo assess the reliability of using USI to measure EPB tendon excursion and to quantify EPB tendon excursion in 3 wrist positions.MethodsUSI with speckle-tracking analysis were utilized to assess 49 normal EPB tendons (25 subjects). Tendon excursion was measured in wrist flexion (45°), wrist neutral and wrist extension (45°) on 2 different occasions.ResultsThe within- and between-session reliability of using USI to quantify EPB tendon excursion was “excellent” and “high,” respectively. Wrist position had a significant influence on EPB tendon excursion (P ≤ .05). EPB excursion in the neutral wrist position was statistically greater than the other 2 positions (P < .05).DiscussionEPB tendon excursion has been shown to be dependent on the wrist positions of flexion and extension. The measures are notably lower than those found in cadaver studies; however, they follow a similar pattern with greatest excursion occurring in the neutral wrist position and least in flexion. This information is useful for EPB tendon rehabilitation and in consideration of biomechanics and pathogenesis of disorders that affect EPB tendon.ConclusionIn vivo EPB tendon excursion measures have been quantified, and wrist position has been found to have an influence on excursion. USI with speckle-tracking analysis are considered to be reliable methods for measuring EPB tendon excursion.     

An analysis of readmission trends by urgency and race/ethnicity in the MBSAQIP registry, 2015–2018

BackgroundLarge-scale analyses stratifying bariatric surgery readmissions by urgency are lacking.ObjectivesIdentify predictors of urgent/nonurgent readmission among “ideal” bariatric candidates, using a national registry.SettingMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database.MethodsWe extracted an “ideal” patient cohort from the 2015–2018 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) registry, characterized by only typical weight-related comorbidities (hypertension [HTN], obstructive sleep apnea [OSA], gastroesophageal reflux disease [GERD], and diabetes (insulin-dependent diabetes mellitus [IDDM] and non–insulin-dependent diabetes mellitus [NIDDM]) undergoing primary bariatric surgery with an uneventful postoperative course. Readmissions were classified as “urgent” (UR; e.g., leak, obstruction, bleeding) or “nonurgent” (NUR; e.g., dehydration, nonspecific abdominal pain). χ² or t test analyses were used for bivariate significance testing. Multivariate logistic regression models were constructed to assess independent predictors of readmission.ResultsThe cohort (N = 292,547) comprised 38.5% of all MBSAQIP patients (mean age [standard deviation] = 43.2 [11.7]; body mass index [BMI] = 44.9 [6.6]; 81% female; 62% White, 17% Black, 14% Hispanic). Total readmission rates were 2.75% (n = 8046) and decreased from 2015–2018 (3.00%–2.63%; P < .001). Independent predictors of readmissions included Roux-en-Y gastric bypass (RYGB) (odds ratio [OR] = 1.97, p < .001), Black (OR = 1.46, P < .001) and Hispanic race (OR = 1.14, P < .001), GERD (OR = 1.27, P < .001), HTN (OR = 1.08, P = .003), and IDDM (OR = 1.39, P < .001). NUR and UR readmission rates were 1.27% (n = 3702) and 1.06% (n = 3090), respectively. NURs decreased over time (1.42%–1.16%, P < .001), with no change in Urs (1.01%–1.06%, P = .51); this trend persisted in multivariate analysis (2017: NUR OR = .85, P < .001; 2018: NUR OR = .82, p < .001). Independent predictors of both URs and NURs included Black (NUR OR = 1.71, p < .001; UR OR = 1.27, p < .001) and Hispanic (NUR OR = 1.15, P < .001; UR OR = 1.19, P < .001) race, RYGB (NUR OR = 1.84, P < .001; UR OR = 2.34, P < .001), and GERD (NUR OR = 1.39, p < .001; UR OR = 1.17, P < .001). Female sex (NUR OR = 1.64, P < .001), age (NUR OR = .98, P < .001), HTN (NUR OR = 1.22, P < .001), and IDDM (NUR OR = 1.41, P < .001) predicted NURs, while higher BMI (UR OR = 1.01, P < .001), and OSA (UR OR = 1.10, P = .02) predicted URs.ConclusionReadmission rates for “ideal” bariatric patients improved over time, driven by reductions in non-urgent etiologies. Racial disparities persist for both urgent and non-urgent causes of readmission.     

Self-efficacy corresponds to wrist function after combined plating of distal radius fractures

Study DesignA prospective cohort single-center study.IntroductionSelf-efficacy (SE) refers to beliefs in ones capabilities to organize and execute the courses of action required to produce given goals. High SE is an important factor for recovery from injury/illness; people who believe in their capability will more likely reach a good outcome.Purpose of the StudyThe aim of this study was to examine if SE has an effect to physical functioning, pain and patient-rated wrist function three months postoperatively in patients undergoing plating due to a distal radius fracture.MethodsSixty-seven patients undergoing plating for a distal radius fracture rated SE at the first appointment with the physiotherapist. At the three-month follow-up, the following assessments were administered: Patient-Rated Wrist Evaluation (PRWE), pain-scores, hand grip strength, and range of motion.ResultsThe group with a high SE showed significantly better range of motion for flexion (P = .046) and supination (P = .045), hand grip strength (P = .001) and PRWE scores (P = .04). The NRS pain during activity was lower, although not significantly lower (P = .09). Using Spearman's rank correlation coefficient, there was a moderate correlation between SE and pain during activity, wrist flexion, and PRWE score.DiscussionSE corresponds to wrist function after combined plating of distal radius fractures.ConclusionMeasurement of SE could possibly be useful to identify patients in special need of support during the postoperative rehabilitation.     

Histopathological Features of Gallbladder Specimens Obtained From Liver Recipients

BackgroundTo evaluate the histopathological features of gallbladder specimens obtained from liver transplantation (LT) recipients and to find the correlation between these findings with the clinical features of patients.MethodsThe 1985 patients who underwent LT in our institute between March 2002 and January 2021 and whose data regarding pathologic analysis of gallbladder could retrospectively be obtained were included in the study. The data of the patients including age, gender, the reason for LT (fulminant or nonfulminant), presence of ascites, macroscopic characteristics of gallbladder (the length, diameter, and wall thickness), and microscopic findings were all obtained and analyzed in the present study.ResultsA total of 1985 patients (men = 1300 and women = 685) with a median age of 39.4 years were included in this study. LT was performed in 249 patients because of fulminant liver failure, and abdominal ascites were detected in 933 patients during LT. There were statistical differences in terms of age (P < .001), gallbladder length (P < .001). and width (P < .001) among the both gender, but there was no difference in terms of histopathologic characteristics and presence of gallstones. On the other hand, there were significant differences in terms of age (P < .001), gallbladder length (P < .001), width (P < .001), wall thickness (P = .021), presence of gallstones (P < .001), and histopathologic characteristics (P < .001) between the patients with fulminant and nonfulminant liver failure etiologies. Similar results were obtained when characteristics of patients with and without ascites were compared.ConclusionsThis the first study analyzing the histopathological analysis of gallbladder specimens in LT recipients. Chronic liver disease, presence of ascites and gender are the factors affecting the macroscopic and microscopic features of the gallbladder.     

Age at the Time of Surgery Is Not Predictive of Early Patient-Reported Outcomes After Periacetabular Osteotomy

BackgroundThe clinical success of periacetabular osteotomy (PAO) for the treatment of symptomatic acetabular dysplasia is well-documented. Conflicting evidence exists regarding the correlation of age with clinical outcomes. Hip disability and Osteoarthritis Outcome Score - global (HOOSglobal) is a recently validated patient-reported outcome measure following PAO. The purpose of this study is to asses HOOSglobal and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at early follow-up based on age at the time of PAO.MethodsA prospective multicenter cohort of 391 patients undergoing PAO with minimum 2-year follow-up (average 4.71 years) were identified. Patients were categorized into 4 age groups: <20 years (N = 131), 20-29 (N = 102), 30-39 (N = 65), and ≥40 (N = 34). A 4 × 2 repeated measures analysis of variance (Age Group × Time) was used to compare preoperative and postoperative HOOSglobal and WOMAC scores between age groups. A multiple linear regression was used to identify predictors of postoperative HOOSglobal scores.ResultsHOOSglobal and WOMAC scores increased across all age groups; however, a statistically greater increase in preoperative to postoperative HOOSglobal and WOMAC scores was found in those ≥40 years compared to those <20 (P < .002), 20-29 (P = .01), and 30-39 years (P = .02). Higher preoperative HOOSglobal scores were predictive of greater postoperative HOOSglobal scores (P < .001) but age (P = .65), gender (P = .80), body mass index (P = .50), and Tönnis Classification (P = .07) were not independent predictors of 1-year outcomes.ConclusionThe absence of differences in early postoperative patient-reported outcomes across multiple age ranges emphasizes that PAO in the setting of symptomatic acetabular dysplasia can be successful regardless of patient age alone. Therefore, age alone might not be an appropriate selection criterion when evaluating surgical candidates for PAO.Level of EvidenceII.     

Effect of Kinesio taping on wrist kinematics and functional performance: A randomized controlled trial

BackgroundKinesio taping (KT) is a popular adjunct treatment modality for musculoskeletal injuries, hand and wrist injuries. The effectiveness of KT on wrist kinematics has been analyzed during single plane movements in general, and no study has investigated its effectiveness during dart throwing motion (DTM).PurposeTo compare the effects of different KT techniques on wrist kinematics during DTM and functional performance of hand in healthy participants.Study DesignRandomized, double-blind, placebo-controlled, crossover study.MethodsSeventy-two healthy participants were included. Dominant wrist kinematics during DTM was evaluated by a Leap motion controller and wrist functional performance was evaluated by Minnesota Manual Dexterity Test. In order to compare the effects of KT on different muscles and also the effects of KT and placebo taping (PT), wrists of participants were evaluated under 5 conditions: without any taping, KT on flexor carpi ulnaris (FCU), KT on extensor carpi radialis brevis and longus (ECRB/L), PT on FCU and PT on ECRB/L. Means of outcome measures without any taping and with different 4 tapings were compared by repeated measures analysis of variance. PT and KT effects were compared by Wilcoxon signed rank test.ResultsDTM range increased (P = .0) and Minnesota Manual Dexterity Test time decreased (P = .0) after KT and PT applications on FCU and ECRB/L muscles. Amount of change in wrist kinematics (P = .0; effect size = 0.2 and 0.3) and functional performance (P = .0; effect size = 0.6 and 0.8) were more obvious with KT applications, independent from the muscles they were applied on (P = .2 for wrist kinematics and P = .7 for functional performance).ConclusionsKT on either FCU or ECRB/L muscles improve wrist kinematics and functional performance, significantly. Further studies should investigate if these findings apply for the patients with different wrist injuries, for both immediate- and long-term effectiveness.     

Importance of Imaging Plane of Gadoxetic Acid--Enhanced Magnetic Resonance Cholangiography for Bile Duct Anatomy in Healthy Liver Donors

PurposeThe purpose of this study was to compare the image quality and accuracy of axial vs coronal contrast-enhanced magnetic resonance cholangiography (CE-MRC) for assessing bile duct anatomy.MethodsData from 313 healthy donors who underwent axial and coronal CE-MRC before liver donation were retrospectively analyzed. Motion artifacts and bile duct visibility were assessed using 4-point scales, with scores ≥3 considered interpretable. The sensitivity and specificity of axial and coronal CE-MRC for diagnosing anatomic variations were compared, as were the proportions of correctly categorized biliary anatomic types.ResultsAxial CE-MRC provided better image quality than coronal CE-MRC in terms of both motion artifacts (3.83 vs 3.17; P < .001) and duct visibility (3.50 vs 3.17, P < .001), resulting in more interpretable images with axial than coronal CE-MRC (92.7% vs 82.1%; P < .001). Among 249 donors with interpretable images, coronal CE-MRC performed significantly better for identifying duct anatomic variation than axial CE-MRC (sensitivity, 96.9% vs 80.4%, P < .001; specificity, 100% vs 96.7%, P = .025). Coronal CE-MRC was significantly better than axial CE-MRC at correctly categorizing anatomic types of right posterior hepatic duct into left hepatic duct and accessory duct with incomplete right hepatic duct.ConclusionsWith interpretable image quality, coronal CE-MRC performed better than axial CE-MRC for evaluating bile duct anatomy.     

Primary laparoscopic sleeve gastrectomy versus gastric bypass: a propensity-matched comparison of 30-day outcomes

BackgroundBariatric surgery is the most effective treatment for obesity. There is uncertainty regarding rates of adverse outcomes between the most common methods: laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG).ObjectivesTo compare rates of readmission, reoperation, intervention, unplanned intensive care unit (ICU) admission, all-cause and procedure-related mortality, and postoperative complications at 30 days between LRYGB and LSG.SettingRetrospective, observational, multicenter registry.MethodsWe identified 611,619 patients from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry between January 1, 2015, and December 31, 2018 (447,326 [73.1%] LSG; 164,293 [26.9%] LRYGB).ResultsAdverse events were more common after LRYGB (readmission: 3% with LSG versus 5.9% with LRYGB [P < .001; odds ratio {OR}, LSG/LRYGB = .489]; intervention: .9% with LSG versus 2.4% with LRYGB [P < .001; OR, LSG/LRYGB = .357]; reoperation: .8% with LSG versus 2.3% with LRYGB [P < .001; OR, LSG/LRYGB = .363]; unplanned ICU admission: .52% with LSG versus 1.1% with LRYGB [P < .001; OR, LSG/LRYGB = .454]; all-cause mortality: .07% with LSG versus .15% with LRYGB [P < .001; OR, LSG/LRYGB = .489]; procedure-related mortality: .04% with LSG versus .08% with LRYGB [P < .001; OR, LSG/LRYGB = .446]; Clavien-Dindo I: .20% with LSG versus .63% with LRYGB [P < .001; OR, LSG/LRYGB = .317]; Clavien-Dindo II: .70% with LSG versus 1.3% with LRYGB [P < .001; OR, LSG/LRYGB = .527]; Clavien-Dindo III: 3.3% with LSG versus 6.6% with LRYGB [P < .001; OR, LSG/LRYGB = .481]; Clavien-Dindo IV: .36% with LSG versus .76% with LRYGB [P < .001; OR, LSG/LRYGB = .466]; and Clavien-Dindo V: .07% with LSG versus .15% with LRYGB [P < .001; OR, LSG/LRYGB = .488]). Surgery type was among the strongest independent predictors of adverse events, and LRYGB conferred higher adjusted odds of all adverse outcomes (all-cause mortality: OR, LRYGB/LSG = 1.791 [P < .001]; procedure-related mortality: OR, LRYGB/LSG = 1.979 [P < .001]; readmission: OR, LRYGB/LSG = 1.921 [P < .001]; unplanned ICU admission: OR, LRYGB/LSG = 1.870 [P < .001]; intervention: OR, LRYGB/LSG = 2.662 [P < .001]; reoperation: OR, LRYGB/LSG = 2.646 [P < .001]; and Clavien-Dindo grade: OR, LRYGB/LSG = 2.007 [P < .001]).ConclusionThe rates of 30-day adverse outcomes are lower after LSG compared with after LRYGB. LRYGB independently conferred increased odds of adverse outcomes compared with LSG, and surgery type was among the strongest predictors of adverse outcomes.     

Sonographic assessment of calcium pyrophosphate deposition disease at wrist. A focus on the dorsal scapho-lunate ligament

ObjectivesTo investigate the diagnostic accuracy of ultrasound and conventional radiography in the evaluation of calcium pyrophosphate crystal deposits at wrist level.MethodsConsecutive patients with a “definite” diagnosis of calcium pyrophosphate deposition disease and disease-controls were prospectively included in this cross-sectional single-centre study. Scapho-lunate ligament, triangular fibrocartilage complex, and volar recess of the radio-lunate joint were explored using ultrasound, conventional radiography and computed tomography.ResultsSixty one patients and 39 disease controls were enrolled. Two-hundred wrists were evaluated using both conventional radiography and ultrasound and 26 using computed tomography. Ultrasound findings indicative of crystal deposits were found in at least one wrist in 95.1% of patients and in 15.4% of controls (P < 0.001). Scapho-lunate ligament calcifications were reported in 83.6% of patients and in 5.1% of controls (P < 0.001). On conventional radiography, calcifications were found in at least one wrist in 72.1% of patients and in 0% of controls (P < 0.001). Using the Ryan-McCarty criteria as a gold standard, sensitivity, specificity and diagnostic accuracy were 0.72 (0.59–0.83), 1.0 (0.91–1.0) and 0.83 (0.74–0.90) for conventional radiography and 0.95 (0.86–0.99), 0.85 (0.69–0.94) and 0.91 (0.84–0.96) for ultrasound. The agreement between ultrasound and computed tomography was substantial when assessing triangular fibrocartilage complex (kappa = 0.70; 0.43–0.97) and scapho-lunate ligament (kappa = 0.69; 0.41–0.97), and moderate for radio-lunate joint (kappa = 0.46; 0.12–0.80).ConclusionsThis study supports the diagnostic accuracy of ultrasound in evaluating wrist involvement in calcium pyrophosphate deposition disease. The inclusion of the scapho-lunate ligament in a disease-oriented scanning protocol could improve the diagnostic performance of ultrasound.     

Wrist pain in gymnasts: Efficacy of a wrist brace to decrease wrist pain while performing gymnastics

Study DesignThis was a clinical trial of prospective cohort.IntroductionWrist pain in gymnasts is a global phenomenon. Compression forces acting on wrists while performing gymnastics is a predisposing factor in the development of wrist pain and consequential injury of the distal radial physis in skeletally immature gymnasts. One approach to mitigate these forces is wrist bracing; however, studies on the efficacy of wrist braces to reduce wrist pain experienced by gymnasts are limited.Purpose of the StudyThe purpose of this study was to investigate the efficacy of an innovative design of a wrist brace to decrease gymnasts' wrist pain while performing gymnastics.MethodsA wrist brace was designed and trialled over 3 weeks by 48 male gymnasts (aged 8-22 years, levels 4-7) with wrist pain. Wrist pain was recorded on a visual analog scale of 1 to 10 before and after trial. Data analysis was performed using SPSS-22 (IBM Inc). Paired t-tests were performed to compare variables before and after trial, with effect size analyses used to quantify the relative magnitude of any differences.ResultsPaired t-tests indicated the gymnasts reported significantly reduced pain (P = .002; 53.5%) while wearing the braces for training on the pommel, floor, and parallel bars. The overall large effect size value was practically significant (d = 0.902).DiscussionFor any wrist brace to be effective, it needs to be implemented when the gymnast experiences wrist pain before an injury occurs. This would minimize the development of pain-provoked adaptive movement patterns that perpetuate dysfunction.ConclusionsThe brace with the volar gel pad is recommended to be worn as an adjunct to current strategies in management of gymnasts' wrist pain or as an injury prevention device in skeletally immature gymnasts.     

Predictive Factors for Revision and Survivorship Analysis of a Prevalent 36-mm Metal-on-Metal Total Hip Replacement System: A Large Single-Center Retrospective Cohort Study

BackgroundTo our knowledge, this is the largest single-center cohort of the 36-mm Corail-Pinnacle metal-on-metal total hip replacements system, aiming to determine 10-year survivorship and identify predictors of revision. We further assessed year of implantation given reports of manufacturing variations affecting shells made after 2006 predisposing these components to increasing wear.MethodsAll Corail-Pinnacle 36-mm metal-on-metal hips implanted in a single center (2005-2012). The effect of patient and implant-related variables, and year of implantation on revision risk was assessed using Kaplan-Meier, Cox regression, and interrupted time series analysis.ResultsIn total, 1212 metal-on-metal total hip replacements were implanted with a 10-year survival rate of 83.4% (95% confidence interval [CI] = 81.3-85.5). Mean follow-up duration was 7.3 years with 61% of patients reaching a minimum of 7 years of follow-up. One hundred nineteen patients required revision surgery (9.8%). Univariate analysis identified female gender (hazard ratio [HR] = 1.608, CI = 1.093-2.364, P = .016), age at implantation (HR = 0.982, CI = 0.968-0.997, P = .019), smaller 50-mm to 54-mm cup diameter (HR = 1.527, CI = 1.026-2.274, P = .037), and high-offset stems (HR = 2.573, CI = 1.619-4.089, P < .001) as predictors of revision. Multivariate modeling confirmed female gender and high-offset stems as significant predictors of revision. For components implanted after 2007, the number of revisions showed no statistically significant step increase compared to pre-2007 implantation.ConclusionWe observed a high 10-year failure rate (16.6%) with this implant, mostly due to adverse reaction to metal debris. Female gender and high femoral offset stems were significant predictors for all-cause revision. Year of implantation was not significantly associated with an increasing number of revisions from 2007 onwards, although further studies to validate the impact of manufacturing discrepancies are recommended.     

Age but not gender modulates the relationship between PTH and vitamin D

ContextIt is unclear whether the relationship between 25-OHD and PTH is modulated by age or gender.ObjectiveTo assess the 25-OHD–PTH relationship in 340 adolescents (10–17 years) and 443 elderly (65–85 years) of the same ethnic group, and living in the same sunny country.AssessmentsCalcium intake was estimated. Serum calcium, phosphorus, 25-OHD and PTH were measured. Body fat was determined by DXA.Results25-OHD levels were lower in the elderly in the overall group (p < 0.001) and within genders. 25-OHD levels were lower in females in the overall group and within age subgroups (p < 0.05). PTH levels were higher in the elderly in the overall population and in both genders (p < 0.001). There were no gender differences in PTH levels within age subgroups. For the same 25-OHD level, PTH levels were comparable across genders but were 1.5–2 folds higher in the elderly compared to adolescents (p < 0.001). PTH correlated positively with age (p < 0.001), body fat (p = 0.02), and negatively with calcium intake (p < 0.001), and 25-OHD (p < 0.001). The magnitude of the correlation with 25-OHD decreased after adjustment for age but not for gender. In multivariate analyses, age, 25-OHD and fat mass were independent predictors for PTH. In the elderly, after adjustment for serum creatinine, only 25-OHD and creatinine were independent predictors of PTH.ConclusionThe negative relationship between 25-OHD and PTH is modulated by age but not gender. Desirable 25-OHD levels derived from examining the 25-OHD–PTH relationship should therefore take into account the age of the population of interest.     

Urinary Retinol-Binding Protein 4 is Associated With Renal Function and Rapid Renal Function Decline in Kidney Transplant Recipients

BackgroundUrinary retinol-binding protein 4 (RBP4) has been known as a biomarker of chronic kidney disease. In this study, we evaluated the association of urinary RBP4 with renal function and progression of renal function in kidney transplant recipients (KTRs).MethodsA total 50 KTRs were included in this study. Proteomic analysis with liquid chromatography-mass spectrometry and tandem mass spectrometry was performed to discover potential urinary biomarkers. Several urinary proteins including RBP4 were identified and then validated by enzyme-linked immunosorbent assay. Rapid renal function decline was defined as estimated glomerular filtration rate (eGFR) decline of >3 mL/min/1.73 m²/year or initiation of dialysis, and 19 (38%) were included in rapid renal function decline group.ResultsUrinary RBP4/creatinine was inversely correlated with allograft function (r = –0.54, P < .001 with eGFR, and r = 0.49, P < .001 with serum creatinine, respectively). Urinary RBP4/creatinine was higher in rapid renal function decline group than in stable renal function group (184.9 ± 156.7 vs 83.1 ± 99.9, P = .017). Log-transformed urinary RBP4/creatinine was significantly associated with rapid renal function decline in univariate logistic regression analysis (Odds ratio [OR] 7.59, confidence interval [CI] 2.04-36.70, P = .005). In multivariate logistic regression adjusted with recipient age and sex, donor age, number of HLA mismatch, and acute rejection episode, urinary RBP4/creatinine remained a significant factor for rapid renal function decline (OR 9.43, CI 1.99-65.65, P = .010). Receiver operating characteristic analysis showed that the area under the curve of urinary RBP4/creatinine was 0.747 (CI 0.608-0.886, P < .001) for rapid renal function decline.ConclusionsUrinary RBP4 levels are associated with renal function and might be used to predict rapid renal function decline in KTRs.     

A National Cancer Database analysis of the predictors of unplanned 30-day readmission after proctectomy for rectal adenocarcinoma: The CCF RETURN-30 Score

BackgroundUnplanned 30-day readmission is common after major surgery, including rectal cancer surgery. The present study aimed to assess the rate and predictors of unplanned 30-day readmission after proctectomy for rectal cancer.MethodsThis was a retrospective case-control study using data from the National Cancer Database. Patients with non-metastatic rectal cancer who underwent proctectomy were included, and patients who required readmission within 30 days after discharge were compared to patients who were not readmitted in regard to patient and treatment baseline factors to determine the predictors of 30-day readmission after proctectomy. The main outcome measures were the rate and predictors of 30-day unplanned readmission and the impact of readmission on short-term mortality and overall survival.ResultsA total of 55,181 patients (60.9% men) with a mean age of 61.2 years were included. The 30-day readmission rate was 7.07% (95% confidence interval: 6.9–7.3). A Charlson score of 0 (odds ratio: 0.75, P < .001), Medicare insurance (odds ratio: 0.836, P = .04), and private insurance (odds ratio: 0.73, P = .0003) were predictive of a lower likelihood of 30-day readmission, whereas urban living area (odds ratio: 1.18, P = .01), rural living area (odds ratio: 1.65%, P = .0004), neoadjuvant radiation therapy (odds ratio: 1.37, P = .001), pull-through coloanal anastomosis (odds ratio: 1.37, P = .0005), conversion to open surgery (odds ratio: 1.25, P = .001), and hospital stay ≥6 days (odds ratio: 1.02, P < .001) were predictive of a higher likelihood of 30-day readmission. Readmitted patients had a higher rate of 90-day mortality (3.1% vs 2.1%, P < .001) and a lower 5-year overall survival (67.0% vs 72.7%, P < .001) than non-readmitted patients. Using the weighted ORs of the significant predictors of 30-day readmission, a risk score, the Cleveland Clinic Florida REadmission afTer sUrgery for Rectal caNcer in 30 days (RETURN-30) score, was developed.ConclusionComorbidities, residence in urban or rural areas, neoadjuvant radiation therapy, pull-through coloanal anastomosis, conversion to open surgery, and extended hospital stay were predictive of a higher risk of 30-day readmission. Patients who were readmitted had a higher rate of 90-day mortality and a lower 5-year overall survival.     

Factors associated with grip strength among adolescents: An observational study

Study DesignCross-sectional.IntroductionThe muscle strength has been studied in different populations in relation with individual and other factors.Purpose of the StudyThe purpose of this study was to determine values of grip strength in adolescents and to examine its association with sex, age, weight, height, nutritional status, handedness, and academic performance.MethodsA total of 452 adolescents (246 men and 206 women) aged 12 to 17 years were included in the study. Grip strength was measured using a Takei dynamometer.ResultsBoys were significantly stronger than girls with both the dominant hand (33.1 kgf vs 25.0 kgf; mean difference = 8.1 kgf; P < .001) and the nondominant hand (30.9 kgf vs 23.1 kgf; mean difference = 7.8 kgf; P < .001), and there was a significant increase in strength values as the age rises in both sexes (P < .001). The dominant hand was stronger than the nondominant one (29.4 kgf vs 27.3 kgf; mean difference = 2.1 kgf; P < .001), except for left-handed subjects who were significantly stronger than right-handed ones in their nondominant hand. Furthermore, strength was positively associated with nutritional status and negatively associated with academic performance in men.ConclusionsSex, age, handedness, nutritional status, and academic performance have a significant influence on the grip strength values. There seems to be a sexual dimorphism in the relationship between strength and both nutritional status and academic performance.