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1.
Takashi Kaito Shiro Ohshima Hiroyasu Fujiwara Takahiro Makino Shota Takenaka Yusuke Sakai Hideki Yoshikawa 《Journal of orthopaedic science》2019,24(2):214-218
Background
Biologic agents (BAs) enabled not only a reduction of disease activity but also a slowing down of structural damage to the joints in patients with rheumatoid arthritis (RA). However, the incidence of cervical lesions in patients with RA is still high.Purpose
To elucidate the predictors for the progression of two different cervical lesions in patients with RA under BA treatment.Methods
Of 151 subjects who received more than two years of continuous BA treatment, 101 subjects who had cervical X-ray images taken at baseline and final visit were enrolled. The mean disease duration and mean radiography interval were 10.6 years and 4.4 years, respectively. The existence and progression of cervical lesions (atlanto-axial subluxation [AAS], vertical subluxation [VS], and subaxial subluxation [SS]) were investigated. And predictors for the AAS or VS progression were analyzed by multivariate logistic regression analysis.Results
The incidence of cervical lesions at baseline were no pre-existing cervical lesion (none) in 50 cases (50%), AAS only in 32 (32%), both AAS and VS in 12 (12%), and VS only in 7 cases (7%). In the none group, only 4 cases of AAS progression (8%) was observed during the follow-up. In contrast, in the groups with pre-existing cervical lesions, a high incidence of VS progression was observed (63% in the AAS only group, 58% in the AAS + VS group, and 71% in the VS only group). Multivariate regression analysis demonstrated that the DAS-CRP value at baseline (odds ratio [OR] = 9.23) and matrix metaloprotease-3 level at baseline (OR = 1.01) were significant predictors for the progression of AAS, and pre-existing AAS (OR = 18.38) was a sole significant predictor for the progression of VS.Conclusions
Cervical lesions progressed irrespective of disease activity after AAS development. Strict disease control before the development of AAS is crucial for preventing further progression and development of cervical lesions. 相似文献2.
Takamitsu Okada Hidehiko Yuge Takeshi Kamitani Takahiro Senju Naohide Takeuchi Koji Sagiyama Naoya Kozono Yoshitaka Nakanishi Hiroshi Honda Yasuharu Nakashima 《Journal of orthopaedic science》2019,24(2):258-262
Background
It is unclear whether smaller rotator cuff tears cause cartilage degeneration. This study was designed to detect early humeral head cartilage degeneration in patients with small-to-medium cuff tears using magnetic-resonance-imaging T1 rho mapping.Methods
Five male and 5 female volunteers without shoulder symptoms (control group) and 5 male and 5 female patients with small-to-medium (<3 cm) rotator cuff tears underwent 3.0-T magnetic resonance imaging of a single shoulder. T1 rho values of the humeral head cartilage were measured and analyzed.Results
The total mean T1 rho value was 40.4 ± 3.4 ms for the control group and 45.0 ± 5.3 ms for the patient group. In the control group, the T1 rho values in the inferior articular cartilage were significantly higher than those in the superior and middle articular cartilage. In the patient group, there was no significant difference between all regions. A comparison between the patient and control groups showed that the mean T1 rho values in the superior-to-middle articular cartilage were significantly higher for the patient group than for the control group. However, in the inferior articular cartilage, there was no significant difference between both groups.Conclusions
This study showed the possibility of early cartilage degenerative changes in the superior-to-middle humeral head articular cartilage of patients with small-to-medium rotator cuff tears. 相似文献3.
Takamasa Miyake Tomonori Tetsunaga Hirosuke Endo Kazuki Yamada Tomoaki Sanki Kazuo Fujiwara Eiji Nakata Toshifumi Ozaki 《Journal of orthopaedic science》2019,24(2):326-331
Background
Acetabular dysplasia of the hip following open reduction can complicate the treatment of developmental dysplasia of the hip (DDH). The purposes of this retrospective study were to investigate the long-term results of open reduction performed via an extensive anterolateral approach for DDH after walking age and to predict acetabular development using postoperative radiographs and arthrograms.Methods
From 1973 to 2001, we performed open reduction for 131 hips in 119 pediatric patients with DDH after failed closed reduction. Of these, 85 hips of 73 patients who underwent arthrography at 5 years old were followed-up radiologically until skeletal maturity. Mean age at the time of surgery was 17 ± 4.6 months (range, 10–33 months), and mean age at final survey was 19 ± 5.7 years (range, 14–33 years). Mean follow-up time was 17.7 ± 5.8 years (range, 13–32 years). Groups with satisfactory outcomes (66 hips) and unsatisfactory outcomes (19 hips) according to the Severin classification were compared. Factors predicting acetabular development were identified using univariate and multiple logistic analyses.Results
Univariate analysis showed a significant between-group difference in acetabular index (AI) at 2 months postoperatively, and in center-edge (CE) angle, cartilaginous AI (CAI), and cartilaginous CE angle at 5 years old (p < 0.05 each). In multiple logistic regression analysis, CAI at 5 years old represented a predictor of acetabular development after open reduction for DDH (odds ratio, 1.81; 95% confidence interval (CI), 1.04–3.13; p < 0.05). Area under the receiver operating characteristic curve for CAI at 5 years old was 0.93 (95%CI, 0.85–1.0), and the optimal cut-off was 10° (81.8% sensitivity, 92% specificity).Conclusions
A CAI ≥10° on hip arthrograms at 5 years old may offer a useful indicator of the need for corrective surgery following open reduction after walking age. 相似文献4.
Kosei Nagata Takeshi Ando Hideki Nakamoto So Kato Katsuyuki Sasaki Yasushi Oshima 《Journal of orthopaedic science》2019,24(2):219-223
Background
Surgical strategy for pyogenic spondylitis is controversial when vertebral body erosion is severe. Radical debridement and anterior column reconstruction is indicated for the purpose of early ambulatory to prevent secondary complication for long bed rest. However, such aggressive debridement and risk of perioperative complications are trade-off. The purpose of this study was to evaluate the risk factor of poor prognosis after anterior column debridement and reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine.Methods
We performed a retrospective review of 40 patients diagnosed with pyogenic spondylitis in lower thoracic and lumbar spine who were introduced to our institution due to losing ambulatory ability and underwent anterior column debridement and reconstruction between January 2008 and May 2016. After the patient population was split into a regaining ambulatory group (Group A; n = 23) and a poor prognosis group (Group P; n = 17), we used Fisher exact tests and t-tests as appropriate for univariate analyses to compare patient characteristics and outcomes between the 2 groups.Results
Univariate analysis showed that the significant variables were massive bleeding (>2000 ml) (P < 0.01), Charlson Comorbidity Index ≥3 (P = 0.01), and two-stage surgery needed (P = 0.04). Logistic regression analysis showed that the factors associated with poor prognosis were massive bleeding (Odds Ratio 11.9; 95% confidence interval 1.8 to 119.7; P = 0.04).Conclusions
Massive bleeding was associated with poor prognosis after debridement followed by anterior column reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine. 相似文献5.
6.
Tiziana Ascione Giovanni Balato Massimo Mariconda Renato Rotondo Andrea Baldini Pasquale Pagliano 《The Journal of arthroplasty》2019,34(4):704-709
Background
Reimplantation microbiology and serum C-reactive protein have low diagnostic accuracy in predicting recurrence in patients with prosthetic joint infection (PJI) undergoing 2-stage exchange. We aimed at identifying factors relating to failure and comparing effect of continuous antibiotic therapy versus a holiday antibiotic period pre-reimplantation.Methods
This observational study included patients with PJI undergoing 2-stage exchange. Group A patients did not discontinue antibiotic treatment pre-reimplantation; in group B patients, antibiotic treatment was followed with 2 weeks of holiday antibiotic period pre-reimplantation. We defined cure as absence of recurrence for 96 weeks post-reimplantation. Statistical analyses were performed using Mann-Whitney U test, Fisher exact test, and multivariate analysis.Results
We evaluated 196 patients with PJI (median age, 66 years [interquartile range, 59-72], 91 [46%] males). Comorbidity was reported in 77 (39%), and microbiologic evidence was obtained in 164 (84%). Staphylococcus aureus was isolated in 63 of 164 (38%) patients; coagulase-negative staphylococci were isolated in 71 of 164 (43%). Favorable outcome was achieved for 169 (86%) patients (91% and 79% in groups A and B, respectively). No immunocompromise (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.3-7.3; P = .04), a positive culture (OR, 3.96; 95% CI, 1.55-10.19; P = .02), and no antibiotic discontinuation (OR, 3.32; 95% CI, 1.3-8.44; P = .02) predicted favorable outcome using multivariate analysis.Conclusion
Treatment with continuous antibiotic therapy ameliorated success rate, permitting a better outcome in immunocompromised and reducing the time to reimplantation. Continuous antibiotic therapy can be considered a valid option for the treatment of patients with PJI undergoing 2-stage exchange.Level of evidence
Therapeutic level II. 相似文献7.
Leonard Shan Akshat Saxena David Goh Domenic Robinson 《Journal of vascular surgery》2019,69(4):1268-1281
Objective
Endovascular aneurysm repair (EVAR) and open repair (OR) of abdominal aortic aneurysms (AAAs) are increasingly performed in elderly patients (>75 years of age) with satisfactory results. Quality of life (QOL) is increasingly considered a primary goal of intervention after AAA repair. However, there is currently no consensus on QOL after these procedures in elderly patients.Methods
A systematic review was performed using strict eligibility criteria. Clinical studies reporting QOL in elderly patients (average age >75 years) after EVAR and OR were included. Quality appraisal and data tabulation were performed using predetermined forms. Data were synthesized by narrative review. Study quality was assessed.Results
Thirteen studies with 1272 patients were included. After elective EVAR, disease-specific and generic QOL scores demonstrated an initial postoperative deterioration. By 4 to 6 weeks postoperatively, mental health components have improved to scores similar to or better than those at baseline. Physical health components take up to 3 months to return to baseline. After this, 36-Item Short-Form Health Survey and EuroQol-5 Dimension scores are maintained at preoperative levels for 1 to 3 years. In emergent EVAR, long-term survivors may have QOL comparable to that of the general population. Elective OR appears to have comparable QOL for up to 3 years compared with a matched population. QOL after emergent OR seems poor. Data on OR in elderly patients remain limited.Conclusions
QOL after EVAR and OR declines early, with a 4- to 6-week delay in mental health recovery and 1- to 3-month delay in physical health recovery. QOL eventually returns to baseline and can be maintained in the long term. This review supports AAA repair in elderly patients from a QOL perspective. 相似文献8.
A. Ríos A. Sánchez A. López-Navas L. Martínez M.A. Ayala J. Carillo J.J. Ruiz-Manzanera A.M. Hernández P. Ramírez P. Parrilla 《Transplantation proceedings》2019,51(2):290-292
Introduction
The knowledge of the brain death (BD) concept is important when determining the attitude toward organ donation.Objective
To analyze the level of knowledge of the BD concept among the population in Santiago de Cuba and determine the factors that condition it.Methods
From the Collaborative International Donor Project, we obtained a sample of Cubans living in the area of Santiago de Cuba (n = 455). The attitude was assessed using a validated questionnaire (PCID-DTO-RIOS). The survey was self-administered and completed anonymously. Student t test, χ2, Fisher, and logistic regression analysis were used.Results
Forty percent (n = 180) of the respondents know the BD concept and consider it as the death of an individual. Of the rest, 43% (n = 199) do not know about it, and the remaining 17% (n = 76) consider that it does not mean the death of a patient. The variables significantly related to the correct knowledge of BD in the multivariate analysis and considered as independent are: level of studies; the opinion of the couple toward organ donation; the religion of the respondent; having offspring; and a favorable attitude toward organ donation.Conclusion
There is ignorance about the brain death concept among the population of Santiago de Cuba. This lack of knowledge has a direct relationship with various psychosocial factors. 相似文献9.
Study Design
Two-group randomized controlled trial.Introduction
Upper limb orthoses worn during functional tasks are commonly used in pediatric neurologic rehabilitation, despite a paucity of high-level evidence.Purpose of the Study
The purpose of this study was to investigate if a customized functional wrist orthosis, when placed on the limb, leads to an immediate improvement in hand function for children with cerebral palsy or brain injury.Methods
A 2-group randomized controlled trial involving 30 children was conducted. Participants were randomized to either receive a customized functional wrist orthosis (experimental, n = 15) or not receive an orthosis (control, n = 15). The box and blocks test was administered at baseline and repeated 1 hour after experimental intervention, with the orthosis on if randomized to the orthotic group.Results
After intervention, there were no significant differences on the box and blocks test between the orthotic group (mean, 10.13; standard deviation, 11.476) and the no orthotic group (mean, 14.07; standard deviation, 11.106; t[28], ?0.954; P = .348; and 95% confidence interval, ?12.380 to 4.513).Discussion
In contrast to the findings of previous studies, our results suggest that a functional wrist orthosis, when supporting the joint in a ‘typical’ position, may not lead to an immediate improvement in hand function.Conclusions
Wearing a functional wrist orthosis did not lead to an immediate improvement in the ability of children with cerebral palsy or brain injury to grasp and release. Further research is needed combining upper limb orthoses with task-specific training and measuring outcomes over the medium to long term. 相似文献10.
Felice De Stefano Catherine R. Garcia Meera Gupta Francesc Marti Lilia Turcios Adam Dugan Roberto Gedaly 《American journal of surgery》2019,217(4):664-669
Background/Aim
We aim to study the impact of PH in patients undergoing gastrointestinal surgery (GI).Methods
We queried the ACS-NSQIP database from 2005 through 2010 for patients undergoing GI surgery with PH. Esophageal varices (EV) diagnosis was used as a surrogate of PH.Results
A total of 192,296 patients underwent GI surgery, of which 379 had PH. Regression analyses revealed that patients with PH had a 6-fold (95% CI 4.6–7.9) increase in 30-day mortality, a 3-fold (95% CI 2.5–3.7) increase in morbidity, a 3.2-fold (95% CI 2.6–3.9) increase in critical care complications (CCC), and a 6.5-day (95% CI 5.1–7.8) increase in hospital LOS. After PSM, the impact of PH on the outcomes remained. These differences were significant regardless of the emergent or elective status of the procedure. AUC analysis demonstrated that MELD and MELDNa + score greater than 10.5 was the most predictive of peri-operative mortality in elective PH cases.Conclusions
PH is associated with an increased risk of poor surgical outcomes in patients undergoing elective and emergent gastrointestinal surgery. 相似文献11.
E. Cholongitas N. Antoniadis I. Goulis E. Theocharidou G. Ιmvrios O. Giouleme D. Filis E. Mouloudi E. Akriviadis I. Fouzas 《Transplantation proceedings》2019,51(2):450-453
Purpose
Everolimus, a mammalian target of rapamycin inhibitor, may have a protective role on hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT), but data regarding the impact of its trough serum levels on HCC recurrence are missing.Methods
Fifty-five patients (43 men, age 55 ± 8 years) who underwent LT for HCC were evaluated. Several demographic and clinical variables were recorded, including radiological and histological characteristics of HCC as well as dosages and trough levels of immunosuppressive regimens.Results
HCC recurrence occurred in 11 (20%) patients: 5 (25%) of 20 patients under calcineurin inhibitors and 6 (17%) of the 35 patients under everolimus (P = .48). The patients with HCC recurrence (n = 11, group 1), compared to those without recurrence (n = 44, group 2), had significantly more frequent HCC in the explant: outside Milan criteria (P = .001), microvascular invasion (P < .001), and higher number of nodules (P = .001). In multivariate analysis, microvascular invasion was the only independent factor significantly associated with HCC recurrence (OR: 2.3, 95% CI: 1.4–10.5, P = .03). Among the patients who received everolimus-based immunosuppression, the recipients with HCC recurrence, compared to those without HCC recurrence, had significantly lower mean trough levels of everolimus at 7–12 months post-LT (3.9 vs 5.9 ng/mL, P = .001), while the patients with mean trough levels of everolimus >6 ng/mL had decreased HCC recurrence rates (log rank: 2.3, P = .007).Conclusions
We found for the first time mean concentrations of everolimus between 7–12 months post-LT as the only modifiable variable related with HCC recurrence in LT recipients. However, larger studies are needed for final conclusions. 相似文献12.
A. Ríos A.I. López-Navas M.A. Ayala G. Garrido M.J. Sebastián J. Carrillo Á. Sánchez J. Flores-Medina J.J. Ruiz-Manzanera A.M. Hernández P. Ramírez P. Parrilla 《Transplantation proceedings》2019,51(2):258-260
The Latin American population has a double way of immigration, one toward the United States by proximity and another toward Spain by sociocultural affinity. This population increase is affecting organ donation and transplantation in receiving countries.
Objective
To analyze the brain death (BD) concept knowledge in the Dominican Republic immigrant population in Florida (United States) and Spain.Method
Population under study: Population born in the Dominican Republic, resident in Florida (United States) and in Spain. Inclusion criteria: Population older than 15 years stratified by age and sex. Assessment instrument: Donation attitude questionnaire PCID-DTO-Ríos. Fieldwork: Random selection based on stratification. Immigration support association collaboration in Florida and Spain was needed to locate potential respondents. Completion was anonymous and self-administered, with verbal consent.Results
A total of 123 respondents, 57 residents in Spain and 66 in Florida, have been included in the study. The 27% (n = 33) of the respondents knowledgeable of the BD concept consider it the death of an individual. Of the remainder, 52% (n = 64) do not know about it, and the remaining 21% (n = 26) believe it does not mean the death of a patient. No differences were observed regarding migration countries (P > .05). There was no association of the BD concept with other psychosocial factors analyzed or with the attitude toward organ donation.Conclusions
Knowledge of the BD concept among the Dominican immigrant population is similar in Spain and Florida, and, unlike most studies, there is no objective association with the attitude toward organ donation. 相似文献13.
A. Ríos S. López-Gómez J. Belmonte A. López-Navas A. Sánchez J. Carrillo J.J.A. Ruiz-Manzanera A.M. Hernández P. Ramírez P. Parrilla 《Transplantation proceedings》2019,51(2):293-295
Introduction
Organ refusal rates among Gypsies is much higher than that of any other social group in Spain. However, their attitude toward new therapies related to transplantation, such as the xenotransplantation, is not known. This is especially important in countries such as Spain, where there are research and development units for xenotransplantation.Objective
To analyze the attitude toward xenotransplantation among the Gypsy population living in Spain.Method
Type of study: Observational sociological study. Population under study: Adult Gypsy population currently residing in Spain. Sample: A random sampling of 230 adult Gypsies. Assessment instrument: A validated attitude questionnaire for xenotransplantation—PCID–XenoTx Ríos. Fieldwork: Random selection based on stratification. Anonymity and self-administered fulfillment. Statistics: Student t test, χ2, Fisher, and a logistic regression analysis.Results
A sample of 206 Gypsies was obtained. Forty-five percent (n = 93) would accept a solid organ xenotransplantation if they needed it, and the results were similar to those currently obtained with human organs; 24% (n = 49) have doubts, and 31% (n = 64) would not accept the xenotransplantation. If the results were worse than with human organs, only 9% would accept the xenotransplantation (n = 19). Respondents with a favorable attitude toward xenotransplantation presented a more favorable attitude toward cadaveric organ donation (55% vs 34%, P = .01).Conclusions
Gypsies do not present a very favorable attitude toward xenotransplantation, especially compared with other Spanish population groups. A favorable sensitivity is presented by the population group in favor of it to cadaveric organ donation, which could be used to sensitize this social group and promote donation campaigns with the aim of increasing donation rates. 相似文献14.
Kuniji Ohara Yasuhito Tanaka Akira Taniguchi Hiroaki Kurokawa Tsukasa Kumai Harumoto Yamada 《Journal of orthopaedic science》2019,24(2):312-319
Background
Hallux rigidus and metatarsus primus elevatus (MPE) are associated, but their causal relationship remains unknown. Several surgical approaches for treating hallux rigidus are available. We evaluated morphological characteristics of hallux rigidus with different grades to determine the optimal surgical approach. The amount of degenerative change in the metatarsophalangeal joint on the preoperative roentgenograms was graded on a scale of 1–3. We analyzed the morphology of hallux rigidus using X-ray image mapping developed by our team.Methods
This study involved weight-bearing, dorsoplantar, and lateral foot X-rays of 36 feet from 26 patients underwent surgery for hallux rigidus (Group R) at our institution, and 26 normal feet (Group N). A two-dimensional coordinate system was used to analyze the sharps of these feet by converting each dot on the radiographs into X and Y coordinates. Diagrams of the feet from each group were drawn for comparison. Feet with grades 2 (Group R2) and 3 (Group R3) hallux rigidus and normal feet were compared by Kruskal–Wallis test.Results
Mapping revealed that the tip of distal phalanges of the second, and third toes in Group R medially shifted (P < 0.05) in dorsoplantar image of the feet, and that the medial point, a part of the talus, navicular, cuneiform, and first metatarsal bone in Group R, shifted lower (P < 0.05) in lateral feet images of the feet. Multiple comparisons revealed a significant navicular bone depression in grade 3 hallux rigidus compared with normal feet. A significant difference was observed between Group N and R3 but not between Group R2 and N or R3.Conclusions
X-ray morphological analysis of the foot revealed MPE in Group R. Elevation gradually increased as hallux rigidus grade worsened. Therefore, osteotomy combined with cheilectomy, whereby the first metatarsal bone can be tilted toward the plantar side, are useful for treating a higher-grade hallux rigidus.Level of evidence
Level III, comparative study. 相似文献15.
Joseph R. Esparaz Greg C. McGovern Alyssa R. Mowrer Ryan T. Nierstedt Elise A. Biesboer Breanna M. Elger Richard H. Pearl Charles J. Aprahamian 《American journal of surgery》2019,217(3):469-472
Background
With similar effectiveness of ultrasonography, our institution replaced CT imaging with ultrasound for diagnosing appendicitis in children. An unexpected consequence was the overutilization of ultrasound. Our objective was to establish measures that could help prevent this overuse.Methods
A retrospective chart review of 327 consecutive pediatric patients evaluated for appendicitis between October 2014 and September 2015?at our institution was performed. Data on clinical, radiographic, and histopathologic findings were reviewed. Diagnostic accuracy of US and white blood cell (WBC) values was determined. An algorithm was created.Results
327 (100%) patients received an ultrasound for suspected appendicitis. WBC of 10,000/μl was determined to be the primary discriminant for management and ultrasound utilization. If a WBC ≥10,000/μL had been utilized as criteria for imaging, 49.5% fewer patients would have received an ultrasound.Conclusions
Clinical exam, WBC count, and surgery consultation prior to ultrasonography can lessen then need for ultrasound utilization in children with suspected appendicitis. 相似文献16.
Rushabh M. Vakharia Wayne B. Cohen-Levy Ajit M. Vakharia Chester J. Donnally Tsun Yee Law Martin W. Roche 《The Journal of arthroplasty》2019,34(5):959-964.e1
Background
Sleep apnea (SA) negatively affects bone mineralization, cognition, and immunity. There is paucity in the literature regarding the impact of SA on total joint arthroplasty (TJA). The purpose of this study is to compare complications in patients with and without SA undergoing either total knee (TKA) or total hip arthroplasty (THA).Methods
A retrospective review from 2005 to 2014 was conducted using the Medicare Standard Analytical Files. Patients with and without SA on the day of the primary TJA were queried using the International Classification of Diseases, ninth revision codes. Patients were matched by age, gender, Charlson Comorbidity Index), and body mass index. Patients were followed for 2 years after their surgery. Ninety-day medical complications, complications related to implant, readmission rates, length of stay, and 1-year mortality were quantified and compared. Logistic regression was used to calculate odds ratios (OR) with their respective 95% confidence interval and P values.Results
After the random matching process there were 529,240 patients (female = 271,656, male = 252,106, unknown = 5478) with (TKA = 189,968, THA = 74,652) and without (TKA = 189,968, THA = 74,652) SA who underwent primary TJA between 2005 and 2014. Patients with SA had greater odds of developing medical complications following TKA (OR 3.71) or THA (OR 2.48).Conclusion
The study illustrates an increased risk of developing postoperative complications in patients with SA following primary TJA. Surgeons should educate patients on these adverse effects and encourage the use of continuous positive airway pressure which has been shown to mitigate many postoperative complications. 相似文献17.
A. Ríos A. López-Navas P.R. Gutiérrez F.J. Gómez J. Iriarte R. Herruzo G. Blanco F.J. Llorca A. Asunsolo P. Sánchez A. Fernández M.T. de Jesús L. Martínez Alarcón A. Lana L. Fuentes J.R. Hernández J. Virseda J. Yelamos P. Parrilla 《Transplantation proceedings》2019,51(2):250-252
Introduction
Religious factors have conditioned the attitude toward organ donation and transplantation (ODT) since the beginning of transplantation, despite the fact that most religions are in favor of transplantation.Objective
To assess the impact of religious beliefs of medical students on their attitude toward ODT.Method
Population under study: Medical students in Spanish universities. Study sample: Stratified by geographical area and academic course. Assessment instrument: Attitude ODT questionnaire PCID-DTO-Ríos, anonymous and self-administered.Results
Of all students, 42% (n = 3907) declare themselves atheists or agnostics. The remaining 58% (n = 5368) declare themselves to be religious, the majority being Catholic (55%, n = 5102). Of the rest, 0.2% are Muslims (n = 8), 0.1% Protestants (n = 1), and the remaining 2.7% (n = 257) indicate other religious doctrines but do not want to specify it. Regarding their attitude toward ODT, those who consider themselves atheists or agnostics have a more favorable attitude than those who consider themselves religious (84% versus 76%; P < .001). Among those who follow some kind of religion, Catholics are more in favor of ODT than non-Catholics (77% vs 64%, P < .001). Note that among the religious, only 57% (n = 3050) know which religion is in favor of transplantation, while 22% (n = 1,152) consider that it has not been pronounced on the matter, 13% (n = 723) think the religion is against donation, and the remaining 8% (n = 443) do not know.Conclusion
The religion professed by medical students conditions their attitude toward donation, with the atheists and agnostics being more in favor of donation. 相似文献18.
M. Arlaban P. Barreda M.A. Ballesteros E. Rodrigo B. Suberviola R. Valero E. Miñambres J.C. Ruiz-San Millán 《Transplantation proceedings》2019,51(2):311-313
Introduction
We aimed to evaluate if ex vivo machine perfusion could minimize the negative impact of cold ischemia on those renal grafts obtained from controlled donation after circulatory death (cDCD).Material and methods
Prospective observational paired study of kidney transplants from cDCD performed in our center. The kidney from each pair preserved on ice was transplanted first within the first few hours following procurement, while the contralateral kidney was machine-perfused with a LifePort device (Organ Recovery Systems, Brussels, Belgium) and transplanted the following day.Results
A total of 12 cDCDs were included. No differences were observed in delayed graft dysfunction or graft survival between the 2 groups.Conclusion
The use of ex vivo perfusion devices is simple and they do not require any large infrastructural or high economic investments, considering the fact that it allows a better selection of recipients and viable organs no longer need to be discarded because of prolonged warm ischemia times. 相似文献19.
Kenji Shigemoto Takeshi Sawaguchi Kenichi Goshima Shintarou Iwai Akira Nakanishi Ken Ueoka 《Journal of orthopaedic science》2019,24(2):280-285
Background
This study aimed to report results of the multidisciplinary treatment approach for geriatric hip fractures and evaluate its effectiveness compared with conventional treatment. Patients aged 65 years and older who presented with a hip fracture at our hospital on or after 2014 were treated according to a multidisciplinary approach.Method
Two groups of patients with hip fracture were compared. Group I (n = 364) was treated according to the new multidisciplinary approach in 2014–2016, and Group II (n = 105) which received conventional treatment in 2012. Time to surgery, length of hospital stay, postoperative complications, osteoporosis treatment, functional recovery, in-hospital mortality, 90-day mortality, and 1-year mortality were evaluated. The medical costs of multidisciplinary treatment were compared with those in other hospitals every year.Results
There were no significant differences in the time to surgery between Group I and Group II, but each was considerably shorter than the average time in other Japanese hospitals. The length of hospital stay was longer in Group I. The overall postoperative complication rate was lower in Group I, but there was no significant difference for each individual complication. The rate of anti-osteoporosis pharmacotherapy administration at the time of discharge was significantly higher in Group I. Moreover, the proportion of patients who recovered to their pre-injury functional level was significantly higher in Group I. The mortality rates did not significantly differ year on year. The total hospitalization medical cost per patient for the multidisciplinary treatment was lower than other hospital costs every year.Conclusions
Multidisciplinary treatment produced no significant improvement in time to surgery, length of hospital stay, or postoperative complications. However, the use of the multidisciplinary treatment approach led to a significant increase in osteoporosis treatment rate and better functional recovery. Furthermore, the total medical costs for multidisciplinary treatment were lower than the acute care hospital costs. 相似文献20.
Elise A. Dasinger Westyn Branch-Elliman Steven D. Pizer Hassen Abdulkerim Amy K. Rosen Martin P. Charns Mary T. Hawn Kamal M.F. Itani Hillary J. Mull 《American journal of surgery》2019,217(4):605-612