Robotic Guidance Does Not Improve Component Position or Short-Term Outcome in Medial Unicompartmental Knee Arthroplasty

We performed a retrospective review in a matched group of patients on the use of robotic-assisted UKA implantation versus UKA performed using standard operative techniques to assess differences between procedures. While both techniques resulted in reproducible and excellent outcomes with low complication rates, the results demonstrate little to no clinical or radiographic difference in outcomes between cohorts. Average operative time differed significantly with, and average of 20 minutes greater in, the robotic-assisted UKA group (P = 0.010). Our minimal clinical and radiographic differences lend to the argument that it is difficult to justify the routine use of expensive robotic techniques for standard medial UKA surgery, especially in a well-trained, high-volume surgeon. Further surgical, clinical and economical study of this technology is necessary.     

Post-traumatic stress reactions among individuals with visual impairments: a systematic review

Purpose: To conduct a systematic review of post-traumatic stress reactions among individuals with visual impairment (VI).

Materials and methods: Qualitative and quantitative studies were identified through searches in MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Libraries. The literature search was limited to humans, of English and Scandinavian languages and publication year between 1980 and 2017. Study quality was assessed for all the included studies and extracted data were synthesized using narrative analysis.

Results: Of 4235 records identified through literature search, eleven were included in the analyses. Results from the qualitative studies illustrated multiple physical, behavioral, emotional, and cognitive manifestations of trauma. Four out of five quantitative studies showed that various types of potentially traumatic events were significantly associated with mental health adversities (p?<?0.05). The prevalence of post-traumatic mental disorders was 4–21.2% for depression, 0.9% for dysthymia, and 32% for substance misuse. The quality of the reviewed studies was considered low to moderate.

Conclusion: Traumatic experiences appear to have a great impact on the mental health in people with visual impairment (VI) and these results highlight their need for mental health care. Future studies with higher methodological rigor are recommended.

• Implications for rehabilitation

• Visual impairment entails a greater susceptibility to some types of potentially traumatic events, especially threats in everyday life. This calls for a greater emphasis on safe community environments and universal design in public spaces.

• In rehabilitation after serious accidents or potentially traumatic events, professionals working with people with vision impairment should be aware of the different manifestations of post-traumatic stress responses and that some stress responses may cause additional disability.

• The high prevalence of traumatic events and their impact on mental health in individuals with visual impairments highlights a need of mental health care.

     

Neutrophils and platelets accumulate in the heart, lungs, and kidneys after cardiopulmonary bypass in neonatal pigs

OBJECTIVE: Cardiac surgery with cardiopulmonary bypass elicits a systemic inflammatory response. An exaggerated response is associated with organ dysfunction and increased morbidity and mortality. DESIGN: The aim of the present study was to investigate whether the cardiopulmonary bypass procedure in itself results in accumulation of isotope-labeled platelets, polymorphonuclear neutrophils, and fibrinogen at organ levels in neonatal pigs and to monitor changes in organ function. SETTING: Pediatric cardiopulmonary bypass setup with 60 mins of aortic cross-clamp time and 120 mins of hypothermic cardiopulmonary bypass time. SUBJECTS: Thirty piglets were allocated to sternotomy alone (sham group, n = 15) or to sternotomy and cardiopulmonary bypass (n = 15). MEASUREMENTS AND MAIN RESULTS: Isotope-labeled autologous polymorphonuclear neutrophils, platelets, and commercially available fibrinogen were infused, and the specific accumulation at organ level was measured in a gamma counter 4 hrs after termination of cardiopulmonary bypass. Concomitant changes in oxygenation index and cardiac output were registered. Animals exposed to cardiopulmonary bypass showed a significantly higher technetium-99m-polymorphonuclear neutrophil accumulation in the lungs and kidneys, whereas indium-111-platelets accumulated in the heart and kidneys compared with the sham group. There was a significantly larger increase in oxygenation index and significantly larger decrease in cardiac output between the pre- and postcardiopulmonary bypass period in the cardiopulmonary bypass group compared with the sham group. CONCLUSIONS: The cardiopulmonary bypass procedure without cardiac surgery elicits organ dysfunction in terms of impaired respiratory and hemodynamic function. Platelets and polymorphonuclear neutrophils were entrapped in the heart, lungs, and kidneys of cardiopulmonary bypass animals, indicating that cell accumulation may contribute to the developing organ dysfunction.     

Development of a Type 2 Diabetes Risk Model From a Panel of Serum Biomarkers From the Inter99 Cohort

OBJECTIVE

The purpose of this study was to develop a model for assessing the 5-year risk of developing type 2 diabetes from a panel of 64 circulating candidate biomarkers.

RESEARCH DESIGN AND METHODS

Subjects were selected from the Inter99 cohort, a longitudinal population-based study of ∼6,600 Danes in a nested case-control design with the primary outcome of 5-year conversion to type 2 diabetes. Nondiabetic subjects, aged ≥39 years, with BMI ≥25 kg/m² at baseline were selected. Baseline fasting serum samples from 160 individuals who developed type 2 diabetes and from 472 who did not were tested. An ultrasensitive immunoassay was used to measure of 58 candidate biomarkers in multiple diabetes-associated pathways, along with six routine clinical variables. Statistical learning methods and permutation testing were used to select the most informative biomarkers. Risk model performance was estimated using a validated bootstrap bias-correction procedure.

RESULTS

A model using six biomarkers (adiponectin, C-reactive protein, ferritin, interleukin-2 receptor A, glucose, and insulin) was developed for assessing an individual''s 5-year risk of developing type 2 diabetes. This model has a bootstrap-estimated area under the curve of 0.76, which is greater than that for A1C, fasting plasma glucose, fasting serum insulin, BMI, sex-adjusted waist circumference, a model using fasting glucose and insulin, and a noninvasive clinical model.

CONCLUSIONS

A model incorporating six circulating biomarkers provides an objective and quantitative estimate of the 5-year risk of developing type 2 diabetes, performs better than single risk indicators and a noninvasive clinical model, and provides better stratification than fasting plasma glucose alone.The prevalence of type 2 diabetes has reached epidemic levels, affecting ∼7% of the U.S. population, and current epidemiological trends indicate that the prevalence will continue to increase dramatically (1). Several long-term prospective clinical trials have shown that interventions can delay or possibly prevent the onset of type 2 diabetes in high-risk individuals (2,3), underscoring the importance of identifying individuals at risk to begin interventions as early as possible and focus resources on those with the highest risk.The most commonly used method of assessing risk of type 2 diabetes is measuring fasting plasma glucose (FPG); however, the specificity of this test is poor (4,5). Although many individuals are identified as having impaired fasting glucose (IFG), their absolute risk of conversion to diabetes is only 5–10% per year (6). The oral glucose tolerance test (OGTT) is more accurate for risk assessment. However, it is rarely used in practice because it is unpleasant for the patient and requires 2 h to perform. Another challenge is that by the time glucose regulation is abnormal, the underlying disease has been progressing for many years, and complications have already occurred in a significant number of individuals (7). Thus, the rationale of using one variable to assess risk is questionable, when the risk of harm actually varies based on a range of variables and would be better assessed using a multivariable individualized risk score (8).Several indexes using clinical information and routine laboratory measurements have been developed for assessing type 2 diabetes risk (9–11). These have never been widely adopted by physicians. Given the limitations of the OGTT, FPG, and indexes that the clinician must calculate, it is clear that an improved method for assessing type 2 diabetes risk, with a convenient format for routine clinical use, would enable physicians to accurately evaluate more individuals.The dysregulation of many biological pathways precedes the development of overt type 2 diabetes (12). Although many studies have assessed whether levels of a few molecules might predict future diabetes (13–15), none have quantitatively measured a large number of molecules simultaneously in a sufficient number of samples to robustly evaluate their utility for risk assessment. We undertook a systematic analysis of many candidates in pathways dysregulated in diabetes to search for patterns of biomarkers with more predictive power than individual biomarkers or previously examined biomarker combinations. For this analysis, we selected 632 baseline samples from the Inter99 Study and an ultrasensitive immunoassay to measure many proteins in small amounts of serum.     

Factors associated with mode of transport to acute care hospitals in rural communities

This study identifies factors associated with mode of transport to rural hospitals. We evaluated 11,541 trauma patient visits that came by ground ambulance or private vehicle to the Emergency Department of one of six northwest Iowa rural hospitals. We performed univariate analyses and logistic regression analyses to identify factors associated with mode of transport for each severity level (fatal, major and minor). For major/fatal injuries, we found that those aged 65 years and over were 3.6 (95% CI = 2.7-4.9) times more likely to use ambulances than those under 15. Motor vehicle traffic injuries and hip fractures were also associated with ambulance usage, while arm fractures and farm-related injuries were not. We conclude that for major/fatal injuries, older persons, those injured from high velocity causes, and those with hip fractures are more likely to use an ambulance. Emergency Medical Services may improve the community's ambulance utilization by providing public education (e.g., proper use of 911 and injury severity recognition), and by collaborating with dispatch, the local community and health care providers. Further study of the community's and individuals' decision-making factors determining mode of transportation is needed.     

Review of the comparative effectiveness of radical prostatectomy,radiation therapy,or expectant management of localized prostate cancer in registry data

Summary

Evidence regarding the effectiveness of treatment for prostate cancer is primarily based on randomized controlled trials. Long-term outcomes are generally difficult to evaluate within experimental studies and may benefit from large pools of observational data. We conducted a systematic review of administrative and registry studies to evaluate the comparative effectiveness of treatment for clinically localized prostate cancer on overall and prostate-cancer specific mortality.