Alterations of the thrombin generation profile in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder resulting in the erosion of the cartilage and bone. Systemic involvement including the cardiovascular system with the risk of atherosclerosis may also occur. Calibrated automated thrombogram (CAT), a commercially available thrombin generation assay is suitable for the general assessment of the functionality of coagulation system. In this study we performed CAT assay in RA patients and in non-affected control subjects (matched for age, sex and comorbidities). Among the CAT parameters Velocity Index increased (from 60 to 83 nM/min), Lag Time and Time to Peak decreased (from 3.47 to 2.83 min and from 6.98 to 5.58 min respectively) in RA. On the other hand, Endogenous Thrombin Potential values decreased (from 1242 to 1108 nM min). The observed alterations were not associated with the applied therapy. These results indicate that the velocity of thrombin formation is increased, while the thrombin generating capability is reduced in RA.     

Cryoneurolysis before Total Knee Arthroplasty in Patients With Severe Osteoarthritis for Reduction of Postoperative Pain and Opioid Use in a Single-Center Randomized Controlled Trial

BackgroundWe hypothesized that preoperative cryoneurolysis of the superficial genicular nerves in patients with osteoarthritis would decrease postoperative opioid use relative to standard of care (SOC) treatment in patients undergoing total knee arthroplasty (TKA).MethodsPatients received either cryoneurolysis (intent-to-treat [ITT]: n = 62) or SOC (ITT: n = 62). The cryoneurolysis group received cryoneurolysis of the superficial genicular nerves 3–7 days before surgery plus a similar preoperative, intraoperative, and postoperative pain management protocol as the SOC group. The primary end point was cumulative opioid consumption in total daily morphine equivalents from discharge to the 6-week study follow-up assessment. Secondary end points included changes in pain and functional scores. Primary and secondary end points were assessed using ITT and per-protocol (PP) analyses.ResultsThe primary end point was not met in the ITT analysis (4.8 [cryoneurolysis] vs 6.1 [SOC] mg; P = .0841) but was met in the PP analysis (4.2 vs 5.9 mg; P = .0186) after excluding patients with medication deviations or missing follow-up data. Compared with the SOC group, the cryoneurolysis group had improved functional scores and numerical improvements in pain scores across all follow-up assessments, with significant improvements observed in current pain from baseline to the 72-hour and 2-week follow-up assessments and pain in the past week from baseline to the 12-week follow-up assessment.ConclusionFindings from the PP analysis suggest that preoperative cryoneurolysis in patients with knee osteoarthritis can reduce opioid consumption and improve functional outcomes after TKA.     

Oliguria after prophylactic ureteric stenting in gynaecological surgery—a report of three cases and review of the literature

Ureteric injury is one of the most serious complications of gynaecological surgery. Use of prophylactic preoperative bilateral ureteric stents to reduce ureteric injury is established in colorectal surgery and becoming commonplace in complex gynaecological surgery. The safety of the procedure has been questioned due to reports of stent-induced complications including a rare but serious phenomenon of stent-induced transient obstructive oligo-anuria termed reflex anuria, a response to manipulation and irritation of the ureters. A retrospective case-note review of patients who had bilateral ureteric stents placed prior to gynaecological surgery at Salford Royal Hospital, UK, from 2007 to 2011 was performed to identify cases of oligo-anuria post-stenting, which were not related to hypovolaemia, nephrotoxic drugs or a radiologically evident obstruction. All patients had their stents removed immediately at the end of surgery before leaving the operating theatre. Three out of 439 patients (0.7 %), who had preoperative bilateral ureteric stents, developed post-operative oligo-anuria despite relatively normal radiological assessment. In these three cases outlined below, one self-resolved, and two required urgent re-stenting to relieve obstruction. Use of ureteric stents for major gynaecological surgery can expedite intraoperative identification of the ureters to help reduce accidental ureteric injury but can directly cause complications. These three cases have contributed to knowledge of the complications of ureteric stents during major gynaecological surgery. Awareness of reflux anuria as a possible root cause of post-operative acute renal failure is important for guiding appropriate and timely management to preserve renal function.     

Pubarche and serum dehydroepiandrosterone sulphate levels in children with Prader–Willi syndrome

Context Premature pubarche (PP) is reported in children with Prader–Willi Syndrome (PWS). Pubarche is preceded by adrenarche – an increase in serum levels of adrenal androgens, most specifically dehydroepiandrosterone sulphate (DHEAS). Objectives To assess DHEAS levels, the age at and progression of pubarche and the prevalence of PP in children with PWS. Design/Patients In the Dutch PWS Cohort Study, 120 children (6 months–17 years) are prospectively followed. Their age at onset of pubarche and various pubic hair stages and prevalence of PP were determined. Serum DHEAS levels were assessed in 97 children. Results Median serum DHEAS levels were significantly higher in children with PWS than in healthy age‐matched controls at ages 3–6 years (girls: P = 0·004 and boys: P = 0·010) and 6–10 years (girls: P = 0·045 and boys: P = 0·001). Age and gender significantly influenced DHEAS levels in children with PWS. The median [P10–P90] age at onset of pubarche in children with PWS was significantly younger than in healthy peers, 9·04[6·75–11·84] years in PWS girls (P < 0·0001) and 10·31 [8·65–12·29] years in PWS boys (P = 0·003). The prevalence of PP in children with PWS was 30·0% in girls and 16·1% in boys. Conclusions Compared to healthy children, children with PWS have significantly higher DHEAS levels from 3 to 10 years of age. They are younger at onset of pubarche and have a higher prevalence of premature pubarche. DHEAS levels in PWS are influenced by age and gender. Our findings indicate earlier maturation of the zona reticularis of the adrenal glands in children with PWS.