The effect of ethnic origin on pulmonary prediction equations in a Jewish immigrant population

BACKGROUND: Ethnic origin affects spirometric prediction values. Our aims were to investigate the effect of ethnic origin on prediction equations in an immigrant-based society, identify possible deviations from commonly used prediction equations and analyze the effect of miscalculation in a large cohort of apparently healthy individuals. METHODS: Healthy never-smokers participants from a large Israeli survey underwent lung function testing and were divided into two major ethnic groups: Ashkenazi Jews (AJ) and Sephardic Jews (SJ). Data were analyzed by multiple linear regressions. Forced vital capacity (FVC), forced expiratory volume in 1s (FEV1) and the FEV1/FVC ratio were measured according to ERS-ATS guidelines. RESULTS: The study population comprised 3150 individuals (AJ=1817; SJ=1333). AJ tended to be older and taller than SJ (all p<0.005). Ethnicity entered as a significant regression variable for FVC for both genders and for FEV1 for females only. The final regression model for both FVC and FEV1 had R2=0.71 and the standard error of the estimate (SEE) for FVC and FEV1 were 0.54 and 0.43 L, respectively. The regression model for the FEV1/FVC ratio has less statistical strength (R2=0.06, SEE=6.15%). We found statistically significant underestimates of predicted lung volumes from the commonly used prediction equation for each ethnic group. CONCLUSIONS: Ashkenazi and Sephardic Jews have different ranges of normal pulmonary function values. Lung function prediction equations in an immigrant-based society should be based on local and not previously reported regional equations and adjusted for ethnic attributed variance.     

Predicting the need for blood transfusion in patients with hip fractures

Purpose

The need for perioperative blood management measures aimed at improving patient outcomes and reducing allogenic blood transfusion (ABT) is increasingly recognised. Our study aim is to create an algorithm to predict and manage the need for blood transfusion in patients with hip fractures.

Methods

We retrospectively assessed 1,484 patients with hip fractures and analysed the probability of receiving an ABT within 72 hours of admission. Univariate, multiple logistic regression analysis and a probability algorithm for predicting the need for blood transfusion on the basis of independent multivariate predictors were used.

Results

Significant predictors for ABT were: older age; lower haemoglobin on admission; female gender; type of surgical implant (cephalomedullary nail and dynamic hip screw more than hemiarthroplasty); and a shorter wait time from admission to surgery. A regression model algorithm correctly predicted the need for an ABT in 73 % of the cases.

Conclusion

An algorithm and a simple clinical tool were devised to predict and manage the need for a blood transfusion within 72 hours of admission in patients with hip fractures.     

Fusion and subsidence rate of stand alone anterior lumbar interbody fusion using PEEK cage with recombinant human bone morphogenetic protein-2

Introduction

Anterior lumbar interbody fusion (ALIF) is an established treatment for structural instability associated with symptomatic disk degeneration (SDD). Stand-alone ALIF offers many advantages, however, it may increase the risk of non-union. Recombinant human bone morphogenetic protein-2 (BMP-2) may enhance fusion rate but is associated with postoperative complication. The optimal dose of BMP-2 remains unclear. This study assessed the fusion and subsidence rates of stand-alone ALIF using the SynFix-LR interbody cage with 6 ml/level of BMP-2.

Methods

Thirty-two ALIF procedures were performed by a single surgeon in 25 patients. Twenty-five procedures were performed for SDD without spondylolisthesis (SDD group) and seven procedures were performed for SDD with grade-I olisthesis (SDD-olisthesis group). Patients were followed-up for a mean of 17 ± 6 months.

Results

Solid fusion was achieved in 29 cases (90.6 %) within 6 months postoperatively. Five cases of implant subsidence were observed (16 %). Four of these occurred in the SDD-olisthesis group and one occurred in the SDD group (57 % vs. 4 % respectively; p = 0.004). Three cases of subsidence failed to fuse and required revision. The body mass index of patients with olisthesis who developed subsidence was higher than those who did not develop subsidence (29 ± 2.6 vs. 22 ± 6.5 respectively; p = 0.04). No BMP-2 related complications occurred.

Conclusion

The overall fusion rate of stand-alone ALIF using the SynFix-LR system with BMP-2 was 90.6 %, comparable with other published series. No BMP-2 related complication occurred at a dose of 6 mg/level. Degenerative spondylolisthesis and obesity seemed to increase the rate of implant subsidence, and thus we believe that adding posterior fusion for these cases should be considered.     

Sequelae of Underdiagnosed Foot Compartment Syndrome after Calcaneal Fractures

The calcaneus is the most frequently fractured tarsal bone. Compartment syndrome (CS) complicates fractures and other injuries and is most commonly described in association with the lower leg. The long-term sequelae of CS of the foot can include toe clawing, permanent loss of function, persistent pain, muscle atrophy, contracture, painful warts, weakness, and sensory disturbances. The incidence and clinical significance of untreated CS after calcaneal fractures were questioned. All compliant patients treated by us for a calcaneus fracture underwent a physical examination and medical interview: 47 (49 fractures) were included in the final cohort (36 males, 11 females, mean age 49 ± 14.5 years, mean follow-up 23 ± 16 months). Missed CS sequelae were diagnosed by the presence of claw toes and plantar sensory deficits. The functional outcome and pain at rest and during activity were scored. Five patients (10%) had missed CS, and their functional score was significantly lower than for those without CS (52 ± 21.5 versus 77.4 ± 22 for no CS, p < .05). All missed CS cases were diagnosed in patients with a Sanders type 3 or 4 fracture. Intra-articular fracture was a significant factor associated with developing CS sequelae (p = .045). Untreated CS can cause muscle and nerve injury and contribute to a poor functional outcome. Because CS is more likely to develop after highly comminuted intra-articular fractures, these patients warrant close monitoring for CS development. Early detection and treatment might result in fewer late disabling sequelae of this injury.     

Analyzing transformation of myelodysplastic syndrome to secondary acute myeloid leukemia using a large patient database

One‐third of patients with myelodysplastic syndrome (MDS) progress to secondary acute myeloid leukemia (sAML), with its concomitant poor prognosis. Recently, multiple mutations have been identified in association with MDS‐to‐sAMLtransition, but it is still unclear whether all these mutations are necessary for transformation. If multiple independent mutations are required for the transformation, sAML risk should increase with time from MDS diagnosis. In contrast, if a single critical biological event determines sAML transformation; its risk should be constant in time elapsing from MDS diagnosis. To elucidate this question, we studied a database of 1079 patients with MDS. We classified patients according to the International Prognostic Scoring System (IPSS), using either the French‐American‐British (FAB) or the World Health Organization (WHO) criteria, and statistically analyzed the resulting transformation risk curves of each group. The risk of transformation after MDS diagnosis remained constant in time within three out of four risk groups, and in all four risk groups, when patients were classified according to FAB or to the WHO‐determined criteria, respectively. Further subdivision by blast percentage or cytogenetics had no influence on this result. Our analysis suggests that a single random biological event leads to transformation to sAML, thus calling for the exclusion of time since MDS diagnosis from the clinical decision‐making process. Am. J. Hematol. © 2012 Wiley Periodicals, Inc.     

Can flow cytometry of bone marrow aspirate predict outcome of patients with diffuse large B cell lymphoma? A retrospective single centre study

Bone marrow (BM) trephine biopsy is a part of routine staging of patients with newly diagnosed diffuse large B cell lymphoma (DLBCL). The significance of lymphoid monoclonal population on flow cytometry (FC) of the BM aspirate in the presence of negative BM histology has not been clarified. In this study, we assessed the clinical role of positive FC in predicting outcome of patients with DLBCL and a negative BM histology. We retrospectively analysed 101 patients diagnosed with DLBCL at a single institution between years 1994–2003. Three groups of patients were compared: patients with histologic involvement of the BM (BM+), patients with no histologic involvement of the BM but with positive FC (BM?FC+) and patients with neither histologic or FC evidence of BM involvement (BM?FC?). The BM+ group included 13 patients (13%). The BM?FC+ group 16 patients (16%), and the BM?FC?included 72 patients (71%). Median age of the cohort was 67 years. Disease stage and International Prognostic Index score were significantly higher in the BM+ and BM?FC+ groups compared with the BM?FC? group. Median overall survival (OS) for the BM?FC?, BM?FC+ and BM + groups were 4.6, 2.2 and 0.9 years, respectively. Median progression free survival (PFS) for the BM?FC?, BM?FC+ and BM+ groups were 3.2, 1.4 and 0.6 years, respectively (p=0.01 for both analysis). In multivariable Cox regression models adjusting for age, sex, stage and International Prognostic Index, there was no significant differences in OS or PFS between the BM?FC+ and BM?FC? groups. In conclusion, positive FC in the setting of negative BM histology at diagnosis did not significantly affect OS or PFS. Copyright © 2014 John Wiley & Sons, Ltd.     

The incidence and possible relevance of Y-linked microdeletions in babies born after intracytoplasmic sperm injection and their infertile fathers

Microdeletions linked to deletion intervals 5 and 6 of the Ychromosome have been associated with male factor infertility.Members from at least two gene families lie in the region containingazoospermia factor (AZF), namely YRRM and DAZ. With the adventof intracytoplasmic sperm injection (ICSI), it is possible formen with severe male factor infertility to produce a child.The genetic consequences of such a procedure have been questioned.This report describes the first study of a population (32 couples)of infertile fathers and their sons born after ICSI. The objectiveswere firstly to determine the incidence and map location ofY chromosome microdeletions and to compare the frequencies withother population studies involving severe male factor infertility,and secondly to formulate a working hypothesis concerning developmentalaetiology of Y chromosome microdeletions. The incidence of microdeletionsin the ICSI population was shown to be 9.4% (within the range9–18% reported for populations of severe male factor infertilitypatients). Microdeletions in two out of three affected fatherisonpairs mapped in the region between AZFb and AZFc and the thirdinvolved a large microdeletion in AZFb and AZFc. Of three affectedfather/son pairs, microdeletions were detected in the bloodof one infertile propositus father and three babies. Assumingthat the gonomes of the ICSI-derived babies are direct reflectionsof those of their fathers' germ lines, it is possible that twoof three infertile fathers were mosaic for intact Y and microdeletedY chromosomes. In such cases, the developmental aetiology ofthe microdeletion may be due to a de-novo microdeletion arisingas a post-zygotic mitotic error in the infertile propositusfather, thus producing a mosaic individual who may or may nottransmit the deletion to his ICSI-derived sons depending onthe extent of primordial germ cell mosaicism. In one of threeaffected fathers, the microdeletion detected in his blood wasalso detected in his ICSI-derived son. In this case the de-novoevent giving rise to the microdeletion may have occurred dueto a post- (or pre-) meiotic error in the germ line of thisfather's normally fertile father (i.e. the ICSI-derived baby'sgrandfather). aetiology/intracytoplasmic sperm injection/Y-chromosome microdeletions