Radiological follow-up after implanting cervical disc prosthesis in anterior discectomy: a systematic review

Objective

The objective of this study was to review current literature on the comparison of the radiological outcome of cervical arthroplasty with fusion after anterior discectomy for radiculopathy.

Development and validation of a guide for the continuity of care in perioperative medication management

Background

Increased longevity and the prevalence of associated pathologies is leading to more hospital admissions involving chronic patients with multiple pathological problems. In orthopedic surgical patients, it is very important to individually evaluate the risk/benefit of maintaining or suppressing chronic medications. For certain medications, there are consensus recommendations, but for others, the available information may be limited or controversial.

Objective

To develop and validate a new guide for the continuity of care in perioperative medication management in older orthopedic surgical patients.

Materials and methods

An expert pharmacist developed the guide by systematically reviewing each medication category according to the Anatomical Therapeutic Chemical (ATC) classification system. The Pharmacy and Therapeutics Committee at the Hospital General Universitario de Elche reviewed the guide. After a training course on the guide for pharmacists, the guide was validated by studying the interobserver variability between pharmacists as well as between each pharmacist and the expert pharmacist. Cohen’s kappa index (κ) was applied to determine interrater reliability.

Results

The guide includes 51 therapeutic groups. Each ATC pharmacological subgroup is structured according to the benefits and risks of continuing therapy. When we compared each pharmacist’s recommendations with those of the expert pharmacist, the kappa value was found to be 0.8 [95% CI (0.7, 0.9)], indicating almost perfect concordance (overall percentage agreement 89.3%).

Conclusions

We developed a guide for the continuity of care in perioperative medication management to improve the rationalization of medicines in the perioperative environment. After the pharmacists had been trained, the guide was validated by demonstrating a high level of concordance among the pharmacists’ recommendations. Formal training seems to be essential to ensure consistency in medical decisions.

Level of evidence

IV (Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653).

     

Matched cohort study of topical tranexamic acid in cementless primary total hip replacement

Purpose

Tranexamic acid has been shown to be effective in reducing blood loss after total hip replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use to reduce blood loss after primary total hip replacement and to compare these outcomes with those of a matched control group from a similar cohort that did not have received tranexamic acid.

Methods

This is a prospective matched control study to assess the effect of a 2 g topical tranexamic acid in 50 mL physiological saline solution in total hip replacement. Primary outcomes were hemoglobin and hematocrit drop, and total blood loss. Secondary outcomes were transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events.

Results

We could match 100 patients to a control group. There were no statistical significantly differences between the two groups. The hemoglobin and hematocrit postoperative values were significantly higher in topical tranexamic acid group than in control group (P?<?0.001). The mean total blood loss was 769 in topical tranexamic acid group and 1163 in control group with significant differences (P?=?0.001), which meant 34% reduction in total blood loss. Length of stay was lower in topical tranexamic acid group. The risk of deep vein thrombosis and pulmonary events did not increase.

Conclusions

A single dose of 2 g tranexamic acid in 50 mL physiological saline solution topical administration was effective and safe in reducing bleeding in patients undergoing unilateral primary non-cemented total hip replacement compared to a matched control group.

     

Reducing the Human Burden of Breast Cancer: Advanced Radiation Therapy Yields Improved Treatment Outcomes

Radiation therapy is an important modality in the treatment of patients with breast cancer. While its efficacy in the treatment of breast cancer was known shortly after the discovery of x‐rays, significant advances in radiation delivery over the past 20 years have resulted in improved patient outcomes. With the development of improved systemic therapy, optimizing local control has become increasingly important and has been shown to improve survival. Better understanding of the magnitude of treatment benefit, as well as patient and biological factors that confer an increased recurrence risk, have allowed radiation oncologists to better tailor treatment decisions to individual patients. Furthermore, significant technological advances have occurred that have reduced the acute and long‐term toxicity of radiation treatment. These advances continue to reduce the human burden of breast cancer. It is important for radiation oncologists and nonradiation oncologists to understand these advances, so that patients are appropriately educated about the risks and benefits of this important treatment modality.     

Effect of Two Types of Active Recovery on Fatigue and Climbing Performance

Performing intra-session recovery is important in rock climbing due to the multiple efforts that climbers are required to make in competitions, as well as repeated climbing trials that they carry out during training sessions. Active recovery has been shown to be a better option than passive recovery. However, the type of active recovery that should be done and the influence of the type and quantity of muscle mass activated are not clear. The aim of this study was to compare the effects of recovering with easy climbing (CR) or walking (WR) on markers of fatigue and climbing performance. For this purpose, 14 subjects participated in this randomly assigned crossover protocol completing three two-minute climbing trials separated by two minutes of active recovery with the assigned method. Seven days later participants carried out the same protocol with the other recovery method. Blood lactate (La^-), rating of perceived exertion (RPE), and heart rate (HR) were analyzed as markers of fatigue and recovery, while meters climbed (MC) and handgrip force (HF) were analyzed for performance. La- values before the last climbing trial (p < 0.05; d = 0.69) and Peak La- values (p < 0.05; d = 0.77) were lower for CR than for WR. Climbers were able to ascend more meters in the set time when following the CR protocol (p < 0.01; d = 0.6), which shows the important role of the active recovery method carried out on climbing performance. There were no differences in HR, HF or RPE between protocols. A more sport-specific recovery protocol, in addition to moving great muscle mass (e.g. lower limbs), seems to enhance recovery and to facilitate lactate removal. For this reason, CR appears to be a more effective active recovery method than WR in sport rock climbing.

Key points

• Climbing recovery improved lactate removal in comparison with walking recovery.
• Subjects were able to climb more meters in a determined time when easy climbing instead of walking during recoveries.
• Activating both great muscle mass like that of the lower limbs as well as the main fatigue producing muscles (forearms in climbing) seems more effective for recovering than activating just great muscle mass.

Key words: Blood lactate, rock climbing, handgrip force, active recovery, fatigue, performance     

Single Antigen–Mismatched Unrelated Hematopoietic Stem Cell Transplantation Using High-Dose Post-Transplantation Cyclophosphamide Is a Suitable Alternative for Patients Lacking HLA-Matched Donors

The optimal prophylaxis regimen for graft-versus-host disease (GVHD) in the setting of mismatched unrelated donor (MMUD) allogeneic hematopoietic stem cell transplantation (alloHSCT) is not defined. The use of high-dose post-transplant cyclophosphamide (PTCy) in haploidentical transplantation has proven feasible and effective in overcoming the negative impact of HLA disparity on survival. We hypothesized that PTCy could also be effective in the setting of MMUD transplantation. We retrospectively analyzed 86 consecutive adult recipients of alloHSCT in our institution, comparing 2 contemporaneous groups: PTCy MMUD (n?=?26) versus matched unrelated donor (MUD) (n?=?60). Graft source was primarily peripheral blood (92%). All PTCy MMUD were HLA 7/8 (differences in HLA class I loci in 92% of patients) and received PTCy plus tacrolimus ± mofetil mycophenolate as GVHD prophylaxis. No differences were observed between PTCy MMUD and MUD in the 100-day cumulative incidence of acute GVHD grades II to IV (31% versus 22%, respectively; P?=?.59) and III to IV (8% versus 10%, P?=?.67). There was a trend for a lower incidence of moderate to severe chronic GVHD at 1 year after PTCy MMUD in comparison with MUD (22% versus 41%, P?=?.098). No differences between PTCy MMUD and MUD were found regarding nonrelapse mortality (25% versus 18%, P?=?.52) or relapse rate (11% versus 19%, P?=?.18). Progression-free survival and overall survival at 2 years were similar in both cohorts (67% versus 54% [HR, .84; 95% CI, .38 to 1.88; P?=?.68] and 72% versus 57% [HR, .71; 95% CI, .31 to 1.67; P?=?.44], respectively). The 2-year cumulative incidence of survival free of moderate to severe chronic GVHD and relapse tended to be higher in the PTCy MMUD group (47% versus 24%; HR, .60; 95% CI, .31 to 1.14; P?=?.12). We conclude that HLA 7/8 MMUD transplantation using PTCy plus tacrolimus is a suitable alternative for those patients who lack a MUD.     

Experiencia de aprendizaje cooperativo en una asignatura optativa del Grado en Enfermería

This work is the result of an innovation project included in the call for Teaching Innovation Projects - UAM 2016/17.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome – Evidence for an autoimmune disease

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a frequent and severe chronic disease drastically impairing life quality. The underlying pathomechanism is incompletely understood yet but there is convincing evidence that in at least a subset of patients ME/CFS has an autoimmune etiology. In this review, we will discuss current autoimmune aspects for ME/CFS. Immune dysregulation in ME/CFS has been frequently described including changes in cytokine profiles and immunoglobulin levels, T- and B-cell phenotype and a decrease of natural killer cell cytotoxicity. Moreover, autoantibodies against various antigens including neurotransmitter receptors have been recently identified in ME/CFS individuals by several groups. Consistently, clinical trials from Norway have shown that B-cell depletion with rituximab results in clinical benefits in about half of ME/CFS patients. Furthermore, recent studies have provided evidence for severe metabolic disturbances presumably mediated by serum autoantibodies in ME/CFS. Therefore, further efforts are required to delineate the role of autoantibodies in the onset and pathomechanisms of ME/CFS in order to better understand and properly treat this disease.