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61.
Rafael Walker-Santiago Jason D. Tegethoff William M. Ralston James A. Keeney 《The Journal of arthroplasty》2021,36(2):653-656
BackgroundRevision total knee arthroplasty (rTKA) rates are increasing in younger patients. Few studies have assessed outcomes of initial aseptic rTKA performed for younger patients compared with traditional-aged patients.MethodsA detailed medical record review was performed to identify patient demographics, medical comorbidities, surgical rTKA indications, timing from index TKA to rTKA, subsequent reoperation rates, component rerevision rates, and salvage procedures for 147 young patients (158 knees) aged 55 years and younger and for a traditional older cohort of 276 patients (300 knees) between 60 and 75 years. Univariate analysis was performed to assess differences in these primary variables, and a log-rank test was used to estimate 5-year implant survival based on either reoperation or component revision and salvage procedures.ResultsYounger TKA patients were more likely to undergo initial aseptic rTKA within 2 years of their primary TKA (52.5% vs 29.0%, P < .001) and were more likely to undergo early reoperation (17.7% vs 9.7%, P = .02) or component rerevision (11.4% vs 6.0%, P < .05) after rTKA. Infection and extensor mechanism complications were more commonly noted in younger patients. Estimated 5-year survival was also lower for both reoperation (59.4% vs 65.7%, P = .02) and component rerevision or salvage (65.8% vs 80.1%, P = .02).ConclusionEarly reoperation and component re-rTKA were performed nearly twice as often in younger rTKA than traditional-aged TKA patients. Care should be given to reduce perioperative infection and extensor mechanism failures after rTKA in younger patients. 相似文献
62.
Rafael Lucas Costa de Carvalho Miguel Lia Tedde Jose Ribas Milanese de Campos Niura Noro Hamilton Gustavo Falavigna Guilherme Vanessa Moreira Sousa Vitor Floriano Salomao Junior Flavio Henrique Savazzi Paulo Manuel Pego-Fernandes 《Journal of pediatric surgery》2021,56(3):545-549
Background/PurposeThe aim of the study was to evaluate the postoperative quality of life (QoL) of patients who underwent minimally invasive repair of pectus excavatum (MIRPE) with a newly designed bar and bar stabilizers.MethodsWe conducted a prospective randomized study in which patients were operated either with standard perpendicular stabilizers (control group) or with the newly designed oblique stabilizers (intervention group). All patients were evaluated 6 months after the operation with the Pectus Excavatum Evaluation Questionnaire (PEEQ).ResultsThere were 16 patients in the control group and 14 in the intervention group. Mean age was 17 (SD: 3.3, range 14–27) years. There were no demographic differences between groups. Two patients in the control group and one in the intervention group were repaired with two bars instead of one. There was one reoperation in each group. There was a significant difference between the pre- and postoperative scores, in both groups, in the patient body image domain (control group: 9.5 to 3; p < 0.01; intervention group 10 to 3; p < 0.01), as well as in the psychosocial domain (control group: 13.5 to 24, p < 0.01; intervention group: 15 to 24, p < 0.01). With regards to the patients' perception of physical difficulties before and after MIRPE, the difference between pre- and postoperative scores was greater in the intervention group (8 to 12, p < 0.01) than in the control group (10 to 11, p = 0.04). The mean length of stay was 4.5 and 5 days in the intervention group and the control group, respectively.ConclusionOur study showed that patients who underwent MIRPE with the newly designed bars and stabilizers had non-inferior outcomes than patients reported in the literature who underwent MIRPE with standard bars and stabilizers. We found slightly better outcomes in patients in the intervention group compared to the control group, but larger studies will be needed to confirm if those differences are statistically significant.Level of evidenceII 相似文献
63.
André Luís Conde Watanabe Mateus Silva Feijó Vinícius Paulo Lima de Menezes Mayara Regina Galdino-Vasconcelos Jorge Luis Salinas Caballero Gustavo Ferreira Fernando Jorge Natália Trevizoli Luiz Gustavo Diaz Priscila Brizolla de Campos Gabriel Cajá Raquel Ullmann Ana Virgínia Figueira Tiago Morato Adriano Moraes Juan Rafael Branez Pereira Marcelo Perosa 《Transplantation proceedings》2021,53(1):73-82
IntroductionLiver transplantation is the standard treatment for end-stage liver disease. Brazil holds the third highest number of liver transplants performed per year, but center maldistribution results in high discrepancies in accessing this treatment. In 2012, an interstate partnership successfully implemented a new liver transplantation program in the middle west of Brazil. Here, we report the results of the first 500 liver transplants performed in this new program and discuss the impacts of a new transplant center in regional transplantation dynamics.MethodsWe reviewed data from the first 500 consecutive deceased donor liver transplants performed in the new program during an 8-year period. We analyzed data on patients’ clinical and demographic profiles, postoperative outcomes, and graft and recipient survival rates. Univariate survival analysis was conducted using log-rank tests to compare the groups.ResultsAlmost half (48%) of the procured organs and 40% of the recipients transplanted in our center were from outside our state. Recipient 30-day mortality was 9%. Overall recipient survival at 1 year and 5 years was 85% and 80%, respectively. Mortality was significantly associated with higher Model for End-Stage Liver Disease (P < .001) but not with the presence of hepatocellular carcinoma (P = .795).DiscussionThe new transplantation program treated patients from different regions of Brazil and became the reference center in liver transplantation for the middle west region. Despite the recent implementation, our outcomes are comparable to experienced centers around the world. This model can inspire the creation of new transplantation programs aiming to democratize access to liver transplantation nationwide. 相似文献
64.
Zafer Tandogdu Justin Collins Greg Shaw Jennifer Rohn Bela Koves Ashwin Sachdeva Ahmed Ghazi Alexander Haese Alex Mottrie Anup Kumar Ananthakrishnan Sivaraman Ashutosh Tewari Benjamin Challacombe Bernardo Rocco Camilo Giedelman Christian Wagner Craig G. Rogers Declan G. Murphy Dmitry Pushkar Gabriel Ogaya-Pinies James Porter Kulthe Ramesh Seetharam Markus Graefen Marcelo A. Orvieto Marcio Covas Moschovas Oscar Schatloff Peter Wiklund Rafael Coelho Rair Valero Theo M. de Reijke Thomas Ahlering Travis Rogers Henk G. van der Poel Vipul Patel Walter Artibani Florian Wagenlehner Kris Maes Koon H. Rha Senthil Nathan Truls Erik Bjerklund Johansen Peter Hawkey John Kelly 《BJU international》2021,127(6):729-741
65.
Carlos Solano Lourdes Vázquez Estela Giménez Rafael de la Cámara Eliseo Albert Montserrat Rovira Ildefonso Espigado Carmen M. Calvo Javier López-Jiménez María Suárez-Lledó Anabella Chinea Albert Esquirol Ariadna Pérez Aránzazu Bermúdez Raquel Saldaña Inmaculada Heras Ana J. González-Huerta Tamara Torrado Guiomar Bautista Montserrat Batlle Santiago Jiménez Carlos Vallejo Pere Barba María Á. Cuesta José L. Piñana David Navarro 《American journal of transplantation》2021,21(1):258-271
The net impact of cytomegalovirus (CMV) DNAemia on overall mortality (OM) and nonrelapse mortality (NRM) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a matter of debate. This was a retrospective, multicenter, noninterventional study finally including 749 patients. CMV DNA monitoring was conducted by real-time polymerase chain reaction (PCR) assays. Clinical outcomes of interest were OM and NRM through day 365 after allo-HSCT. The cumulative incidence of CMV DNAemia in this cohort was 52.6%. A total of 306 out of 382 patients with CMV DNAemia received preemptive antiviral therapy (PET). PET use for CMV DNAemia, but not the occurrence of CMV DNAemia, taken as a qualitative variable, was associated with increased OM and NRM in univariate but not in adjusted models. A subcohort analysis including patients monitored by the COBAS Ampliprep/COBAS Taqman CMV Test showed that OM and NRM were comparable in patients in whom either low or high plasma CMV DNA threshold (<500 vs ≥500 IU/mL) was used for PET initiation. In conclusion, CMV DNAemia was not associated with increased OM and NRM in allo-HSCT recipients. The potential impact of PET use on mortality was not proven but merits further research. 相似文献
66.
Jon Kobashigawa Darshana M. Dadhania Maryjane Farr W. H. Wilson Tang Arvind Bhimaraj Lawrence Czer Shelley Hall Abdolreza Haririan Richard N. Formica Jignesh Patel Rafael Skorka Savitri Fedson Titte Srinivas Jeffrey Testani Julie M. Yabu Xingxing S. Cheng the Consensus Conference Participants 《American journal of transplantation》2021,21(7):2459-2467
67.
68.
M. Pilar Honrubia M. Paz Herráez Rafael Alvarez 《Archives of environmental contamination and toxicology》1993,25(2):184-191
Embryos of Rana perezi were kept under laboratory conditions and treated with carbamate ZZ-Aphox® at chronic doses of 0.02 and 0.14 for 9 weeks. Both the histological study and the analysis of mortality show a direct relationship between the dosage and the effects of the pesticide. The histological study of the survivors over 56 days show damages in gills, liver, gall-bladder, heart, and notochord. Damages on the epithelia of gills (on their distal portion) and gall-bladder recover over a few days, whereas those provoked on the compacting of the hepatic parenchyma and the hepatocytes, the auricle and the perinotochordal collagenic fibers alter their structure in a lasting way. Potentials of such alterations are discussed, with special reference to the possible interference of the pesticide on the successful synthesis of the supporting connective sheaths. 相似文献
69.
Sex selection may be inadvertently performed in in-vitro fertilization--embryo transfer programmes 总被引:3,自引:2,他引:1
Tarin Juan J.; Bernabeu Rafael; Baviera Amparo; Bonada Maria; Cano Antonio 《Human reproduction (Oxford, England)》1995,10(11):2992-2998
The present study aims to ascertain whether sex selection maybe inadvertently performed in human in-vitro fertilization (IVF)and embryo transfer (IVF-embryo transfer) programmes when selectingfor high quality embryos (those with the fastest cleaving ratesand/or the best morphology) at the fresh transfer cycle. Allpatients entering into the study were treated with gonadotrophinsafter pituitary suppression with gonadotrophin-releasing hormoneagonists (GnRHa) and had intrauterine embryo transfer on day2 post-insemination. These patients were retrospectively dividedinto three groups according to whether the difference in meannumber of cells between embryos transferred and all embryosavailable for transfer in a given cycle was less than (negativeselection), equal to (no selection) or greater (positive selection)than zero. In cycles resulting in singleton births, the sexratio of the resulting babies was significantly (P 0.005) shiftedtoward the female (88.8%) and to the male (90.0%) in the negativeand positive selection groups respectively. No shift in sexratio was observed in cycles resulting in multiple births. Maternalage was another independent factor affecting sex ratio at birth.Sex ratio was significantly (P 0.05) skewed in favour of males(62.7%) and females (71.4%) in women <35 and 235 years ofage respectively. Maternal age, number of embryos transferredand the event of selecting or not selecting the slowest cleavingembryos for transfer were entered automatically in a three-groupdiscriminant model for distinguishing cycles resulting in onlyboys, both boys and girls, and only girls. These data suggestthat (i) sex selection may be inadvertently performed in IVF-embryotransfer programmes when selecting for high quality embryosat the fresh transfer cycles; (ii) human endometria may be favourable,indifferent or hostile to either fast cleaving or slow cleavingembryos depending on maternal age; and (iii) naturalsex selection may be performed for social, psychological ormedical reasons. 相似文献
70.
Gastro-Gastric Fistulas and Marginal Ulcers in Gastric Bypass Procedures for Weight Reduction 总被引:7,自引:5,他引:2
Background: Gastro-gastric fistulas and marginal ulcers are frequent and serious complications of gastric compartmentalization
procedures for obesity. Methods: The authors analyzed 810 patients after 911 operations for gastro-gastric fistulas and marginal
ulcers over an 8-year period. All patients underwent a form of gastric bypass, in which a pouch is constructed along the lesser
curvature of the stomach. The outlet of the pouch was restricted with a prosthetic band. In the first 189 patients (Group
I), the pouch and stomach were stapled in continuity or partially divided. In the next 222 patients (Group II), segments were
stapled and separated by transection. In the remaining 492 cases (Group III), in addition to transection of the stomach, a
limb of jejunum was interposed between the pouch and excluded stomach. Stapled anastomoses were done in Group I and II patients
and a portion of Group III patients. The remaining patients underwent hand-sewn anastomosis. Results: Gastro-gastric fistulas
occurred in 49% of the patients in Group I, 2.6% of those in Group II, and 0% of those in Group III. In stapled anastomosis,
the incidence of marginal ulceration in Groups I, II, and III were 8.5%, 5.4%, and 5.1%, respectively. In a subset of Group
III patients, in whom a two-layer, hand-sewn anastomosis was done, the incidence was 1.6% when the outer layer was not absorbable
and 0% when both layers were absorbable. Conclusions: Gastro-gastric fistulas and marginal ulcerations are likely the result
of breakdown of the mucosa resulting from migrating staples and other foreign material. Lack of integrity of the gastric lining
facilitates the action of the gastric digestive process. Transection of gastric segments with interposition of jejunum prevents
gastro-gastric fistula formation. An intact serosa appears to block the digestion of bowel wall by gastric enzymes. Our early
data suggest that the use of absorbable sutures at the gastrojejunostomy significantly decreases the incidence of marginal
ulceration. 相似文献