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21.
Eytan M. Debbi Benjamin Bernfeld Amir Herman Moshe Salai Yocheved Laufer Alon Wolf 《The Journal of arthroplasty》2019,34(1):47-55
Background
Biomechanics after total knee arthroplasty (TKA) often remain abnormal and may lead to prolonged postoperative recovery. The purpose of this study is to assess a biomechanical therapy after TKA.Methods
This is a randomized controlled trial of 50 patients after unilateral TKA. One group underwent a biomechanical therapy in which participants followed a walking protocol while wearing a foot-worn biomechanical device that modifies knee biomechanics and the control group followed a similar walking protocol while wearing a foot-worn sham device. All patients had standard physical therapy postoperatively as well. Patients were evaluated throughout the first postoperative year with clinical measures and gait analysis.Results
Improved outcomes were seen in the biomechanical therapy group compared to the control group in pain scores (88% vs 38%, P = .011), function (86% vs 21%, P = .001), knee scores (83% vs 38%, P = .001), and walking distance (109% vs 47%, P = .001) at 1 year. The therapy group showed healthier biomechanical gait patterns in both the sagittal and coronal planes at 1 year.Conclusion
A postoperative biomechanical therapy improves outcomes following TKA and should be considered as an additional therapy postoperatively. 相似文献22.
Sophia A. Traven Russell A. Reeves Molly G. Sekar Harris S. Slone Zeke J. Walton 《The Journal of arthroplasty》2019,34(1):140-144
Background
While the 11-factor modified frailty index (mFI) has been shown to predict adverse outcomes in patients undergoing total joint arthroplasty, the 5-factor index has not been evaluated in this patient population. The goal of this study was to evaluate the utility of the mFI-5 as a predictor of morbidity and mortality in patients undergoing primary total hip and knee arthroplasty.Methods
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program's database for patients undergoing total hip arthroplasty and total knee arthroplasty between the years 2005 and 2016 was conducted. The 5-factor score, which includes the presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications while controlling for demographic variables.Results
One hundred forty thousand one hundred fifty-eight patients undergoing total hip arthroplasty and 226,398 patients undergoing total knee arthroplasty were identified. After adjusting for demographic variables and comorbid conditions, logistic regression analyses revealed that the mFI-5 was a strong predictor for total complications, Clavien-Dindo grade IV complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), surgical site infections, readmission, and 30-day mortality (P < .001).Conclusions
The mFI-5 is an independent predictor of postoperative complications including life-threatening medical complications, surgical site infections, hospital readmission, and 30-day mortality after primary hip and knee arthroplasty. This clinical tool can be used to identify high-risk surgical patients and guide preoperative counseling to optimize outcomes.Level of Evidence
III. 相似文献23.
Arne de Niet Michel M.P.J. Reijnen Clark J. Zeebregts 《Journal of vascular surgery》2019,69(2):348-356
Objective
The objective of this study was to investigate the feasibility of a specific custom-made fenestrated aortic cuff in the treatment of complex abdominal aortic aneurysms (AAAs).Methods
Between 2013 and 2016, a total of 57 custom-made Fenestrated Anaconda (Vascutek, Inchinnan, Scotland, UK) aortic cuffs were placed in 38 centers worldwide. All centers were invited to participate in this retrospective analysis. Postoperative and follow-up data included the presence of adverse events, necessity for reintervention, and renal function.Results
Fifteen clinics participated, leading to 29 cases. Median age at operation was 74 years (interquartile range [IQR], 71-78 years); five patients were female. Two patients were treated for a para-anastomotic AAA after open AAA repair, 19 patients were treated because of a complicated course after primary endovascular AAA repair, and 8 cases were primary procedures for AAA. A total of 76 fenestrations (mean, 2.6 per case) were used. Four patients needed seven adjunctive procedures. Two patients underwent conversion, one because of a dissection of the superior mesenteric artery and one because of perforation of a renal artery. Median operation time was 225 minutes (IQR, 150-260 minutes); median blood loss, 200 mL (IQR, 100-500 mL); and median contrast volume, 150 mL (IQR, 92-260 mL). Primary technical success was achieved in 86% and secondary technical success in 93%. The 30-day morbidity was 7 of 29 with a mortality rate of 4 of 29. Estimated glomerular filtration rate remained unchanged before and after surgery (76 to 77 mL/min/m2). Between preoperative and median follow-up of 11 months, estimated glomerular filtration rate was reduced statistically significantly (76 to 63 mL/min/m2). During follow-up, 9 cases had an increase in aneurysm sac diameter (5 cases >5 mm); 14 cases had a stable or decreased aneurysm sac diameter; and in 2 cases, no aneurysm size was reported. No type I endoleak was reported, and two cases with a type III endoleak were treated by endovascular means during follow-up. Survival, reintervention-free survival, and target vessel patency at 1 year were 81% ± 8%, 75% ± 9%, and 99% ± 1%, respectively. After 2 years, these numbers were 81% ± 8%, 67% ± 11%, and 88% ± 6%, respectively. During follow-up, the two patients with a type III endoleak needed endograft-related reinterventions.Conclusions
Treatment with this specific custom-made fenestrated aortic cuff is feasible after complicated previous (endovascular) aortic repair or in complex AAAs. The complexity of certain AAA cases is underlined in this study, and the Fenestrated Anaconda aortic cuff is a valid option in selected cases in which few treatment options are left. 相似文献24.
Javed Butler Mei Yang Massimiliano Alfonzo Manzi Gregory P. Hess Mahesh J. Patel Thomas Rhodes Michael M. Givertz 《Journal of the American College of Cardiology》2019,73(8):935-944
Background
Epidemiology of patients with worsening heart failure and reduced ejection fraction (HFrEF) in the real-world setting is not well described.Objectives
The purpose of this study was to describe incidence, clinical characteristics, treatment, and outcomes of patients with HFrEF who develop worsening heart failure (HF) in the real-world setting.Methods
Data on patients with incident HFrEF from the National Cardiovascular Data Registry PINNACLE were linked to pharmacy, private practitioner, and hospital claims databases. Incidence, clinical characteristics, treatment (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, and mineralocorticoid receptor antagonist) and outcomes of patients with worsening HF, defined as ≥90 days of stable HF with subsequent worsening requiring intravenous diuretic agents, were assessed.Results
Of 11,064 HFrEF patients, 1,851 (17%) developed worsening HF on average 1.5 years following initial HF diagnosis. Patients who developed worsening HF were more likely to be African American, be octogenarians, and have higher comorbidity burden (p < 0.001). At the onset of worsening HF, 42.4% of patients were on monotherapy, 43.4% were on dual therapy, and 14.1% were on triple therapy. A total of 48%, 61%, and 98% of patients were on >50% target dose for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, and mineralocorticoid receptor antagonist, respectively. The 2-year mortality rate was 22.5%, and 56% of patients were rehospitalized within 30 days of the worsening HF event.Conclusions
In the real-world setting, 1 in 6 patients with HFrEF develop worsening HF within 18 months of HF diagnosis. These patients have a high risk for 2-year mortality and recurrent HF hospitalizations. The use of standard-of-care therapies both before and after the onset of worsening HF is low. With high unmet medical need, patients with worsening HF require novel treatment strategies as well as greater optimization of existing guideline-directed therapy. 相似文献25.
Andrea Garatti Andrea Daprati Marzia Cottini Claudio F. Russo Margherita Dalla Tomba Giovanni Troise Antonio Salsano Francesco Santini Roberto Scrofani Francesca Nicolò Elisa Mikus Alberto Albertini Luca Di Marco Davide Pacini Marco Picichè Loris Salvador Guglielmo M. Actis Dato Paolo Centofanti Lorenzo Menicanti 《The Annals of thoracic surgery》2021,111(4):1242-1251
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26.
27.
Optimizing glycemic control remains a shared challenge for clinicians and their patients with diabetes. Flash continuous glucose monitoring (CGM) provides immediate information about an individual’s current and projected glucose level, allowing users to respond promptly to mitigate or prevent pending hypoglycemia or hyperglycemia. Large randomized controlled trials (RCTs) have demonstrated the glycemic benefits of flash CGM use in both type 1 and type 2 diabetes. However, whereas RCTs are mostly focused on the efficacy of this technology in defined circumstances, real-world studies can assess its effectiveness in wider clinical settings. This review assesses the most recent real-world studies demonstrating the effectiveness of flash CGM use to improve clinical outcomes and health care resource utilization in populations with diabetes.During the past 5 years, increasing numbers of people with type 1 or type 2 diabetes have integrated continuous glucose monitoring (CGM) into their diabetes self-management regimens. Unlike traditional blood glucose meters, CGM systems provide immediate information about the concentration and the direction and rate of change of interstitial glucose. This information enables patients to intervene promptly to prevent or reduce acute hypoglycemia or hyperglycemia.Flash CGM is among the most recent CGM technologies. Currently, the FreeStyle Libre 14-day system (Abbott Diabetes Care) and FreeStyle Libre 2 are the only flash CGM systems available, and these systems are being adopted rapidly. Large randomized controlled trials (RCTs) have confirmed the glycemic benefits of flash CGM use in people with type 1 diabetes (1,2) and those with type 2 diabetes (3–6). However, because RCTs are mostly focused on measures of efficacy in defined circumstances, real-world studies can usefully assess the effectiveness of flash CGM in wider clinical settings.Although adoption of flash CGM continues to expand within endocrinology and diabetes specialty practices, primary care providers may be less familiar with this technology and how it can benefit patients with diabetes. This review assesses recent real-world studies demonstrating the impact of flash CGM use on clinical outcomes and health care resource utilization in both type 1 and type 2 diabetes populations. 相似文献
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29.
Though cerebrovascular complications of pregnancy remain relatively rare, they represent a potentially devastating event that necessitates prompt identification and treatment. Eighteen percent of strokes occurring in young women are linked to pregnancy. They occur mostly in the third trimester or during the post-partum period. Their biggest risk factors are hypertension, preeclampsia/eclampsia and migraine. Cerebrovascular events occurring during this period may involve specific pathophysiological processes that include embolic phenomena or endothelial dysfunction, but can also have common etiologies that are simply favored by the context of pregnancy. Thus, posterior encephalopathy and vasoconstriction cerebral syndrome are relatively frequently involved in cerebrovascular complications of pregnancy. Other very specific causes like amniotic fluid embolism or postpartum cardiomyopathy can also be responsible for such events. The management of stroke during pregnancy must be multidisciplinary and include a neurovascular expertise. Some conditions can lead to a long-life follow-up and modify the management of a future pregnancy. 相似文献
30.