Tag: pubmed

Acta Orthop Belg. 2024 Dec;90(4):739-743. doi: 10.52628/90.4.12808.

ABSTRACT

Metastasis stands as one of the most prominent prognostic factors in osteosarcoma. Over 70% of metastatic osteosarcoma occurrences affect the lung. Nonetheless, to date, there has been a scarcity of research addressing predictive factors for lung metastasis risk in osteosarcoma. The objective of this study is to identify the predictive factors that have a role in the risk of lung metastasis in osteosarcoma. This is a retrospective study conducted between January 2018 until January 2023. From the obtained research subjects, an assessment selection was carried out using inclusion and exclusion criteria. Subsequently, preoperative data related to predictive factors will be collected from the research subjects, followed by a clinicopathological conference, chemotherapy, and surgery. Afterward, an evaluation of pulmonary metastasis will be conducted six months after the diagnosis. A total of 47 osteosarcoma patients who met the inclusion and exclusion criteria were analyzed. Bivariate and multivariate logistic regression analyses revealed statistically significant predictive factors for the risk of pulmonary metastasis in osteosarcoma: ALP levels (p=0.014), LDH levels (p=0.038), presence of pathological fractures (p=0.025), and tumor size (p=0.027).

PMID:39869878 | DOI:10.52628/90.4.12808

Acta Orthop Belg. 2024 Dec;90(4):731-737. doi: 10.52628/90.4.10536.

ABSTRACT

Atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLPS) are low-grade, slow-growing, and locally aggressive tumors. We investigated clinical outcomes and recurrence factors for ALT/WDLPS of the extremities. This is retrospective study across three institutions which included patients who underwent surgery for ALT/WDLPS from 2001 to 2019. We collected the data such as the patient demographics, anatomical locations of the tumors (subcutaneous, intramuscular, intermuscular, upper extreme/lower extremity), immunohistochemical data, and the resected margin status. The following variables were evaluated as potential recurrence factors: age, sex, tumor diameter, anatomical location of the tumor, immunohistochemical results, and resected margins. The 5- year local recurrence-free survival rate (RFS) was calculated and differences in survival were assessed. Sixty-two patients were identified, including 29 men and 33 women. The mean age was 63.7 years (range, 34-82 years). The average maximum tumor diameter was 15.9 cm (range, 5-28 cm). The maximum tumor diameter (≥20 cm) was significantly associated with local recurrence (p=0.042). Ten patients (16.1%) developed local recurrence, and the mean time to recurrence was 48.4 months (range, 5-161 months). In our series of 62 patients, the differences in local recurrences were not statistically significant for age, sex, tumor site, surgical margin (R0 or not) and immunohistochemical results. Tumor diameter ≥20 cm, which was the only identified factor for recurrence.

PMID:39869877 | DOI:10.52628/90.4.10536

Acta Orthop Belg. 2024 Dec;90(4):699-707. doi: 10.52628/90.4.12369.

ABSTRACT

Correct treatment of chronic osteomyelitis depends on proper identification of the bone-infecting microorganism, but it is difficult identify the specific etiology in previously treated patients and in those with implants. Small colony variants auxotrophyc for menadione had been related with false-negative results in culture of patient with chronic osteomyelitis, but menadione supplementation can increase bone culture performance. The purpose was to evaluate the effect of menadione supplementation on isolates in bone cultures, in a cohort of patients with osteomyelitis, Medellín- Colombia. We performed a study of a retrospective cohort with 40 adult patients with culture-negative and chronic osteomyelitis, supplemented with 3 doses of menadione. Effect was defined as the proportion of positive bone cultures after treatment administration. The comparison of the effect with clinical variables was made with Chi-square, Fisher and Mann-Whitney U test in SPSS 29.0. Microbiological isolates from bone culture ranged from 0% (pre- treatment) to 62.5% (post-treatment), mainly S. aureus sensitive to methicillin, coagulase-negative Staphylococcus, E. coli and Enterobacter spp. This effect did not present statistical differences according to the clinical characteristics or comorbidities of the patients. We concluded that in patients with chronic osteomyelitis and negative bone cultures, menadione supplementation produces a high proportion of isolates and identification of the etiological agent, which favors correct treatment and reduces readmissions, complications, and resistance to antibiotics.

PMID:39869875 | DOI:10.52628/90.4.12369

Acta Orthop Belg. 2024 Dec;90(4):659-664. doi: 10.52628/90.4.13073.

ABSTRACT

This prospective, observational cohort study compares the clinical and radiographic outcomes of the modified Weaver and Dunn (WD) technique with the newer, anatomical double-button plus tendon allograft technique (DB), and the suture anchor repair plus tendon allograft (SA). The study cohort includes 53 patients, who underwent surgery for acromioclavicular joint (ACJ) dislocation Rockwood type 3, 4 and 5. Patient-reported outcome scores and clinical results, including Disabilities of the Arm, Shoulder and Hand (DASH), the Subjective Shoulder Value (SSV), the Visual Analogue Scale (VAS) and the Constant score (CS) results as well as loss of reduction rates on plain radiographs were compared. Nineteen patients in the DB group, 19 patients in the SA group and 15 patients in the WD group were included. Average time of follow up was 5 years. The mean VAS scores (SD) were 0.3 (0.6), 0.5 (0.8) and 1.2 (1.4) in the WD, DB and SA groups (p=0.06). There were no significant differences in DASH, SSV and Constant scores between groups. Loss of reduction on plain radiographs occurred in 4 patients in total (1 WD, 1 DB, 2 SA). The SSV score, the DASH score, the Constant score and the VAS-score revealed no statistically significant differences between the group with good alignment compared to groups with partial reduction or loss of reduction. In conclusion we can state that the use of anatomical reconstruction techniques with tendon allograft and additional button or suture anchors fixation does not affect the clinical and radiographical outcomes compared to the classic Weaver and Dunn procedure. Loss of reduction was not correlated to worse clinical outcome scores.

PMID:39869870 | DOI:10.52628/90.4.13073

Acta Orthop Belg. 2024 Dec;90(4):575-579. doi: 10.52628/90.4.12752.

ABSTRACT

Dislocation is the second most common indication for revision total hip arthroplasty (THA). In revision cases the dislocation rate can be as high as 5-30%. The aim of this study was to assess the outcome, specifically the dislocation rate in revision THA where a dual mobility cup was used. We retrospectively reviewed all the revision THAs where a dual mobility cup (G7) was used. The pre-operative and post-operative oxford hip scores were recorded. Patients’ electronic records and radiographs were studied for the indications, approaches used, post-operative complications, re-operation rates, and re-revision surgery. Between 2016 and 2020, we performed 59 revision total hip replacements where a dual mobility cup (G7) was used. There were 23 males and 36 females. The average age was 74 years (range, 64-89). Acetabular components were revised in 47 (80%) cases and both the femoral and the acetabular components were revised in 12 (20%) cases. The average follow-up time was 4 years (range, 2-6 years). Average pre-operative and post-operative oxford hip scores were 17 and 36 respectively. The improvement was significant with P value of <.001. Complications were noted in 5 (8%) patients. One patient had dislocation. This patient required re-revision with constrained liner. One patient had intraoperative fracture of the femur and was treated with plate and cables. We conclude that the dual mobility cup can significantly reduce the risk of dislocation when used in revision THA.

PMID:39869859 | DOI:10.52628/90.4.12752

JMIR Public Health Surveill. 2025 Jan 27;11:e59845. doi: 10.2196/59845.

ABSTRACT

BACKGROUND: Numerous studies have assessed the risk of SARS-CoV-2 exposure and infection among health care workers during the pandemic. However, far fewer studies have investigated the impact of SARS-CoV-2 on essential workers in other sectors. Moreover, guidance for maintaining a safely operating workplace in sectors outside of health care remains limited. Workplace surveillance has been recommended by the Centers for Disease Control and Prevention, but few studies have examined the feasibility or effectiveness of this approach.

OBJECTIVE: The objective of this study was to investigate the feasibility and effectiveness of using frequent point-of-care molecular workplace surveillance as an intervention strategy to prevent the spread of SARS-CoV-2 at essential rural workplaces (mining sites) where physical distancing, remote work, and flexible schedules are not possible.

METHODS: In this nonrandomized controlled clinical trial conducted from February 2021, to March 2022, 169 miners in New Mexico (intervention cohort) and 61 miners in Wyoming (control cohort) were enrolled. Investigators performed point-of-care rapid antigen testing on midnasal swabs (NSs) self-collected by intervention miners. Our first outcome was the intervention acceptance rate in the intervention cohort. Our second outcome was the rate of cumulative postbaseline seropositivity to SARS-CoV-2 nucleocapsid protein, which was analyzed in the intervention cohort and compared to the control cohort between baseline and 12 months. The diagnostic accuracy of detecting SARS-CoV-2 using rapid antigen testing on NSs was compared to laboratory-based reverse transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs (NPSs) in a subset of 68 samples.

RESULTS: Our intervention had a mean acceptance rate of 96.4% (11,413/11,842). The intervention miners exhibited a lower cumulative postbaseline incident seropositivity at 12 months compared to control miners (14/97, 14% vs 17/45, 38%; P=.002). Analysis of SARS-CoV-2 antigen detection in self-administered NSs revealed 100% sensitivity and specificity compared to laboratory-based RT-PCR testing on NPSs.

CONCLUSIONS: Our findings establish frequent point-of-care molecular workplace COVID-19 surveillance as a feasible option for keeping essential rural workplaces open and preventing SARS-CoV-2 spread. These findings extend beyond this study, providing valuable insights for designing interventions to maintain employees’ safety at other essential workplaces during an infectious disease outbreak.

PMID:39869851 | DOI:10.2196/59845

J Urol. 2025 Jan 27:101097JU0000000000004455. doi: 10.1097/JU.0000000000004455. Online ahead of print.

ABSTRACT

PURPOSE: Urinary incontinence (UI) is common in nulliparous female elite athletes, but underlying pathophysiology is inadequately understood. We examined urinary symptoms and associated pelvic floor anatomy and function in this population, hypothesizing that athletes with UI would exhibit pelvic floor findings seen in older incontinent women (e.g., pelvic floor descent and urethral hypermobility) and findings attributable to elite sporting such as muscle hypertrophy.

MATERIALS AND METHODS: We performed a cross-sectional study of NCAA Division 1 nulliparous female athletes comparing symptomatic (i.e. currently or previously experienced urinary leakage during exercise) and asymptomatic athletes. We assessed demographics, sport characteristics, relevant medical history (including Brief Eating Disorder in Athletes Questionnaire) and validated genitourinary symptom questionnaires (Lower Urinary Tract Dysfunction Network Symptom Index-29; Female Genitourinary Pain Index). Pelvic exam and dynamic MRI were used to assess the pelvic floor at rest and at maximal strain. Pelvic floor anatomic structures were evaluated and segmented by MRI.

RESULTS: Of 29 athletes (11 asymptomatic, 18 symptomatic), demographics, sport characteristics, and pelvic exam findings were not statistically different between groups. Symptomatic athletes had significantly worse urinary symptoms (median LURN SI-29 8.5 vs. 8.0, P=0.022) and genitourinary pain (median GUPI 7 vs. 3, P=0.036), greater anterior thickness of the striated urethral sphincter muscle (median 2.5 vs. 1.8 mm, P=0.016) and puborectalis and levator ani muscles (median 10.3 vs. 8.6 mm, P=0.028), and worse disordered eating (median BEDA-Q 7.5 vs. 4.5, P=0.022).

CONCLUSIONS: In nulliparous female elite athletes with UI, dynamic pelvic MRI identified differences in pelvic floor anatomy, which may be part of a multifactorial etiology of UI.

PMID:39869821 | DOI:10.1097/JU.0000000000004455

Proc Natl Acad Sci U S A. 2025 Feb 4;122(5):e2401237121. doi: 10.1073/pnas.2401237121. Epub 2025 Jan 27.

ABSTRACT

Funding of curiosity-driven science is the lifeblood of scientific and technological innovation. Various models of funding allocation became institutionalized in the 20th century, shaping the present landscape of research funding. There are numerous reasons for scientists to be dissatisfied with current funding schemes, including the imbalance between funding for curiosity-driven and mission-directed research, regional and country disparities, path-dependency of who gets funded, gender and race disparities, low inter-reviewer reliability, and the trade-off between the effort and time spent on writing or reviewing proposals and doing research. We discuss possible alternative models for dealing with these issues. These alternatives include incremental changes such as placing more weight on the proposals or on the investigators and representative composition of panel members, along with deeper reforms such as distributed or concentrated funding and partial lotteries in response to low inter-reviewer reliability. We also consider radical alternatives to current funding schemes: the removal of political governance and the introduction of international competitive applications to a World Research Council alongside national funding sources. There is likely no single best way to fund curiosity-driven research; we examine arguments for and against the possibility of systematically evaluating alternative models empirically.

PMID:39869812 | DOI:10.1073/pnas.2401237121

Int J Surg. 2025 Jan 24. doi: 10.1097/JS9.0000000000002240. Online ahead of print.

ABSTRACT

BACKGROUND: Liver malignancies present substantial challenges to surgeons due to the extensive hepatic resections required, frequently resulting in posthepatectomy liver failure. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was designed to increase the resectable liver volume, yet it is associated with significant mortality and morbidity rates. Recently, minimally invasive techniques have been incorporated into ALPPS, with the potential to improve the procedure’s safety profile whilst maintaining efficacy.

MATERIALS AND METHODS: This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase and Cochrane for all interventional studies that evaluated the operative outcomes of minimally invasive ALPPS compared to open ALPPS. Two independent reviewers appraised and extracted the summary data from published studies. Random effects meta-analyses were used for primary analysis.

RESULTS: Nine studies with 637 patients undergoing ALPPS were included. Meta-analyses indicated a statistically significant decreased risk of 90-day mortality (RR = 0.48, 95%CI: 0.29;0.80) and decreased overall length of hospital stay (MD = -8, 95%CI: -11.25;-4.74) in patients undergoing minimally invasive ALPPS compared to patients undergoing open ALPPS. No significant differences in terms of the rate of future liver remnant growth (MD = 11.37, 95%CI: -4.02;26.77) and risk of posthepatectomy liver failure (RR = 0.52, 95%CI: 0.09;2.97) were identified. Subgroup analyses identified a trend in lowering the risk of posthepatectomy liver failure in patients undergoing laparoscopic ALPPS compared to robotic ALPPS. In terms of oncologic surgical outcomes, 92% of patients undergoing minimally invasive ALPPS achieved negative margin resections, while 86% of patients undergoing open ALPPS achieved negative margin resections.

CONCLUSION: This systematic review and meta-analysis provide evidence that minimally invasive ALPPS offers a safer alternative with reduced mortality and shorter hospital stays, while maintaining comparable efficacy in liver remnant growth and R0 resections. These findings highlight the potential of minimally invasive techniques to combat the criticism that ALPPS has been placed under.

PMID:39869398 | DOI:10.1097/JS9.0000000000002240

Int J Surg. 2025 Jan 24. doi: 10.1097/JS9.0000000000002232. Online ahead of print.

ABSTRACT

BACKGROUND: The impact of aortic arch (AA) morphology on the management of the procedural details and the clinical outcomes of the transfemoral artery (TF)-transcatheter aortic valve replacement (TAVR) has not been evaluated. The goal of this study was to evaluate the AA morphology of patients who had TF-TAVR using an artificial intelligence algorithm and then to evaluate its predictive value for clinical outcomes.

MATERIALS AND METHODS: A total of 1480 consecutive patients undergoing TF-TAVR using a new-generation transcatheter heart valve at 12 institutes were included in this retrospective study. The AA measurements were evaluated by deep learning, and then the approach index (IA) was determined. The machine learning algorithm was used to construct the predictive model and was validated externally.

RESULTS: The area under the curve of the IA model using random forest and logistic regression was 0.675 [95% confidence interval (CI): 0.586-0.764] and 0.757 (95% CI: 0.665-0.849), respectively. The IA model was validated externally, and consistent distinctions were obtained. After we used a generalized propensity score matching method for continuous exposure, the IA was the strongest correlation factor for major procedural events (odds ratio: 3.87; 95% CI: 2.13-7.59, P < 0.001). When leaflet morphology or transcatheter heart valve type was an interactive item with IA, neither of them was statistically significant in terms of clinical outcomes.

CONCLUSION: IA may be used to identify the impact of AA morphology on procedural and clinical outcomes in patients having TF-TAVR and to help to predict the procedural complications.

PMID:39869394 | DOI:10.1097/JS9.0000000000002232