Procedural Outcomes of Double Vs. Single Fluoroscopy for Fixing Supracondylar Humerus Fractures in Children: A Case–Control Study

Introduction: Orthopaedic emergency department commonly receives paediatric fractures, of which forearm fractures constitute a larger proportion with the burden greatest in low-middle income countries. Studies done in the temperate region found an association between forearm fractures in children and low serum vitamin D3. Some studies in our environment have shown low levels of 25-hydroxy vitamin D3 {25(OH)D} in normal Nigerian children, but the association with forearm fractures has not been studied. Aim: To determine if serum vitamin D3 level can predict the occurrence of forearm fractures in children. Materials and Methods: This was a case control study conducted over a year from January 2018 to December 2018 at a tertiary health facility in South-West Nigeria among paediatric patients. Thirty children with forearm fractures and thirty children with no forearm fractures were recruited for the study. Socio-demographic data, mechanisms of fracture, anthropometric measurements and serum 25(OH)D levels were determined. Univariate and multivariate analyses were done for the variables concerning the presence or absence of forearm fractures (dependent variable is the presence or absence of forearm fractures; independent variables include the age, sex, mechanism of injury, outdoor playing time, serum vitamin D3 level). Results: The mean serum 25(OH)D levels in the study group were significantly lower than the controls; (60.751±15.041 ng/mL and 95.506±19.489 ng/mL, respectively). There was a statistically significant relationship between the serum level of 25(OH)D and the presence of forearm fracture in children (p=0.002 and OR of 0.838). Conclusion: Children with forearm fracture have relatively lower serum vitamin D3 compared with age matched ones without fracture and they have correspondingly increased odd risks of sustaining forearm fracture.

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Baseline pro-inflammatory gene expression in whole blood is related to adverse long-term outcomes after transcatheter aortic valve replacement: a case control study

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02186-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Deena S. Goldwater ◽

Mei Leng ◽

Arun Karlamangla ◽

Teresa Seeman ◽

David Elashoff ◽

...

Keyword(s):

Gene Expression ◽

Transcatheter Aortic Valve Replacement ◽

Case Control Study ◽

Case Control ◽

Type I ◽

Transcription Factor Activity ◽

Transcatheter Aortic Valve ◽

Procedural Outcomes ◽

Control Study

Abstract Background Age-associated inflammation and immune system dysfunction have been implicated as mechanisms that increase risk for adverse long-term procedural outcomes in older adults. The purpose of this study was to investigate relationships between baseline inflammatory and innate antiviral gene expression and outcomes after transcatheter aortic valve replacement (TAVR) in older adults with severe aortic stenosis. Methods We performed a retrospective case–control study comparing pre-procedural pro-inflammatory and Type 1 interferon (IFN) gene expression in 48 controls with favorable outcomes (alive 1 year after TAVR with improved quality of life [QoL]) versus 48 individuals with unfavorable outcomes (dead by 1 year or alive at 1 year but with reduced QoL). Gene expression was evaluated in whole blood via (1) pre-defined composite scores of 19 inflammation-associated genes and 34 Type I IFN response genes, and (2) pro-inflammatory and antiviral transcription factor activity inferred from promotor based bioinformatics analyses of genes showing > 25% difference in average expression levels across groups. All analyses were adjusted for age, gender, body mass index, diabetes, immunosuppression, cardiovascular disease (CVD), and frailty. Results Relative to controls, those with unfavorable outcomes demonstrated higher expression of the pro-inflammatory gene composite prior to TAVR (p < 0.01) and bioinformatic indicators of elevated Nuclear Factor kB (p < 0.001) and Activator Protein 1 (p < 0.001) transcription factor activity, but no significant differences in Type I IFN-related gene expression. Conclusions These results demonstrate that a pro-inflammatory state prior to TAVR, independent of CVD severity and frailty status, is associated with worse long-term procedural outcomes.

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