scholarly journals THU0338 THE CIRCULATING CD19-POSITIVE LYMPHOCYTES IN PATIENTS WITH SYSTEMIC SCLEROSIS: MODULATION WITHIN A YEAR AFTER THE INITIATION OF RITUXIMAB THERAPY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 400.1-400
Author(s):  
L. P. Ananyeva ◽  
L. Garzanova ◽  
O. Koneva ◽  
M. Starovoytova ◽  
O. Desinova ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
B Lymphocytes ◽  
Cumulative Dose ◽  
Negative Correlation ◽  
Early Stage ◽  
Absolute Number ◽  
Short Disease Duration ◽  
Group 2 ◽  
Group 1

Background:Significant disorders of B-cell homeostasis have been detected in systemic sclerosis (SSc) [1,2]. The improvement of the disease with anti-CD20 monoclonal antibody rituximab (RTM) has been shown in SSc [3]. There are limited data on change in circulating B lymphocytes count after RTM treatment in patients with SSc.Objectives:to investigate the modulations in absolute and relative numbers of circulating CD19-positive B lymphocytes (B-lymph) in patients with SSc within a year after the initiation of RTM therapy.Methods:71 pts with SSc were included in the prospective study. Mean age was 46±13 yrs., 83% were women, 59% had diffuse subset. Duration of SSC from the first non-Raynaud`s symptom was 5.6 ± 4.4 yrs. All pts received low doses of glucocorticoids and 45% -immunosuppressive medications. The average follow-up of patients was 13.2 ± 2.0 (11-18) months. The mean dose of RTM for the period of follow up was 1.43 ± 0.60 grams, 48 patients received < 2 g of RTM (group 1, mean of 1.1 ± 0.1 g) and 23 patients received ≥ 2 grams of RTM (group 2, mean dose of 2.2 ± 0.6 g). Peripheral blood CD19-positive cell count was obtained by flow cytometry in patients and in 20 healthy persons, comparable in sex and age. Data are presented as the percentage (P %) and absolute number (AN) of B-lymph per ml of blood. In patients, the number of B-lymph was determined before (n=67 pts), within first month after the first introduction of RTM (n=66), 6 months later (n=34) and at the end of the study (n=71)Results:At baseline, the AN and P% of B-lymph in pts did not differ from the healthy control. In pts with short disease duration (≤ 3 yrs.) the number of B-lymph before treatment with RTM was the higher (compared with longer duration > 3 yrs) those who was ill ≥3 yrs.) and there was negative correlation between B-lymph count and duration of the disease (R - 0.36, p=0.003 for AN and R - 0.48, p=0.001 for P %). The number of B-lymph was significantly lower in patients receiving cyclophosphamide (Cyc) before being started with RTM. There was a negative correlation between the AN of B-lymph and the cumulative dose of Cyc (R -0.293, p=0.016). In 1 month after the initiation of RTM a complete depletion of B-lymph was observed in all pts and in six months it persisted in 79% of cases, the rest began to repopulate (15%) or reached a normal levels (6%). At the end of the follow up the number of B-lymph was significantly lower than before treatment and a complete (n=41 pts) or partial (n=23) depletion of B-lymph remained, and only in 7 (10%) pts the count of this cells was normalized. We revealed a negative correlation between the AN of B-lymph and the cumulative dose of RTM (R-0.237, p=0.048). Higher doses of RTM in group 2 induced a more significant depletion than in group 1. Change in forced vital capacity and diffusing capacity of the lung (% predicted) during follow up were less pronounced for pts in group 1 compared with group 2 (ΔFVC 2,4% and 7,5% p=0,01; ΔDLCO -0,35% and 5,05%, p=0,001, respectively).Conclusion:RTM may be more effective at the early stage of the disease, when the level of B-lymph is the highest. In SSc, the repopulation of B-lymph after depletion with RTM develops slowly. There were a more significant depletion of B-lymph and a more pronounced improvement in pulmonary function with the higher dose of RTM to compare with the lower one. This results indicate the option of a flexible dosing regimen of RTM.References:[1]Sanges S. et al. La Revue de médecine interne 38 (2017) 113–124[2]Forestier A. et al. Autoimmunity Reviews 17 (2018) 244–255[3]Jordan S, et al. Ann Rheum Dis 2015;74:1188–1194.doi:10.1136/annrheumdis-2013-204522Disclosure of Interests:None declared

scholarly journals THU0345 EFFECT OF THE LONG-TERM RITUXIMAB TREATMENT ON B-LYMPHOCYTES AND ANTINUCLEAR AUTOANTIBODY LEVEL IN PATIENTS WITH SYSTEMIC SCLEROSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 404.2-404
Author(s):  
L. Garzanova ◽  
L. P. Ananyeva ◽  
O. Koneva ◽  
O. Desinova ◽  
O. Ovsyannikova ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
B Lymphocytes ◽  
Clinical Improvement ◽  
Disease Duration ◽  
Absolute Number ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background:Anti-B-cell therapy is seen as a promising therapeutic option for systemic sclerosis (SSc). The study of antinuclear antibody levels during treatment with rituximab (RTX) in patients (pts) with SSc could have theoretical and practical interest.Objectives:To assess the changes in ANA, anti-topoisomerase-1 (Scl-70) levels and B-lymphocytes (B-lymph) count during RTX therapy during prospective observation.Methods:This prospective study included 88 pts with SSc, 83% of them had interstitial lung disease and 75% had positive Scl-70 autoantibody. The mean age was 47 yrs (17-71), female-73 pts (83%), the diffuse cutaneous subset of the disease had 50 pts (57%). The mean disease duration was 5,9±4,8 yrs. The mean follow-up period was 27 months (12-42). The cumulative mean dose of RTX was 2,9±1,1grams. All patients received prednisolone at a dose of 11,7±4,4 mg, immunosuppressants received 42% of them. Patients were divided into groups depending on the duration of the disease: group 1 (n=33) - up to 3 yrs, group 2 (n=25) - from 3 to 6 yrs, group 3 (n=30) - more than 6 years (6-18yrs). The results are presented in the form of mean values, median, upper and lower quartiles.Results:Parallel to clinical improvement in most patients (96%) we found positive changes in many parameters at the end of the study compared to the baseline. The Rodnan skin score decreased from 11,21±9,33 to 6,19±4,74 (p<0,001). The disease activity index (EScSG-AI) decreased from 2,9±1,74 to 1,36±1,15 (p<0,001). Forced vital capacity, % predicted, increased from 76,35±19,65 to 84,37±21,04 (p<0,001). Diffusing capacity for carbon monoxide, % predicted, increased from 45,56±17,72 to 47,62±16,96 (p<0,019). The dose of prednisolone decreased from 11,7±4,4 to 9,2±3,2 mg (p<0,001). The absolute number of B-lymph decreased from 0,224±0,19 to 0,0175±0,058 (p<0,001). The pts of the group 1 showed the highest values of B-lymph at baseline and level of B-lymph decreased from 0,326±0,22 to 0,008±0,01 (Δ 0,318) at the end of the study. In group 2 depletion was less pronounced (from 0,197±0,14 to 0,026±0,07 (Δ 0,171) and the lowest depletion was observed in group 3 (from 0,151±0,16 to 0,019±0,07 (Δ 0,131), p<0,001 for all groups. An initially positive ANA was found in 92% of pts (range 1/320-1/1280). During observation, the number of pts with high (1/640-1/1280) ANA titers decreased from 70 to 41 (p<0,001), and the average level of ANA decreased by 30-40% in all groups. At baseline 63 pts (75%), had positive Scl-70 with equal levels in all groups. At the end of the study level of Scl-70 decreased from 125,02±89,12 to 108,6±86,89 units/ml (p<0,007). A negative correlation was found between the duration of the disease and ANA (r = -0,54; p<0,003) and Scl-70 (r = -0,44; p<0,017).Conclusion:In our study a clinical improvement was shown in most pts at the long-term complex therapy, including RTM. We found a significant decrease in the absolute number of B-lymph, as well as decrease of ANA and Scl-70 levels. Initially pts with a short duration of the disease had a higher level of B-lymph and in these pts depletion was more pronounced, compared to those with a longer duration of the disease. However, the level of Scl-70 and ANA decreased both to those who started RTX therapy at an early stage of the disease (<3yrs) and to those who had a long disease duration.Disclosure of Interests:None declared

Effect of Lisinopril and Verapamil on Angiopoietin 2 and Endostatin in Hypertensive Diabetic Patients with Nephropathy: A Randomized Trial

2021 ◽  
Vol 53 (07) ◽  
pp. 470-477
Author(s):  
Al-Aliaa M. Sallam ◽  
Mohamed Salem ◽  
Eman Abdel-Aleem ◽  
Hala O. El-Mesallamy
Keyword(s):  
Early Stage ◽  
Controlled Trial ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Converting Enzyme Inhibitors ◽  
Angiogenic Proteins ◽  
Group 2 ◽  
Angiopoietin 2 ◽  
Group 1

AbstractAngiogenesis is a multistep process implicated in the pathophysiology and progression of diabetic nephropathy (DN). Angiotensin-converting enzyme inhibitors (ACEI) and calcium channel blockers (CCB) have an important role in DN. We performed a randomized-controlled trial of lisinopril alone (an ACEI) or in combination with verapamil (a CCB) as a therapy for DN in type 2 diabetes mellitus (T2DM) patients with hypertension (HTN) and urinary albumin creatinine ratio (UACR) (30–300 mg/g) also to evaluate their effect on UACR, the angiogenic proteins: Angiopoietin 2 (Ang-2) and Endostatin (EST). Forty T2DM patients with microalbuminuria, aged 45–65 years were included. Patients were randomly assigned into group 1 receiving oral lisinopril and group 2 receiving oral lisinopril and verapamil once daily. After 3 months follow-up fasting blood glucose (FPG), HbA1c, lipid profile, UACR, serum urea and creatinine levels were assessed. EST and Ang-2 were measured using ELISA technique. Baseline Ang-2 and EST levels were elevated in both groups compared with controls (p<0.001). After follow-up, group 2 had significantly decreased FPG, HbA1c, UACR, EST and Ang-2 compared with their baseline levels (p<0.001 for all comparisons) and with group 1 (p<0.001). No adverse reactions were reported. Baseline EST and Ang-2 were positively correlated to UACR (r=0.753, p<0.001) (r=0.685, p<0.001). Lisinopril/verapamil combination enhanced glycemic control and kidney function via diminishing EST and Ang-2. This combination can be considered as a safe and effective approach for early stage nephropathy therapy in T2DM.

scholarly journals Spectral-Domain Optical Coherence Tomography and Multifocal Electroretinography Results in the Long-Term Follow-Up of Glaucoma Patients

2020 ◽  
pp. 22-32
Author(s):  
Ersan Cetınkaya ◽  
Sibel Inan ◽  
Kenan Yıgıt ◽  
Mehmet Cem Sabaner ◽  
Ümit Übeyt Inan
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Early Stage ◽  
Open Angle Glaucoma ◽  
Implicit Time ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Group 2 ◽  
Group 1

Objective: To investigate the changes in macular retinal layers and panretinal neuroretinal functions in the long-term follow-up of patients with primary open-angle glaucoma. Materials and Methods: Forty-one patients diagnosed with primary open-angle glaucoma were followed up for 12 months. According to their mean deviation (MD) values), the patients were put into two groups as Group 1 with early stage glaucoma (MD≥-6) and Group 2 with middle-advanced stage glaucoma (MD<-6). Optical coherence tomography (OCT) and multifocal electroretinography (mfERG) were performed at the baseline and at the sixth- and 12th-month evaluations. The OCT, retinal layer and mfERG findings were compared between the two groups. Results: There was no statistically significant difference between the groups in terms of gender and age In Group 2, the mean baseline macula Retina Nerve Fiber Layer, Ganglion Cell Layer and Inner Pleksiform Layer measurements were lower in each quadrant compared to Group 1. Concerning progression in OCT measurements, there was no significant difference between the two groups. However, it was noteworthy that in Group 2, there was a decrease especially in the first and second ring amplitudes of the P1 and N2 waves and prolongation of the implicit time. At the 12-month evaluation, there was prolongation of the implicit time of the N1 wave and a decrease in the P1 wave amplitude in Group 1. Conclusion: Retinal layers are affected in patients with intermediate and advanced stage glaucoma. In the follow-up of early stage glaucoma patients, mfERG measurements can show damage that may occur.

scholarly journals Effect of rituximab on the manifestations of activity and pulmonary function in patients with systemic sclerosis: one-year follow-up evaluation

2019 ◽  
Vol 57 (3) ◽  
pp. 265-273 ◽  
Author(s):  
L. P. Ananyeva ◽  
O. A. Koneva ◽  
O. V. Desinova ◽  
L. A. Garzanova ◽  
S. I. Glukhova ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Pulmonary Function ◽  
Safety Profile ◽  
Left Ventricular Ejection ◽  
The Mean ◽  
Group 2 ◽  
One Year ◽  
Tract Infections ◽  
Group 1

The choice of drugs for the treatment of interstitial lung disease (ILD) associated with systemic sclerosis (SS) is currently very limited. Data from a number of studies show that rituximab (RTM) can improve lung function and reduce the severity of skin fibrosis in patients with SS.Objective: to evaluate the efficiency of RTM in a cohort of patients with SS-associated ILD after one-year follow-up. The indications for prescribing RTM were: 1) the inefficiency of standard therapy with glucocorticoids and immunosuppressants (ISs) or the impossibility of their use; 2) the early stage (first 3 years of the disease) with signs of poor prognosis, such as diffuse form, high skin scores (>14), male gender, rapid progression with a significant initial decline in forced vital capacity (FVC) and/or diffusion lung capacity (DLC), and a high anti-Scl-70 antibody positivity.Subjects and methods. The investigators selected a group of patients who had at least two assessment points at a 12-to-18 month interval (the mean follow-up period of 13±2 months) and took at least 1 g of RTM during this period. The investigation included 71 patients with a valid diagnosis of SS. Multi-slice spiral computed tomography (MSCT) revealed ILD in 90% of patients. The disease duration was 5.6±4.4 years. The presence of anti-Scl-70 antibodies was detected in 73% of patients. The mean cumulative dose of RTM was 1.43±0.6 g; 48 patients in Group 1 received ≤2 g of RTM (the mean dose, 1.1±0.1 g) and 23 patients in Group 2 took ≥2 g of RTM (mean dose, 2±0.6 g). Before starting treatment with RTM, all the patients received concomitant therapy with prednisone and 45% - with immunosuppressants.Results and discussion. The results assessed by a physician showed that good and moderate effects of the therapy were observed in 52 (73.2%) and 16 (22.6%) patients, respectively; no effect was seen in 3 (4.2%) patients. Overall, 95.8% of patients reported various degrees of improvement. There were significant changes as reductions in the disease activity index, skin scores, C-reactive protein and IgG levels, the number of patients with a high antinuclear antibody level, and the mean dose of prednisolone as well as increases in an oral aperture size, left ventricular ejection fraction, and 6-minute walk test scores. There were no changes in pulmonary artery systolic pressure and the HAQ DI. FVC increased from 77.35±19.9 to 82.6±20.7% (p=0.001). A minimal clinically significant increase in FVC ≥5% was noted in 41 (57.7%) people. The overall improvement in FVC (ΔFVC) reached 5.24%, while the changes were more significant in Group 2 (ΔFVC 8.98%) than in Group 1 (ΔFVC 3.75%; p=0.01). DLC remained stable, but there were significant group differences: ΔDLC was 3.75% in Group 2 and, conversely, decreased in Group 1 (1.6%; p=0005). The safety profile of the therapy was regarded as good and quite comparable with both the safety profile of ISs and the use of RTM in other trials. Infectious complications were recorded to be most common in 11 (15%) people. Of these, upper respiratory tract infections developed in 7 patients; plantar phlegmon occurred in one case; urinary tract infection and herpes zoster were detected in two and one cases, respectively.The results of this study confirm data from other studies that have demonstrated that RTM exerts a positive effect on SS-associated ILD. We were the first to show the association of positive changes in the measures of pulmonary function tests with the dose of RTM.

Muscarinic-3 acetylcholine receptor autoantibody in patients with systemic sclerosis: contribution to severe gastrointestinal tract dysmotility

2008 ◽  
Vol 68 (5) ◽  
pp. 710-714 ◽  
Author(s):  
Y Kawaguchi ◽  
Y Nakamura ◽  
I Matsumoto ◽  
E Nishimagi ◽  
T Satoh ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Gastrointestinal Tract ◽  
Acetylcholine Receptor ◽  
Early Stage ◽  
Mean Value ◽  
Exact Test ◽  
The Mean ◽  
Group 2 ◽  
Onset Group ◽  
Group 1

Objective:Patients with systemic sclerosis (SSc) complicated by severe gastrointestinal tract (GIT) dysmotility at an early stage are difficult to treat and mortality is high. To clarify the pathogenesis of GIT involvement, the occurrence of autoantibody was investigated for muscarinic-3 acetylcholine receptor (M3R) in patients with SSc.Methods:Fourteen patients with severe GIT involvement (malabsorption syndrome and/or pseudo-obstruction) within 2 years of SSc onset (group 1) were enrolled in the present study. Sixty-two patients with SSc without severe GIT involvement within 2 years of onset (group 2) were also recruited, along with 70 healthy control subjects. Using an established enzyme immunoassay (EIA) system detecting autoantibody against the second loop domain of M3R, the presence of an anti-M3R antibody was examined in SSc patients.Results:The mean optical density (OD) titres of group 1 were significantly higher than those of group 2 (0.65 (SD 0.58) vs 0.066 (SD 0.13), p<0.001). The positivity of anti-M3R antibody was significantly higher in group 1 than in group 2 (9/14 vs 3/62, p = 2.5 × 10−6 by Fisher’s exact test). The cutoff OD was calculated from the EIA reaction of the 70 healthy controls (the mean value plus 2 SD was 0.295).Conclusion:The findings indicated that anti-M3R antibody very frequently appears in patients with SSc, which is accompanied by severe GIT involvement, suggesting that M3R-mediated enteric cholinergic neurotransmission may provide a pathogenic mechanism for GIT dysmotility in SSc.

scholarly journals Effectiveness of a Double Air-Cushioned Shoe Compared with Physiotherapy in the Treatment of Plantar Fasciitis

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
S. S. Eun ◽  
S. Chachan ◽  
S. H. Lee
Keyword(s):  
Plantar Fasciitis ◽  
Chart Review ◽  
Early Stage ◽  
Retrospective Chart Review ◽  
Noninvasive Treatment ◽  
Alternative Treatment Option ◽  
Foot Function ◽  
Group 2 ◽  
Group 1

Objective. This study was aimed at comparing the plantar fasciitis treatment effect of a double air-cushioned shoe to that of physiotherapy combined with ESWT. Methods. Retrospective chart review of 40 patients diagnosed with plantar fasciitis was performed. Group 1 wore a double air-cushioned shoe for 2 months, and group 2 underwent physiotherapy with ESWT once/week over a 4-week period. The foot function index (FFI) score was obtained at the initial visit, 1 month, and 2 months. Results. There were 25 patients in group 1 and 15 patients in group 2. The pretreatment FFI was 62.6 for group 1 and 50 for group 2. The 1-month posttreatment FFI was 45.6 for group 1 and 35.7 for group 2. The 2-month posttreatment FFI was 35 for group 1 and 43.1 for group 2. In both groups 1 and 2, follow-up FFIs were significantly improved from the initial FFI (p<0.05) and there were no significant differences between two groups (p>0.05). Conclusions. The double air-cushioned shoe can be considered an alternative treatment option for noninvasive treatment of early-stage plantar fasciitis.

Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Proff ◽  
B Merkely ◽  
R Papp ◽  
C Lenz ◽  
P.J Nordbeck ◽  
...  
Keyword(s):  
Heart Rate ◽  
Closed Loop ◽  
Funding Source ◽  
Chronotropic Incompetence ◽  
First Results ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG

scholarly journals Effects of posterior tibial slope on the mid-term results of medial unicompartmental knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Zhijie Chen ◽  
Kaizhe Chen ◽  
Yufei Yan ◽  
Jianmin Feng ◽  
Yi Wang ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
Significant Difference ◽  
Medial Unicompartmental Knee Arthroplasty ◽  
Group 3 ◽  
Group 2 ◽  
Postoperative Knee ◽  
Group 1

Abstract Objective To evaluate the effect of medial posterior tibial slope (PTS) on mid-term postoperative range of motion (ROM) and functional improvement of the knee after medial unicompartmental knee arthroplasty (UKA). Methods Medical records of 113 patients who had undergone 124 medial UKAs between April 2009 through April 2014 were reviewed retrospectively. The mean follow-up lasted 7.6 years (range, 6.2–11.2 years). Collected were demographic data, including gender, age, height, weight of the patients. Anteroposterior (AP) and lateral knee radiographs of the operated knees were available in all patients. The knee function was evaluated during office follow-up or hospital stay. Meanwhile, postoperative PTS, ROM, maximal knee flexion and Hospital for Special Surgery (HSS) knee score (pre−/postoperative) of the operated side were measured and assessed. According to the size of the PTS, patients were divided into 3 groups: group 1 (<4°), group 2 (4° ~ 7°) and group 3 (>7°). The association between PTS and the knee function was investigated. Results In our cohort, the average PTS was 2.7° ± 0.6° in group 1, 5.6° ± 0.9° in group 2 and 8.7° ± 1.2° in group 3. Pairwise comparisons showed significant differences among them (p < 0.01). The average maximal flexion range of postoperative knees in each group was 112.4° ± 5.6°, 116.4° ± 7.2°, and 117.5° ± 6.1°, respectively, with significant difference found between group 1 and group 2 (p < 0.05), and between group 1 and group 3 (p < 0.05). However, the gender, age, and body mass index (BMI) did not differ between three groups and there was no significant difference between groups in terms of pre−/postoperative HSS scores or postoperative knee ROM. Conclusion A mid-term follow-up showed that an appropriate PTS (4° ~ 7°) can help improve the postoperative flexion of knee. On the other hand, too small a PTS could lead to limited postoperative knee flexion. Therefore, the PTS less than 4° should be avoided during medial UKA.

scholarly journals Percutaneous posteroanterior screw fixation for Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture: Operative technique and randomized clinical results

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199799
Author(s):  
Tianming Yu ◽  
Jichong Ying ◽  
Jianlei Liu ◽  
Dichao Huang ◽  
Hailin Yan ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Malleolar Fracture ◽  
Malleolar Fractures ◽  
Posterior Malleolar Fracture ◽  
Post Traumatic ◽  
Group 2 ◽  
Traumatic Arthritis ◽  
Group 1

Purpose: The study described a novel surgical treatment of Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture and patient outcomes at intermediate period follow-up. Methods: All patients from January 2015 to December 2017 with tri-malleolar fracture of which posterior malleolar fractures were Haraguchi type 1, were surgically treated in this prospective study. Lateral and medial malleolar fractures were managed by open reduction and internal fixation through dual incision approaches. 36 cases of Haraguchi type 1 posterior malleolar fractures were randomly performed by percutaneous posteroanterior screw fixation with the aid of medial exposure (group 1). And 40 cases were performed by percutaneous anteroposterior screw fixation (group 2). Clinical outcomes, radiographic outcomes and patient-reported outcomes were recorded. Results: Seventy-six patients with mean follow-up of 30 months were included. There were no significant differences in the mean operation time (81.0 ± 11.3 vs. 77.2 ± 12.4), ankle function at different periods of follow-up, range of motions and visual analog scale (VAS) at 24 months between the two groups ( p > 0.05). However, the rate of severe post-traumatic arthritis (Grade 2 and 3) and the rate of step-off rather than gap in radiological evaluation were lower in group 1 than that in group 2 ( p < 0.05). Conclusion: Using our surgical technique, more patients had good outcome with a lower rate of severe post-traumatic arthritis, compared with the group of percutaneous anteroposterior screw fixation. Percutaneous posteroanterior screw fixation can be a convenient and reliable alternative in treating Haraguchi type 1 posterior malleolar fracture.

The Relationship between Serum Ferritin Levels and 5-Year All-Cause Mortality in Hemodialysis Patients

2021 ◽  
pp. 1-7
Author(s):  
Emre Erdem ◽  
Ahmet Karatas ◽  
Tevfik Ecder
Keyword(s):  
Serum Ferritin ◽  
Hemodialysis Patients ◽  
Rank Test ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Group 3 ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

<b><i>Introduction:</i></b> The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. <b><i>Methods:</i></b> A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin &#x3c;800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin &#x3e;1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. <b><i>Results:</i></b> Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, <i>p</i> = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; <i>p</i> = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; <i>p</i> = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; <i>p</i> = 0.063). <b><i>Conclusion:</i></b> Time-averaged serum ferritin levels &#x3e;1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

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