scholarly journals 18: IMPROVEMENT IN PSORIASIS SKIN DISEASE SEVERITY IS ASSOCIATED WITH REDUCTION OF CORONARY PLAQUE BURDEN

2016 ◽  
Vol 64 (3) ◽  
pp. 814.1-814 ◽  
Author(s):  
JB Lerman ◽  
AA Joshi ◽  
J Rodante ◽  
T Aberra ◽  
MT Kabbany ◽  
...  
Keyword(s):  
Severity Index ◽  
Coronary Plaque ◽  
Longitudinal Change ◽  
Human Model ◽  
Plaque Burden ◽  
Categorical Variables ◽  
P Value ◽  
Longitudinal Impact ◽  
Psoriasis Area Severity Index

Purpose of StudyPsoriasis (PSO), a chronic inflammatory disease associated with increased cardiovascular (CV) risk, provides a clinical human model to study inflammatory atherogenesis. While PSO severity is associated with both in vivo vascular disease and future CV risk, the longitudinal impact of PSO severity on coronary disease progression is unknown. We hypothesized that an improvement in PSO severity may lead to a reduction in coronary plaque burden by coronary CT angiography (CCTA).Methods UsedConsecutively recruited PSO patients (N=50) underwent CCTA (320 detector row, Toshiba) and cardiometabolic profiling at baseline and 1-year follow-up. Total (TB) and non-calcified (NCB) coronary plaque burden were quantified using QAngio (Medis, Netherlands). PSO severity was measured as the psoriasis area severity index (PASI). The longitudinal change in coronary plaque burden was analyzed with unadjusted and adjusted regression.Summary of ResultsThe cohort had a low Framingham Risk Score and mild to moderate PSO. Patients whose PSO severity improved (ΔPASI −27%; p<0.001) (N=33) had significant improvement in TB (β=0.40, p=0.003) and NCB (β=0.49, p<0.001) (table 1), beyond adjustment for traditional CV risk factors, BMI, statin use, & systemic/biologic PSO therapy.ConclusionsImprovement in PSO severity was associated with improvement in coronary plaque burden by CCTA. Our study suggests that a reduction in skin inflammation may reduce the progression of early, non-calcified coronary plaque. Larger studies are needed to confirm these findings.Abstract 18 Figure 1*P-value is calculated by comparing baseline and 1-year follow-up values for variables using paired t-test for continuous variables, and Pearson's chi-squared test for categorical variables. All values are expressed as Mean±SD, unless specified otherwise. PASI: Psoriasis Area Severity Index.

Abstract 549: Visceral Adipose Tissue Associates With Coronary Plaque Burden Beyond Cardiovascular Risk Factors in Psoriasis

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Joshua P Rivers ◽  
Amit K Dey ◽  
Jonathan H Chung ◽  
Anshuma Rana ◽  
Abhishek Chaturvedi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adipose Tissue ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Coronary Plaque ◽  
Human Model ◽  
Plaque Burden ◽  
P Value ◽  
Adipose Tissue Dysfunction ◽  
Beta Coefficient

Background: Psoriasis (PSO), a chronic inflammatory disease associated with increased cardiovascular (CV) risk, provides a reliable human model to study inflammatory atherogenesis. PSO has been known to be associated with cardiometabolic dysfunction including adipose tissue dysfunction. Recently, visceral adiposity (VAT) was shown to be associated with increased CV events, but whether VAT is associated with subclinical atherosclerosis as assessed by coronary plaque burden has not been characterized. Hypothesis: We hypothesized that VAT volume by CT is associated with total burden (TB) and more specifically with non-calcified burden (NCB) by CCTA. Methods: Consecutive PSO patients (N=68) underwent CT scans to measure abdominal adiposity. VAT volume was quantified from the level of the diaphragm to the pubic symphysis and reported in volume. Coronary plaque characterization was performed by CCTA (Toshiba 30 slice) via QAngio CT software (Medis, The Netherlands). The relationship of VAT with TB and NCB was analyzed using unadjusted and adjusted multivariable regression models (STATA 12). Results: The cohort was middle-aged, predominantly male, at low CV risk by FRS with mild to moderate PSO by skin disease severity (Table 1). VAT volume associated with both TB (beta coefficient= 0.49, p-value <0.001) and NCB (beta coefficient= 0.51, p-value <0.001). This relationship remained significant after adjustment for cardiovascular risk factors for TB (beta coefficient= 0.28, p-value = 0.004) and NCB (beta coefficient = 0.34, p-value <0.001). Conclusions: Directly quantified VAT directly associated with TB and NCB independent of cardiovascular risk factors. These findings suggest that adipose tissue dysfunction may in part contribute to the high CV events observed in psoriasis and support efforts to provide weight control as a strategy to reduce CV disease in psoriasis.

Abstract P193: Increased High Density Lipoprotein Cholesterol:ApolipoproteinA1 Ratio is Associated with Less Progression of Coronary Atherosclerosis in Statin-Treated Patients

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Preethi Mani ◽  
Kiyoko Uno ◽  
Julie Thornton ◽  
Stephen Nicholls
Keyword(s):  
Coronary Atherosclerosis ◽  
Coronary Plaque ◽  
Cholesterol Content ◽  
Favorable Effect ◽  
Plaque Burden ◽  
P Value ◽  
Plaque Progression ◽  
Coronary Syndrome ◽  
Hdl Function ◽  
Atheroma Volume

Background HDL cholesterol (HDL-C) and apolipoprotein AI (apoAI) levels are inversely related to adverse cardiovascular outcome. Associations between these HDL related measures and their ratio with coronary plaque progression have not been studied. It has been proposed that increasing HDL particle cholesterol content impairs HDL function, but impact on disease progression is unknown. We hypothesize that all HDL related measures are inversely associated with coronary plaque progression. Methods Retrospective analysis was performed of 1528 statin treated patients with angiographic CAD who had serial evaluation of atheroma burden with intravascular ultrasound. Relationships between achieved levels of HDL related measures with clinical characteristics and changes in plaque burden were determined. Results Strong correlation between HDL-C and apoAI (r=0.73, p<0.0001) was noted. Patients with highest levels of HDL-C:apoAI were more likely to be female, black, and have lower BMI and less likely to be smokers or have previous revascularization (all p<0.001) or acute coronary syndrome (p=0.013). HDL-C, apoAI, and HDL-C:apoAI demonstrated negative correlation with change in total atheroma volume (p<0.01). For HDL-C:apoAI and HDL-C, increasing tertiles of achieved levels were associated with a linear benefit in slowing progression. For apoAI, a nonlinear association was seen, with similar benefit on progression in the middle and upper tertiles ( Table ). There was no statistical interaction for heterogeneity between HDL-C:apoAI and atheroma burden based on achieved levels of HDL-C (p=0.581). Change in IVUS Measures By Tertiles of Achieved HDL-related Parameters Percent Atheroma Volume Parameter T1 T2 T3 P Value HDL-C 0.58±0.27 0.26±0.27 0.11±0.27 0.012 ApoAI 0.28±0.26 −0.04±0.26 −0.08±0.26 0.10 HDL-C:ApoAI 0.22±0.27 0.13±0.27 −0.27±0.27 0.021 Total Atheroma Volume Parameter T1 T2 T3 P Value HDL-C −2.46±2.21 −4.18±2.20 −5.31±2.20 0.035 ApoAI −4.94±2.13 −6.30±2.13 −7.40±2.13 0.135 HDL-C:ApoAI −4.59±2.25 −6.38±2.24 −8.07±2.26 0.022 Conclusions Increase in all HDL related measures was associated with less progression of coronary atherosclerosis. Association of higher HDL-C:ApoAI with favorable effect on plaque progression at all levels of HDL-C suggests intact HDL functionality of larger cholesterol rich particles. Interventions that increase HDL particle cholesterol content, such as CETP inhibitors, may thus have beneficial effect at the artery wall.

scholarly journals Effect of Isoniazid Preventive Therapy on the Incidence of Tuberculosis among Seropositive Children Attending HIV/AIDS Care in Two General Hospitals, Northwest Ethiopia, 2021

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Fassikaw Kebede ◽  
Birhanu Kebede ◽  
Tsehay Kebede ◽  
Melaku Agmasu
Keyword(s):  
Cox Regression ◽  
Data Entry ◽  
Concomitant Administration ◽  
Preventive Therapy ◽  
Northwest Ethiopia ◽  
Isoniazid Preventive Therapy ◽  
Categorical Variables ◽  
P Value ◽  
Human Immune Deficiency Virus

The human immune deficiency virus (HIV) is the strongest risk factor for the incidence of tuberculosis (TB) by way of reactivation of latent or new infection. The provision of isoniazid preventive therapy (IPT) is one of the public health interventions for the prevention of TB. To date, there have been limited clinical data regarding the effectiveness of isoniazid preventive therapy (IPT) on TB incidence. This study aimed to assess the effect of isoniazid preventive therapy on the incidence of tuberculosis for seropositive children in Northwest Ethiopia. Methods. A facility-based retrospective follow-up was employed for reviewing 421 files from 1 January 2015 up to 30 December 2019. EpiData version 3.2 and Stata/14 software were used for data entry and analysis, respectively. Categorical variables at bivariable Cox regression were assessed for candidates transferred at P value <0.25 for multivariable Cox regression to claiming predictors associated with TB incidence rate at 95% CI at P < 0.005 . Result. The overall incidence of TB was found to be 4.99 cases per 100 person-years at 95% CI (3.89–6.53). Missed IPT (AHR = 7.45, 95% CI: 2.96, 18.74, P < 0.001 ), missed cotrimoxazole preventive therapy (CPT) (AHR = 2.4, 95% CI: 1.84–4.74, P < 0.022 ), age ≥ 11 years (AHR = 4.2, 95% CI: 1.04–7.03, P < 0.048 ), MUAC ≤ 11.5 cm (AHR = 4.36, 95% CI: 1.97–9.97, P < 0.001 ), WHO stages III and IV (AHR = 2.04, 95% CI: 1.12–3.74, P < 0.022 ), and CD4 count ≤100 cells/μl (AHR = 3.96, 95% CI: 1.52–10.34, P < 0.005 ) were significantly associated with TB incidence. Conclusion. Concomitant administration of ART with IPT had demoted more than ninety-six percent of new TB incidences for this report. Undertaking in-depth TB screening and frequent follow-up among all these children is critical in order to prevent and control tuberculosis.

Abstract P049: Serum Uric Acid Levels Are Associated With Non-Calcified Coronary Plaque Independent of Traditional Cardiovascular Risk Factors in Patients With Psoriasis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Youssef A Elnabawi ◽  
Amit K Dey ◽  
Agastya D Belur ◽  
Aditya Goyal ◽  
Jacob W Groenendyk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Uric Acid ◽  
Coronary Artery ◽  
Serum Uric Acid ◽  
Coronary Plaque ◽  
Chronic Inflammatory Disease ◽  
Human Model ◽  
Plaque Burden ◽  
Artery Disease

Introduction: Serum uric acid (sUA), a known inflammosome-inducer, is associated with prospective risk of coronary artery disease in a dose-dependent fashion. Psoriasis (PSO), a chronic inflammatory disease associated with elevated burden of systemic inflammation and subclinical coronary artery disease, provides a reliable human model to study how sUA may relate to non-calcified coronary plaque burden (NCB) measured by computed coronary tomography angiography (CCTA). Hypothesis: We hypothesized that sUA would directly associate with NCB beyond traditional cardiovascular (CV) risk factors. Methods: 103 consecutive PSO patients and 47 healthy volunteers (HV) underwent CCTA (320 detector row, Toshiba) for coronary plaque burden quantification using QAngio (Medis). PSO severity was assessed by Psoriasis Area Severity Score (PASI) and divided into severe PSO (PASI>10) and mild-moderate PSO (PASI<10). All patients had fasting blood draws for the measurement of sUA at a certified clinical lab. Results: PSO patients were older than HV and had a higher CV risk by Framingham risk score (FRS) (Table 1). We observed a significant trend towards increase in sUA among severe PSO, mild-moderate PSO, and HV groups (mean 6.4, 5.9, 5.4 respectively, p=0.02 for trend). A positive association was observed between sUA and NCB, which was stronger in severe PSO after adjustment for traditional CV risk, alcohol, statins, and systemic/biologic PSO treatment (Severe PSO: β=0.27, p<0.001; Mild-moderate PSO: β=0.18, p=0.03), not significant in HV (β=0.18, p=0.12). Conclusions: sUA is independently associated with NCB in states of chronic inflammation such as PSO, and as such, may potentially serve as a biomarker for subclinical coronary atherosclerosis. However, larger prospective studies of CV outcomes in chronic inflammatory diseases are needed to confirm these results.

scholarly journals A Ten Years Retrospective Study of Hysterectomy in Goba Referral Hospital, Bale Zone, South East Ethiopia, Magnitude Indications and Outcomes

2020 ◽  
Author(s):  
Aklilu Getachew ◽  
Takele Mengistu ◽  
Yaregal Asres
Keyword(s):  
Retrospective Study ◽  
Antenatal Care ◽  
Low Income ◽  
Uterine Rupture ◽  
Female Genital Tract ◽  
Referral Hospital ◽  
Low Income Countries ◽  
Categorical Variables ◽  
P Value

Abstract Background: Hysterectomy is one of the major surgeries performed in clinical practice for commonly encountered diseases of the female genital tract worldwide. Even if Hysterectomy is widely performed surgery in both developed and low income countries little is known about is epidemiology in rural part of develop countries. Especially in developing countries like Ethiopia representative reliable statistics are rarely available on this important aspect of women’s health mainly on its prevalence, indication and outcome. So the aim of this study was to assess the magnitude indication and outcome of hysterectomy in Goba Referral Hospital from January 1, 2008 to January1, 2018. Methods: institutional based retrospective study was conducted in Goba Referral Hospital. Self-administered structured checklists were used to collect the data. The data were entered into Epi data version 3.1 and analyzed by SPSS version 20. Continuous and categorical variables were summarized by tables, graph and descriptive statistics. Logistic regression was used to determine association between predictors and Hysterectomy prevalence. P-value <0.05 was -considered as statistically significant. Results: a total of 200 hysterectomies were done for obstetrics and gynecology indications, of which the commonest, 47% (n=94), indication was uterine rupture. From the total of 116 women, who had no antenatal care follow up, 40% (n=47) had uterine rupture. This study also indicated that, most of uterine rupture cases 80% (n=76) were living far away from the hospital (> 50km from the hospital) 94.6% (n-89) were multiparous. This study has also indicated that from the total of 20 discharged dead, 90% (n=18)) were came from a distance of >100km far from the hospital and 95% (n=19) were those who didn’t attend antenatal care. Conclusions: the higher rate of uterine rupture was seen in those who were multi Para, far from Hospitals and those who have no ANC follow up. Large scale study for the identification of determinant factors for evidence based intervention will be very important.

High WT1 Expression Has An Independent Positive Influence On CR Rate and EFS in Non M3 AML Patients Treated with Chemotherapy.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4675-4675
Author(s):  
Nicoletta Colombo ◽  
Raffaella Grasso ◽  
Maurizio Miglino ◽  
Marino Clavio ◽  
Gianmatteo Pica ◽  
...  
Keyword(s):  
Regression Model ◽  
Prognostic Value ◽  
Cox Regression ◽  
Conflicts Of Interest ◽  
Categorical Variables ◽  
P Value ◽  
Prognostic Impact ◽  
Chi Square Analysis ◽  
The Impact

Abstract Abstract 4675 The prognostic value of WT1 expression at diagnosis is still controversial. It has been retrospectively evaluated in 99 consecutive non pretreated non M3 AML patients who had undergone a complete prognostic work up at diagnosis and had received intensive chemotherapy. Biological markers were evaluated on fresh marrow samples collected at diagnosis. WT1 expression was evaluated using TaqMan Gene Expression Assays as described. All patients received induction therapy with combination of fludarabine, Ara-C and anthracycline ± low dose gemtuzumab ozogamicin (n. 59) or with a conventional combination of Ara-C and anthracycline (n. 40) A conventional post-induction chemotherapy including intermediate dosage Ara-C was administered to all responding patients. Univariate comparisons between patients in CR vs non CR were performed using chi-square analysis or Fisher's exact test for categorical variables and t-test for continuous variables. P values < 0.05 were considered statistically significant. Analyses were performed using SPSS. The prognostic impact of WT1 expression was evaluated using quartiles as cut off point and selecting the one with the lowest p value. The event free survival and OS were calculated using the Kaplan Meier method. Non CR after the first induction course, relapse and death due to any cause were considered events. OS and EFS duration were calculated from start of treatment. The impact of multiple predictor variables was assessed by multivariate analyses according to the Cox regression model for OS and EFS while for the evaluation of RC was used the Logistic regression model. Median age of patients was 59 years (range 17-81). Cytogenetic alterations were prognostically favorable in 3 patients and belonged to the intermediate prognostic group in 77 patients (normal karyotype in 75 patients and +8 in two). Nineteen patients had a poor prognosis cytogenetics. For statistical analyses we considered two karyotipic groups: unfavorable (19 patients) and not unfavorable (80 patients). CRs were 60/99 (60%), of which 40 in 51 patients aged 60 or less (78%) and 20 in 48 older than 60 years (41%). Twenty-six patients relapsed, 54 are alive, 45 have died, with a median follow up of 360 days (range 20-2300). In Table 1 are reported clinical indicators of outcome being patients grouped according to the percentile of WT1 expression with the lowest p value (75th). Statystical analysis showed that all WT1 quartiles were balanced for other prognostic factors, such as cytogenetics, BAALC expression, FLT3 and NPMA and B mutations, age, blast count and therapy. The lack of consense on the role of WT1 level at diagnosis in the prognostic stratification indicate that further clinical studies are required. The clear correlation between the level of WT1 transcript and the tumor burden explains why WT1 is used in the follow up of leukemic patients as universal marker of residual disease, also in patients with specific chimeric products. On the contrary, the biological explanation of the prognostic impact of WT1 transcript level at diagnosis remains uncertain. Over the years WT1 gene has been considered as an oncogene or a tumor suppressor gene. In our experience the protective influence of high WT1 expression cannot be explained with an association with good prognosis biological features (such as mut NPM and / or low BAALC). The positive prognostic value of high WT1 expression might be implicated either with WT1 antioncogenic function, or with the stimulating effect of WT1 oncogene on leukemic cellular cycle, possibly associated with an enhanced response to chemotherapy.Table 1WT1 <= 2400 N./N.pts (%)WT1 > 2400 N./N.pts (%)p univ,p multiv.*RR (95% CI)CR (all karyotypes)41/ 75 (54)19/24 (82)0,0260.063.364 (0.927-12.202)CR (int/good karyot.)36/59 (61)19/210.010,0276.649 (1.240-35.645)CR (denovo AML int kar)31/45 (69)14/15 (98)0.020,03412.557 (1.218-129.446)CR (denovo, N.K.)26/40 (65)15/16 (94)0.0250.0413.430 (1.111-162.318)EFS at 24 months (all karyotypes)8%6%0.0020.050.486 (0.235-1.007)EFS at 24 months (int / good karyot.)9%64%0.0010.0230.360 (0.150-0.866)EFS at 24 months (de novo, N.K.)5%70%0.0010.0070.227 (0.077-0.671)OS (all karyot)15%55%0,110,660.837 (0.371-1.890)OS (int/good kar.)18%63%0,050,180.507 (0.186-1.381)Table 1 legend: * for multivariate analysis age, karyotype, FLT3, NPM mutation, BAALC expression, denovo/secondary disease were considered. Disclosures: No relevant conflicts of interest to declare.

Can we reverse atherogenesis with the eradication of toxic LDL-C? A comparative pooled analysis of selected therapies in quest of the revolutionary approach

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kharlamov
Keyword(s):  
East Asian ◽  
Caucasian Population ◽  
Lipid Lowering ◽  
Plaque Burden ◽  
P Value ◽  
Funding Source ◽  
Arterial Remodeling ◽  
Imaging Studies ◽  
Progression Of Atherosclerosis

Abstract Background The LDL-C is a toxic substrate of progressive atherosclerosis and the concept of the cumulative LDL-C exposure is proved in Mendelian trials. The eradication of LDL-C becomes a critical clinical target. Notwithstanding can we truly manage a related arterial remodeling that remains a question. Purpose The aim of the study was to estimate the atheroprotective disparities in the relevant lipid-lowering intravascular imaging studies in comparison with novel transient scaffolding and nanomedicine-based strategies. Methods This hypothesis-generating pooled subanalysis comparatively evaluates patterns of the regression of atherosclerosis in Caucasian and East Asian populations (EAP) in 38 intravascular ultrasound (IVUS) imaging studies (N=9,146). The analysis has revealed 7 so-called Classic (51.1% of the total analyzed population) studies (conducted by the group of Nicholls/ Nissen) with mostly Caucasian population, 18 clinical studies (31.7%) with White/ Caucasian population, and 13 trials (17.2%) with EAP (11 Japanese studies, 2 – South Korean, and 1 – Chinese). Results The regression of atherosclerosis was documented in 18 of 38 studies. A −1.67±5.99% mean absolute reduction of PB reported in all 38 studies with a −18.46±20.35% decrease of LDL cholesterol. The Glagovian threshold of a 40% plaque burden/ percent atheroma volume (PB) was achieved in one study, a NANOM-FIM trial (a 30.7% reduction of PB at 12 months, p&lt;0.05, see a Figure). The invasive ABSORB A (a 1.63% PB increase at 24-month follow-up, p&lt;0.02) and ABSORB B1 (a 2.46% PB decrease at 60-month follow-up, the p-value was about 0.06) studies revealed a progression of atherosclerosis after implantation of bioresorbable scaffolds. Only the ABSORB B2 study demonstrated that transient scaffolding has a potential to manage atherogenesis (a 1.1% PB decrease at 36 months, the p-value is about 0.05). A pooled linear regression analysis revealed a moderate association between LDL-C and PB (r=0.3314, p=0.008) with an LDL-C threshold of 106 mg/dl (a 80 mg/dl in Classic Caucasian randomized studies, a 88 mg/dl threshold – in the rest Caucasian studies, and a 123 mg/dl - in East Asian studies; R2=0.0953, r=0.3314, p=0.008 for pooled studies). The EAP studies substantially differ from Caucasian trials by the smaller size of both lesions and vessels. Unlike the modest 0.14±0.94% (p=0.89) progression of atherosclerosis in classic studies (p=0.11) LDL-C reduction), the EAP demonstrate a −1.99±3.57% (p=0.19) atheroregression amid a mean −31.29±15.66% (p&lt;0.0001) decrease of LDL-C. Conclusion LDL-C threshold of 106 mg/dl is a target for any lipid-lowering strategy to accomplish the regression of atherosclerosis. The lower LDL-C level is associated with a better atheroprotective effect. The invasive strategies grant a promise to properly treat arterial remodeling. A comparative analysis Funding Acknowledgement Type of funding source: Private company. Main funding source(s): De Haar Research Task Force, Rotterdam, The Netherlands

scholarly journals Results of Acetabular Microfracture in Patients undergoing FAI surgery are Strongly Correlated with Age (142)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0028
Author(s):  
Robert Westermann ◽  
Jeffrey Nepple ◽  
Cecilia Pascual Garrido ◽  
John Clohisy ◽  
Christopher Larson ◽  
...  
Keyword(s):  
Alpha Angle ◽  
Harris Hip Score ◽  
Categorical Variables ◽  
P Value ◽  
Strongly Correlated ◽  
Full Thickness ◽  
Multicenter Cohort Study ◽  
Composite Failure ◽  
Comparison Cohort

Objectives: Full-thickness cartilage injury is not uncommon in patients undergoing primary treatment of Femoroacetabular impingement (FAI). Treatment of these lesions with microfracture is commonly performed. However, the outcomes of these procedures relative to other patients undergoing FAI surgery is not well established and the literature on this topic is limited to small, retrospective single surgeon studies. The purpose of the present study was to evaluate outcomes of patients who underwent concurrent FAI correction and acetabular microfracture and to identify predictors treatment failure. Methods: A prospective multicenter cohort study of the treatment of FAI was performed. A total of 760 hips undergoing primary FAI surgery were enrolled. Inclusion criteria were primary FAI surgery, Tonnis 0 or 1 osteoarthritis grade, and age between 16 and 55 years. A total of 61 hips underwent treatment of full-thickness acetabular cartilage lesions with microfracture, with 55 (90.2%) having follow-up greater than 1 year (mean 4.0 years). This group had a mean age of 35.0+10.1 years, BMI of 27.2+4.2, and included 81.8% (45/55) males. A comparison cohort of 492 hips undergoing primary FAI surgery without treatment of acetabular full-thickness cartilage was utilized. Baseline, intraoperative, and follow-up data was recorded including the modified Harris hip score (mHHS) and HOOS domains of pain, ADLs, sports and recreation, symptoms, and quality of life. Composite failure was characterized by reoperation [total hip arthroplasty (THA) or revision surgery] or clinical failure (failure to meet either MCID or PASS for mHHS). Age was assessed in 5 year intervals. Students t-test was used for continuous variables and chi squared were used for categorical variables. A p value less than 0.05 was considering significant. Results: Hips undergoing acetabular microfracture were more likely (compared to comparison cohort) to be male (81.8% vs. 40.9%, p<.001) older (35.0 vs. 29.9 years, p=0.001), had higher BMI (27.2 vs. 25.0, p=.001), and greater alpha angle (69.6 vs. 62.3, p<.001). In the microfracture cohort, 12.7% of patients progressed to THA (compared to 3.0% in comparison cohort, p=.001), while the rate of composite failure was similar to the comparison cohort (29.1% vs. 26.0%, p=.618). Age was highly correlated with the risk of THA and composite failure. The rate of THA for patients <35, 35-40*, and >40 years* of age was 0%, 20.0%, and 22.7% p=.016*), while the rate of composite failure in these groups was 17.4%, 20.0% and 45.5%, respectively (p=.029*). Hips greater than 35 years of age demonstrated inferior HOOS outcomes for domains of pain, ADLs, sports and recreation, QOL, and symptoms and SF-12 physical component scores(Table 1). Conclusions: The results of acetabular microfracture in patients undergoing FAI surgery at a mean follow-up of 4.0 years postoperatively are strongly correlated with age. Patients under 35 years of age demonstrate excellent outcomes with low rates of revision or progression to THA. Acetabular microfracture should have a limited to absent role in patients over the age of 40.

Sleeve Gastrectomy as a Novel Procedure for Gastroparesis

2020 ◽  
pp. 000313482097978
Author(s):  
Evan T. Alicuben ◽  
Jamil S. Samaan ◽  
Caitlin C. Houghton ◽  
Edy Soffer ◽  
John C. Lipham ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Retrospective Chart Review ◽  
Severity Index ◽  
Tube Placement ◽  
P Value ◽  
Jejunostomy Tube ◽  
Symptom Index ◽  
Electrical Stimulator ◽  
Cardinal Symptom

Background Laparoscopic sleeve gastrectomy (LSG) has recently been considered for the surgical management of refractory gastroparesis. Our study aims to determine the efficacy of LSG as a new treatment modality for gastroparesis. Methods A multi-surgeon single institution retrospective chart review of patients who underwent LSG for refractory gastroparesis from September 2016-December 2017. Pre- and postoperative Patient Assessment of Upper Gastrointestinal Disorders-Symptoms Severity Index and/or Gastroparesis Cardinal Symptom Index (GCSI) questionnaires were reviewed. A telephone survey was conducted. Statistical analysis consisted of two-sample t test and utilized SAS v9.4. A P-value <.05 was considered significant. Results There were 10 patients included and 80% were women with an average age of 43 years (24-63). Mean Body Mass Index was 24.5 (16.8-39.6), and median gastric emptying at 4 hours was 50% (30-85). Etiology of gastroparesis was 50% idiopathic, 40% diabetic, and 10% postsurgical. 80% of patients had previously undergone gastric electrical stimulator implantation, 20% pyloric botox injections, and 1 patient jejunostomy tube placement. One patient required conversion from laparoscopic to open secondary to adhesions. Median length of stay was 5 days (2-13), and median follow-up was 13.3 months. 90% of patients were tolerating a regular diet at longest follow-up with significant improvement in self-reported symptoms. GCSI scores were 33.6 preoperatively and 14.9 postoperatively ( P = .01). Discussion Our study adds to the literature examining the role of LSG in the treatment of gastroparesis. LSG has favorable outcomes at short-term follow-up for patients with refractory gastroparesis.

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