Percutaneous Cement-Augmented Screws Fixation in the Fractures of the Aging Spine: Is It the Solution?

Introduction. Management of elderly patients with thoracolumbar fractures is still challenging due to frequent osteoporosis and risk of screws pull-out. The aim of this study was to evaluate results of a percutaneous-only procedure to treat these fragile patients using cement-augmented screws.Methods. 12 patients diagnosed with a thoracolumbar fracture associated with an important loss of bone stock were included in this prospective study. Surgical procedure included systematically a percutaneous osteosynthesis using cemented fenestrated screws. When necessary, additional anterior support was performed using a kyphoplasty procedure. Clinical and radiographic evaluations were performed using CT scan.Results. On the whole series, 15 fractures were diagnosed and 96 cemented screws were inserted. The difference between the pre- and postoperative vertebral kyphosis was statistically significant (12.9° versus 4.4°,P=0.0006). No extrapedicular screw was reported and one patient was diagnosed with a cement-related pulmonary embolism. During follow-up period, no infectious complications, implant failures, or pull-out screws were noticed.Discussion. Aging spine is becoming an increasing public health issue. Management of these patients requires specific attention due to the augmented risk of complications. Using percutaneous-only screws fixation with cemented screw provides satisfactory results. A rigorous technique is mandatory in order to achieve best outcomes.

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Re-Increased Male Suicide Rates in the Recovery Phase Following the Great East Japan Earthquake

Crisis ◽

10.1027/0227-5910/a000656 ◽

2020 ◽

Vol 41 (6) ◽

pp. 422-428 ◽

Cited By ~ 1

Author(s):

Masatsugu Orui

Keyword(s):

Social Connectedness ◽

Recovery Phase ◽

Great East Japan Earthquake ◽

Temporary Housing ◽

Period Analysis ◽

Suicide Rates ◽

Male Suicide ◽

The Social ◽

The Difference

Abstract. Background: Monitoring of suicide rates in the recovery phase following a devastating disaster has been limited. Aim: We report on a 7-year follow-up of the suicide rates in the area affected by the Great East Japan Earthquake, which occurred in March 2011. Method: This descriptive study covered the period from March 2009 to February 2018. Period analysis was used to divide the 108-month study period into nine segments, in which suicide rates were compared with national averages using Poisson distribution. Results: Male suicide rates in the affected area from March 2013 to February 2014 increased to a level higher than the national average. After subsequently dropping, the male rates from March 2016 to February 2018 re-increased and showed a greater difference compared with the national averages. The difference became significant in the period from March 2017 to February 2018 ( p = .047). Limitations: Specific reasons for increasing the rates in the recovery phase were not determined. Conclusion: The termination of the provision of free temporary housing might be influential in this context. Provision of temporary housing was terminated from 2016, which increased economic hardship among needy evacuees. Furthermore, disruption of the social connectedness in the temporary housing may have had an influence. Our findings suggest the necessity of suicide rate monitoring even in the recovery phase.

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POS0208 GENDER DIFFERENCES IN RESPONSE TO BIOLOGICALS. WOMEN FARE WORSE ACROSS INFLAMMATORY ARTHRITIS DISEASES - DATA FROM THE BIOREG

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3596 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 320.1-321

Author(s):

E. Loibner ◽

V. Ritschl ◽

B. Leeb ◽

P. Spellitz ◽

G. Eichbauer-Sturm ◽

...

Keyword(s):

Gender Differences ◽

Psoriatic Arthritis ◽

Gender Difference ◽

Disease Activity ◽

Inflammatory Arthritis ◽

Tnf Inhibitors ◽

Significant Difference ◽

The Difference ◽

All Diseases

Background:Gender differences in prevalence and disease course are known in various rheumatic diseases; however, investigations of gender difference concerning therapeutical response have yielded variable results.Objectives:The aim of this retrospective study was to investigate, whether a gender difference in response rate to biological disease-modifying antirheumatic drugs (bDMARDs) and apremilast in bDMARD-naïve patients could be observed across the three most prevalent inflammatory arthritis diseases: rheumatoid arthritis (RA), spondylarthritis (SpA) and psoriatic arthritis (PsA). Additionally, a response to individual TNF blockers was investigated in this respect.Methods:Data from bDMARD-naïve RA-, SpA- and PsA-patients from Bioreg, the Austrian registry for biological DMARDs in rheumatic diseases, were used. Patients with a baseline (Visit 1=V1) and follow-up visits at 6 months (Visit 2=V2) and 12 months (Visit 3=V3) were included and response to therapy with TNF-inhibitors (TNFi), furthermore to therapy with rituximab, tocilizumab and apremilast was analyzed according to gender. The remaining bDMARDs were not analyzed due to small numbers. Key response-parameter for RA was disease activity score (DAS28), whereas for PsoA the Stockerau Activity Score for Psoriatic Arthritis (SASPA) and for SpA the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were employed; in addition, the Health assessment Questionnaire (HAQ) was used. Data were analyzed in R Statistic stratified by gender using Kruskal-Wallis and Wilcoxon tests.Results:354 women and 123 men with RA (n=477), 81 women and 69 men with PsA (n=150), 121 women and 191 men with SpA (n=312) were included. No significant differences in biometrics was seen between female and male patients at baseline in all diseases.In RA patients overall DAS28 decreased from baseline (V1) to V2 and V3 (DAS28: V1: male: 4.38 [3.66, 5.11], female: 4.30 [3.68, 5.03], p(m/f) = 0.905; V2: male: 2.66 [1.73, 3.63], female: 3.10 [2.17, 3.98], p(m/f) = 0.015; V3: male: 2.25 [1.39, 3.36], female: 3.01 [1.87, 3.87], p(m/f) = 0.002). For TNF inhibitors (n=311), there was a significant difference between genders at V2 (Fig.1a). Patients receiving Rituximab (n=41) displayed a significantly higher DAS28 at baseline in females, which diminished in the follow up: V1: (p(m/f) p=0.002; V2: p=0.019; V3: p=0.13); response to tocilizumab (n=63) did not show any gender differences.In PsA patients overall SASPA decreased from baseline (V1) to V2 and V3 (SASPA: V1: male: 4.00 [2.80, 5.20], female: 4.40 [2.80, 5.80], p(m/f) = 0.399; V2: male: 2.20 [1.20, 3.50], female: 3.40 [2.00, 5.00], p(m/f) = 0.071; V3: male: 1.80 [0.80, 2.70], female: 3.01 [2.35, 4.80], p(m/f) = 0.001). For TNF inhibitors (n=79), there was a significant difference between genders at V3 (Fig 1a). For Apremilast (n=39), there was a significant difference between genders at V2 (Fig.1c).In SpA patients overall BASDAI decreased from baseline (V1) to V2 and V3 (BASDAI: V1: male: 4.70 [2.88, 6.18], female: 4.80 [3.30, 6.20], p(m/f) = 0.463; V2: male: 3.05 [2.00, 4.60], female: 3.64 [2.62, 5.41], p(m/f) = 0.039; V3: male: 3.02 [1.67, 4.20], female: 3.65 [2.18, 5.47], p(m/f) = 0.016). In V3 a differential BASDAI in response to TNFi (n=299) was observed (Fig.1a).Possible differences of response to individual TNFi (etanercept, infliximab, other TNFi) measured by HAQ were investigated in all diseases together. The difference between male and females was significant at baseline for all 3 TNFi; whereas with the use of ETA the significant difference was carried through to V2 and V3, it was lost with the use of IFX and was variable with the other TNFi (Fig.1b)Figure 1.Conclusion:Female patients showed a statistically lower response to TNFi in all three disease entities (RA, SpA and PsoA) to a variable degree in our homogenous central european population. Interestingly, the difference was not uniform across individual TNFi when measured by HAQ. Gender differences were also seen in response to Apremilast.Disclosure of Interests:Elisabeth Loibner: None declared, Valentin Ritschl: None declared, Burkhard Leeb Speakers bureau: AbbVie, Roche, MSD, Pfizer, Actiopharm, Boehringer-Ingelheim, Kwizda, Celgene, Sandoz, Grünenthal, Eli-Lilly, Grant/research support from: TRB, Roche, Consultancies: AbbVie, Amgen, Roche, MSD, Pfizer, Celgene, Grünenthal, Kwizda, Eli-Lilly, Novartis, Sandoz;, Peter Spellitz: None declared, Gabriela Eichbauer-Sturm: None declared, Jochen Zwerina: None declared, Manfred Herold: None declared, Miriam Stetter: None declared, Rudolf Puchner Speakers bureau: AbbVie, BMS, Janssen, Kwizda, MSD, Pfizer, Celgene, Grünenthal, Eli-Lilly, Consultant of: AbbVie, Amgen, Pfizer, Celgene, Grünenthal, Eli-Lilly, Franz Singer: None declared, Ruth Fritsch-Stork: None declared

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Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment

Vascular and Endovascular Surgery ◽

10.1177/15385744211023281 ◽

2021 ◽

pp. 153857442110232

Author(s):

Spyridon N. Mylonas ◽

Konstantinos G. Moulakakis ◽

Nikolaos Kadoglou ◽

Constantinos Antonopoulos ◽

Thomas E. Kotsis ◽

...

Keyword(s):

Arterial Stiffness ◽

Surgical Repair ◽

Open Repair ◽

Abdominal Aortic ◽

Gender And Age ◽

Baseline Values ◽

The Difference ◽

The Impact ◽

Repair Group

Purpose: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. Materials and Methods: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. Results: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Conclusion: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.

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Impact of immediate postpartum insertion of TCu380A on the quantity and duration of lochia discharges in Tanzania

Contraception and Reproductive Medicine ◽

10.1186/s40834-020-00145-2 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Projestine Selestine Muganyizi ◽

Grasiana Festus Kimario ◽

France John Rwegoshora ◽

Ponsian Patrick Paul ◽

Anita Makins

Keyword(s):

Service Providers ◽

International Federation ◽

Teaching Hospitals ◽

Evidence Based ◽

Contraceptive Device ◽

Postpartum Contraception ◽

Gynecology And Obstetrics ◽

Intrauterine Contraceptive ◽

The Difference

Abstract Background The insertion of Intrauterine Contraceptive Device (PPIUD) for the purpose of contraception immediately after delivery is becoming popular in countries where the use of IUD for contraception has been extremely low. Since 2015, Tanzania implemented the initiative by the International Federation of Gynecology and Obstetrics (FIGO) to institutionalize PPIUD. As a result of capacity building and information delivery under the initiative, there have been increased uptake of the method. Working in this context, the focus of the study was to generate evidence on the effect of TCu380A IUD on amount and duration of lochia and equip service providers with evidence-based knowledge which can help them in counselling their PPIUD clients. Objective Establish impact of postpartum TCu380A on amount and duration of lochia. Methods A prospective cohort study of delivered women in two teaching hospitals in Tanzania with immediate insertion of TCu380A or without use of postpartum contraception in 2018. TCu380A models; Optima (Injeflex Co. Brazil) and Pregna (Pregna International, Chakan, India) were used. Follow-up was done by weekly calls and examination at 6th week. Lochia was estimated by Likert Scale 0–4 relative to the amount of lochia on the delivery day. An estimated 250 women sample (125 each group) would give 80% power to detect a desired 20% difference in the proportion of women with prolonged lochia discharges among the Exposed and Unexposed groups. Data analysis was by SPSS. Results Two hundred sixty women were analysed, 127 Exposed and 133 Unexposed. Medical complaints were reported by 41 (28.9%) Exposed and 37 Unexposed (27.8%), p = 0.655. Lack of dryness by end of 6th week was to 31 (23.3%) Exposed and 9 (7.1%) Unexposed, p < 0.001. Exposed had higher weekly mean lochia scores throughout with the difference most marked in 5th week (3.556 Versus 2.039, p < 0.001) and 6th week (1.44 Versus 0.449, p<0.001). Conclusion PPIUD is associated with increased amount of lochia and slows progression to dryness within 6 weeks of delivery. The implications of PPIUD clients’ needs to be informed about the possibility of delayed dryness of lochia at time of counseling are discussed.

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Fibromuscular dysplasia with recurrence after “long-term” following percutaneous transcatheter renal angioplasty: two case reports with a review of 26 patients

BMC Nephrology ◽

10.1186/s12882-021-02342-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shuntaro Oribe ◽

Takafumi Toyohara ◽

Eikan Mishima ◽

Takehiro Suzuki ◽

Koichi Kikuchi ◽

...

Keyword(s):

Fibromuscular Dysplasia ◽

Age Of Onset ◽

Case Reports ◽

Case Presentation ◽

Renal Angioplasty ◽

Long Term Follow Up ◽

Percutaneous Transluminal Renal Angioplasty ◽

The Difference

Abstract Background Fibromuscular dysplasia (FMD) often causes renal artery stenosis with renovascular hypertension. Recent clinical outcomes encourage percutaneous transluminal renal angioplasty (PTRA) to treat FMD; however, the necessary follow-up period remains unclear. Moreover, previous studies have not revealed the difference in the period until recurrence between two major types of FMD—multifocal and focal. Case presentation We describe two patients with multifocal FMD who developed hypertension during their teenage years and had recurrence of FMD > 10 years after PTRA. We further examined the types of FMD and age of onset in 26 patients who underwent PTRA. The period until recurrence of multifocal FMD was longer than that of focal FMD. Moreover, patients with early-onset multifocal FMD are likely to have a delayed recurrence after PTRA compared to other types. Conclusions Our report suggests that patients with multifocal FMD, especially those with onset at an early age, may need long-term follow-up for at least ≥ 10 years.

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Age-dependency in mortality of Finnish family caregivers: a nationwide register-based study

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1191 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

T M Mikkola ◽

H Kautiainen ◽

M Mänty ◽

M B von Bonsdorff ◽

T Kröger ◽

...

Keyword(s):

General Population ◽

Family Caregivers ◽

Family Caregiver ◽

Causes Of Death ◽

Lower Mortality ◽

All Cause Mortality ◽

The Difference ◽

Caregiver Role ◽

Selection Of

Abstract Purpose Mortality appears to be lower in family caregivers than in the general population. However, there is lack of knowledge whether the difference in mortality between family caregivers and the general population is dependent on age. The purpose of this study was to analyze all-cause mortality in relation to age in family caregivers and to study their cause-specific mortality using data from multiple Finnish national registers. Methods The data included all individuals, who received family caregiver's allowance in Finland in 2012 (n = 42 256, mean age 67 years, 71% women) and a control population matched for age, sex, and municipality of residence (n = 83 618). Information on dates and causes of death between 2012 and 2017 were obtained from the Finnish Causes of Death Register. Flexible parametric survival modeling and competing risk regression adjusted for socioeconomic status were used. Results The total follow-up time was 717 877 person-years. Family caregivers had lower all-cause mortality than the controls over the follow-up (8.1% vs. 11.6%) both among women (hazard ratio [HR]: 0.64, 95% CI: 0.61-0.68) and men (HR: 0.73, 95% CI: 0.70-0.77). Younger adult caregivers had equal or only slightly lower mortality than their controls, but after age 60, the difference increased markedly resulting in over 10% lower mortality in favor of the caregivers in the oldest age groups. Caregivers had lower mortality for all the causes of death studied, namely cardiovascular, cancer, neurological, external, respiratory, gastrointestinal and dementia than the controls. Of these, the lowest was the risk for dementia (subhazard ratio=0.29, 95%CI: 0.25-0.34). Conclusions Older family caregivers have lower mortality than the age-matched controls from the general population while younger caregivers have similar mortality to their peers. This age-dependent advantage in mortality is likely to reflect selection of healthier individuals into the family caregiver role. Key messages The difference in mortality between family caregivers and the age-matched general population varies considerably with age. Advantage in mortality observed in family caregiver studies is likely to reflect the selection of healthier individuals into the caregiver role, which underestimates the adverse effects of caregiving.

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Inheritance and reflection: “re-study” of three anthropology fieldwork sites in China’s Yunnan Province

International Journal of Anthropology and Ethnology ◽

10.1186/s41257-021-00050-9 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Mingming Wang

Keyword(s):

Rural Society ◽

Research Report ◽

Ancestor Worship ◽

Land System ◽

Peking University ◽

The Difference ◽

And Shifts ◽

West Town ◽

The Relationship

AbstractThis article is a research report involving three anthropological studies conducted during the period of “Kuige” and their “re-studies.” By narrating the project, I set forth my views on the connections and differences between Chinese anthropological explorations from two historical periods. These anthropological explorations refer to the study of Lu Village conducted by Fei Xiaotong, that of “West Town” (Xizhou) by Francis L. K. Hsu, and that of “Pai-IPai” (Dai) villages by Tien Ju-Kang. They were all completed in the late 1930s and early 1940s. Each writer extracted a framework to analyze the land system, ancestor worship, and the relationship between humans and gods from the writer’s own field experience. Despite the difference in research methods, all three studies noticed the cultural differences between rural society and modernity. Since 2000, Peking University and Yunnan Minzu University have launched a “Province-university Cooperation Project.” During the project, a research team formed of several young scholars revisited Lu Village, “West Town” (Xizhou), and Namu Village. These writers’ works were based on the data acquired in their fieldwork and drew upon the opinions raised by global anthropologists on “re-study” in recent decades. Considering the dual effects of social change and shifts in academic concepts around “follow-up research,” the scholars put forward several points of view with their ethnographies, which all featured the characteristics of inheritance and reflection. Based on the results of the three “re-studies,” this article emphasizes the importance of the study of public rituals for the research of rural society. This article also attempts to re-examine the methodology of “human ecology,” which profoundly impacts Chinese anthropology and sociology.

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Low-grade serous epithelial ovarian cancer: a comprehensive review and update for radiologists

Insights into Imaging ◽

10.1186/s13244-021-01004-7 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Sofia Amante ◽

Filipa Santos ◽

Teresa Margarida Cunha

Keyword(s):

Ovarian Cancer ◽

Serous Carcinoma ◽

Low Grade ◽

Resonance Imaging ◽

Clinicopathologic Characteristics ◽

Borderline Tumour ◽

Molecular Features ◽

Serous Epithelial Ovarian Cancer ◽

The Difference

AbstractLow-grade serous carcinoma (LGSC) is an infrequent subtype of ovarian cancer, corresponding to 5% of epithelial neoplasms. This subtype of ovarian carcinoma characteristically has molecular features, pathogenesis, clinical behaviour, sensitivity to chemotherapy, and prognosis distinct to high-grade serous carcinoma (HGSC). Knowing the difference between LGSC and other ovarian serous tumours is vital to guide clinical management, which currently is only possible histologically. However, imaging can provide several clues that allow differentiating LGSC from other tumours and enable precise staging and follow-up of ovarian cancer treatment. Characteristically, LGSC appears as mixed lesions with variable papillary projections and solid components, usually in different proportions from those detected in serous borderline tumour and HGSC. Calcified extracellular bodies, known as psammoma bodies, are also a common feature of LGSC, frequently detectable within lymphadenopathies and metastases associated with this type of tumour. In addition, the characterisation of magnetic resonance imaging enhancement also plays an essential role in calculating the probability of malignancy of these lesions. As such, in this review, we discuss and update the distinct radiological modalities features and the clinicopathologic characteristics of LGSC to allow radiologists to be familiarised with them and to narrow the differential diagnosis when facing this type of tumour.

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Facial Rejuvenation with Concentrated Lipograft—A 12 Month Follow-Up Study

Cells ◽

10.3390/cells10030594 ◽

2021 ◽

Vol 10 (3) ◽

pp. 594

Author(s):

Lukas Prantl ◽

Eva Brix ◽

Sally Kempa ◽

Oliver Felthaus ◽

Andreas Eigenberger ◽

...

Keyword(s):

Stromal Vascular Fraction ◽

Facial Rejuvenation ◽

Fat Graft ◽

Volume Loss ◽

Patient’S Satisfaction ◽

Resazurin Assay ◽

Long Term Follow Up ◽

The Difference

Lipofilling is a popular technique to treat volume loss in aging patients. The isolated adipose tissue is composed of adipocytes and stromal vascular fraction cells, which include adipose-derived stem cells (ASC). We hypothesize that the patient’s wrinkle severity scale (WSS) and patient’s satisfaction on the global aesthetic improvement scale (GAIS) can be improved after using concentrated lipoaspirate. Fourteen patients (54 years ± 11.09 years) with volume loss in the midface area underwent waterjet-assisted liposuction (Human Med AG, Schwerin, Germany). Fat was centrifuged in an ACP Double Syringe (Arthrex GmbH, Munich, Germany) using Rotofix 32A centrifuge (Andreas Hettich, GmbH & Co.KG, Tuttlingen, Germany). Homogenization was performed using the double syringe and a 1.4 mm female–female luerlock connector. After a second centrifugation, patients received periorbital (PO) and nasolabial (NL) lipografting. ASC count was performed after enzymatical digestion. Vitality of cells was assessed using a resazurin assay. During long-term follow up (12 months, n = 10), we found a high patient’s satisfaction (GAIS 1+/−0.52) and a good improvement of the WSS during short- and long-term follow-up. The ASC count of processed lipoaspirate was 2.1-fold higher than of unprocessed lipoaspirate (p < 0.001). The difference of ASC in sedimented and simply centrifuged lipoaspirate was also significant (p < 0.05). Facial rejuvenation with concentrated fat graft offers good results concerning objective aesthetic outcome and patient’s satisfaction.

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Effect of carvedilol versus nebivolol on insulin resistance among non-diabetic, non-ischemic cardiomyopathy with heart failure

The Egyptian Heart Journal ◽

10.1186/s43044-020-00099-5 ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Yasser Gaber Metwally ◽

Heba Kamal Sedrak ◽

Inass Fahiem Shaltout

Keyword(s):

Heart Failure ◽

Insulin Resistance ◽

Insulin Sensitivity ◽

Ischemic Cardiomyopathy ◽

Diabetic Patients ◽

Promising Strategy ◽

Improve Insulin Resistance ◽

First Choice ◽

The Difference

Abstract Background Although B-blockers provide unequivocal benefits in heart failure (HF) management, some B-blockers worsen insulin resistance. It will be a promising strategy to recruit such a B blocker that did not worsen or can even improve insulin resistance (IR). So, this study aimed to assess the effect of two of the third-generation B-blockers (carvedilol versus nebivolol) on insulin sensitivity state in non-diabetic patients with non-ischemic cardiomyopathy with heart failure. Results Out of 43 patients enrolled, 58.1% represented the carvedilol group while 41.9% represented the nebivolol group. Nebivolol improves insulin resistance-related variables (fasting glucose, fasting insulin, and HOMA-IR; P < 0.001, 0.01, and 0.01 respectively). The percentage of change at homeostasis model of assessment (HOMA-IR), indicative of insulin sensitivity status, between baseline versus at 3-months follow-up level of intra-group comparison was increased by 4.58% in the carvedilol arm whereas it was decreased by 11.67% in the nebivolol arm, and the difference on the intragroup level of comparison was significant (P < 0.001 and 0.01 respectively). Conclusion Nebivolol improves insulin resistance-related variables .Nebivolol may be recommended as the B blocker of the first choice for those with non-ischemic cardiomyopathy heart failure with evident insulin resistance; however, larger scaled prospective multicenter randomized trials are needed for confirming our favorable results.

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