Is There a Borderline Value in the Radiological Findings of Patients With Calcaneal Malunion That May Help to Select an Appropriate Treatment Option?

Background: Despite the constant evolution of technological support, operative techniques, and rehabilitation techniques after conservative treatment and operative treatment, a considerable number of patients with calcaneal fractures have constant pain, frequently resulting in loss of occupation. There are numerous options for the operative treatment of painful calcaneal malunion; however, very few publications suggest specific radiological measurements for pre- and postoperative planning—even fewer have statistically analyzed how these radiological measurements affect clinical outcomes. Methods: We performed a retrospective study of 100 patients after operative treatment of calcaneal malunion to determine the correlation between radiological measurements and clinical outcomes. Data were used to create an algorithm that would help to choose between in situ subtalar arthrodesis and complex reconstructive operations. The algorithm was then used to treat 27 prospective patients. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) were used for clinical assessment, whereas standard weightbearing anteroposterior (AP), lateral (LAT) ankle x-rays, and long axial hindfoot view were used for radiological assessment. Results: The talar declination angle was positively correlated with clinical outcome. Patients with talar declination angles less than 6.5 degrees showed worse results in AOFAS score than patients with a greater angle did (57.3 ± 15.3 and 81 ± 15.6, respectively). Conclusion: The combination of subtalar arthrodesis with distraction bone block or calcaneal osteotomy in patients with calcaneal malunion and a talar declination angle less than 6.5 degrees showed better results than isolated in situ arthrodesis. Level of Evidence Level III, retrospective cohort study, case series.

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Treatment of Displaced Intra-articular Calcaneal Fractures with the Intramedullary Nail

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00079 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0007

Author(s):

Julien Lucas ◽

Antoine Fourgeaux

Keyword(s):

Intramedullary Nail ◽

Weight Bearing ◽

Ct Scans ◽

Nerve Lesion ◽

X Rays ◽

New Device ◽

Subtalar Arthrodesis ◽

Number Of Patients ◽

The Mean

Category: Trauma Introduction/Purpose: In 2010, a new closed reduction, internal fixation procedure for displaced intra-articular calcaneus fractures (DIACF) was developed with an intramedullary nail introduces through a channel in the calcaneal tuberosity. The goal was to reduce the rate of skin complications following principles of open reduction procedures. The aim of this prospective mono-centric study was to assess the occurrence of complications and the functional results using the AOFAS-AHS score. The secondary objectives were to assess first the restoration of the Böhler and Gissane angles on X-ray and shape of the calcaneus (Height, length, width) on CT scans, then thalamic reduction on 3D CT scans based on Goldzak’s global articular reduction classification. Methods: 26 Patients were included prospectively between 2014 and 2016 with analysis of X-rays and CT scans. Two were lost to follow-up and 2 patients sustained a secondary subtalar arthrodesis. After positioning a distractor and drilling, reduction was done with tamps and spatula. The nail was then introduced and locked with screws in the tuberosity and the constant fragment. After 3 weeks of non-weight bearing and 3 weeks with hindfoot off-loading shoe, full weight bearing was allowed. The functional outcome and restoration of the radiographic angles were evaluated postoperatively, at 3 months, 1 year and at the last follow-up. Global calcaneal shape and thalamic surface were evaluated postoperatively, at 1 year and at the last follow-up. The following early complications (delayed healing, infection, annoyed material, sural nerve lesion) and later complications (painful stiffness of the subtalar joint, hindfoot varus malalignment and calcaneofibular conflict) were recorded. Results: Mean follow up was 2.4 years. The mean AOFAS-AHS score was 79 ± 12 [100; 61] in the 22 patients examined. The mean Böhler angle rose from -1.29°± 18° [-35; 28] pre-operatively to 33°± 6° [22; 44] post-operatively. The mean calcaneal height index and length rose respectively from 0.44± 0,18 [0,12; 0,83] to 0.86± 0,22 [0,46; 1,1] and 82,4± 5,4 [72; 93] mm to 86,7mm ±4,6 [76; 97], and the width decreased from 49,8± 4,8 [38; 59] to 46,3± 3,7 [38; 55] mm. The Goldzak global articular reduction assessment was excellent in 39% of cases, good in 42% of cases and poor in 19% of cases. One case of deep infection was reported. Three patients needed device removal and two sustained a secondary subtalar arthrodesis. Conclusion: Our prospective study on this new device has the longest time of follow-up. The results confirm the effectiveness and the reliability over time of the procedure to restore the global shape and the thalamic surface with a low rate of complications and quick return to activities. It appears to be an excellent compromise between the respect of the principles of reduction as applied in the ORIF procedures, and the low cutaneous risk of percutaneous procedures. A subsequent study, with a larger number of patients, will enable analysis of the correlation between the radiological markers and the AOFAS-AHS.

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1252: Impact of Concomitant Carcinoma in situ on Clinical Outcomes after Radical Cystectomy

The Journal of Urology ◽

10.1016/s0022-5347(18)33465-7 ◽

2006 ◽

Vol 175 (4S) ◽

pp. 403-403 ◽

Cited By ~ 1

Author(s):

Shahrokh F. Shariat ◽

Ganesh S. Palapattu ◽

Gilad E. Amiel ◽

Pierre I. Karakiewicz ◽

Craig G. Rogers ◽

...

Keyword(s):

Clinical Outcomes ◽

Radical Cystectomy ◽

Carcinoma In Situ

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Tissue Factor (TF) and Urokinase Plasminogen Activator Receptor (uPAR) and Bleeding Complications in Leukemic Patients

Thrombosis and Haemostasis ◽

10.1055/s-0038-1655908 ◽

1997 ◽

Vol 77 (01) ◽

pp. 062-070 ◽

Cited By ~ 15

Author(s):

Chary López-Pedrera ◽

Merce Jardí ◽

Maria del Mar Malagón ◽

Julia Inglés-Esteve ◽

Gabriel Dorado ◽

...

Keyword(s):

Tissue Factor ◽

Leukemic Cell ◽

Bleeding Complications ◽

Urokinase Plasminogen Activator Receptor ◽

Leukemic Cell Lines ◽

Number Of Patients ◽

Blast Cells ◽

Plasminogen Activator Receptor ◽

Hemostatic Disorder

SummaryTissue factor (TF) and urokinase receptor (uPAR) are key cellular receptors triggering, respectively, coagulation and fibrinolysis. Bleeding complications among leukemic patients have been related to an abnormal expression of TF by blast cells and/or to an abnormal fibrinolytic response. In this study the expression of TF and uPAR has been assessed in 18 acute non-lymphoblastic and 8 lymphoblastic leukemic blast cells using several methodological approaches. TF mRNA was evaluated by in situ hybridization and TF and uPAR antigen were evaluated immunologically in cell lysates and on the cell surface by flow cytometry. In addition, TF-procoagulant activity was measured in coagulation-based assays. The reliability of these methods was corroborated in six leukemic cell lines of different lineages and states of maturation. Disseminated intravascular coagulation was detected in two M3 leukemia patients whose blast cells expressed high amounts of TF. Hyperfibrinolysis was detected in one M1 and two M2 patients, whose blast cells displayed a high content of uPAR antigen, but no TF. Furthermore, M5 leukemia blast cells expressed both TF and uPAR, although no hemostatic defects or bleeding complications were detected in these patients. Taken together, although a limited number of patients was included in this study, these data suggest that in leukemia patients exhibiting bleeding, either TF or uPAR are expressed by their blast cells. However, the presence of these receptors does not necessarily imply the existence of a hemostatic disorder.

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288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.331 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S144-S144

Author(s):

Azza Elamin ◽

Faisal Khan ◽

Ali Abunayla ◽

Rajasekhar Jagarlamudi ◽

aditee Dash

Keyword(s):

Clinical Outcomes ◽

Antibiotic Treatment ◽

Readmission Rate ◽

Blood Cultures ◽

Categorical Variables ◽

Gram Negative ◽

Number Of Patients ◽

Significant Difference ◽

The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

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Clinical Outcomes of Digital Cholangioscopy-Guided Procedures for the Diagnosis of Biliary Strictures and Treatment of Difficult Bile Duct Stones: A Single-Center Large Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10081638 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1638

Author(s):

Hirohito Minami ◽

Shuntaro Mukai ◽

Atsushi Sofuni ◽

Takayoshi Tsuchiya ◽

Kentaro Ishii ◽

...

Keyword(s):

Bile Duct ◽

Adverse Events ◽

Clinical Outcomes ◽

Significant Risk ◽

Histopathological Analysis ◽

Bile Duct Stones ◽

Serious Adverse Events ◽

Visualization System ◽

Visual Impression ◽

Number Of Patients

Although Spy DS (SpyGlass DS Direct Visualization System) is considered to be useful for the diagnosis of bile duct strictures and the treatment of bile duct stones, there is limited data to date validating its efficacy. We hence retrospectively evaluated the clinical outcomes of the use of Spy DS in a large number of patients. A total of 183 patients who underwent Spy DS-guided procedures for indeterminate bile duct strictures (n = 93) and bile duct stones (n = 90) were analyzed retrospectively. All patients (93/93) with bile duct strictures successfully underwent visual observation, and 95.7% (89/93) of these patients successfully underwent direct biopsy. The sensitivity, specificity, and overall accuracy were 94.7%, 83.3%, and 90.3%, respectively, for visual impression; 80.9%, 100%, and 89.2%, respectively, for histopathological analysis of a direct biopsy; and 96.5%, 91.7%, and 94.6%, respectively, for visual impression combined with biopsy. Successful visualization of the stones was achieved in 98.9% (89/90) of the patients, and complete stone removal was achieved in 92.2% (83/90) of the patients, with an average of 3.3 procedures. The adverse events rate was 17.5% (32/183; cholangitis in 15 patients, fever the following day in 25, pancreatitis in 1, hemorrhage in 1, and gastrointestinal perforation in 1). No administration of antibiotics before the procedure was found to be a statistically significant risk factor for the development of fever after the procedure (p < 0.01). Spy DS-guided procedures are effective for the diagnosis and treatment of bile duct lesions and can be performed with a low risk of serious adverse events.

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Reoperations Following Lumbar Discectomy Are Associated With Worse Clinical Outcomes and Greater Socioeconomic Burden 3 Years After the Primary Procedure

Neurosurgery ◽

10.1093/neuros/nyz310_606 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Claudius Thomé ◽

Ali Araghi ◽

Jason Inzana ◽

Jonathan Stieber ◽

Joshua M Ammerman

Keyword(s):

Back Pain ◽

Clinical Outcomes ◽

Lumbar Discectomy ◽

Control Treatment ◽

Control Group ◽

Closure Device ◽

Number Of Patients ◽

Patient Reported ◽

Socioeconomic Burden ◽

Index Level

Abstract INTRODUCTION Lumbar discectomy patients with large annular defects are at significantly greater risk for symptom recurrence and revision. Previous studies suggest that outcomes following revision surgery are less positive than outcomes from primary discectomy. This analysis aimed to assess the clinical and socioeconomic outcomes associated with postdiscectomy reoperations and the utility of a bone-anchored annular closure device (ACD) for avoiding reoperations. METHODS This study was a retrospective analysis of a prospective randomized controlled trial (RCT). Lumbar discectomy patients with large (>6 mm) annular defects were treated with discectomy alone (Control; n = 278) or discectomy with an ACD (n = 272). Patient-reported outcomes included visual analog scale (VAS) for ipsilateral leg or back pain and Oswestry Disability Index (ODI). At 3 yr, clinical outcomes were available for 75% of the patients. Comparisons of outcomes were made between reoperated (n = 64) and nonreoperated (n = 351) patients, regardless of ACD or Control treatment, at 3 yr following the primary surgery. RESULTS Reoperated patients had significantly worse scores for ODI (24 ± 19 vs 11 ± 13; P < .0001), VAS leg pain (28 ± 30 vs 12 ± 19; P < .0001), and VAS back pain (36 ± 31 vs 17 ± 21; P < .0001). Significantly more nonreoperated patients were working at 3 yr (97% vs 84%; P < .001). Based on Kaplan-Meier analysis, the proportion of subjects experiencing at least 1 index-level reoperation in 3 yr was 11% in the ACD group and 19% in the Control group (P = .007). CONCLUSION Index-level reoperations following lumbar discectomy are associated with worse outcomes and greater socioeconomic burden in patients with large annular defects (>6 mm). These findings are consistent with reports from large registry analyses, including the Spine Patient Outcomes Research Trial (SPORT) and the Swedish National Spine Registry (Swespine). The ACD reduced the number of patients experiencing index-level reoperation by 43%.

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AIforCOVID: predicting the clinical outcomes in patients with COVID-19 applying AI to chest-X-rays. An Italian multicentre study.

Medical Image Analysis ◽

10.1016/j.media.2021.102216 ◽

2021 ◽

pp. 102216

Author(s):

Paolo Soda ◽

Natascha Claudia D’Amico ◽

Jacopo Tessadori ◽

Giovanni Valbusa ◽

Valerio Guarrasi ◽

...

Keyword(s):

Multicentre Study ◽

Clinical Outcomes ◽

X Rays

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In Situ Testing and X Rays Radiation Effects of Pt/Bi3.15Nd0.85Ti3O12/Pt Ferroelectric Capacitors

Advanced Materials Research ◽

10.4028/www.scientific.net/amr.712-715.293 ◽

2013 ◽

Vol 712-715 ◽

pp. 293-297

Author(s):

Li Li

Keyword(s):

Radiation Effects ◽

Hysteresis Loops ◽

Electrical Performance ◽

Hysteresis Curve ◽

X Rays ◽

Shanghai Synchrotron Radiation Facility ◽

X Ray ◽

In The Beginning ◽

Ferroelectric Capacitors

Pt/Bi3.15Nd0.85Ti3O12(BNT)/Pt ferroelectric capacitors were monitored using in situ X-ray irradiation with 10 keV at BL14B1 beamline (Shanghai Synchrotron Radiation Facility). BL14B1 combined with a ferroelectric analyzer enabled measurements in situ of electrical performance. The hysteresis curve (PE) of distortion depended on the polarization during irradiation, but the diffracted intensities of the (117) peak did not change in the beginning. ThePEcurve had a negligible change from 2.09×109Gy to 4.45×109Gy. Finally, bothPrandPr+very rapidly increased, but the intensities of (117) decreased. The hysteresis loops were remarkably deformed at the maximum total dose of 4.87×109Gy.

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An epidemiological study of concomitant use of herbal medicine and antipsychotics in schizophrenic patients: implication for herb-drug interaction

European Psychiatry ◽

10.1016/s0924-9338(11)73240-0 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1536-1536

Author(s):

Z.-J. Zhang

Keyword(s):

Herbal Medicine ◽

Clinical Outcomes ◽

Epidemiological Study ◽

Urban Areas ◽

Psychiatric Hospitals ◽

Adverse Outcomes ◽

Antipsychotic Treatment ◽

Clinical Effects ◽

Association Analyses ◽

Number Of Patients

Herb-drug interactions are an important issue in drug safety and clinical practice. The aim of this epidemiological study was to characterize associations of clinical outcomes with concomitant herbal and antipsychotic use in patients with schizophrenia. A total of 1795 patients with schizophrenia who were randomly selected from 17 psychiatric hospitals in China were interviewed face-to-face using a structured questionnaire. Association analyses were conducted to examine correlates between Chinese medicine (CM) use and demographic, clinical variables, antipsychotic medication mode, and clinical outcomes. The prevalence of concomitant CM and antipsychotic treatment was 36.4% [95% confidence interval (95% CI) 34.2%–38.6%]. Patients using concomitant CM had a significantly greater chance of improved outcomes than non-CM use (61.1% vs. 34.3%, OR = 3.44, 95% CI 2.80–4.24). However, a small but significant number of patients treated concomitantly with CM had a greater risk of developing worse outcomes (7.2% vs. 4.4%, OR = 2.06, 95% CI 2.06–4.83). Significant predictors for concomitant CM treatment-associated outcomes were residence in urban areas, paranoid psychosis, and exceeding 3 months of CM use. Herbal medicine regimens containing Radix Bupleuri, Fructus Gardenia, Fructus Schisandrae, Radix Rehmanniae, Akebia Caulis, and Semen Plantaginis in concomitant use with quetiapine, clozapine, and olanzepine were associated with nearly 60% of the risk of adverse outcomes. Our study suggests that concomitant herbal and antipsychotic treatment could produce either beneficial or adverse clinical effects in schizophrenic population. Potential herb-drug pharmacokinetic interactions need to be further evaluated.

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