scholarly journals Clinical Outcomes For Open Reduction Internal Fixation Of Midshaft Clavicle Fractures In Adolescent/post-adolescent Athletes Utilizing A Two Month Return To Play Protocol

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0038
Author(s):  
Robert W. Lindeman ◽  
Brandon S. Lanier ◽  
Douglas E. Parsell ◽  
James R. Ramsey
Keyword(s):  
Adverse Outcome ◽  
Return To Sport ◽  
High Energy ◽  
Open Reduction Internal Fixation ◽  
Adverse Outcomes ◽  
Control Group ◽  
Adult Control ◽  
Patient Groups ◽  
Clavicle Fractures ◽  
Athlete Group

Objectives: The success rate and the return to sport after midshaft clavicle fracture has been shown to improve with open reduction internal fixation (ORIF) treatment versus non-operative management. The period of time for return to sport, post-ORIF, has been reported in the literature with considerable range. Return to sport times for NFL athletes are reported to typically require three to seven months, while professional cyclists have resumed training in only one week. As the percentage of clavicle fractures in athletes is likely dominated by the high school and college populations, it is clinically relevant to evaluate the success of specific return to sport protocols after clavicle ORIF with respect to age. To evaluate this aspect of care, a retrospective study utilizing an adolescent/immediate post-adolescent and an adult control patient was performed. Methods: A single surgeon performed locking plate ORIF of clavicle fractures with patient population of athletes, ages 13 to 22 years old (mean 16.7 yrs.), and an adult control group (mean 50.8 yrs.). A uniform period for return to sport of two months was utilized for the athlete group, unless complications were present. The athlete group contained 90 patients, and the adult control group contained 64 patients. The athlete group had 48% of fractures resulting from football. High energy mechanisms (auto accident, ATV accident, etc.) accounted for 23.3% of the athlete group fractures, while these mechanisms accounted for 46.9% of the adult group fractures. Post-operative complications and adverse outcomes were monitored for a minimum period of one year. Results: Clavicle fractures within both patient groups were dominantly midshaft fractures with 97.7% of the athlete fractures and 88.5% of the adult fractures being located midshaft. The athlete group exhibited minimal post-operative complication/adverse outcomes with one patient reporting pain with weightlifting and two patients requiring minor scar revisions, for a total complication/adverse outcome rate of 3.3%. The adult group included ten patients with significant residual pain and one patient requiring revision for non-union, yielding a total complication/adverse outcome rate of 15.6% in this group. Applying a Chi-square analysis, a statistically significant difference in complication/adverse outcome rates exist between the patient groups (p=0.003). Additionally, all patients in the athlete group, desiring to return to their sport, did so within the two-month post-operative period. Conclusion: Locking plate ORIF of midshaft clavicle fractures allowed for a successful two month return to sport, with a low occurrence of complications, for a young athlete patient group. High energy fracture events and an adult aged patient group were associated with higher rates of adverse clinical outcome.

scholarly journals Abnormal Expression of YAP Is Associated With Proliferation, Differentiation, Neutrophil Infiltration, and Adverse Outcome in Patients With Nasal Inverted Papilloma

2021 ◽  
Vol 9 ◽  
Author(s):  
Tian Yuan ◽  
Rui Zheng ◽  
Xiang-min Zhou ◽  
Peng Jin ◽  
Zhi-qun Huang ◽  
...  
Keyword(s):  
Adverse Outcome ◽  
Inferior Turbinate ◽  
Neutrophil Infiltration ◽  
Adverse Outcomes ◽  
Inverted Papilloma ◽  
Control Group ◽  
Abnormal Expression ◽  
Proliferation And Differentiation ◽  
Epithelial Remodeling

BackgroundNasal inverted papilloma (NIP) is a common benign tumor. Yes-associated protein (YAP) is the core effector molecule of the Hippo pathway, which regulates the proliferation and differentiation of airway epithelium. While its role in proliferation may be connected to NIP formation, no definitive association has been made between them.MethodsWe compared the difference of YAP expression and proliferation level between the control inferior turbinate, NP (nasal polyps), and NIP groups. In addition, we further used PCR, immunofluorescence, and immunohistochemistry to investigate YAP’s role in the proliferation and differentiation of the nasal epithelium and inflammatory cell infiltration, correlating them with different grades of epithelial remodeling. We further used an IL-13 remodeling condition to investigate YAP’s role in differentiation in an in vitro air-liquid interface (ALI) human nasal epithelial cell (hNECs) model. Finally, we also explored the correlation between YAP expression and clinical indicators of NIP.ResultsThe expression of YAP/active YAP in the NIP group was significantly higher than that in the NP group and control group. Moreover, within the NIP group, the higher grade of epithelial remodeling was associated with higher YAP induced proliferation, leading to reduced ciliated cells and goblet cells. The finding was further verified using an IL-13 remodeling condition in differentiating ALI hNECs. Furthermore, YAP expression was positively correlated with proliferation and neutrophil infiltration in NIP. YAP expression was also significantly increased in NIP patients with adverse outcomes.ConclusionAbnormal expression of YAP/active YAP is associated with proliferation, differentiation, neutrophil infiltration, and adverse outcome in NIP and may present a novel target for diagnosis and intervention in NIP.

scholarly journals Protective Effectiveness of Long-Lasting Permethrin Impregnated Clothing Against Tick Bites in an Endemic Lyme Disease Setting: A Randomized Control Trial Among Outdoor Workers

2020 ◽  
Vol 57 (5) ◽  
pp. 1532-1538
Author(s):  
Cedar Mitchell ◽  
Megan Dyer ◽  
Feng-Chang Lin ◽  
Natalie Bowman ◽  
Thomas Mather ◽  
...  
Keyword(s):  
United States ◽  
Rhode Island ◽  
The United States ◽  
Amblyomma Americanum ◽  
Adverse Outcomes ◽  
Control Group ◽  
Tick Bites ◽  
Outdoor Workers ◽  
Significant Difference ◽  
Protective Effectiveness

Abstract Tick-borne diseases are a growing threat to public health in the United States, especially among outdoor workers who experience high occupational exposure to ticks. Long-lasting permethrin-impregnated clothing has demonstrated high initial protection against bites from blacklegged ticks, Ixodes scapularis Say (Acari: Ixodidae), in laboratory settings, and sustained protection against bites from the lone star tick, Amblyomma americanum (L.) (Acari: Ixodidae), in field tests. However, long-lasting permethrin impregnation of clothing has not been field tested among outdoor workers who are frequently exposed to blacklegged ticks. We conducted a 2-yr randomized, placebo-controlled, double-blinded trial among 82 outdoor workers in Rhode Island and southern Massachusetts. Participants in the treatment arm wore factory-impregnated permethrin clothing, and the control group wore sham-treated clothing. Outdoor working hours, tick encounters, and bites were recorded weekly to assess protective effectiveness of long-lasting permethrin-impregnated garments. Factory-impregnated clothing significantly reduced tick bites by 65% in the first study year and by 50% in the second year for a 2-yr protective effect of 58%. No significant difference in other tick bite prevention method utilization occurred between treatment and control groups, and no treatment-related adverse outcomes were reported. Factory permethrin impregnation of clothing is safe and effective for the prevention of tick bites among outdoor workers whose primary exposure is to blacklegged ticks in the northeastern United States.

scholarly journals Ventilatory response during exercise among chronic Chagas cardiopathy patients

2006 ◽  
Vol 124 (5) ◽  
pp. 280-284 ◽  
Author(s):  
Fátima Palha de Oliveira ◽  
Roberto Coury Pedrosa
Keyword(s):  
Ventilatory Response ◽  
Exercise Duration ◽  
Peak Oxygen Uptake ◽  
Cycle Ergometer ◽  
Control Group ◽  
Gas Exchange Parameters ◽  
Peak Vo2 ◽  
Ventilatory Parameters ◽  
Patients With Heart Failure ◽  
Patient Groups

CONTEXT AND OBJECTIVE: The change in slope of the VE/VCO2 curve with time during exercise (VE/VCO2 slope) has been recommended as a parameter for analyzing the ventilatory response during exercise among patients with heart failure of different etiologies. The aim of this work was to evaluate the ventilatory response among patients with chronic Chagas cardiopathy. METHODS: Forty-eight patients, divided into four groups according to the Los Andes clinical/hemodynamic classification, were studied. They were also classified according to peak oxygen uptake (peak VO2) for a second analysis. The results from the patients were compared with results from a control group consisting of 21 healthy male volunteers (no Chagas disease). Exercise was performed on a cycle ergometer with loads increasing at the rate of 12.5 watts/min, and exercise duration was symptom-limited. Gas concentration and flow rate data were fed into a computer, which produced a real-time report on ventilatory and gas exchange parameters (breath-by-breath). The ventilatory parameters of VE/VCO2 slope and VE/VCO2 ratio computed at different times of the test were adopted. RESULTS: Although there were no significant differences in VE/VCO2 ratio and VE/VCO2 slope when patients were grouped using the Los Andes clinical/hemodynamic classification, these parameters varied significantly when peak VO2 was used to define patient groups. CONCLUSION: Our results indicate that progressive deterioration in ventilatory response among chronic Chagas cardiopathy patients during exercise is more evident when the functional capacity (peak VO2) is reduced, than when changes are related to the Los Andes classification.

Altered Knee Laxity and Stiffness in Response to a Soccer Match Simulation in Players Returning to Sport Within 12 Months After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110130
Author(s):  
Stefano Nuccio ◽  
Luciana Labanca ◽  
Jacopo Emanuele Rocchi ◽  
Pier Paolo Mariani ◽  
Paola Sbriccoli ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Activity Level ◽  
Soccer Players ◽  
Control Group ◽  
Soccer Match ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: The acute effects of exercise on anterior knee laxity (AKL) and anterior knee stiffness (AKS) have been documented in healthy participants, but only limited evidence has been provided for athletes cleared to return to sports after anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose/Hypothesis: The purpose was to determine if 45 minutes of a soccer match simulation lead to acute changes in AKL and AKS in soccer players returning to sport within 12 months after ACLR. We hypothesized that the reconstructed knee of the ACLR group would exhibit an altered response to sport-specific exercise. Study Design: Controlled laboratory study. Methods: A total of 13 soccer players cleared to return to sport after ACLR and 13 healthy control soccer players matched for age, physical activity level, limb dominance, and anthropometric characteristics were recruited. To assess the effects of a standardized soccer match simulation (Soccer Aerobic Field Test [SAFT45]) on AKL and AKS, an arthrometric evaluation was carried out bilaterally before and immediately after SAFT45. To conduct a comprehensive examination of the force-displacement curve, the absolute and side-to-side difference (SSD) values of both AKL and AKS were extracted at 67, 134, and 200 N. Results: The ACLR and control groups showed similar AKL and AKS at baseline ( P > .05). In response to SAFT45, laxity increased bilaterally at all force levels by 14% to 17% only in the control group ( P < .025). Similarly, AKS at 134 and 200 N decreased in response to SAFT45 only in the control group (10.5% and 20.5%, respectively; P < .025). After SAFT45, the ACLR group had 1.9 and 2.5 times higher SSDs of AKS at 67 and 134 N compared with the control group, respectively ( P < .025), as well as a 1.9 times higher SSD of AKS at 134 N compared with baseline ( P = .014). Conclusion: Soccer players at the time of return to sport after ACLR showed an altered mechanical response to a sport-specific match simulation consisting of bilaterally unchanged AKL and AKS. Clinical Relevance: Soccer players showing altered AKL and AKS in response to exercise after ACLR may not be ready to sustain their preinjury levels of sport, thus potentially increasing the risk of second ACL injuries.

scholarly journals Preliminary Evidence for a Relationship between Elevated Plasma TNFα and Smaller Subcortical White Matter Volume in HCV Infection Irrespective of HIV or AUD Comorbidity

2021 ◽  
Vol 22 (9) ◽  
pp. 4953
Author(s):  
Natalie M. Zahr ◽  
Kilian M. Pohl ◽  
Allison J. Kwong ◽  
Edith V. Sullivan ◽  
Adolf Pfefferbaum
Keyword(s):  
White Matter ◽  
Proinflammatory Cytokines ◽  
Soluble Protein ◽  
Subcortical White Matter ◽  
Control Group ◽  
White Matter Volume ◽  
Brain Volumes ◽  
Protein Levels ◽  
Matter Volume ◽  
Patient Groups

Classical inflammation in response to bacterial, parasitic, or viral infections such as HIV includes local recruitment of neutrophils and macrophages and the production of proinflammatory cytokines and chemokines. Proposed biomarkers of organ integrity in Alcohol Use Disorders (AUD) include elevations in peripheral plasma levels of proinflammatory proteins. In testing this proposal, previous work included a group of human immunodeficiency virus (HIV)-infected individuals as positive controls and identified elevations in the soluble proteins TNFα and IP10; these cytokines were only elevated in AUD individuals seropositive for hepatitis C infection (HCV). The current observational, cross-sectional study evaluated whether higher levels of these proinflammatory cytokines would be associated with compromised brain integrity. Soluble protein levels were quantified in 86 healthy controls, 132 individuals with AUD, 54 individuals seropositive for HIV, and 49 individuals with AUD and HIV. Among the patient groups, HCV was present in 24 of the individuals with AUD, 13 individuals with HIV, and 20 of the individuals in the comorbid AUD and HIV group. Soluble protein levels were correlated to regional brain volumes as quantified with structural magnetic resonance imaging (MRI). In addition to higher levels of TNFα and IP10 in the 2 HIV groups and the HCV-seropositive AUD group, this study identified lower levels of IL1β in the 3 patient groups relative to the control group. Only TNFα, however, showed a relationship with brain integrity: in HCV or HIV infection, higher peripheral levels of TNFα correlated with smaller subcortical white matter volume. These preliminary results highlight the privileged status of TNFα on brain integrity in the context of infection.

Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence

2020 ◽  
Vol 48 (4) ◽  
pp. 329-334
Author(s):  
Soo Jin Han ◽  
Seung Mi Lee ◽  
Sohee Oh ◽  
Subeen Hong ◽  
Jeong Won Oh ◽  
...  
Keyword(s):  
Cord Blood ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Control Group ◽  
Long Term Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Monochorionic Twin ◽  
Increased Risk ◽  
Study Population

AbstractBackgroundIn monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS.MethodsThe study population consisted of monochorionic twin pregnancies with preterm birth (24–37 weeks of gestation) between November 2003 and December 2016 and in which cord blood was taken at the time of delivery. According to the result of hemoglobin in cord blood, the study population was divided into two groups: a spontaneous TAPS group and a control group. Neonatal and neurodevelopmental outcomes were compared between the two groups.ResultsDuring the study period, 11 cases were diagnosed as spontaneous TAPS (6.4%). The TAPS group had lower gestational age at delivery and had a higher risk for cesarean delivery. However, neonates with TAPS were not at an increased risk for neonatal mortality and significant neonatal morbidity. In addition, the frequency of severe cerebral lesion during the neonatal period and the risk of cerebral palsy at 2 years of age were not different between the two groups.ConclusionThe spontaneous TAPS diagnosed by postnatal diagnostic criteria was not associated with the increased risk of adverse neonatal and neurodevelopmental outcomes. Further studies are needed to evaluate the morbidity of antenatally diagnosed TAPS.

scholarly journals Optimization of Lutein Recovery from Tetraselmis suecica by Response Surface Methodology

Biomolecules ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 182
Author(s):  
Kang Hyun Lee ◽  
Ye Won Jang ◽  
Hansol Kim ◽  
Jang-Seu Ki ◽  
Hah Young Yoo
Keyword(s):  
Response Surface Methodology ◽  
Response Surface ◽  
Radical Scavenging Activity ◽  
Radical Scavenging ◽  
High Energy ◽  
Solid Loading ◽  
Control Group ◽  
Energy Yield ◽  
Tetraselmis Suecica ◽  
Antioxidant Power

Microalgae have been attracting attention as feedstock for biorefinery because they have various advantages, such as carbon fixation, high growth rate and high energy yield. The bioactive compounds and lutein contained in microalgae are known to be beneficial for human health, especially eye and brain health. In this study, in order to improve the recovery of bioactive extracts including lutein from Tetraselmis suecica with higher efficiency, an effective solvent was selected, and the extraction parameters such as temperature, time and solid loading were optimized by response surface methodology. The most effective solvent for lutein recovery was identified as 100% methanol, and the optimum condition was determined (42.4 °C, 4.0 h and 125 g/L biomass loading) by calculation of the multiple regression model. The maximum content of recovered lutein was found to be 2.79 mg/mL, and the ABTS radical scavenging activity (IC50) and ferric reducing antioxidant power (FRAP) value were about 3.36 mg/mL and 561.9 μmol/L, respectively. Finally, the maximum lutein recovery from T. suecica through statistical optimization was estimated to be 22.3 mg/g biomass, which was 3.1-fold improved compared to the control group.

scholarly journals Prolonged Emergency Department Length of Stay as a Predictor of Adverse Outcomes in Patients with Intracranial Hemorrhage

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Erica M. Jones ◽  
Amelia K. Boehme ◽  
Aimee Aysenne ◽  
Tiffany Chang ◽  
Karen C. Albright ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Adverse Outcome ◽  
Independent Predictor ◽  
Adverse Outcomes ◽  
Stroke Patients ◽  
Significant Independent Predictor ◽  
Prolonged Length ◽  
Stroke Center ◽  
Shift Change

Objectives. Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH). Methods. Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08–6/30/12. Outcomes (frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate) were compared based on shift change experience and length of stay (LOS) dichotomized at 5 hours after arrival. Results. Of the 162 patients included, 60 (37.0%) were present in the ED during a SC. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of any outcome. LOS in the ED ≥5 hours was a significant independent predictor of discharge mRS 4–6 (OR 3.638, 95% CI 1.531–8.645, and P = 0.0034) and discharge NIHSS (OR 3.049, 95% CI 1.491–6.236, and P = 0.0023) but not death. Conclusions. Our study found no association between nursing SC and adverse outcome in patients with ICH but confirms the prior finding of worsened outcome after prolonged length of stay in the ED.

scholarly journals Diverticular fistulation is associated with nicorandil usage

2010 ◽  
Vol 92 (6) ◽  
pp. 463-465 ◽  
Author(s):  
James McDaid ◽  
Claire Reichl ◽  
Ihsan Hamzah ◽  
Samantha Fitter ◽  
Laura Harbach ◽  
...  
Keyword(s):  
Diverticular Disease ◽  
Fistula Formation ◽  
Control Group ◽  
Number Of Patients ◽  
Significant Difference ◽  
Patient Groups ◽  
The Mean ◽  
Uncomplicated Diverticular Disease ◽  
And Control ◽  
Control Study

INTRODUCTION We observed that a number of patients presenting to our clinic with diverticular fistulation were taking nicorandil for angna. Recognised side effects of nicorandil include gastrointestinal and genital ulceration. The aim of our study was to determine whether nicorandil is an aetiological agent in diverticular fistulation. PATIENTS AND METHODS We conducted a case-control study of patients with diverticular disease related enteric fistulae. Two patient groups were identified: a study group of patients with diverticular fistulae, and a control group with uncomplicated diverticular disease. The proportion of patients who had ever used nicorandil was compared between the two groups. RESULTS A total of 153 case notes were analysed, 69 patients with fistulae and 84 control patients with uncomplicated diverticular disease. Female to male ratio in both groups was 2:1. The mean age was 71 years in the fistula group and 69 years in the control diverticular disease group (P = ns). Of those with colonic fistulae, 16% were taking nicorandil compared with 2% of the control group (odds ratio 7.8; 95% confidence interval 1.5–39.1; P = 0.008). There was no significant difference in rates of ischaemic heart disease between fistula and control groups. CONCLUSIONS Nicorandil is associated with fistula formation in diverticular disease.

scholarly journals Management of colorectal polyp cancers

2012 ◽  
Vol 94 (8) ◽  
pp. 574-578 ◽  
Author(s):  
S Naqvi ◽  
S Burroughs ◽  
HS Chave ◽  
G Branagan
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Resection Margin ◽  
Adverse Outcome ◽  
Colorectal Polyps ◽  
Adverse Outcomes ◽  
Resection Margins ◽  
Residual Tumour ◽  
Clear Resection Margin ◽  
Node Metastases

INTRODUCTION Management of malignant colorectal polyps is controversial. The options are resection or surveillance. Resection margin status is accepted as an independent predictor of adverse outcome. However, the rate of adverse outcome in polyps with a resection margin of <1mm has not been investigated. METHODS A retrospective search of the pathology database was undertaken. All polyp cancers were included. A single histopathologist reviewed all of the included polyp cancers. Polyps were divided into three groups: clear resection margin, involved resection margin and unknown resection margin. Polyps were also analysed for tumour grade, morphology, Haggitt/Kikuchi level and lymphovascular invasion. Adverse outcome was defined as residual tumour at the polypectomy site and/or lymph node metastases in the surgical group and local or distant recurrence in the surveillance group. RESULTS Sixty-five polyps (34 male patients, mean age: 73 years, range: 50–94 years) were included. Forty-six had clear polyp resection margins; none had any adverse outcomes. Sixteen patients had involved polyp resection margins and twelve of these underwent surgery: seven had residual tumour and two of these patients had lymph node metastases. Four underwent surveillance, of whom two developed local recurrence. Three patients had resection margins on which the histopathologist was unable to comment. All patients with a clear resection margin had no adverse outcome regardless of other predictive factors. CONCLUSIONS Polyp cancers with clear resection margins, even those with <1mm clearance, can be treated safely with surveillance in our experience. Polyp cancers with unknown or involved resection margins should be treated surgically.

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