Evaluation of Lumbar Stiffness after Long-Level Fusion for Degenerative Lumbar Scoliosis in Chinese population

Abstract Study Design: a retrospective study.Summary of Background Data: Long-level spinal instrumented fusion for DLS by intention eliminated spinal motion in an attempt to alleviate pain, improve deformity, and reduce disability. However, this surgery considerably impaired performance of activities of daily living (ADL) due to the resulting stiffness. The lumbar stiffness disability index (LSDI) was a validated measure of the effect of lumbar stiffness on functional activity, however, which might not be fully applicable to elderly Chinese population because of their several special lifestyles.Objective: To evaluate the lumbar stiffness in patients with degenerative lumbar scoliosis (DLS) after long-level fusion by Chinese-LSDI (C-LSDI).Methods: 129 DLS patients underwent long-level (≧4 levels) fusion surgery with at least one-year follow-up were included. The C-LSDI was designed by modifying LSDI and Korean-LSDI (K-LSDI) considering elderly Chinese lifestyles, and the patient-reported outcome questionnaire measuring the impact of lumbar stiffness on functional abilities in elderly Chinese with DLS was assessed for internal consistency and retest repeatability.Results: All patients showed increased lumbar stiffness with significantly improvement in pain and deformity postoperatively, and for items of performing personal hygiene after toileting and getting out of a car, people performed more inconvenient with increasing fixed levels. Compared with LSDI and K-LSDI, the C-LSDI demonstrated high internal consistency (Cronbach’s alpha=0.902) and retest reliability (ICC=0.904) in the elderly Chinese population. Conclusion: This study demonstrated that the C-LSDI questionnaire was a reliable and valid instrument for assessing functional limitations due to lumbar stiffness among elderly Chinese patients with DLS after long-level fusion. Although the effects of stiffness did trend toward greater impacts among patients underwent longer fusions, most patients were satisfied with trade-offs of function and pain relief in exchange for perceived increases in lumbar stiffness.

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Evaluation of Lumbar Stiffness after Long-Level Fusion for Degenerative Lumbar Scoliosis

10.21203/rs.3.rs-24904/v1 ◽

2020 ◽

Author(s):

Xinling Zhang ◽

Lei Yuan ◽

Yan Zeng ◽

Zhongqiang Chen ◽

Weishi Li ◽

...

Keyword(s):

Internal Consistency ◽

Chinese Population ◽

Chinese Patients ◽

Personal Hygiene ◽

Degenerative Lumbar Scoliosis ◽

Lumbar Scoliosis ◽

Patient Reported ◽

Elderly Chinese ◽

The Impact ◽

Level Fusion

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Oral anticoagulation improves survival in very elderly Chinese patients with atrial fibrillation: A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

International Journal of Stroke ◽

10.1177/17474930211046743 ◽

2021 ◽

pp. 174749302110467

Author(s):

Yutao Guo ◽

Agnieszka Kotalczyk ◽

Jacopo F Imberti ◽

Yutang Wang ◽

Gregory YH Lip ◽

...

Keyword(s):

Atrial Fibrillation ◽

Elderly Patients ◽

Oral Anticoagulant ◽

Oral Anticoagulants ◽

Chinese Patients ◽

Very Elderly ◽

Elderly Chinese ◽

All Cause Mortality ◽

The Impact ◽

New Onset

Background Advancing age is a major risk factor for ischemic stroke in atrial fibrillation. We aimed to evaluate the predictors of all-cause death/any thromboembolism and the impact of oral anticoagulant on clinical outcomes in very elderly (≥85 years) Chinese atrial fibrillation patients. Methods The ChiOTEAF is a prospective registry proceeded in 44 sites from 20 provinces in China between October 2014 and December 2018. Outcomes of interest were all-cause mortality, any thromboembolism, major bleeding, and new onset/worsening heart failure. Results The eligible cohort for this analysis included 6416 patients and 1215 (18.9%) patients were aged ≥85 years. Only 320 (26.4%) very elderly patients were treated with oral anticoagulant, of whom 205 (64.1%) received non-vitamin K antagonist oral anticoagulants, while antiplatelet therapy was used among 642 (53.1%) very elderly patients. On multivariate analysis, the use of oral anticoagulant was an independent predictor of a lower risk of the composite outcome (OR: 0.46; 95% CI: 0.32–0.66) and all-cause death (OR: 0.47; 95% CI: 0.32–0.69) among these very elderly atrial fibrillation patients. Conclusions Advanced age should not be a reason to withhold oral anticoagulant, since the use of oral anticoagulants is safe and improves survival.

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Reliability and Validity of a Novel Cognitive Self-Assessment Tool for Patients with Cancer

Neuro-Oncology Practice ◽

10.1093/nop/npab045 ◽

2021 ◽

Author(s):

Giuliana V Zarrella ◽

Alice Perez ◽

Jorg Dietrich ◽

Michael W Parsons

Keyword(s):

Cognitive Function ◽

Internal Consistency ◽

Concurrent Validity ◽

Assessment Tool ◽

Clinical Care ◽

Self Report ◽

Measurement Information ◽

Subjective Cognitive Function ◽

Patient Reported ◽

The Impact

Abstract Background Subjective cognitive function is an important outcome measure in oncology. The Functional Assessment of Cancer Therapy-Brain (FACT-Br) is a quality of life (QoL) measure that includes indices of physical, emotional, social, and neurologic aspects of disease, but does not measure cognitive function. This study seeks to validate a novel index of cognition derived from the FACT-Br. Methods Patients with heterogeneous cancer diagnoses (N=214) completed neuropsychological evaluation and self-report measures. Nine FACT-Br items regarding cognition were combined to form the FACT-Br-Cognitive Index (CI). Reliability was evaluated by exploratory factor analysis and internal consistency. Concurrent validity was assessed by correlating FACT-Br-CI with the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive-8 scales. Discriminant validity was assessed by correlating FACT-Br-CI with other FACT-Br indices and the Beck Depression and Anxiety Inventories (BDI, BAI). Exploratory analyses evaluated the impact of cognitive performance and disease variables on FACT-Br-CI. Results The FACT-Br-CI consisted of a single factor that demonstrated high internal consistency (α=.867) and strong concurrent validity, correlating strongly with PROMIS-Cognitive-8 scales (r=.675-.782). The relationship between the FACT-Br-CI and other FACT subscales ranged from moderate to strong (r=.372-.601), as did correlations with measures of depression (BDI, r=-.621) and anxiety (BAI, r=-.450). Modest correlations were observed with neuropsychological measures (r’s=.249-.300). Conclusions The FACT-Br-CI is a reliable and valid measure of self-reported cognition. Studies that included the FACT-Br could be retrospectively analyzed to assess subjective cognitive outcomes, enriching the information from prior research. Integration of the FACT-Br-CI in routine clinical care may be an efficient method of monitoring cognition.

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Shoulder Pain and Disability Index: Italian cross-cultural validation in patients with non-specific shoulder pain

Shoulder & Elbow ◽

10.1177/1758573220913246 ◽

2020 ◽

pp. 175857322091324

Author(s):

Fabrizio Brindisino ◽

Tiziana Indaco ◽

Giuseppe Giovannico ◽

Diego Ristori ◽

Lorenza Maistrello ◽

...

Keyword(s):

Visual Analogue Scale ◽

Shoulder Pain ◽

Internal Consistency ◽

Analogue Scale ◽

Test Reliability ◽

Oxford Shoulder Score ◽

Culturally Adapted ◽

Patient Reported ◽

The Impact ◽

Shoulder Score

Background Health-related patient reported outcome measures are considered essential to determine the impact of disease on the life of individuals. Aim of this study is to culturally adapt the Italian version of the Shoulder Pain and Disability Index (SPADI). The secondary aim is to evaluate psychometric proprieties in patients with non-specific shoulder pain. Methods The current study is an analysis of a sample of 59 adult patients with non-specific shoulder pain. The SPADI was translated and cross-culturally adapted, and then psychometric properties were tested. Participants completed the Shoulder Pain and Disability Index-Italian (SPADI-I), 36-item short form health survey, the Oxford Shoulder Score, the Disability of Arm, Shoulder, and Hand scale and a pain intensity visual analogue scale. Results SPADI-I included two domains. Internal consistency analysis showed good values for total (α = 0.84) and subscales (α = 0.94 and α = 0.76). For construct validity, there was good correlation between the visual analogue scale, the Oxford Shoulder Score, the DASH and the SPADI-I total score and subscales. Standard error of measurement and minimally detectable change were calculated. Conclusions The SPADI-I was culturally adapted into Italian. SPADI-I is centred on pain and disability of the shoulder only and can be considered as a useful tool in daily clinical practice for assessing musculoskeletal non-specific shoulder pain because of its good internal consistency and validity. Further studies should focus on other psychometric proprieties such as test re-test reliability, responsiveness and clinical interpretability to improve the available clinimetrics of the tool.

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Impact of CYP2C9, VKORC1, ApoE and ABCB1 polymorphisms on stable warfarin dose requirements in elderly Chinese patients

Pharmacogenomics ◽

10.2217/pgs-2019-0139 ◽

2020 ◽

Vol 21 (2) ◽

pp. 101-110

Author(s):

Wenyan Li ◽

Ping Zhao ◽

Liwen Chen ◽

Xiaoyin Lai ◽

Guohua Shi ◽

...

Keyword(s):

Linear Regression Analysis ◽

Warfarin Dose ◽

Multiple Linear Regression Analysis ◽

Han Chinese ◽

Chinese Patients ◽

Individual Variations ◽

Elderly Chinese ◽

The Individual ◽

The Impact ◽

Dose Variation

Aim: To analyze the impact of nongenetic factors and gene polymorphisms on warfarin dose requirements in elderly Shanghai Han Chinese patients. Materials & methods: Genotypes of CYP2C9 (rs1799853 and rs1057910), FPGS (rs7856096), ApoE (rs7412 and rs429358), GGCX (rs699664 and rs12714145), EPHX1 (rs4653436, rs1877724, rs1051740 and rs1131873), NQO1 (rs1800566 and rs10517), ABCB1 (rs1045642), VKORC1 (rs9923231) and CYP4F2 (rs2108622) in 214 patients with stable warfarin dose were determined and their demographic characteristics were recorded. Results: Multiple linear regression analysis revealed that VKORC1 rs9923231, CYP2C9*3 rs1057910, ApoE rs7412, age, BMI and concomitant amiodarone could explain 37.0% of the individual variations of daily stable warfarin dose. Conclusion: VKORC1 rs9923231, CYP2C9*3 rs1057910, ApoE rs7412, age, BMI and concomitant amiodarone play an important role in stable dose variation of warfarin in elderly Shanghai Han Chinese patients, whereas ABCB1 rs1045642 is not a significant genetic factor.

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Orientation of L4 coronal tilt relative to C7 plumb line as a predictor for postoperative coronal imbalance in patients with degenerative lumbar scoliosis

Scientific Reports ◽

10.1038/s41598-020-73352-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Jiandang Zhang ◽

Zheng Wang ◽

Pengfei Chi ◽

Cheng Chi

Keyword(s):

Deformity Correction ◽

Plumb Line ◽

Lower Amount ◽

Consecutive Series ◽

Degenerative Lumbar Scoliosis ◽

Lumbar Scoliosis ◽

Coronal Imbalance ◽

Correction Surgery ◽

The Impact ◽

The Relationship

Abstract The study design is case–control. To evaluate the impact of preoperative coronal patterns based on the relationship between orientation of L4 coronal tilt and C7 plumb line on immediate postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients. Although lumbosacral fractional curve has been long stressed in correction surgery of DLS, there is paucity of literature focusing on preoperative coronal pattern based on the relationship between orientation of L4 coronal tilt and C7 plumb line and its impact on immediate postoperative coronal imbalance in DLS patients. A consecutive series of DLS patients who underwent deformity correction surgery via posterior-only approach were reviewed. According to the relationship between orientation of L4 coronal tilt and C7 plumb line preoperatively, a total of 77 DLS patients who underwent posterior spinal corrective surgery were classified into: 1. Coronal consistency pattern, L4 coronally tilts toward C7 plumb line; 2. Coronal opposition pattern, L4 coronally tilts opposite C7 plumb line. Coronal imbalance was defined as global coronal malalignment (GCM) on either side more than or equal to 20 mm. Whole-spine standing radiographs of both pattern groups were assessed preoperatively and postoperatively. There were 37 patients with coronal consistency pattern and 40 patients with coronal opposition pattern. Compared to patients with coronal opposition pattern, patients with coronal consistency pattern had significantly higher postoperative GCM (P = 0.028), lower amount of GCM correction (P = 0.013) and higher incidence of postoperative coronal imbalance (P = 0.001); further logistic regression analysis revealed coronal consistency pattern was associated with increased odds of postoperative coronal imbalance (odds ratio: 5.981; 95% confidence interval 2.029–17.633; P = 0.001). DLS patients with preoperative coronal consistency pattern carried greater risk for immediate postoperative coronal imbalance following posterior long correction surgery. Level of evidence 3

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Vascular Access Type Was Not Associated with Mortality and the Predictors for Cardiovascular Death in Elderly Chinese Patients on Hemodialysis

Blood Purification ◽

10.1159/000502941 ◽

2019 ◽

Vol 49 (1-2) ◽

pp. 63-70

Author(s):

Yang Yu ◽

Yuqin Xiong ◽

Chunle Zhang ◽

Martina Fu ◽

Yi Li ◽

...

Keyword(s):

Vascular Access ◽

Venous Catheter ◽

Multivariate Regression Analysis ◽

Cardiovascular Death ◽

Chinese Patients ◽

West China Hospital ◽

Kaplan Meier ◽

Elderly Chinese ◽

The Impact

Objectives: Current studies suggest arteriovenous fistula (AVF) and arteriovenous graft as superior vascular access (VA) types for elderly hemodialysis (HD) patients due to better outcomes. This study aimed to examine the impact of VA type on cardiovascular and all-cause mortality as well as the predictors for outcome in elderly Chinese patients. Methods: Patients who initiated HD aged ≥70 years and received a primary VA creation at the West China Hospital were enrolled in this retrospective study. Clinical characteristics, maturation, utilization, conversion of VA, and outcomes were collected. The observational period for each patient was from the point of the first permanent VA creation to the last time of follow-up. Kaplan-Meier and multivariate regression analysis were employed. Results:A total of 358 elderly Chinese HD patients with a median age of 74 (72–78) years were analyzed. During the study period of 25.8 (12–43) months, 54 (15.1%) and 113 patients (15.1%) died of cardiovascular events and all-cause, respectively. With regard to VA type, the modality of AVF, tunneled cuffed central venous catheter (tcCVC), or AVF and tcCVC was not associated with mortality. Furthermore, diastolic blood pressure (DBP) and congestive heart failure (CHF) were the independent predictors for cardiovascular mortality. Conclusions: The modality of VA types showed an insignificant effect on mortality in elderly Chinese population, while preoperative DBP and the presence of CHF might be used for the risk assessment of cardiovascular death. Disparities among nations in the areas of VA and HD necessitate additional studies.

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Reliability and Validity of the FACT-AN In Patients with Low or Int-1-Risk Myelodysplastic Syndromes with Deletion 5q.

Blood ◽

10.1182/blood.v116.21.3827.3827 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3827-3827 ◽

Cited By ~ 2

Author(s):

Nancy A Brandenburg ◽

Ren Yu ◽

Dennis A Revicki

Keyword(s):

Clinical Trial ◽

Internal Consistency ◽

Myelodysplastic Syndromes ◽

Secondary Analysis ◽

Reliability And Validity ◽

Internal Consistency Reliability ◽

Index Score ◽

Phase 3 ◽

Patient Reported ◽

The Impact

Abstract Abstract 3827 Background: Assessment of health-related quality of life (HRQoL) is important for the comprehensive evaluation of treatment effectiveness from the patient's perspective. The Functional Assessment of Cancer Therapy-Anemia (FACT-An) was developed to measure HRQoL and fatigue in cancer patients with anemia. There is little evidence on the reliability and validity of the FACT-An in patients with low or intermediate-1 (Int-1) risk myelodysplastic syndromes (MDS) with deletion (del) 5q cytogenetic abnormality. Aim: To evaluate the reliability, validity and responsiveness of the FACT-An based on a secondary analysis of data from a phase 3 randomized placebo controlled clinical trial (MDS-004) in patients with low or Int-1-risk MDS with del5q. Methods: This is a secondary analysis of clinical and HRQoL data from a randomized phase 3 clinical trial (Fenaux, 2009) comparing lenalidomide treatment with placebo in patients with MDS with del5q. Patient-reported HRQoL was assessed using the FACT-An questionnaire (Yellen, 1997; Cella, 2002). FACT-A consists of the FACT-General plus additional items that assess the impact of fatigue (FACT-F subscale) and other anemia-related symptoms (FACT-An subscale). The FACT-An was administered at baseline, and weeks 12, 24, 36, and 48. Preference-based HRQoL was measured by the EQ-5D at baseline. Internal consistency reliability (coefficient alpha) was assessed, and construct validity was evaluated using correlations between the baseline FACT scales and the EQ-5D index score. Known groups validity was assessed by analyzing FACT-An scores by hemoglobin (Hb) groups (<8; 8-<10; >=10gd/L) using analysis of variance models. T-tests were used to compare changes in FACT-An scores between Hb responders (>= 1 g/dL improvement) to non-responders at 12 weeks relative to baseline. Results: Overall, 205 patients participated in the clinical trial; 188 were included in the psychometric analyses (median age 68 y, range 36–86 y). Internal consistency reliability was 0.93 for FACT-An total, 0.94 for the FACT-An Treatment Outcome Index (TOI), 0.93 for the FACT-F TOI, 0.92 for the FACT-An subscale, and 0.91 for FACT-F subscale scores, and ranged from 0.72 to 0.83 for FACT-G scores. At baseline, FACT-An scores were correlated 0.65 to 0.72 with the EQ-5D index score. Mean FACT-An total (p=0.007), FACT-An TOI (p=0.005), FACT-F TOI (p=0.003), FACT-An subscale (p=0.001), FACT-F subscale (p=0.0004) score varied significantly by Hb group, with greater impairment associated with lower Hb levels. Hb responders reported significantly increased FACT-An total (7.5, p=0.0003), FACT-An TOI (8.5, p=0.0001), FACT-F TOI (6.5, p=0.0004), FACT-An subscale (5.5, p<0.0001), and FACT-F subscale (4.2, p=0.0002) scores. Conclusions: The FACT-An has good reliability and validity in patients with low or Int-1 risk MDS with del5q and is a relevant measure of HRQoL outcomes for clinical trials in patients with this disorder. FACT-An scores were responsive to changes in Hb, demonstrating the ability to detect patient-reported longitudinal changes in HRQoL associated with changes in underlying disease status. Disclosures: Brandenburg: Celgene: Employment, Equity Ownership. Revicki:Celgene: Consultancy, Research Funding.

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