The Effectiveness of Diffusion Tensor Imaging in Determining Radiological Response after Radiosurgery in Patients with Vestibular Schwannoma

2021 ◽  
Vol 17 ◽  
Author(s):  
Dilek Hacer Cesme ◽  
Alpay Alkan ◽  
Lutfullah Sari ◽  
Ahmet Kaya ◽  
Ismail Yurtsever ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Vestibular Schwannoma ◽  
Tumor Volume ◽  
Diffusion Tensor ◽  
Response To Treatment ◽  
Adc Values ◽  
Radiological Response ◽  
Group 2 ◽  
Group 1

Background: The effectiveness of Diffusion Tensor Imaging (DTI) in demonstrating functional changes in the tumor in determining the response to treatment after radiosurgery in patients with vestibular schwannoma (VS) is not clear yet. Objective: The study aimed to determine the change total in tumor volume (TTV) in terms of radiological response in patients who had VS and were treated with radiosurgery and investigate the relationship between the TTV, follow-up times and DTI parameters. Methods: Thirty-one patients were assessed using DTI and MRI. TTV, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were calculated. Patients were divided into tree groups: those who responded to the treatment (group 1) (n=11), who did not (group 0) (n=9) and who remained stable (group 2) (n=11). Background: The effectiveness of Diffusion Tensor Imaging (DTI) in demonstrating functional changes in the tumor in determining the response to treatment after radiosurgery in patients with vestibular schwannoma (VS) is not clear yet. Objective: The study aimed to determine the change total in tumor volume (TTV) in terms of radiological response in patients who had VS and were treated with radiosurgery and investigate the relationship between the TTV, follow-up times and DTI parameters. Methods: Thirty-one patients were assessed using DTI and MRI. TTV, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were calculated. Patients were divided into tree groups: those who responded to the treatment (group 1) (n=11), who did not (group 0) (n=9) and who remained stable (group 2) (n=11). Results: The mean duration of follow-up was 28.81±14 months. ADC values increased in patients with VS after radiosurgery (p=0.004). There was no statistical difference in the FA values. A significant reduction in TTV after radiosurgery was detected in group 1 (p=0.003). ADC values increased significantly after radiosurgery in group 2 (p=0.04). Although there were no significant differences, ADC values after radiosurgery increased in group 1 and group 0. Conclusions: ADC values continuously increase due to radiation damage in the period before the tumor volume shrinks after radiosurgery. We think that it is not appropriate to diagnose inadequate treatment or progression only when TTV is evaluated in terms of response to treatment in the early period after radiosurgery.

Importance of Pre-treatment Fractional Anisotropy Value in Predicting Volumetric Response in Patients with Meningioma Treated with Gamma Knife Radiosurgery

2021 ◽  
Vol 17 ◽  
Author(s):  
Dilek Hacer Cesme ◽  
Alpay Alkan ◽  
Lutfullah Sari ◽  
Fatma Yabul ◽  
Hafize Otcu Temur ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Tumor Volume ◽  
Diffusion Tensor ◽  
Gamma Knife Radiosurgery ◽  
Response To Treatment ◽  
Pre Treatment ◽  
Group 2 ◽  
The Relationship ◽  
Diffusion Tensor Imaging Dti ◽  
Group 1

Background: The importance of pre-treatment Diffusion Tensor Imaging (DTI) parameters in determining the response to treatment after radiosurgery in patients with meningioma has not yet been clearly revealed. Objective: To determine tumor volume changes in terms of radiological response in patients with meningioma treated with Gamma Knife Radiosurgery (GKR) and to analyze the relationship between total tumor volume (TTV) and Diffusion Tensor Imaging (DTI) parameters. In addition, we investigated whether the response to treatment can be predicted by pre-radiosurgery DTI findings. Methods: Fifty-four patients were assessed using MRI and DTI before and after GKR. Mean diffusivity (MD), Fractional anisotropy (FA), Radial diffusivity (RD) and TTV were calculated from the tumor. Patients with 10% or more decrease in TTV after GKR were classified as group 1 and those with less than 10% decrease in volume or increase in volume were considered as group 2. The relationships between MD, RD, and FA values and TTV were investigated. Results: A decrease of 46.34% in TTV was detected in group 1 after GKR, while TTV increased by 42.91% in group 2. The lowest pre-treatment FA value was detected in group 1. In addition, after GKR, FA values showed a significant increase in group 1. MD and RD values increased in both groups after radiosurgery. There was a negative correlation between pre-treatment FA, and RD and MD values after radiosurgery. Conclusions: Detection of low FA values due to poor fiber content in meningioma before radiosurgery may be a guide in predicting the response to treatment. Further studies are required to have a better understanding of the relationship between pre- and post-treatment follow-up FA values and tumor volume in determining the efficacy of GKR in patients with meningioma.

scholarly journals Evaluation of Brainstem Subcortical Auditory Pathways with Diffusion Tensor Imaging After Gamma Knife Radiosurgery in Intracanalicular Vestibular Schwannoma

2021 ◽  
Author(s):  
Dilek Hacer Çeşme ◽  
Alpay Alkan ◽  
Mehmet Ali Gültekin ◽  
Lütfullah Sarı ◽  
Gökberk Alkan ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Tumor Volume ◽  
Diffusion Tensor ◽  
Gamma Knife Radiosurgery ◽  
Response To Treatment ◽  
Auditory Pathways ◽  
Significant Difference ◽  
Before And After ◽  
Adc Values ◽  
The Relationship

Objective: To investigate changes in DTI (Diffusion Tensor Imaging) parameters in brainstem subcortical auditory pathways after Gamma Knife Radiosurgery (GKR) in patients with intracanalicular vestibular schwannoma (ICVS) and to analyze the relationship between tumor volume and ADC (apparent diffusion coefficient) and FA (fractional anisotropy) values. Method: Seventeen patients with ICVS were evaluated before and after GKR. ADC and FA values of the lateral lemniscus (LL) and inferior colliculus (IC) and tumor volume were calculated. Patients who responded to GKR were classified as Group 1 and those who did not respond adequately as Group 2. The relationship between ADC and FA values and changes in tumor volume were analyzed. Results: Tumor volume significantly decreased after GKR. ADC values obtained from the tumor increased after GKR (p: 0.002). There was no significant difference in LL and IC before and after GKR in terms of FA and ADC values (n: 17). There was a positive correlation between response to treatment and contralateral LL ADC values after GKR (p=0.005, r: 0.652). There was a negative correlation between contralateral IC FA values after GKR and response to treatment (p=0.017, r: -0.568). There was a significant difference between Groups 1 and 2 in regards to contralateral LL ADC (p=0.03) and IC FA values (p=0.017). Conclusion: Since the cochlear nerve and subcortical auditory pathways have low regeneration potential after nerve damage, ADC and FA changes in LL and IC may be explained with the presence of intracanalicular tumors prior to GKR. Since GKR does not cause additional damage to the subcortical auditory pathways at the brainstem level, we think that GKR is a noninvasive treatment method that can be used safely in patients with ICVS.

Diffusion Tensor Imaging of Brain Metastases in Patients with Breast Cancer According to Molecular Subtypes

2020 ◽  
Vol 16 ◽  
Author(s):  
Ismail Yurtsever ◽  
Lutfullah Sari ◽  
Mehmet Ali Gultekin ◽  
Huseyin Toprak ◽  
Haci Mehmet Turk ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diffusion Tensor Imaging ◽  
Brain Metastases ◽  
Triple Negative ◽  
Molecular Subtypes ◽  
Diffusion Tensor ◽  
Positive Group ◽  
Adc Values ◽  
Group 2 ◽  
Group 1

Background and Purpose: Recent studies have shown that diffusion tensor imaging (DTI) parameters are used to follow the patients with breast cancer and correlate well as a prognostic parameter of breast cancer. However, as far as we know there is no data to compare the DTI features of breast cancer brain metastases according to molecular subtypes in the literature. Our aim is to evaluate whether there are any differences in DTI parameters of brain metastases in patients with breast cancer according to molecular subtypes. Methods: Twenty-seven patients with breast cancer and 82 metastatic brain lesions were included. We classified subjects into three subgroups according to their hormone expression; Group 0, triple negative (n; 6, 19 lesions), group 1, HER2-positive (n;16, 54 lesions) and group 2, hormone positive group (n; 5, 9 lesions). The apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) values in DTI were measured and compared between three groups. Results: ADC, AD and RD values of group 2 were significantly lower compared to group 0. No significant differences were found in FA, ADC, AD and RD values between the group 0 and 1 and the group 1 and 2. Conclusion: Metastasis of aggressive triple negative breast cancer showed higher ADC values compared to less aggressive hormone positive group. Higher ADC values in brain metastases of breast cancer may indicate a poor prognosis, so DTI findings could play a role in planning appropriate treatment.

Both Higher Level of (bcr,abl) Transcripts and High Hasford Risk Score Are Associated with Cytogenetic Response but Absence of Molecular Remission during First Line Use of Imatinib Mesilate(IM): A Finding Not Observed Following Use among Interferon Failures.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4671-4671
Author(s):  
Selami K. Toprak ◽  
Klara Dalva ◽  
Dilsa Mizrak ◽  
Mutlu Arat ◽  
Muhit Ozcan ◽  
...  
Keyword(s):  
Risk Score ◽  
Prognostic Score ◽  
Response To Treatment ◽  
Quantitative Detection ◽  
Molecular Response ◽  
First Line ◽  
Group 2 ◽  
Hasford Score ◽  
Group 1

Abstract Factors that predict response to treatment in CML has been defined for busulphan and Interferon. Search for prognostic parameters in the imatinib era are still continuing. Very recently a new prognostic scoring of CML patients has been defined by Kantarjian et al (Blood, 2004; 10: 1182).The value of these scoring systems in prediction of molecular response to first line use of IM has not been published yet. With this aim, we have evaluated the hematological and molecular response of all CML patients chronic (n: 74)/accelerated (n: 9) treated with IM in this prospective study. Since IM has been approved for secondary ( May 2001)and primary (May 2003) treatment in Turkey, we have evaluated 22 patients- first line use (Group 1) and 61 Interferon failures (Group 2) following a median follow-up of 9–35 months. Hasford prognostic score was available and calculated in 67 of these patients online at www.pharmacoepi.de/cmlscore.html. Scores were: Group 1 low:8 /medium:5 /high:2; Group 2:low:16 /medium:29 /high:7. In group 2, time from diagnosis to IM treatment was 29 m(3–144). Method: RNA was isolated from blood or marrow (High Pure RNA isolation kit, Roche) and used for quantitative detection of bcr-abl transcripts with “LightCycler t(9;22) Quantification Kit”. Results were expressed as ratio to G6PD standarts. Results: Age and Hasford distribution were comparable in group 1 and 2. The tumor burden (median)according to scoring was Group1: low: 0.014 /high: 0.0453 and Group 2: low: 0.0035 /high: 0.012. Level of bcr-abl transcripts were higher in group1 vs 2(0.03 vs 0.009) and Hasford-high vs low, regardless of previous treatment. We could not show any correlation between Hasford score and transcript level at diagnosis (Pearson, r=.314, p=0.255). 20% of the Group 1-high and 60% of Group 1-low patients achieved major and complete CR at 6m and 12m. Similar evaluation revealed a weaker response rate in Group-2: 21–30% depending on risk score and time (6–12m). Time to mol CR (less than 10e5) occurred at a median of 6 (6–12) months in 26.7% (6m) of Group1 and 9m (3–12) in 7.7% (6m) of Group 2. Resistance developed both in Group 1(2/22) and Group 2 (7/61). Among scored patients, mol CR was achievable in Group-1(only low risk). However in Group 2, molCR could be obtained both in low (n:17) and high (n:17) risk patients. The median levels of bcr,abl transcript were: Group1:0.029 (molCR+) vs 0.059(molCR-) and Group 2: 0.0498 (molCR+) vs 0.0988(molCR−). Conclusion: In accordance with previous reports both molecular and cytogenetic remissions were observed earlier and more frequently among patients who received IM as a first line agent compared to second line use. Among patients being treated after Interferon, Hasford scoring at diagnosis did not have an impact on the prediction of response to IM. This finding is in paralel to Kantarjian’s results. However, in our study de novo CML patients’ bcr,abl transcript levels and the Hasford score showed an association with response. The shorter median follow-up in Group 1 may also have an impact on these results and updates are warranted. Like ours, the recent publications (Brummendorf 2003 and Drummond, 2004) on the correlation of telomere length with Hasford score and the response to treatment with IM support the value of this score in previously untreated patients with CML.

Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 87-97 ◽  
Author(s):  
Wen-Yuh Chung ◽  
Kang-Du Liu ◽  
Cheng-Ying Shiau ◽  
Hsiu-Mei Wu ◽  
Ling-Wei Wang ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Tumor Volume ◽  
Radiation Effect ◽  
Gamma Knife Surgery ◽  
Homogeneous Distribution ◽  
Content Type ◽  
Fine Print

Object. The authors conducted a study to determine the optimal radiation dose for vestibular schwannoma (VS) and to examine the histopathology in cases of treatment failure for better understanding of the effects of irradiation. Methods. A retrospective study was performed of 195 patients with VS; there were 113 female and 82 male patients whose mean age was 51 years (range 11–82 years). Seventy-two patients (37%) had undergone partial or total excision of their tumor prior to gamma knife surgery (GKS). The mean tumor volume was 4.1 cm3 (range 0.04–23.1 cm3). Multiisocenter dose planning placed a prescription dose of 11 to 18.2 Gy on the 50 to 94% isodose located at the tumor margin. Clinical and magnetic resonance (MR) imaging follow-up evaluations were performed every 6 months. A loss of central enhancement was demonstrated on MR imaging in 69.5% of the patients. At the latest MR imaging assessment decreased or stable tumor volume was demonstrated in 93.6% of the patients. During a median follow-up period of 31 months resection was avoided in 96.8% of cases. Uncontrolled tumor swelling was noted in five patients at 3.5, 17, 24, 33, and 62 months after GKS, respectively. Twelve of 20 patients retained serviceable hearing. Two patients experienced a temporary facial palsy. Two patients developed a new trigeminal neuralgia. There was no treatment-related death. Histopathological examination of specimens in three cases (one at 62 months after GKS) revealed a long-lasting radiation effect on vessels inside the tumor. Conclusions. Radiosurgery had a long-term radiation effect on VSs for up to 5 years. A margin 12-Gy dose with homogeneous distribution is effective in preventing tumor progression, while posing no serious threat to normal cranial nerve function.

scholarly journals Integrated slice-specific dynamic shimming diffusion weighted imaging (DWI) for rectal Cancer detection and characterization

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jianxing Qiu ◽  
Jing Liu ◽  
Zhongxu Bi ◽  
Xiaowei Sun ◽  
Xin Wang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Image Quality ◽  
Diffusion Weighted Imaging ◽  
Rectal Tumor ◽  
B Values ◽  
Primary Rectal Cancer ◽  
Diffusion Weighted ◽  
Adc Values ◽  
Group 2 ◽  
Group 1

Abstract Purpose To compare integrated slice-specific dynamic shimming (iShim) diffusion weighted imaging (DWI) and single-shot echo-planar imaging (SS-EPI) DWI in image quality and pathological characterization of rectal cancer. Materials and methods A total of 193 consecutive rectal tumor patients were enrolled for retrospective analysis. Among them, 101 patients underwent iShim-DWI (b = 0, 800, and 1600 s/mm2) and 92 patients underwent SS-EPI-DWI (b = 0, and 1000 s/mm2). Qualitative analyses of both DWI techniques was performed by two independent readers; including adequate fat suppression, the presence of artifacts and image quality. Quantitative analysis was performed by calculating standard deviation (SD) of the gluteus maximus, signal intensity (SI) of lesion and residual normal rectal wall, apparent diffusion coefficient (ADC) values (generated by b values of 0, 800 and 1600 s/mm2 for iShim-DWI, and by b values of 0 and 1000 s/mm2 for SS-EPI-DWI) and image quality parameters, such as signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of primary rectal tumor. For the primary rectal cancer, two pathological groups were divided according to pathological results: Group 1 (well-differentiated) and Group 2 (poorly differentiated). Statistical analyses were performed with p < 0.05 as significant difference. Results Compared with SS-EPI-DWI, significantly higher scores of image quality were obtained in iShim-DWI cases (P < 0.001). The SDbackground was significantly reduced on b = 1600 s/mm2 images and ADC maps of iShim-DWI. Both SNR and CNR of b = 800 s/mm2 and b = 1600 s/mm2 images in iShim-DWI were higher than those of b = 1000 s/mm2 images in SS-EPI-DWI. In primary rectal cancer of iShim-DWI cohort, SIlesion was significantly higher than SIrectum in both b = 800 and 1600 s/mm2 images. ADC values were significantly lower in Group 2 (0.732 ± 0.08) × 10− 3 mm2/s) than those in Group 1 ((0.912 ± 0.21) × 10− 3 mm2/s). ROC analyses showed significance of ADC values and SIlesion between the two groups. Conclusion iShim-DWI with b values of 0, 800 and 1600 s/mm2 is a promising technique of high image quality in rectal tumor imaging, and has potential ability to differentiate rectal cancer from normal wall and predicting pathological characterization.

Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Proff ◽  
B Merkely ◽  
R Papp ◽  
C Lenz ◽  
P.J Nordbeck ◽  
...  
Keyword(s):  
Heart Rate ◽  
Closed Loop ◽  
Funding Source ◽  
Chronotropic Incompetence ◽  
First Results ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG

scholarly journals Effects of posterior tibial slope on the mid-term results of medial unicompartmental knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Zhijie Chen ◽  
Kaizhe Chen ◽  
Yufei Yan ◽  
Jianmin Feng ◽  
Yi Wang ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
Significant Difference ◽  
Medial Unicompartmental Knee Arthroplasty ◽  
Group 3 ◽  
Group 2 ◽  
Postoperative Knee ◽  
Group 1

Abstract Objective To evaluate the effect of medial posterior tibial slope (PTS) on mid-term postoperative range of motion (ROM) and functional improvement of the knee after medial unicompartmental knee arthroplasty (UKA). Methods Medical records of 113 patients who had undergone 124 medial UKAs between April 2009 through April 2014 were reviewed retrospectively. The mean follow-up lasted 7.6 years (range, 6.2–11.2 years). Collected were demographic data, including gender, age, height, weight of the patients. Anteroposterior (AP) and lateral knee radiographs of the operated knees were available in all patients. The knee function was evaluated during office follow-up or hospital stay. Meanwhile, postoperative PTS, ROM, maximal knee flexion and Hospital for Special Surgery (HSS) knee score (pre−/postoperative) of the operated side were measured and assessed. According to the size of the PTS, patients were divided into 3 groups: group 1 (<4°), group 2 (4° ~ 7°) and group 3 (>7°). The association between PTS and the knee function was investigated. Results In our cohort, the average PTS was 2.7° ± 0.6° in group 1, 5.6° ± 0.9° in group 2 and 8.7° ± 1.2° in group 3. Pairwise comparisons showed significant differences among them (p < 0.01). The average maximal flexion range of postoperative knees in each group was 112.4° ± 5.6°, 116.4° ± 7.2°, and 117.5° ± 6.1°, respectively, with significant difference found between group 1 and group 2 (p < 0.05), and between group 1 and group 3 (p < 0.05). However, the gender, age, and body mass index (BMI) did not differ between three groups and there was no significant difference between groups in terms of pre−/postoperative HSS scores or postoperative knee ROM. Conclusion A mid-term follow-up showed that an appropriate PTS (4° ~ 7°) can help improve the postoperative flexion of knee. On the other hand, too small a PTS could lead to limited postoperative knee flexion. Therefore, the PTS less than 4° should be avoided during medial UKA.

scholarly journals Percutaneous posteroanterior screw fixation for Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture: Operative technique and randomized clinical results

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199799
Author(s):  
Tianming Yu ◽  
Jichong Ying ◽  
Jianlei Liu ◽  
Dichao Huang ◽  
Hailin Yan ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Malleolar Fracture ◽  
Malleolar Fractures ◽  
Posterior Malleolar Fracture ◽  
Post Traumatic ◽  
Group 2 ◽  
Traumatic Arthritis ◽  
Group 1

Purpose: The study described a novel surgical treatment of Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture and patient outcomes at intermediate period follow-up. Methods: All patients from January 2015 to December 2017 with tri-malleolar fracture of which posterior malleolar fractures were Haraguchi type 1, were surgically treated in this prospective study. Lateral and medial malleolar fractures were managed by open reduction and internal fixation through dual incision approaches. 36 cases of Haraguchi type 1 posterior malleolar fractures were randomly performed by percutaneous posteroanterior screw fixation with the aid of medial exposure (group 1). And 40 cases were performed by percutaneous anteroposterior screw fixation (group 2). Clinical outcomes, radiographic outcomes and patient-reported outcomes were recorded. Results: Seventy-six patients with mean follow-up of 30 months were included. There were no significant differences in the mean operation time (81.0 ± 11.3 vs. 77.2 ± 12.4), ankle function at different periods of follow-up, range of motions and visual analog scale (VAS) at 24 months between the two groups ( p > 0.05). However, the rate of severe post-traumatic arthritis (Grade 2 and 3) and the rate of step-off rather than gap in radiological evaluation were lower in group 1 than that in group 2 ( p < 0.05). Conclusion: Using our surgical technique, more patients had good outcome with a lower rate of severe post-traumatic arthritis, compared with the group of percutaneous anteroposterior screw fixation. Percutaneous posteroanterior screw fixation can be a convenient and reliable alternative in treating Haraguchi type 1 posterior malleolar fracture.

The Relationship between Serum Ferritin Levels and 5-Year All-Cause Mortality in Hemodialysis Patients

2021 ◽  
pp. 1-7
Author(s):  
Emre Erdem ◽  
Ahmet Karatas ◽  
Tevfik Ecder
Keyword(s):  
Serum Ferritin ◽  
Hemodialysis Patients ◽  
Rank Test ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Group 3 ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

<b><i>Introduction:</i></b> The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. <b><i>Methods:</i></b> A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin &#x3c;800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin &#x3e;1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. <b><i>Results:</i></b> Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, <i>p</i> = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; <i>p</i> = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; <i>p</i> = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; <i>p</i> = 0.063). <b><i>Conclusion:</i></b> Time-averaged serum ferritin levels &#x3e;1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

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