Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time—A Systematic Review

Background: Fat embolism (FE) continues to be mentioned as a substantial complication following acute femur fractures. The aim of this systematic review was to test the hypotheses that the incidence of fat embolism syndrome (FES) has decreased since its description and that specific injury patterns predispose to its development. Materials and Methods: Data Sources: MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for articles from 1 January 1960 to 31 December 2019. Study Selection: Original articles that provide information on the rate of FES, associated femoral injury patterns, and therapeutic and diagnostic recommendations were included. Data Extraction: Two authors independently extracted data using a predesigned form. Statistics: Three different periods were separated based on the diagnostic and treatment changes: Group 1: 1 January 1960–12 December 1979, Group 2: 1 January 1980–1 December 1999, and Group 3: 1 January 2000–31 December 2019, chi-square test, χ2 test for group comparisons of categorical variables, p-value < 0.05. Results: Fifteen articles were included (n = 3095 patients). The incidence of FES decreased over time (Group 1: 7.9%, Group 2: 4.8%, and Group 3: 1.7% (p < 0.001)). FES rate according to injury pattern: unilateral high-energy fractures (2.9%) had a significantly lower FES rate than pathological fractures (3.3%) and bilateral high-energy fractures (4.6%) (p < 0.001). Conclusions: There has been a significant decrease in the incidence of FES over time. The injury pattern impacts the frequency of FES. The diagnostic and therapeutic approach to FES remains highly heterogenic to this day.

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Pro- and macroglycogenolysis: relationship with exercise intensity and duration

Journal of Applied Physiology ◽

10.1152/jappl.2001.90.3.873 ◽

2001 ◽

Vol 90 (3) ◽

pp. 873-879 ◽

Cited By ~ 33

Author(s):

T. E. Graham ◽

K. B. Adamo ◽

J. Shearer ◽

I. Marchand ◽

B. Saltin

Keyword(s):

Skeletal Muscle ◽

Metabolic Regulation ◽

Human Skeletal Muscle ◽

Exercise Period ◽

Group 3 ◽

Group 2 ◽

Male Subjects ◽

Muscle Biopsies ◽

Over Time ◽

Group 1

We examined the net catabolism of two pools of glycogen, proglycogen (PG) and macroglycogen (MG), in human skeletal muscle during exercise. Male subjects ( n = 21) were assigned to one of three groups. Group 1 exercised 45 min at 70% maximal O2 uptake (V˙o 2 max) and had muscle biopsies at rest, 15 min, and 45 min. Group 2 exercised at 85%V˙o 2 max to exhaustion (45.4 ± 3.4 min) and had biopsies at rest, 10 min, and exhaustion. Group 3 performed three 3-min bouts of exercise at 100%V˙o 2 max separated by 6 min of rest. Biopsies were taken at rest and after each bout. Group 1 had small MG and PG net glycogenolysis rates (ranging from 3.8 ± 1.0 to 2.4 ± 0.6 mmol glucosyl units · kg−1 · min−1) that did not change over time. In group 2, the MG glycogenolysis rate remained low and unchanged over time, whereas the PG rate was initially elevated (11.3 ± 2.3 mmol glucosyl units · kg−1 · min−1) and declined ( P ≤ 0.05) with time. During the first 10 min, PG concentration ([PG]) declined ( P ≤ 0.05), whereas MG concentration ([MG]) did not. Similarly, in group 3, in both the first and the second bouts of exercise [PG] declined ( P ≤ 0.05) and [MG] did not, although by the end of the second exercise period the [MG] was lower ( P ≤ 0.05) than the rest level. The net catabolic rates for PG in the first two exercises were 22.6 ± 6.8 and 21.8 ± 8.2 mmol glucosyl units · kg−1 · min−1, whereas the corresponding values for MG were 17.6 ± 6.0 and 10.8 ± 5.6. The MG pool appeared to be more resistant to mobilization, and, when activated, its catabolism was inhibited more rapidly than that of PG. This suggests that the metabolic regulation of the two pools must be different.

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Reduction in daily hydrocortisone dose improves bone health in primary adrenal insufficiency

Acta Endocrinologica ◽

10.1530/eje-15-1096 ◽

2016 ◽

Vol 174 (4) ◽

pp. 531-538 ◽

Cited By ~ 31

Author(s):

Julia Schulz ◽

Kathrin R Frey ◽

Mark S Cooper ◽

Kathrin Zopf ◽

Manfred Ventz ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Adrenal Crisis ◽

Mineral Density ◽

Primary Adrenal Insufficiency ◽

Group Reduction ◽

Group 3 ◽

Group 2 ◽

Over Time ◽

Group 1

ObjectiveIndividuals with primary adrenal insufficiency (PAI) or congenital adrenal hyperplasia (CAH) receive life-long glucocorticoid (GC) replacement therapy. Current daily GC doses are still higher than the reported adrenal cortisol production rate. This GC excess could result in long-term morbidities such as osteoporosis. No prospective trials have investigated the long-term effect of GC dose changes in PAI and CAH patients.MethodsThis is a prospective and longitudinal study including 57 subjects with PAI (42 women) and 33 with CAH (21 women). Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry at baseline and after 2 years. Subjects were divided into three groups (similar baseline characteristics) depending on changes in daily hydrocortisone equivalent dose (group 1: unchanged 25.2±8.2 mg (mean±s.d., n=50); group 2: increased 18.7±10.3 to 25.9±12.0 mg (n=13); group 3: decreased 30.8±8.5 to 21.4±7.2 mg (n=27)).ResultsSubjects in group 1 showed normal lumbar and femoral Z-scores which were unchanged over time. Group 2 subjects showed a significant decrease in femoral neck Z-scores over time (−0.15±1.1 to −0.37±1.0 (P<0.05)), whereas group 3 subjects showed a significant increase in lumbar spine and hip Z-scores (L1–L4: −0.93±1.2 to –0.65±1.5 (P<0.05); total hip: −0.40±1.0 to −0.28±1.0 (P<0.05)). No changes in BMI over time were seen within any group. Reduction in GC dose did not increase the risk of adrenal crisis.ConclusionThis study demonstrates for the first time that cautious reduction in hydrocortisone equivalent doses leads to increases in BMD, whereas dose increments reduced BMD. These data emphasize the need for the lowest possible GC replacement dose in AI patients to maintain health and avoid long-term adverse effects.

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TSH variations in chronic heart failure outpatients: clinical correlates and outcomes

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530321666210430131510 ◽

2021 ◽

Vol 21 ◽

Author(s):

Paola Terlizzese ◽

Miriam Albanese ◽

Dario Grande ◽

Giuseppe Parisi ◽

Margherita Ilaria Gioia ◽

...

Keyword(s):

Heart Failure ◽

Thyroid Function ◽

Echocardiographic Parameters ◽

Group 3 ◽

Group 2 ◽

One Year ◽

Tsh Levels ◽

Over Time ◽

Group 1

Background: Hypothyroidism is a frequently observed comorbidity in patients with chronic heart failure (CHF), possibly giving rise to unfavorable outcomes. Aim: The aim of the study was to evaluate the impact of TSH changes over time on cardiac function and prognosis of outpatients with CHF. Methods: Patients underwent clinical, electrocardiographic, and echocardiographic evaluations at baseline and after 12 months. Moreover, blood chemistry tests were performed to evaluate renal function, cardiac biomarkers, fT3, fT4, and TSH levels. Based on TSH serum levels, patients were retrospectively classified into four categories: Group 1, patients with improved thyroid function at one-year follow up vs. baseline; Group 2, patients with stable and mildly high TSH values (3.74 – 10 mUI/L); Group 3, patients with worsening thyroid function; Euthyroid patients Group, TSH levels within the normal range of reference at baseline as well as at 12 months follow-up. We considered as end-points: one-year changes of laboratory and echocardiographic parameters; hospitalizations due to worsening of HF (acute decompensated heart failure - ADHF); death for all causes. Results: Among 257 patients, 174 (67.7%) were euthyroid at baseline and after 12 months. Group 1 patients (n. 22, 8.6%) showed a significant improvement in systolic and diastolic function, filling pressures, NT-proBNP and Galectin-3. Group 2 patients (n. 34, 13.2%) did not exhibit significant modifications in studied parameters. Group 3 patients (n. 27, 10.5%) showed worsening of diastolic function and NT-proBNP and a greater risk of ADHF (HR: 2.12; 95%CI: 1.20-3.74; p: 0.009) and death (HR: 4.05; 95%CI: 2.01-8.15; p<0.001). Conclusion: In patients with CHF, changes in thyroid function over time influenced echocardiographic parameters and biomarkers reflecting modifications of cardiac function and prognosis, thus suggesting the clinical relevance of thyroid deficiency screening and correction.

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Changes of JAK2 V617F Allele Burden Over Time in Patients with Polycythemia Vera or Essential Thrombocythemia: A Retrospective Study of 172 Patients.

Blood ◽

10.1182/blood.v114.22.1892.1892 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1892-1892

Author(s):

Elisabetta Antonioli ◽

Alessandra Carobbio ◽

Lisa Pieri ◽

Alessandro Pancrazzi ◽

Paola Guglielmelli ◽

...

Keyword(s):

Jak2 V617f ◽

Repeated Measure ◽

Interval Time ◽

Allele Burden ◽

Group 3 ◽

Group 2 ◽

Over Time ◽

Group 1 ◽

Median Interval

Abstract Abstract 1892 Poster Board I-915 There are conflicting results about quantitative modifications of V617F allele burden in patients (pts) with myeloproliferative neoplasms (MPN) who are either therapy-naive or are treated with hydroxyurea (HU). In a retrospective single center study in 48 pts with polycythemia vera (PV) or essential thrombocythemia (ET) the granulocyte JAK2V617F allele burden remained stable over time (median follow-up was 34 months for PV and 23 for ET) irrespective of the pts being treated or not with cytotoxic therapy (Theocharides A et al, Haematologica 2008). Conversely, another study in 25 patients reported a significant reduction of V617F allele burden (>30% of baseline level) after HU therapy in 52% of the pts, becoming indetectable in 3 of them (Girodon F et al, Haematologica 2008). The aim of this study was to evaluate any modifications of JAK2V617F allele burden during long-term follow-up in patients with PV or ET and the effects of HU treatment. This two-center (Firenze and Bergamo) retrospective study concerned 172 patients with a diagnosis of PV or ET according to the WHO criteria. The only study inclusion criteria were the presence of JAK2V617F mutation and the availability of at least two sequential blood samples drawn at an interval time of at least 6 months. The JAK2-V617F allele load was measured by sensitive quantitative RT-PCR in granulocyte DNA according to the method of Lippert et al (Blood 2006). Differences between median values of JAK2 V617F allele burden were tested by the Wilcoxon matched-pairs signed-ranks test. Repeated measure test for JAK2 V617F mean change over time, irrespective of diagnosis, was also calculated to investigate a significant variance among ordered time measures. There were 103 pts with PV and 69 with ET; median age was 56 yr (range, 15–84), females were 49%. The median interval time between the baseline and follow-up sample in the whole pt population was 27 months (range 6–60), 26 and 28 months for ET and PV, respectively. The median patient follow-up was 3 years (range 0.5–25); no evolution to myelofibrosis or acute leukemia was recorded. According to previous reports, the mean V617F burden was significantly greater in PV than in ET pts (50 ± 26% and 32 ± 18%, respectively; p <0.0001). Sixty-nine pts (41 PV, 28 ET) remained untreated during follow-up (Group 1), whereas 103 received HU; of the latter, 60 pts were already on treatment at the time of first genotyping (Group 2) whereas 43 patients were chemotherapy-naive and started HU after the first blood sampling (Group 3). In Group 1 pts, the median interval between 1st and 2nd sample was 26 months (range 6–60)for PV pts and 24 mo (range 6–59) for ET pts. The JAK2 V617F allele burden was 47.7±22.3% and 48.3±18.9% in the 1st and 2nd sample in PV pts, respectively, and 25.2±13.1% and 28.6±13.5% in case of ET pts, without any significant difference. In pts included in Group 2, the median interval between 1st and 2nd sample was 28 months (range 6–54) for PV pts and 28 mo (range 6–60) for ET pts. The JAK2 V617F allele burden was 55.1±29.2% and 60.3±25.6% in the 1st and 2nd sample in PV pts, respectively, and 36.3±21.7% and 40.7±22.9% in case of ET pts (P=.039). Considering PV and ET pts together, there was a statistically significant increase of V617F allele burden over time from 47.9±28.0% in the 1st sample to 52.8±26.3% in the 2nd (P= .023, repeated measure test). Among pts of Group 3, the median interval time between 1st and 2nd sample was 32 months (range 10–48) for PV pts and 24 mo (range 7–58) for ET pts. The JAK2 V617F allele burden was 47.0±26.2% and 45.5±20.8% in the 1st and 2nd sample in PV pts, respectively, and 37.3±16.2% and 33.3±15.0% in case of ET pts (P= .024). In conclusion, within the observation period of this study we found no evidence for a time-dependent increase of V617F allele burden in untreated PV and ET pts, although we cannot exclude that these results might be related to the relatively short follow-up. Accordingly, in a previous study in ET pts we found that the mutant allele burden increased significantly after 10 years from diagnosis (Carobbio A et al., Exp Hematol, 2009). Furthermore, we observed a very modest reduction of V617F allele burden in HU newly treated ET patients, while in previously treated PV and ET patients the allele burden actually increased over time, suggesting that HU has very little if any likelihood to impact on the size of mutant hematopoietic cell clone. Disclosures: No relevant conflicts of interest to declare.

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Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010

Public Health Nutrition ◽

10.1017/s1368980015000506 ◽

2015 ◽

Vol 18 (17) ◽

pp. 3096-3107 ◽

Cited By ~ 85

Author(s):

Filippa Juul ◽

Erik Hemmingsson

Keyword(s):

Food Products ◽

High Energy ◽

High Energy Density ◽

Future Research ◽

Processed Foods ◽

Processed Food ◽

Group 3 ◽

Group 2 ◽

Processed Products ◽

Group 1

AbstractObjectiveTo investigate how consumption of ultra-processed foods has changed in Sweden in relation to obesity.DesignNationwide ecological analysis of changes in processed foods along with corresponding changes in obesity. Trends in per capita food consumption during 1960–2010 were investigated using data from the Swedish Board of Agriculture. Food items were classified as group 1 (unprocessed/minimally processed), group 2 (processed culinary ingredients) or group 3 (3·1, processed food products; and 3·2, ultra-processed products). Obesity prevalence data were pooled from the peer-reviewed literature, Statistics Sweden and the WHO Global Health Observatory.SettingNationwide analysis in Sweden, 1960–2010.SubjectsSwedish nationals aged 18 years and older.ResultsDuring the study period consumption of group 1 foods (minimal processing) decreased by 2 %, while consumption of group 2 foods (processed ingredients) decreased by 34 %. Consumption of group 3·1 foods (processed food products) increased by 116 % and group 3·2 foods (ultra-processed products) increased by 142 %. Among ultra-processed products, there were particularly large increases in soda (315 %; 22 v. 92 litres/capita per annum) and snack foods such as crisps and candies (367 %; 7 v. 34 kg/capita per annum). In parallel to these changes in ultra-processed products, rates of adult obesity increased from 5 % in 1980 to over 11 % in 2010.ConclusionsThe consumption of ultra-processed products (i.e. foods with low nutritional value but high energy density) has increased dramatically in Sweden since 1960, which mirrors the increased prevalence of obesity. Future research should clarify the potential causal role of ultra-processed products in weight gain and obesity.

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Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil

Public Health Nutrition ◽

10.1017/s1368980010003241 ◽

2010 ◽

Vol 14 (1) ◽

pp. 5-13 ◽

Cited By ~ 416

Author(s):

Carlos Augusto Monteiro ◽

Renata Bertazzi Levy ◽

Rafael Moreira Claro ◽

Inês Rugani Ribeiro de Castro ◽

Geoffrey Cannon

Keyword(s):

Energy Density ◽

Food Products ◽

High Energy ◽

High Energy Density ◽

Processed Foods ◽

Processed Food ◽

Minimally Processed ◽

Group 3 ◽

Group 2 ◽

Group 1

AbstractObjectiveTo assess time trends in the contribution of processed foods to food purchases made by Brazilian households and to explore the potential impact on the overall quality of the diet.DesignApplication of a new classification of foodstuffs based on extent and purpose of food processing to data collected by comparable probabilistic household budget surveys. The classification assigns foodstuffs to the following groups: unprocessed/minimally processed foods (Group 1); processed culinary ingredients (Group 2); or ultra-processed ready-to-eat or ready-to-heat food products (Group 3).SettingEleven metropolitan areas of Brazil.SubjectsHouseholds;n13 611 in 1987–8,n16 014 in 1995–5 andn13 848 in 2002–3.ResultsOver the last three decades, the household consumption of Group 1 and Group 2 foods has been steadily replaced by consumption of Group 3 ultra-processed food products, both overall and in lower- and upper-income groups. In the 2002–3 survey, Group 3 items represented more than one-quarter of total energy (more than one-third for higher-income households). The overall nutrient profile of Group 3 items, compared with that of Group 1 and Group 2 items, revealed more added sugar, more saturated fat, more sodium, less fibre and much higher energy density.ConclusionsThe high energy density and the unfavourable nutrition profiling of Group 3 food products, and also their potential harmful effects on eating and drinking behaviours, indicate that governments and health authorities should use all possible methods, including legislation and statutory regulation, to halt and reverse the replacement of minimally processed foods and processed culinary ingredients by ultra-processed food products.

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New Trend of Cardiac Myxoma - Case Series and Systematic Review

Clinical Cardiology and Cardiovascular Medicine ◽

10.33805/2639.6807.101 ◽

2016 ◽

pp. 1-5

Author(s):

Junhong Gui ◽

Aadil Maqsood ◽

Saroj Khadka ◽

Kenneth Rodriguez ◽

George Everett

Keyword(s):

Cardiac Myxoma ◽

Case Series ◽

Surgical Mortality ◽

Current Group ◽

Therapeutic Outcomes ◽

Group 3 ◽

Group 2 ◽

Cardiac Myxomas ◽

Over Time ◽

Group 1

Although rare, cardiac myxomas are the most common primary cardiac tumor with an incidence of 0.5 per million per year. Previous case series have reported on the epidemiology, clinical characteristics, diagnostic technologies and therapeutic outcomes that were evident at the time of publication. Because of the evolution of cardiac diagnostic (particularly imaging) and therapeutic options, we theorized that cardiac myxomas would be found at an earlier stage and this would result in improved therapeutic outcomes. Accordingly, a new case series (Current Group) is being reported and compared to historical case series that were published after widespread availability of echocardiography (after 1985). The case series were further divided into those published before (group 3), after (group 1) or overlapping (group 2) the proliferation of chest and cardiac imaging technologies that occurred in the mid-1990s. All 28 patients with pathologically proven cardiac myxoma at Florida Hospital Orlando from April 2007 to August 2013 (the Current Group) were studied. For comparative review, PubMed was searched for case series of cardiac myxoma from January 1, 1985 to December 31, 2013, and studies that met inclusion criteria were divided into three groups: Group 1: cases collected exclusively after 1995 (10 articles); Group 3: cases exclusively before 1995 (31 articles); and Group 2: those not belonging to group 1 or 3 (23 articles). The gender (2:1 female predominance), age and myxoma location (85% left atrium) have not changed significantly over time. However, the tumor size has declined from 5.3 cm to 3.3 cm. Asymptomatic cases (found unexpectedly) have increased to 21% of the Current Group while fever, heart failure and embolism have declined over time. Echocardiography has become the dominant diagnostic technology, followed by CT. Catheter based diagnostic imaging has declined substantially. Surgical mortality and tumor recurrence have remained low but unchanged. In summary, cardiac myxoma has trended to smaller, more frequently asymptomatic tumors found mostly by echocardiography or CT, but this has not altered surgical mortality or recurrence.

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Measuring the Impact of Multidisciplinary Care on Quality for Pancreatic Surgery: Transition to a Focused, Very High-volume Program

The American Surgeon ◽

10.1177/000313481307900817 ◽

2013 ◽

Vol 79 (8) ◽

pp. 775-780 ◽

Cited By ~ 6

Author(s):

Timothy L. Fitzgerald ◽

Noah M. Seymore ◽

Swapnil D. Kachare ◽

Emmanuel E. Zervos ◽

Jan H. Wong

Keyword(s):

Pancreatic Surgery ◽

Multidisciplinary Care ◽

High Volume ◽

Number Of Patients ◽

Group 3 ◽

Group 2 ◽

N 93 ◽

The Impact ◽

Over Time ◽

Group 1

Outcomes are superior for pancreatic resection at high-volume centers. To assess the impact of focused high-volume multidisciplinary care, a quality index (QI) was used to review our experience. Data from 1996 to July 2012 were analyzed in three groups: 1) early (1996 to 2007); 2) transition (2008 to 2009); and 3) mature (2010 to July 2012). A total of 239 patients were included with a mean age of 63.4 years and the majority were white (65.7%). The number of patients with Charlson comorbidity index greater than 2 and age older than 80 years increased comparing Group 1 with latter groups. Volume increased over time: Group 1 (n = 93) 7.75/year, Group 2 (n = 51) 25.5/year, and Group 3 (n = 95) 39/year. Overall mortality was 5.9 per cent: Group 1, 4.3 per cent; Group 2, 11.5 per cent; and Group 3, 3.9 per cent ( P = 0.0454). The QI score incorporates documentation, chemotherapy, resection for Stage I/II, time to treatment, margins, lymph nodes, mortality, and surgical volume with a maximum possible score 10. The QI increased over time: 3 in Group 1; 4 in Group 2; and 6 in Group 3. An improvement was noted for the quality indicators: surgical resection ( P = 0.0125) and use of palliative and adjuvant therapy ( P = 0.0144 and < 0.0001). Implementation of a focused multidisciplinary pancreatic surgery program increases quality.

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POS1325 COMPARISON OF THREE DIFFERENT ALGORITHMS FOR THE TREATMENT OF CHILDREN WITH POLYARTICULAR JIA: THE FIRST YEAR AFTER DIAGNOSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3448 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 945.1-945

Author(s):

K. Minden ◽

T. Schwarz ◽

F. Dressler ◽

I. Foeldvari ◽

J. P. Haas ◽

...

Keyword(s):

Body Height ◽

Treatment Strategies ◽

Inactive Disease ◽

High Dose ◽

Pedsql 4.0 ◽

Group 3 ◽

Group 2 ◽

Over Time ◽

Group 1

Background:Various treatment strategies are used for children with newly diagnosed polyarticular JIA. MTX is usually prescribed, sometimes in combination with high-dose intravenous glucocorticoid pulses (HDGC) or multiple intra-articular GC injections (IAGC). These different approaches were considered in the German consensus-based treatment protocols for polyarticular JIA1, they were also the leading therapies in patients with rheumatoid factor-negative polyarthritis (RF- PA) included in the JIA inception cohort ICON.Objectives:To compare the effectiveness of three different treatment strategies in nearly DMARD-naïve patients with RF- PA.Methods:Patients with RF- PA who were included in the ICON cohort and received one of the following treatments within the first three months were considered for the analysis: Group 1: MTX + IAGC in >4 joints, Group 2: MTX + HDGC, Group 3: MTX, no IAGC in >4 joints, no HDGC. Propensity score-adjusted group differences in outcomes after one and two years were analysed by linear and logistic regression analyses.Results:The analysis included data from 150 patients (79% female, mean age 6.7±4.8 years) enrolled in ICON 1.6±1.9 months after the diagnosis of RF- PA, of whom 52 were in Group 1, 54 in Group 2 and 44 in Group 3. Disease activity did not differ significantly between the groups at treatment start (cJADAS-10 16.7±4.7, 15.8±5.7, 15.9±6.5, respectively).Of the total group, at 1- and 2-year follow-up (FU), 60.9%/60.1% and 52.3%/58.8% of patients had inactive disease (cJADAS ≤1/Wallace criteria2), 21.3% and 35.6% were in remission off drug2, and mean cJADAS-10 scores were 2.6±3.9 and 3.0±3.5, respectively. 60.5% and 67.0% had no functional limitations (CHAQ=0).Patients in Group 1 more often had an inactive disease (according to Wallace2) at the 1-year FU and tended to have inactive disease more often at 2-year FU than patients in Group 3 (78.1% vs. 45.2%, p=0.025; 73.3 vs. 49.1%, p=0.075, respectively). Group 2 patients (inactive disease in 56.1% and 53.4% at 1- and 2-year FU) did not differ significantly from either Group 1 or Group 3. In addition, Group 1 patients had a significantly better quality of life than patients of Group 2 at the 2-year FU (mean PedsQL 4.0 total score 90.4±9.3 vs. 83.8±11.2, p=0.031). At that time, Group 3 patients had a mean PedsQL 4.0 total score of 85.0±14.6, which was not significantly different from either Group 1 or 2.On the other hand, Group 1 patients tended to develop new uveitis more frequently within the first two years of treatment than patients in Groups 2 and 3 (13% vs. 2.2% and 3.6%, p=0.101 and 0.131, respectively). At the 2-year FU, patients in Group 1 also had a significantly lower mean height SDS than patients of Group 3 (-0.3±1.1 vs. 0.2±1.1, p=0.038). Mean height SDS was lowest (-0.5±0.8) in patients in Group 2 and significantly lower than in Group 3 (0.019). Mean body mass index SDS also differed significantly between the groups at 2-year follow-up. The mean BMI SDS was highest in Group 1 patients (0.2±0.8), differing significantly from Group 2 (-0.3±0.7, p=0.014) and Group 3 (-0.4±1.1, p=0.023).There were no significant differences in inactive disease (according to cJADAS) and functional status (CHAQ) between the three groups at 1- and 2-year FU. Over time, treatments were very different in the three groups. In Group 3, biologics were used significantly more often over time than in group 1 (54.0% vs. 18.3%, p=0.014), and Group 2 patients received bDMARDs in 36.1%.Conclusion:While patients with numerous early joint injections seem to achieve inactive disease more frequently and earlier, they have a slightly smaller body height and tend to develop uveitis slightly more often than patients with more intensive DMARD therapy. However, the differences are small between the groups. Further comparative effectiveness studies with higher patient numbers are needed to identify particularly effective and safe treatment strategies.References:[1]Horneff et al. Pediatric Rheumatology 2017;15:78.[2]Wallace et al. Arthritis Care Res (Hoboken) 2011;63:929-36.Acknowledgements:The ICON study is funded by a research grant of the Federal ministry of education and research (BMBF, FKZ 01ER0812, FKZ 01ER1504A-C).Disclosure of Interests:Kirsten Minden Speakers bureau: Pfizer, Abbvie, Consultant of: Novartis, Tobias Schwarz: None declared, Frank Dressler: None declared, Ivan Foeldvari Consultant of: Gilead, Novartis, Pfizer, Hexal, BMS, Sanofi, MEDAC, Johannes-Peter Haas: None declared, Gerd Horneff Speakers bureau: Pfizer, Consultant of: Novartis, Toni Hospach Consultant of: Novartis, Jasmin Kümmerle-Deschner: None declared, Kirsten Moenkemoeller: None declared, Frank Weller-Heinemann Speakers bureau: Pfizer, AbbVie, SOBI, Roche, Novartis, Klaus Tenbrock: None declared, Martina Niewerth: None declared, Claudia Sengler: None declared, Dirk Foell: None declared, Jens Klotsche: None declared

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In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽

10.1024/0301-1526/a000867 ◽

2020 ◽

Vol 49 (4) ◽

pp. 281-284

Author(s):

Atıf Yolgosteren ◽

Gencehan Kumtepe ◽

Melda Payaslioglu ◽

Cuneyt Ozakin

Keyword(s):

Vascular Graft ◽

Graft Infection ◽

Vascular Graft Infection ◽

Group 4 ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Prosthetic Vascular Graft Infection ◽

Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

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