scholarly journals Bisphosphonates and parathyroid hormone analogs for improving bone quality in spinal fusion: State of evidence

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Kivanc Atesok ◽  
Martina Stippler ◽  
Brendan Striano ◽  
Grace Xiong ◽  
Matthew Lindsey ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Spinal Fusion ◽  
Bone Quality ◽  
Treatment Strategies ◽  
Patient Characteristics ◽  
Complication Rates ◽  
Disc Disease ◽  
Potential Benefits ◽  
Hormone Analogs ◽  
Selection Of

Spinal fusion is among the most commonly performed surgical procedures for elderly patients with spinal disorders – including degenerative disc disease with spondylolisthesis, deformities, and trauma. With the large increase in the aging population and the prevalence of osteoporosis, the number of elderly osteoporotic patients needing spinal fusion has risen dramatically. Due to reduced bone quality, postoperative complications such as implant failures, fractures, post-junctional kyphosis, and pseudarthrosis are more commonly seen after spinal fusion in osteoporotic patients. Therefore, pharmacologic treatment strategies to improve bone quality are commonly pursued in osteoporotic cases before conducting spinal fusions. The two most commonly used pharmacotherapeutics are bisphosphonates and parathyroid hormone (PTH) analogs. Evidence indicates that using bisphosphonates and PTH analogs, alone or in combination, in osteoporotic patients undergoing spinal fusion, decreases complication rates and improves clinical outcomes. Further studies are needed to develop guidelines for the administration of bisphosphonates and PTH analogs in osteoporotic spinal fusion patients in terms of treatment duration, potential benefits of sequential use, and the selection of either therapeutic agents based on patient characteristics.

Acute Postoperative Pain

2017 ◽  
Author(s):  
Kelly Zach ◽  
Julio A. Gonzalez-Sotomayor
Keyword(s):  
Postoperative Pain ◽  
Patient Characteristics ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Acute Postoperative Pain ◽  
Analgesic Regimen ◽  
Potential Benefits ◽  
Short And Long Term ◽  
Selection Of

Inadequate management of acute postoperative pain increases morbidity and mortality. Poorly controlled pain results in delayed hospital discharge and may lead to the development of chronic pain. Current evidence supports the implementation of a multimodal analgesic regimen, where different pharmacologic and nonpharmacologic interventions are used. The selection of the different components of this multimodal analgesic approach should consider their potential benefits and limitations, as well as the unique patient characteristics and the surgical procedure. It is the responsibility of the perioperative health care provider to formulate an optimal pain management strategy to ultimately enhance patient satisfaction and improve short- and long-term outcomes.

scholarly journals Outcomes after Surgical Treatment of Metastatic Disease in the Adrenal Gland; Valuable for the Patient?

Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 156
Author(s):  
Madelon J. H. Metman ◽  
Charlotte L. Viëtor ◽  
Auke J. Seinen ◽  
Annika M. A. Berends ◽  
Patrick H. J. Hemmer ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Patient Characteristics ◽  
Minimal Invasive ◽  
Adrenal Metastasis ◽  
Perioperative Outcomes ◽  
Multidisciplinary Teams ◽  
Complication Rates ◽  
Related Data ◽  
Potential Benefits

The adrenal glands are common dissemination sites for metastasis of various solid tumors. Surgical treatment is often recommended because targeted therapies and immunotherapy are frequently ineffective for adrenal metastasis. We report the experience with short-term and long-term surgical outcomes of patients undergoing surgery for adrenal metastasis in two hospitals. A retrospective, multicenter study was performed to analyze patient characteristics, tumor-related data, perioperative outcomes, and oncological outcomes. Postoperative complications that occurred within 30 days were scored according to the Clavien Dindo classification. Metastatic adrenalectomy was performed in 95 patients. We observed an increase from an average of 3 metastatic adrenalectomies per year between 2001–2005 to 10 between 2015–2019. The most frequent underlying malignancies were colorectal and lung cancer. In 55.8%, minimal invasive adrenalectomy was performed, including six conversions to open surgery. A total of 37.9% of patients had postoperative complications, of which ileus or gastroparesis, wound problems, pneumonia, and heart arrhythmias were the most occurring complications. Improved cancer care has led to an increased demand for metastatic adrenalectomy over the past years. Complication rates of 37.9% are significant and cannot be neglected. Therefore, multidisciplinary teams should weigh the decision to perform metastatic adrenalectomy for each patient individually, taking into account the drawbacks of the described morbidity versus the potential benefits.

scholarly journals Diagnosis of Pancreatic Solid Lesions, Subepithelial Lesions, and Lymph Nodes Using Endoscopic Ultrasound

2021 ◽  
Vol 10 (5) ◽  
pp. 1076
Author(s):  
Akashi Fujita ◽  
Shomei Ryozawa ◽  
Masafumi Mizuide ◽  
Yuki Tanisaka ◽  
Tomoya Ogawa ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Treatment Strategies ◽  
Complication Rates ◽  
Diagnostic Ability ◽  
Tissue Acquisition ◽  
Resolution Imaging ◽  
Subepithelial Lesions ◽  
Solid Lesions ◽  
Selection Of

Currently, endoscopic ultrasound (EUS) has become widely accepted and has considerable advantages over computed tomography (CT) and other imaging modalities, given that it enables echostructure assessment in lesions with <1 cm diameter and permits high resolution imaging. EUS-guided tissue acquisition (EUS-TA) provides consistent results under ultrasound guidance and has been considered more effective compared to CT- or ultrasound-guided lesion biopsy. Moreover, complication rates, including pancreatitis and bleeding, have been extremely low, with <1% morbidity and mortality rates, thereby suggesting the exceptional overall safety of EUS-TA. The aggressive use of EUS for various lesions has been key in facilitating early diagnosis and therapy. This review summarizes the diagnostic ability of EUS for pancreatic solid lesions, subepithelial lesions, and lymph nodes where it is mainly used. EUS has played an important role in diagnosing these lesions and planning treatment strategies. Future developments in EUS imaging technology, such as producing images close to histopathological findings, are expected to further improve its diagnostic ability. Moreover, tissue acquisition via EUS is expected to be used for precision medicine, which facilitates the selection of an appropriate therapeutic agent by increasing the amount of tissue collected and improving genetic analysis.

Anatomic Total Shoulder Arthroplasty With a Stemless Humeral Component

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542199712
Author(s):  
Jordan D. Walters ◽  
Stephen F. Brockmeier
Keyword(s):  
Bone Quality ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Complication Rates ◽  
Lesser Tuberosity ◽  
Critical Elements ◽  
Implant Placement ◽  
Humeral Component ◽  
Component Loosening ◽  
Deltopectoral Approach

Background: This technique video reviews anatomic total shoulder arthroplasty (TSA) with a stemless humeral component using a representative case example. Indications: Stemless TSA is indicated for patients with symptomatic glenohumeral arthritis typically younger than 65 years of age. Stemless TSA may be used for other glenohumeral degenerative conditions such as avascular necrosis or posttraumatic arthropathy, provided acceptable humeral bone quality is confirmed intraoperatively using a thumb-press test. Poor bone quality is the primary contraindication. Technique Description: Preoperatively, computed tomography is typically used for planning, and intraoperative navigation through magnetic resonance imaging is also useful. The procedure’s critical elements include beach chair positioning, standard deltopectoral approach with lesser tuberosity osteotomy (LTO), freehand proximal humeral osteotomy, perpendicular proximal humeral exposure and subsequent preparation over a central guidewire, stemless implant and humeral head sizing, perpendicular glenoid exposure and implant placement, and final humeral implantation with LTO repair/fixation. A phased rehabilitation protocol includes 6-week sling immobilization to protect the subscapularis/LTO repair and return to normal activities between 3 and 6 months postoperatively. Discussion/Conclusion: Stemless TSA shows promising early and mid-term outcomes with complication rates, including humeral loosening rates, similar to standard stemmed components. Potential complications include neurovascular injury, infection, glenoid or humeral component loosening, and rotator cuff failure.

scholarly journals Parkinson’s Patients’ Tolerance for Risk and Willingness to Wait for Potential Benefits of Novel Neurostimulation Devices: A Patient-Centered Threshold Technique Study

2021 ◽  
Vol 6 (1) ◽  
pp. 238146832097840
Author(s):  
Brett Hauber ◽  
Brennan Mange ◽  
Mo Zhou ◽  
Shomesh Chaudhuri ◽  
Heather L. Benz ◽  
...  
Keyword(s):  
Trial Design ◽  
Patient Characteristics ◽  
Risk Tolerance ◽  
Level Of Evidence ◽  
Treatment Benefit ◽  
Study Results ◽  
Potential Benefits ◽  
Risk Thresholds ◽  
Time Motor ◽  
Threshold Technique

Background. Parkinson’s disease (PD) is neurodegenerative, causing motor, cognitive, psychological, somatic, and autonomic symptoms. Understanding PD patients’ preferences for novel neurostimulation devices may help ensure that devices are delivered in a timely manner with the appropriate level of evidence. Our objective was to elicit preferences and willingness-to-wait for novel neurostimulation devices among PD patients to inform a model of optimal trial design. Methods. We developed and administered a survey to PD patients to quantify the maximum levels of risks that patients would accept to achieve potential benefits of a neurostimulation device. Threshold technique was used to quantify patients’ risk thresholds for new or worsening depression or anxiety, brain bleed, or death in exchange for improvements in “on-time,” motor symptoms, pain, cognition, and pill burden. The survey elicited patients’ willingness to wait to receive treatment benefit. Patients were recruited through Fox Insight, an online PD observational study. Results. A total of 2740 patients were included and a majority were White (94.6%) and had a 4-year college degree (69.8%). Risk thresholds increased as benefits increased. Threshold for depression or anxiety was substantially higher than threshold for brain bleed or death. Patient age, ambulation, and prior neurostimulation experience influenced risk tolerance. Patients were willing to wait an average of 4 to 13 years for devices that provide different levels of benefit. Conclusions. PD patients are willing to accept substantial risks to improve symptoms. Preferences are heterogeneous and depend on treatment benefit and patient characteristics. The results of this study may be useful in informing review of device applications and other regulatory decisions and will be input into a model of optimal trial design for neurostimulation devices.

scholarly journals Consensus for the General Use of Equine Water Treadmills for Healthy Horses

Animals ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 305
Author(s):  
Kathryn Nankervis ◽  
Carolyne Tranquille ◽  
Persephone McCrae ◽  
Jessica York ◽  
Morgan Lashley ◽  
...  
Keyword(s):  
Working Group ◽  
Best Practice ◽  
Treadmill Exercise ◽  
Good Practice ◽  
Belt Speed ◽  
Research Programmes ◽  
Potential Benefits ◽  
Water Treadmill ◽  
Selection Of

Water treadmill exercise has become popular in recent years for the training and rehabilitation of equine athletes. In 2019, an equine hydrotherapy working group was formed to establish what was commonly considered to be best practice in the use of the modality. This article describes the process by which general guidelines for the application of water treadmill exercise in training and rehabilitation programmes were produced by the working group. The guidelines describe the consensus reached to date on (1) the potential benefits of water treadmill exercise, (2) general good practice in water treadmill exercise, (3) introduction of horses to the exercise, (4) factors influencing selection of belt speed, water depth and duration of exercise, and (5) monitoring movement on the water treadmill. The long-term goal is to reach a consensus on the optimal use of the modality within a training or rehabilitation programme. Collaboration between clinicians, researchers and experienced users is needed to develop research programmes and further guidelines regarding the most appropriate application of the modality for specific veterinary conditions.

Development of a Strain Transferring Sensor Housing for a Lumbar Spinal Fusion Detection System

2006 ◽  
Vol 1 (2) ◽  
pp. 159-164 ◽  
Author(s):  
J. W. Aebersold ◽  
W. P. Hnat ◽  
M. J. Voor ◽  
R. M. Puno ◽  
D. J. Jackson ◽  
...  
Keyword(s):  
Finite Element ◽  
Spinal Fusion ◽  
Detection System ◽  
Spinal Instrumentation ◽  
Strain Sensor ◽  
Internal Surface ◽  
Disc Disease ◽  
Bending Strain ◽  
Exploratory Surgery

Lumbar arthrodesis or spinal fusion is usually performed to relieve back pain, and regain functionality from degenerative disc disease, trauma, etc. Fusion is determined from radiographic images (X-ray) or computed tomography scans, yet these inspection procedures are subjective methods of review. As a result, exploratory surgery is performed if the presence of fusion cannot be confirmed. Therefore, a need exists to provide objective data to determine the presence of fusion that could avoid the cost, pain, and risk of exploratory surgery. One method to achieve this objective is to observe bending strain from spinal rods implanted during surgery. A system has been developed that will attach to the spinal instrumentation rods, transmit strain information wirelessly, and without the use of batteries. Major components of the system include a strain transferring sensor housing, a microelectromechanical (MEMS)-based strain sensor, telemetry circuitry, and antennae. Only discussed herein are the design, testing, and results of the housing without a cover and its ability to transfer strain from the rod to an internal surface where a foil strain gage is attached to characterize strain transfer efficiency. Strain gauges rather than the MEMS sensor were employed for housing characterization due cost and limited availability. Design constraints for the housing are long-term implantation, small size, greater than 95% transfer of bending strain from the spinal rods to the internal strain sensor, and ease of installation. ABAQUS finite element modeling software was employed to develop a working model that was fabricated using polyetheretherkeytone. The housing underwent cycle testing in a material testing system to simulate long-term implantation along with static testing to determine if creep was present. Both series of tests showed that the housing’s response did not degrade over a period of time and there was no indication of creep. The experimental results also validated the results of the ABAQUS finite element model.

scholarly journals IMPLEMENTING HOME SAFETY TOOLKIT TO CAREGIVERS OF VETERANS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S243-S243
Author(s):  
Scott A Trudeau
Keyword(s):  
Formative Evaluation ◽  
Veterans Health ◽  
Health Administration ◽  
Home Safety ◽  
Structured Interviews ◽  
Potential Benefits ◽  
Facilitators And Barriers ◽  
Key Staff ◽  
Type 3 ◽  
Selection Of

Abstract The purpose of this project was to study the processes necessary to make a Home Safety Toolkit (HST) for Veterans with dementia accessible to veterans and their caregivers. This Type 3 Implementation–Effectiveness Hybrid Research Design, included diagnostic analyses of the current processes by which Veterans receive home safety items, and identification of modifications necessary in order to provide the HST to Veterans with dementia. Two Veterans Health Administration Networks, one in the Northeast and one in the Mid-Atlantic region, participated. A formative evaluation used semi-structured interviews with key staff informants and caregivers identified facilitators and barriers to successful acquisition and use of home safety items. Qualitative data analysis reveals key barriers of time and cost, selection of best items, and caregiver reluctance to change. There was resounding support from caregivers regarding the potential benefits of self-paced toolkit including education and home safety items to implement for their veteran.

Strategies for Risk-Adapted Therapy in Myeloma

Hematology ◽  
2007 ◽  
Vol 2007 (1) ◽  
pp. 304-310 ◽  
Author(s):  
Rafael Fonseca
Keyword(s):  
Treatment Strategies ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Disease Biology ◽  
Patient Will ◽  
Baseline Knowledge ◽  
The Individual ◽  
Limited Duration ◽  
Cell Support ◽  
Selection Of

AbstractIt is clear that the clinical heterogeneity of multiple myeloma (MM) is dictated, in large part, by disease biology, predominantly genetics.1 As novel therapeutics have emerged, and augmented our treatment armamentarium against the disease, it is increasingly important to introduce a risk-adapted approach for the optimal management of patients.2 The selection of ideal candidates for high-dose chemotherapy with stem cell support (HDT) and maintenance will undoubtedly have to include baseline knowledge of the genetic nature of the individual. The limited duration of responses after HDT for patients with t(4;14)(p16;q32), t(14;16)(q32;q23) and 17p13 deletions highlight the need to develop a risk-adapted treatment strategy.3–5 Novel ways of determining outcome such as the use of gene expression profiling have demonstrated differentiating capabilities not previously observed.6 Likewise, the order of introduction of novel therapeutic agents (during induction and in the relapsing patient) will be potentially directed by similar information. As we have previously stated, MM is not only multiple but also “many.”7 Accordingly, treatment strategies will be tailored based on risk determination, genetic composition and host features.

scholarly journals Patient Characteristics and Outcomes in Adolescents and Young Adults (AYA) with Acute Myeloid Leukemia (AML): Princess Margaret Cancer Centre Experience

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2609-2609
Author(s):  
Muhned Alhumaid ◽  
Georgina S Daher-Reyes ◽  
Wilson Lam ◽  
Arjun Law ◽  
Tracy Murphy ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Age Groups ◽  
Treatment Strategies ◽  
Patient Characteristics ◽  
Cancer Center ◽  
Advisory Committees ◽  
Disease Behavior

Introduction: Clinical outcomes of acute myeloid leukemia (AML) in adolescents and young adults (AYA) are rarely reported as an isolated subgroup. Treatments vary little across age groups, and treatment intensity depends upon comorbid conditions and performance status. Optimal treatment strategies focused on disease behavior, biological factors, and the distinct needs of this subset of AML patients remain elusive. The purpose of this retrospective analysis is to determine the characteristics and outcomes of AYA AML patients treated at a specialized adult leukemia cancer center in comparison to older adults with AML (40-60 years). Methods: A retrospective analysis was performed on all patients treated at Princess Margaret Cancer Center from 2008-2018. Patients with acute promyelocytic leukemia were excluded. Clinical characteristics, treatment strategies, and survival outcomes were recorded for all patients. Overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier product-limit method and the impact of covariates were assessed using the Log-rank test. Finally, we compared the outcomes of AYA patients treated at our centre between 2015-2018 with older patients. Results: A total of 175 patients aged 18-39 were identified. Patient characteristics are shown in (Table 1). Cytogenetic were available in 163 patients. Based on MRC criteria, 27 (16%) were favorable risk, intermediate in 95 (54%), adverse in 39 (22%), and missing/failed in 14(8%). NPM1 status was available in 110 patients of whom 38 (35%) were positive. FLT3-ITD was available in 67 patients with 24 (36%) positive. Both mutations were present in 13 (54%) patients. There were no significant differences in terms of risk stratification based on cytogenetic and molecular markers based on age (18-29 vs.30-39) (P= 0.98). Most patients 172 (98%) received induction, 157 (91%) with 3+7, and 15 (9%) with FLAG-IDA. Complete remission (CR) was achieved in 133 (77%) after first induction [120 (76%) after 3+7 and 11 (73%) after FLAG-IDA]. Induction related mortality was low (2%). Of the 39 who did not achieve CR, thirty-four patients received re-induction (13 FLAG-IDA, 16 NOVE-HiDAC, 5 others) with CR in 21 (62%). Overall, 154 (89.5%) achieved CR1. Sixty-four (42%) proceeded to hematopoietic stem cell transplantation (HSCT) in CR1. 59 (38%) patients relapsed in CR1 with 8 (12%) relapsing post HSCT. Fifty-five (5 post HSCT) patients received reinduction with 30 (51%) (2 after HSCT) achieving CR2. Fifteen patients received HSCT in CR2. OS and DFS at 2 years were 62% (95% CI 0.53-0.69) and 50% (95% CI 0.41-0.57), respectively. Stratified by cytogenetic risk, OS was 81% for favorable risk, 61% for intermediate, and 50% for adverse risk (P=0.0001), respectively. DFS in these groups was 85%, 57%, and 46 % (P=0.0025), respectively. We further compared outcomes in the 18-29y and 30-39y age groups. The OS was 61.9% compared to 62.5% (P=0.91) and DFS of 52.1% compared to 47% (P=0.65) respectively. On univariate analysis for OS and DFS, cytogenetic risk stratification was the only significant variable (P=0.0004 and P=0.0042). We then compared the outcomes 67 sequential patients aged I8-39 treated from 2014-2018, with those of 176 sequential patients aged 40-60 treated during the same period (table 2). OS at 2 years was not statistically higher in the younger group compared to the older group (66.7% vs. 61.2%, P=0.372). While relapse rate was lower in older patients (15.5% vs. 22.6%, P=0.093), NRM was higher in older patients (29.7% vs. 18.8%,P=0.094). Conclusion: AYA pts. occupy a unique niche amongst AML as a whole. While treatment responses have improved in general, there may be potential for further gains in these patients. Increased tolerance for more intense treatment strategies as well as the incorporation of novel agents into standard treatment protocols may provide a means to optimize care in AYA patients. Finally, research is needed to elucidate biological mechanisms and predictors of disease behavior instead of arbitrary, age-stratified treatment schema. Disclosures McNamara: Novartis Pharmaceutical Canada Inc.: Consultancy. Schimmer:Jazz Pharmaceuticals: Consultancy; Medivir Pharmaceuticals: Research Funding; Novartis Pharmaceuticals: Consultancy; Otsuka Pharmaceuticals: Consultancy. Schuh:Astellas: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Teva Canada Innovation: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios: Honoraria; Jazz: Honoraria, Membership on an entity's Board of Directors or advisory committees. Maze:Pfizer Inc: Consultancy; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Yee:Astellas: Membership on an entity's Board of Directors or advisory committees; Millennium: Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees; Astex: Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck: Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; MedImmune: Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Hoffman La Roche: Research Funding. Minden:Trillium Therapetuics: Other: licensing agreement. Gupta:Incyte: Honoraria, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sierra Oncology: Honoraria, Membership on an entity's Board of Directors or advisory committees.

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