Good Functional Outcome In Patients Research Articles

Plasma Klotho concentrations predict functional outcome at three months after acute ischemic stroke patients

Background: The Klotho protects the cardiovascular system by protecting against cell apoptosis, inhibiting the production of reactive oxygen species, and modulating inflammation. We aimed to investigate relationship of plasma Klotho concentrations with functional outcome at 3 months after acute cerebral infarction.Methods: We prospectively enrolled 262 first-ever acute cerebral infarction patients from whom a blood sample was acquired within 24 h of admission. An enzyme-linked immunosorbent assay was used for evaluating plasma Klotho concentration. Functional outcome on admission and three months was evaluated.Results: Of the 262 patients, 152 (58.0%) were men. The mean age of these patients was 64.7 years. The mean ± standard deviation of plasma Klotho concentrations was 312.7 ± 153.3 pg/mL. As opposed to patients with good outcome, plasma Klotho levels were lower in the poor outcome group (207.8 ± 96.2 vs. 342.5 ± 153.5 pg/mL, p = .001). In multivariate analysis, increased plasma Klotho concentrations were independently associated with good functional outcome (Odds ratio: 2.42, 95% confidence interval: 1.45–4.04, p < .001).Conclusions: Increased plasma Klotho concentrations were associated with good functional outcome in patients with acute ischemic stroke. We attribute these associations to the pleiotropic effects of Klotho in stroke and vascular diseases.Key messageIncreased plasma Klotho concentrations were associated with good functional outcome in patients with acute ischemic stroke.

Study of the functional outcome following surgical management of intertrochanteric fractures with either proximal femoral nailing or dynamic hip screw fixation

Intertrochanteric fractures are one of the most common injuries sustained predominantly in patients over 60 years of age. They are 3 or 4 times more common in elderly women who are osteoporotic, in whom trivial trauma is the most common mode of injury. A total of 98 patients of intertrochanteric fractures of the femur were operated during this period in our institute. Among these patients, 26 patients died after surgery and did not follow up and were not included in this study. The rest of the patients were not traceable via telephone, some even by home visitations by us due to difficulty in tracing certain home addresses. Patients who were followed up for upto 6 months to 1 year were included in this study. All patients were in Sahlstrand’s Grade 1 walking ability before trauma. Post-op walking ability in this study shows 60%PFN patients walking without support with 33.3% DHS patients walking without support and 66.7% patients of DHS walking with cane and 13.3% patients of PFN needing 2 canes or walker post-operatively measured at 6 months post-op. It was found that proximal femoral nailing had better functional outcome in patients with especially unstable fractures and DHS had better functional outcome among the stable fractures.

Abstract TP339: Off Hours Presentation is Not Associated With Poor Functional Outcomes or Faster Recanalization Times in Stroke Patients Receiving Mechanical Thrombectomy in a Large Volume Comprehensive Stroke Center

Background: Faster revascularization times are associated with better functional outcome in patients undergoing thrombectomy. We aim to evaluate the impact of time of day presentation on thrombectomy metrics and its association with long-term functional outcome in an IR equipped OR setting. Methods: We retrospective reviewed all stroke patients who received mechanical thrombectomy between December 2012 and December 2017 at our CSC from our prospectively collected database. Work hours were defined by official OR work hours (Monday-Friday 7 AM and 5PM) and after hours as between 5 PM and 7 AM during weekdays and weekends as well as official hospital holidays. Collected data included baseline demographics, admission NIHSS, receipt of tPA, and location of occlusion. Primary outcomes were delta NIHSS between admission and discharge and 90-day modified Rankin Scale (mRS). Secondary outcomes included door to groin time and revascularization rate (TICI2b and 3). Multivariable logistic and Wilcoxon Rank test were performed to compare groups. Results: A total of 78 (38%) patients underwent mechanical thrombectomy during work hours and 125 (62%) during after-hours. There were more females in the after-hours group (55% vs 40%, P=0.046). There was no difference in mean age (66.8 vs 68.1, P=0.457), race (93% whites in both group) and median admission NIHSS (17 in both groups). Median door to groin time was 85 minutes during work hours vs. 94 minutes during after-hours (P=0.93). There was no difference in revascularization rate (70% vs 76%, P=0.67), delta NIHSS (2.9 vs 5.7, P=0.173) or long-term functional outcome (43% vs 53%, P=0.121) between after-hours vs work hours respectively. Conclusion: Studies suggest that after hours delay could impact functional outcomes on stroke patients undergoing thrombectomy. In-house 24/7 Anesthesia and IR tech services might improve metrics and mitigate this effect.

Predictors of good functional outcome in patients treated with intravenous thrombolysis via telestroke. (P5.249)

Predictors of good functional outcome in patients treated with intravenous thrombolysis via telestroke. (P5.249)

A comparative evaluation of results of proximal femur nail and dynamic hip screw fixation for intertrochanteric femur fractures

Incidence of intertrochanteric femur fractures has increased significantly during the recent decades, due to the change in the demographic profile of Indian population. Conservative management of these fractures has shown higher mortality and morbidity and has largely been abandoned. Rigid Internal fixation and early mobilization is the standard method of treatment. Objective: To verify the advantages and disadvantages of the proximal femur nail over the dynamic hip screw device and also their effect on the eventual functional outcome of the patient. Methods: This is a retrospective and prospective comparative analytical study of 30 cases of intertrochanteric femur fractures admitted in Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur from January 2011 to November 2014. 15 cases were treated by PFN and 15 by DHS. Patients were followed up at 3 months, 6 months and 1 year. The results were compared for functional outcome by modified Harris Hip Score. Results: In our study of 30 patients, there were 4 female and 26 male. Minimum age was 24 years, maximum 70 years with mean age of 46.1 years. Most of the cases sustained fracture by trivial trauma. 60% of the fractures were unstable. More duration of surgery, more blood loss, more number of radiation exposure, more chances of infection was seen with PFN, whereas more screw backout, more chances of varus & valgus non-union was seen with DHS. Conclusion: PFN had better functional outcome in patients with especially unstable fractures and DHS had better functional outcome among the stable fractures.

Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry)

ObjectiveTo determine outcomes and safety of endovascular treatment for acute ischaemic stroke, due to proximal intracranial vessel occlusion in the anterior circulation, in routine clinical practice.DesignOngoing, prospective, observational cohort study.Setting16...

Abstract TP39: Endovascular Treatment Combined With Therapeutic Hypothermia and Decompressive Hemicraniectomy for Malignant Cerebral Venous Thrombosis: A Prospective Study

Background: In malignant cerebral venous thrombosis (CVT) patients, although endovascular thrombectomy usually can open the occluded dural sinuses with full of thrombus, it is impossible to recanalize the ample thrombosed cortical and deep cerebral draining veins in short time, which will still cause severe brain edema and refractory intracranial hypertension. Therapeutic hypothermia is an effective measure to control refractory intracranial hypertension from cerebral injury. So these patients may benefit from endovascular treatment combined with therapeutic hypothermia and decompressive hemicraniectomy. Methods: Prospective case series. We included all consecutive patients who had a malignant CVT as defined: decreased consciousness, straight sinus thrombosis, or large space-occupying lesions from January, 2014 to June, 2016. These patients would first receive endovascular thrombectomy and thrombolysis to open the occluded thrombosed dural sinuses, then assigned to therapeutic hypothermia (33-35°C) for 3-5 days, and decompressive hemicraniectomy (only with cerebral herniation). Outcome was assessed at 12 months after operation with the modified Rankin Scale (mRS). Results: Fifteen patients (10 women) with a median age of 32 years (range 19-54 years) were included. Before surgery 9 patients had GCS &lt; 9, 10 patients had normal pupils, 5 patients who had a unilaterally fixed and dilated pupil underwent unilateral decompressive hemicraniectomy, 12 patients had space-occupying intracranial hemorrhagic infarcts, and 2 patients had straight sinus thrombosis. No patients except one (with minor increase) had increased cerebral hemorrhage after endovascular thrombectomy. 10 patients recovered without disability at 12 months (mRS 0-1). Three patients had some residual handicap (mRS 2). One patient was moderate handicapped (mRS 3). One patient died from progressive cerebral edema due to the ample thrombosed cortical cerebral draining veins even after surgical decompression in short time. Conclusion: Endovascular treatment combined with therapeutic hypothermia and decompressive hemicraniectomy is safe and effective for malignant CVT, and even allow a good functional outcome in patients with cerebral herniation.

Abstract WP4: Age and NIHSS score Predict Outcome in Patients With Mild Stroke and Proximal Large Vessel Occlusion

Background: Current guidelines recommend mechanical thrombectomy for patients with anterior circulation proximal large vessel occlusion (LVO), NIHSS≥ 6, within 6 hours from symptom onset, with a NCCT ASPECTS of 6 or higher. It remains unclear whether patients with NIHSS &lt; 6 and LVO should also undergo mechanical thrombectomy. The benefit of intervention, associated risk and predictors of outcome in this patient population has not been studied. We sought to determine the natural history and predictors of good outcome in patients NIHSS&lt;6 and evidence of LVO who did not undergo mechanical thrombectomy. Methods: We abstracted data from our ischemic stroke prospective database and included patients with NIHSS &lt; 6 and presence of proximal large vessel occlusion admitted between January 1 st , 2015 and April 30 th , 2017. The outcome, 90-day mRS, was collected via a phone call at 90 days. Patients were divided into two groups: good outcome (90-day mRS 0-1) and poor outcome (90-day mRS 2-6). We compared baseline demographics, treatments, neuroimaging data (ASPECTS score), and vascular imaging findings (location of occlusion, collateral score: poor, good, and excellent) between the two groups. P-value &lt; 0.05 was considered significant. Results: A total of 68 patients were identified; 50/68 did not undergo mechanical thrombectomy; out of which only 25/50 (50%) had a good 90-day outcome. Patients with a good outcome were younger (Mean ± SD, 69.3 ±3.2 vs 76 ± 2.2 years of age, p=0.033) and had a lower median admission NIHSS score (3 vs. 4, p=0.026).There was a trend towards good outcome with ICA and M1- MCA occlusion when compared to other locations but this was not statistically significant. Other variables also did not achieve statistical significance. Conclusion: Younger age and lower NIHSS predict good functional outcome in patients with LVO and mild deficits. Larger prospective studies are needed to verify our findings and explore the role of mechanical thrombectomy in patients who might be at risk of poor outcome.

Abstract TP73: Better Functional Outcomes in Patients Treated versus Not Treated for Mild Stroke

Introduction: IV alteplase (tPA) decreases long-term disability from acute ischemic stroke (AIS). Many patients do not receive tPA due to mild stroke symptoms (NIHSS &lt; 5), even when they meet criteria for treatment, perhaps due to concern that risk of treatment in these populations outweighs benefit. This study compares outcomes for acute ischemic stroke (AIS) patients with mild symptoms who received tPA versus those who did not. Methods: Data obtained from a multi-hospital system’s Get With The Guidelines registry included AIS patients with admission NIHSS of less than five who were discharged between January 2014 and December 2016 and presented within 4.5 hours of onset of stroke symptoms. Patients were excluded if they had an in-hospital stroke or were not treated due to a reason other than mild stroke symptoms. Outcomes included discharge modified Rankin Scores (mRS) categorized as no-to-mild disability (mRS≤2) vs moderate disability to death (mRS≥3), hospital length of stay (LOS) and discharge disposition. Generalized linear and Cox proportional hazard models were used to compare outcomes adjusting for admission NIHSS, age, mode of arrival, gender, and last known well to arrival time. Results: A total of 854 patients met inclusion criteria with 53.5% (n=457) treated with tPA and 46.5% (n=397) excluded from treatment for mild stroke only. Median age was 68 (interquartile range = 57 to 77) years and 47% were female. Patients who were excluded from treatment for mild stroke were 2.33 times more likely to have discharge mRS≥3 than patients with mild symptoms treated with tPA (p=0.014). There were no statistically significant differences in likelihood of discharge to home or length of stay. Conclusion: Patients with mild strokes excluded from tPA treatment for mild symptoms were more likely to be disabled based on discharge mRS than those treated with tPA. Physicians should consider treating patients with mild symptoms with tPA to improve patient outcomes.

ARTHROSCOPIC LATARJET TECHNIQUE COMBINED WITH ENDOBUTTONS: FUNCTIONAL OUTCOMES IN 26 CASES.

ABSTRACTObjectiveThe cause of anterior shoulder instability is not fully understood and surgical management remains controversial. The objective of this study was to evaluate the results of patients undergoing arthroscopic Latarjet procedure with endobuttons.MethodsA retrospective study of 26 patients undergoing arthroscopic Latarjet procedure with endobuttons to treat anterior shoulder instability. Patients with previous glenohumeral instability, failure of Bankart procedure or Instability Severity Index Score (ISIS) greater than or equal to 6, were included. Patients were assessed by: DASH, UCLA, Rowe, Visual Analog Scale (VAS) of pain and Short-Form 36 (SF36) scores. Correct position and consolidation of the graft were evaluated.ResultsMean age was 31.5 years (16 to 46). Preoperative duration of symptoms was 1.7 years (1 month to 10 years). Mean follow-up was 14.3 (6 to 24) months. Mean postoperative scores were: 10 points in DASH; 1.6 in VAS, where 23 (88%) patients experienced mild pain and 3 (12%) moderate pain; 89 in Rowe; 32 in UCLA and 78 in SF-36. Positioning of the graft was correct in 25 (96%) cases, and was consolidated in 23 (88%). We had two cases of graft fracture (7%) and postoperative migration (7%).ConclusionSurgical treatment using arthroscopic Latarjet with endobuttons is safe and effective, producing good functional outcomes in patients. Level of Evidence IV, Case Series.

Good functional outcome in patients suffering fragility fractures of the pelvis treated with percutaneous screw stabilisation: Assessment of complications and factors influencing failure

BackgroundLow energy pelvic ring fractures in the elderly have traditionally been treated conservatively, a treatment with potential long-term complications and loss of self-independence. Percutaneous screw stabilisation of the posterior pelvic ring is a new treatment modality that enables immediate mobilisation. The aim of this study was to assess the functional outcome after sacroiliac stabilisation in the elderly. MethodsAll elderly patients with a surgically stabilised low energy pelvic fracture between 2010 and 2015 were included. In 2016 a radiographic follow up and functional test was performed at least one year postoperative. ResultsThe 50 operated patients had a mean age of 79 years and a one-year mortality of 10% (5/50). Only six patients lost independency after the pelvic fracture and moved to nursing home. The mean Timed Up and Go test was 16s at follow-up. The operation of the posterior pelvic ring averaged 63min with a radiation equal to a diagnostic pelvic CT. One intra-foraminally placed screw was immediately removed and 9 patients were later re-operated on due to symptomatic loosening of one or more screws. No loosening of screws was seen in 11 patients where both S1 and S2 were stabilised and out of 23 trans-sacral screws (crossing both sacroiliac joints) only two loosened. DiscussionCT guided stabilisation of the posterior pelvis is safe and most patients resumed good function and independent living. The risk of a revision operation was 20%, but trans-sacral screw stabilisation in both S1 and S2 could reduce the risk of implant loosening.

Multilevel Spondylolysis Repair Using the “Smiley Face” Technique with 3-Dimensional Intraoperative Spinal Navigation

Multilevel spondylolysis is a rare cause of progressive lower back pain, and patients who fail conservative management are treated surgically. Direct repair methods can maintain mobility and lead to decreased morbidity compared with spinal fusion in single-level spondylolysis. In this paper, we present a patient with nonadjacent multilevel spondylolysis who underwent the "smiley face" technique of direct multilevel repair without fusion using 3-dimensional intraoperative spinal navigation. Bilateral spondylolysis at L3 and L5 with associated spondylolisthesis in a 50-year-old male was repaired using the "smiley face" technique. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and visual analog scale scores for back and leg pain, were assessed preoperatively along with 6 weeks and 4 months postoperatively. Postoperative computed tomography imaging showed precise screw insertion and rod placement along with stable hardware alignment in follow-up imaging. The patient's ODI and lower back visual analog scale scores decreased from 25 to 8 and 7.5 to 4, respectively, correlating to an excellent outcome on ODI. Direct repair and avoidance of fusion is possible and can provide good functional outcomes in patients with nonadjacent multilevel spondylolysis and associated spondylolisthesis.

Endoscopic Treatment of Mid-Portion Achilles Tendinopathy: A Retrospective Case Series of Patient Satisfaction and Functional Outcome at a 2- to 8-Year Follow-up

To evaluate the results of endoscopic treatment in patients affected by mid-portion Achilles tendinopathy, by release of the paratenon combined with a resection of the plantaris tendon, regarding patient satisfaction, functional outcome, and pain scores. This retrospective study evaluated patients endoscopically treated for mid-portion Achilles tendinopathy between 2000 and 2013. Patient satisfaction, functional outcome, pain scores, and health-related quality of life were measured by the use of a numeric rating scale, the Foot and Ankle Outcome Score, the Victorian Institute of Sport assessment for the Achilles tendon, the numeric rating scale for pain during running and during sports, and the EuroQol 5D (EQ-5D-3L) standardized questionnaire. Additional questions were asked on the effectiveness of the treatment and sport participation. The response rate was 76.3% (45 of 59). Thirty-five (78%) patients were treated unilaterally and 10 (22%) patients were treated bilaterally. For the unilaterally treated patients, the median time to follow-up was 67months (interquartile range [IQR] 48-99months), and for the bilaterally treated patients, it was 89.5months (IQR 37.5-161.75months). The median satisfaction score for treatment results was 9 out of 10 (IQR 7-10) and 9.5 (IQR 7-10), respectively. The median Foot and Ankle Outcome Score subscales were scored 75 to 99 and 75 to 97, the median Victorian Institute of Sport assessment for the Achilles tendon scored 81 (IQR 47-90) and 97 (IQR 87-100), and the median numeric rating scale pain scores during both running and sports were 1 (IQR 0-6.5) for the unilaterally treated patients and 0 (IQR 0-4.5) and 0 (IQR 0-1) for the bilaterally treated patients, respectively. The median EQ-5D were 0.81 (IQR 0.71-1) and 1 (IQR 0.64-1), respectively. One reoperation for recurrence of symptoms was necessary. This study shows high patient satisfaction and good functional outcomes in patients affected by mid-portion Achilles tendinopathy who were endoscopically treated by means of release of the paratenon in combination with transection of the plantaris tendon. Level IV, retrospective case series (therapeutic).

The arthroereisis procedure in adult flexible flatfoot grade IIA due to insufficiency of posterior tibial tendon

BackgroundTo report on the functional, biomechanical, and radiographic results of patients who had undergone arthroereisis plus tensioning of the posterior tibial tendon for flexible flatfoot. The hypothesis is that arthroereisis associated to a tensioning of the posterior tibial tendon give a good correction with great satisfaction in patients with flexible flatfoot in grade IIA. MethodsWe evaluated 29 patients (31 feet), mean age of 46.4 years, who had been surgically treated for adult flatfoot grade IIA according to Myerson. Mean follow-up was 34.15 months. For clinical evaluation, the AOFAS hindfoot and VAS-FA scores were used. ResultsPostoperative results showed significant increases in both AOFAS and VAS-FA scores: 54.2–81.9 and 61.5–83.2 points, respectively. For the X-ray parameters, we observed a significant variation in the talo-first metatarsal angle, from 13.8° in pre-op to 7.4° in post-op. In lateral view, Djian Annonier angle was improved from 146.6° to 134.1°. The Meary’s angle, compared to an average of 8.8° in pre-operative stage improved to 4.3° in the post-operative stage. Postoperative satisfaction was excellent-good according to 23 patients (79.4%). Pain in the tarsal sinus was reported in 5 out of 31 feet (16.1%) for the first three months after surgery. ConclusionsArthroereisis and tensioning of the posterior tibial tendon provided good functional outcomes for patients under 60 years of age having stage IIA flexible flatfoot without arthritic manifestations.

Does femoral offset recover and affect the functional outcome of patients with displaced femoral neck fracture following hemiarthroplasty?

BackgroundRestoring preoperative horizontal femoral offset (FO) promised good functional outcome in patients receiving total hip arthroplasty. However, relatively little was known regarding the clinical relevance of restoring the offset in patients with bipolar hemiarthroplasty to treat displaced femoral neck fracture. Therefore, the objective of this study was to evaluate postoperative FO accurately and verify its relation with functional outcome. MethodsOne hundred elderly patients who received bipolar hemiarthroplasty to treat displaced femoral neck fracture were identified. Preoperative CT scanning of contralateral hip joint and reconstruction of images led to rotation-free FO. By referencing postoperative implant specification and comparing to measured values in Picture Archive and Communication System, rotation-free postoperative FO and the amount of change were acquired. Postoperative Harris Hip Score (HHS) and Modified Barthel Index (MBI) were evaluated to measure functional outcome at 12-month after the surgery. Patients with significant FO change were identified. Multiple regression analysis was conducted to determine if the FO change might independently affect the outcome regardless of confounding factors. ResultsThe mean preoperative offset was 37.4±2.5 increased by 12.7±9.6% after the surgery. Only 25.0% of postoperative offset after hemiarthroplasty was changed within ±5% of preoperative offset. A total of 45.0% of postoperative offset changed within ±10% while 77.0% of postoperative offset changed within ±20%. 23% of patients whose FO changed more than 20% showed significantly worse outcome score than the patients whose FO change remained within ±20% of initial value. Mean MBI and HHS were negatively correlated with FO change. After adjusting for confounding factors, significant correlation remained between modification of FO and MBI, but not between FO change and HHS (B=4.576; β=0.235; 95% confidence interval of B: 0.534 to 8.135). ConclusionsFO was not properly restored in 23% of subjects receiving bipolar hemiarthroplasty due to femoral neck fracture. FO restoration independently predicted fair MBI after the surgery. Therefore, surgeons should pay attention to restoring FO with meticulous templating.

Distal Middle Cerebral Artery Branch Recanalization Does Not Affect Final Lesion Volume in Ischemic Stroke

Background: Early recanalization in ischemic stroke is associated with favorable outcome. However, limited data are available on the effect of recanalization on infarct growth and functional outcome in stroke with distal middle cerebral artery (MCA) pathology. This study was aimed at determining the effect of recanalization in acute stroke patients with perfusion-diffusion mismatch and occlusion or high-grade stenosis of a distal MCA branch. Methods: We prospectively examined 34 consecutive stroke patients with perfusion-diffusion mismatch and M3 or M4 pathology within 24 h of symptom onset. The MRI protocol consisted of diffusion-weighted images (DWI), fluid-attenuated inversion recovery (FLAIR), T2*, perfusion-weighted imaging, time-of-flight magnetic resonance angiography at days 0, 1, and 4-6. Volume measurements were performed with MRIcron. Infarct growth was defined as the difference between lesion volumes on FLAIR at days 4-6 and DWI at day 0. Certified raters assessed modified Rankin Scale scores at discharge and day 90. Results: Twenty-four patients (71%) showed recanalization at day 1. Infarct growth was modest (median 2.4 mL, 95% CI 0.8-6.7) and not significantly different between patients with and without recanalization (p = 0.87). Functional outcome at discharge was good with 70% of patients suffering no significant disabilities. There was no association between functional outcome at discharge and recanalization (OR 2.1, 95% CI 0.4-13.0, p = 0.40) or infarct volume at days 4-6 (p = 0.40). Conclusions: The high rate of spontaneous recanalization and good functional outcome in patients with distal MCA pathology might obscure a potential benefit from recanalization in this population.

Percutaneous Acetabuloplasty for Metastatic Lesions to the Pelvis.

Metastatic lesions of the acetabulum can be painful and debilitating. First-line treatment is multimodal and consists of disease-specific chemotherapy, osteoclastic inhibitors, analgesics, and radiation therapy. When these therapies fail, surgical intervention usually is indicated and varies from regional defect stabilization to large periacetabular reconstructions that are demanding procedures with high rates of complications. Percutaneous cement augmentation (acetabuloplasty) of lesions in selected patients has been explored as a less invasive method of lesional control. This retrospective review included 11 patients with painful periacetabular lesions who underwent percutaneous acetabuloplasty using fluoroscopic guidance from 2007 to 2012, in addition to standard treatment with either radiation or chemotherapy, or a combination of both radiation and chemotherapy. Primary tumors included 4 multiple myeloma, 4 renal cell, and 3 breast malignancies. Mean procedure length was 58.4 minutes, and mean hospital stay was 1.4 days (range, 1-2 days). Mean blood loss was 33.4 mL, and there were no complications due to infection or cementation. Mean follow-up was 26.4 months (range, 3-36 months), with 2 patients dying from complications of underlying disease. All of the patients experienced pain relief following the procedure, with mean visual analog scale scores improving from 7.7 to 2.1 (P=.002). Postoperative Musculoskeletal Tumor Society and Oxford hip scores were obtained for 7 of 11 patients and demonstrated improvement. One patient underwent conversion to an acetabular reconstruction due to disease progression. This report demonstrates the effective use of a minimally invasive procedure to provide acute stability, pain relief, and good functional outcomes in patients with periacetabular metastatic lesions without pathologic fracture. [Orthopedics. 2017; 40(1):e170-e175.].

Continual Maintenance of Remission Defined by the ACR/EULAR Criteria in Daily Practice Leads to Better Functional Outcomes in Patients with Rheumatoid Arthritis.

To evaluate longterm functional outcomes in rheumatoid arthritis (RA) based on the number of times that the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) or the 28-joint Disease Activity Score (DAS28) remission criteria were fulfilled. Patients with RA who participated in all 6 data collections in an observational cohort from 2008 to 2010 and who fulfilled the DAS28 remission criteria at baseline were studied. Patients were classified by the number of times they fulfilled the ACR/EULAR [Boolean trial, Boolean practice, Simplified Disease Activity Index (SDAI), or Clinical Disease Activity Index (CDAI)] or DAS28 remission criteria at each collection. The OR for the Japanese version of the Health Assessment Questionnaire (J-HAQ) progression, based on the number of times each set of remission criteria was fulfilled, were calculated by logistic regression. A total of 915 patients were studied. The OR (95% CI) for J-HAQ progression were 0.54 (0.33-0.87), 0.55 (0.33-0.92), 0.48 (0.28-0.82), 0.29 (0.16-0.51), 0.24 (0.13-0.47), and 0.07 (0.03-0.15) for those fulfilling the Boolean trial remission from 1 to 6 times. This tendency was also observed for the other 4 criteria. The OR (95% CI) for J-HAQ progression in patients who achieved remission at all 6 data collections were 0.07 (0.03-0.14) for the Boolean practice, 0.10 (0.05-0.20) for the SDAI, and 0.07 (0.04-0.15) for the CDAI, whereas 0.15 (0.08-0.29) for the DAS28. Continual fulfillment of any remission criteria was strongly effective in preventing patients from progression of functional disability; however, the ACR/EULAR criteria appear to be preferable.

Early medical rehabilitation after neurosurgical treatment of malignant brain tumours in Slovenia

BackgroundThe number of patients with malignant brain tumours is on the rise, but due to the novel treatment methods the survival rates are higher. Despite increased survival the consequences of tumour properties and treatment can have a significant negative effect on the patients’ quality of life. Providing timely and appropriate rehabilitation interventions is an important aspect of patient treatment and should be started immediately after surgery. The most important goal of rehabilitation is to prevent complications that could have a negative effect on the patients’ ability to function.ConclusionsBy using individually tailored early rehabilitation it is often possible to achieve the patients’ independence in mobility as well as in performing daily tasks before leaving the hospital. A more precise evaluation of the patients’ functional state after completing additional oncologic therapy should be performed to stratify the patients who should be directed to complex rehabilitation treatment. The chances of a good functional outcome in patients with malignant brain tumours could be increased with good early medical rehabilitation treatment.

Endovascular therapy including thrombectomy for acute ischemic stroke: A systematic review and meta-analysis with trial sequential analysis

One of the primary strategies for the management of acute ischemic stroke is intravenous (IV) thrombolysis with tissue plasminogen activator (t-PA). Over the past decade, endovascular therapies such as the use of stent retrievers to perform mechanical thrombectomy have been found to improve functional outcomes compared to t-PA alone. We aimed to reassess the functional outcomes and complications of IV thrombolysis with and without endovascular treatment for acute ischemic stroke using conventional meta-analysis and trial sequential analysis. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated for the effect of IV thrombolysis with and without endovascular therapy on functional outcome, mortality and symptomatic intracranial hemorrhage (SICH). Trial sequential analysis was done to strengthen the meta-analysis. We analyzed six randomized controlled trials involving 1943 patients. Patients who received IV thrombolysis with endovascular treatment showed significantly higher rates of excellent functional outcomes (modified Rankin Scale [mRS] 0–1) (RR, 1.75 [95% CI, 1.29–2.39]) compared to those who received IV thrombolysis alone. A similar association was seen for good functional outcomes (mRS 0–2) (RR, 1.56 [95% CI, 1.24–1.96]). Trial sequential analysis demonstrated endovascular treatment increased the RR of a good functional outcome by at least 30% compared to IV thrombolysis alone. There was no significant difference in all-cause mortality for mechanical thrombectomy compared to IV thrombolysis alone or the incidence of SICH at 3month follow-up. Endovascular treatment is more likely to result in a better functional outcome for patients compared to IV thrombolysis alone for acute ischemic stroke.