Medium-term Data Research Articles

Contemporary Trends in the Spatial Extent of Common Riverine Fish Species in Australia’s Murray–Darling Basin

As one of the world’s most regulated river basins, the semi-arid Murray–Darling Basin (MDB) in south-eastern Australia is considered at high ecological risk, with substantial declines in native fish populations already identified and climate change threats looming. This places great importance on the collection and use of data to document population trends over large spatial extents, inform management decisions, and provide baselines from which change can be measured. We used two medium-term data sets (10 MDB basin-wide fish surveys from 2004–2022) covering the 23 catchments and 68 sub-catchments of the MDB to investigate trends in the distribution of common riverine species at the entire basin scale. Fifteen native species were analysed for changes in their contemporary range, and whilst short-term changes were identified, all species showed no significant continuous trend over the study period. We further analysed the native species extent relative to their historic records, with bony herring and golden perch occurring in 78% and 68% of their historic river kilometres, respectively, whereas southern pygmy perch, northern river blackfish, silver perch, mountain galaxias, and freshwater catfish were all estimated to occur in less than 10% of their historic extent. Six established non-native species were also analysed and were very consistent in extent over the years, suggesting that they are near the available limits of expansion of their invasion. We provide effect sizes for the spatial extent index which can be used as baselines for future studies, especially those aiming to monitor changes in the spatial extent and population status of native species, or changes in the spatial extent of new or existing non-native species.

Early Results of Total Cementless Hip Joint Arthroplasty with a Conical Screw Cup.

With the development of hip arthroplasty, there are increasingly more indications for effective use of this surgical method. Endoprostheses are now being more and more commonly used in difficult cases of secondary coxarthrosis and in increasingly younger patients. The aim of this study is to present the early results of hip joint arthroplasty with the Zweymüller conical screw cup. The study enrolled 117 patients (64 women and 53 men) who underwent a total of 123 hip joint arthroplasties with the Zweymüller conical screw cup. The mean age of the patients at surgery was 60.8 years (range: 26-81 years). The mean follow-up period was 7.7 years (range: 5-12.6 years). Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.3 points. The outcomes were classified as excellent in 42 cases (34.15%), good in 56 cases (45.53%), satisfactory in 14 (11.38%) and poor in 11 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 8 cases (6.5%). According to the Kaplan-Meier estimator, 5-year survival probability was 91.1% for the whole implant and 94.3% for the stem alone. 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the Zwey-müller conical screw cup affords excellent clinical and functional results in patients operated on for advanced hip osteoarthritis. 2. In patients correctly qualified for this procedure, with good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. As only medium-term follow-up data are available, there may be more cases of loosening over time, indicating a need of regular long-term follow-up.

Analysis of the Results of Hip Arthroplasty with the Use of Khanuja Group 6 stems.

Total cementless hip joint arthroplasty is universally recognized as a method of treatment of ad-vanced hip osteoarthritis. Multifaceted research by a wide group of implant specialists has led to the development of special implants that fulfill their purpose even in the most severe deformities of the hip joint. The aim of the study is to present and analyse the results of hip joint arthroplasty with the Antega anatomical stem. The study enrolled 533 patients (342 women and 191 men) who underwent a total of 595 hip joint arthroplasties with the Antega anatomical stem. The mean age of the patients at surgery was 56.2 years (range: 20-87 years). The mean follow-up period was 7.3 years (range: 5-15.5 years). Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) were poor in all patients. Mean post-operative improvement was 6.1 points. The outcomes were classified as excellent in 419 cases (70.4%), good in 102 cases (17.1%), satisfactory in 39 (6.6%) and poor in 34 cases. Poor results were usually associated with loosening of one of the prosthetic components. Heterotopic ossification was noted in 37 cases (6.2%). According to the Kaplan-Meier estimator, 10 years' survival probability was 89.9% for the whole implant and 96.1% for the stem alone. 1. Our follow-up data (from a mean follow-up period of more than 10 years) indicate that the Antega anatomical stem affords excellent clinical and functional results. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Modification of the Antega stem implantation technique significantly reduces the risk of so-called unexplained thigh pain, which sometimes occurs following hip replacement surgery. 4. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, requiring regular long-term follow-up.

Autologous reconstructions are associated with greater overall medium-term care costs than implant-based reconstructions in the Finnish healthcare system: A retrospective interim case-control cohort study

Previous studies have mainly reported the short-term costs of different reconstruction techniques. Revision operations may increase costs in longer follow-up. Authors report medium-term data on different reconstruction methods. We hypothesised that the reconstruction method would affect not only the duration of reconstruction process but also total costs. The reconstruction database was reviewed from 2008 to 2019. Women with autologous (deep inferior epigastric perforator, transverse musculocutaneous gracilis and latissimus dorsi [LD] without implant) and implant-based (implant and LD with implant) reconstructions were included. Variables evaluated included age, body mass index, smoking, comorbidities, radiotherapy, complications and readmissions. Risk factors for multiple revision surgeries were analysed. Time to definitive reconstruction and related costs were also calculated. In total, 591 patients with autologous reconstructions and 202 with implant-based reconstructions were included. The median follow-up time was 73 months. Definitive reconstruction was obtained in 443 days in implant-based reconstructions and in 403 days in autologous reconstructions (P=0.050). Independent risk factors for multiple surgeries were younger age (P<0.001) and comorbidity (P=0.008). No statistically significant difference was observed in the rate of overall surgical procedures (P=0.098), but implant-based reconstructions were more commonly associated with two or more planned operations (P=0.008). Autologous reconstructions were associated with greater total cost ($22 052vs. $18 329, P<0.001). This review of reconstructions over a 12-year study period revealed that autologous reconstructions are associated with greater overall costs, but there is no statistically significant difference in reconstruction time or rate of surgical procedures. However, a full cost assessment between reconstructive techniques requires a much longer follow-up period.

Design of parallel Computing based on Web Technology in Soil Moisture and Thermal process Simulation system

Most of the traditional simulation software of soil water, soil and crops are based on the C-paw S model, and the efficiency of the simulation and calculation is relatively underground, and the organization and management of the data is slightly inferior, most of them are more powerful on the model. From the point of view of the early organization and management of the data, the simulation and optimization of the medium-term data, the visualization of the late platform and the efficiency of calculation, this project completes a new simulation platform with the help of the classical WHCNS model. At the same time, the innovation is to simulate and optimize the data with the help of big data technology, multi-thread technology, Web technology and the classical WHCNS soil-crop management model, so that the system has become an important experimental means of pilot-scale experiment, which can solve the problems of long experimental period, high cost and regional differences in the pilot-scale experiment of soil organic reconstruction. The simulation platform of the pilot test is constructed, and the relevant mechanism models and research models involved in the experimental research are coupled and integrated into the platform system to form a simulation process of data input-model simulation-calculation output and visual display. Used to assist the pilot test.

Safety and effectiveness in explantation and re-implantation of hypoglossal nerve stimulation devices.

Since 2001, hypoglossal nerve stimulators have been implanted in patients with obstructive sleep apnea around the world, initially in trial situations but more recently also in regular care settings. Medium term data indicate effectiveness and tolerability of treatment. However, when assessing the safety of the procedure, the safe feasibility of explantation or reimplantation must also be considered. Nine patients with an implanted respiratory-driven hypoglossal nerve stimulator. We have evaluated the feasibility and safety of explantation or re-implantation with another stimulation system. In 2012, nine patients were implanted with a respiratory-driven hypoglossal nerve stimulator as part of the Apnex Medical Pivotal Study. The study was ended in 2013. For a variety of reasons, the system was explanted from all nine patients by the year 2019. Three of these patients were re-implanted with a different system with respiratory sensing during the same session (mean incision to closure time for explantation 88.2 ± 35.01min., mean incision to closure time for re-implantation 221.75 ± 52.73min.). Due to extensive scar tissue formation, all procedures were technically challenging. Complication rate was significantly higher when re-implantation was performed or attempted in the same surgical session (0 of 5 patients with explantation versus 3 of 4 patients with attempted re-implantation; p = 0.018). There was no significant difference between the AHI values before and after implantation in patients with re-implantation. Explantation and re-implantation are technically challenging though possible procedures. The single-staged equilateral reimplantation of another hypoglossal nerve stimulation system can, but need not, be successful.

Analysis of Suaeda heteroptera cover change and its hydrology driving factors in the Liao River Estuary wetlands, China

Suaeda heteroptera (S. heteroptera) is the most common indicator plant of solonchak in coastal wetlands of the Liao River Estuary, the influence of meteorology, hydrology environment on vegetation distribution is of growing interest. With the help of satellite remote sensing (RS) technology and geographic information system (GIS), we investigated the spatial-temporal distribution and area change of S. heteroptera in the wetlands of the Liao River Estuary from 1997 to 2016, and the identification of the main driving mechanisms in the S. heteroptera evolution was analyzed in this coastal wetland. The SPSS Statistics 22 software was used to calculate the correlation coefficients between total area of S. heteroptera and each driving factor based on available long-term (1997-2016) and medium-term (2007-2016) data. Correlation analysis results indicated that the change in S. heteroptera coverage had insignificant correlations (correlation coefficients r=−0.241, r=−0.188 and r=−0.269) with annual mean temperature, precipitation, and sunshine duration, respectively. The results also showed that the growth of S. heteroptera was extremely relevant to runoff from the Liao River from April to June (r=0.889) over the last 10 years. This study revealed that some potential factors, such as river discharge may be related to the large-scale degeneration of S. heteroptera in Liao River Estuary wetlands.

Mechanical Occlusion Chemically Assisted Ablation (MOCA) for Saphenous Vein Insufficiency: A Meta-Analysis of a Randomized Trial.

Purpose A previous meta-analysis has conducted nonrandomized trials for mechanochemical ablation (MOCA). Since medium-term follow-up data from randomized clinical trials (RCTs) are becoming available, we chose to perform a meta-analysis of RCTs to assess the efficacy and safety of MOCA for saphenous vein insufficiency. Methods A systematic search of all RCTs comparing the anatomical success of MOCA for saphenous vein insufficiency to thermal ablation was performed using the PubMed and Cochrane Library databases. We employed the Mantel-Haenszel random-effects meta-analysis of outcomes using RevMan 5.3. Results Four studies (615 patients) were included in this meta-analysis. The MOCA group had 93.4% and 84.5%, whereas the thermal ablation group had 95.8% and 94.8% of anatomical success rate at 1 month (short-term) and a period of more than 6 months but less than 1-year follow-up (mid-term), respectively. According to intention-to-treat analysis, there were similar anatomical successes in MOCA and thermal ablation groups at the short-term follow-up (low-quality evidence; relative risk (RR) = 0.98 (95% CI, 0.94–1.03); P = 0.44; I2 = 53%). The estimated effect of MOCA on anatomical success showed a statistically significant reduction at the mid-term follow-up (moderate-quality evidence; RR = 0.89 (95% CI, 0.84–0.95); P = 0.0002; I2 = 0%). MOCA had fewer incidence of nerve injury, deep vein thrombosis, and skin burns compared to the thermal ablation procedure (low-quality evidence; RR = 0.33 (95% CI, 0.09–1.28); P = 0.11; I2 = 0%). Conclusion MOCA offered fewer major complications but lesser anatomical success at the period of more than 6 months but less than 1-year follow-up than thermal ablation. Trial Registration. This trial is registered with UMIN Clinical Trial Registry (UMIN ID 000036727).

A new bone conduction hearing aid to predict hearing outcome with an active implanted device.

We compared our historical medium-term data obtained with an active semi-implanted bone conduction device and the hearing results of a new passive bone conduction hearing device to determine its predictive value for the hearing results with the semi-implanted device. The study sample was 15 patients with an active bone conduction implant (mean follow-up 26months). Pure tone audiometry was performed with headphones, sound field speech audiometry was conducted unaided, and free-field speech audiometry was carried out with both the active bone conduction system and the passive device switched off. As compared with the unaided condition, speech reception was significantly improved with both devices. Comparison of speech reception threshold at 100% of word recognition showed no difference between the active and the passive device. At lower intensity the difference in speech perception was significant in the patients with monaural fitting (group A) and was non-statistically significant in those with binaural fitting (group B); the speech reception threshold at 50% of word recognition was 26.00dB (± 10.22) with the active implant and 30.50dB (± 7.98) with the passive device in group A (p=0.047) and 24.00dB (± 5.48) and 29.00dB (± 2.24) in group B (p=0.052), respectively. The hearing outcome after active bone conduction implant was comparable to published data. Compared with the unaided condition, speech recognition was significantly improved with the passive device. The device may also provide value to predict the hearing outcome with the implanted device, especially at higher intensities. IV.

Forecasting agricultural commodity pricing using neural network-based approach

Over the last decade, unprecedented spikes and drops in commodity prices have been a recurrent source of concern to both policymakers and the investors. This research paper focuses on effective prediction of commodities prices which will be a key contribution to the investment world and policy makers to devise strategies. Neural network and multiple regression models were built that would efficiently predict the price in advance for different forecasting ranges considering Kapas as the product. Historical prices along with various price influencing factors like inflation, rainfall, exchange rate and cottonseed oil cake price were given as input parameters to the feed forward multi-perceptron neural network and multiple regression models for forecasting prices. The results were compared using mean absolute percentage error (MAPE) as an accuracy measure. Artificial neural network models outperformed multiple linear regression models for medium-term and long-term data. The results indicate that for long-term predictions, neural network models have high predictive power.

Summarising wave data for the purpose of operational planning on coastlines

The trends within various coastal hydrodynamic data sets were investigated with the aim of providing a general methodology to gather, condense and store useful wave statistics using data collected on the eastern coast of Trinidad, an island located in the Caribbean region. The lack of local comprehensive long-term data sets necessitates the use of short- to medium-term data in order to establish probabilistic descriptions to be used in long-term modelling, planning and hazard assessment exercises. While the paucity of data at certain locations initially stimulated the investigation of monthly and quarterly trends, as well as near-shore and off-shore differences of the wave parameters, it also identified a method to reduce large data sets while retaining the critical wave characteristics. The summarised data sets can be more readily used for planning and decision making, but can also be used for application to advanced scientific tools for further investigation. General methodologies for analysing the short- to medium-term data were established in order to derive basic statistical parameters, deduce persistence statistics, assess multi-modality and subsequently generate a generic wave height probability density function for the coastal location.

New and Emerging Technologies in Treatment of Lower Urinary Tract Symptoms From Benign Prostatic Hyperplasia.

Lower urinary tract symptoms (LUTS) from bladder outlet obstruction from benign prostatic hyperplasia (BPH) occur in a large percentage of urologic patients. Treatment of this condition with medical and surgical therapy provides symptom relief but has serious adverse effects and causes sexual dysfunction. New technologies to treat BPH-associated LUTS aim to effectively treat urinary symptoms and minimize side effects and sexual dysfunction. To review the efficacy of new and emerging therapies for treatment of LUTS from BPH. A literature search was performed to identify therapies for LUTS from BPH with early outcomes data within the past 5 years. Improvement in International Prostate Symptom Score (IPSS) and effect on sexual functions such as erectile and ejaculatory functions as measured on the International Index of Erectile Function and the Male Sexual Health Questionnaire. Technologies introduced within the past 5 years include techniques using intraprostatic injectables, mechanical devices, and prostatic tissue ablation. Most technologies remain in the development phase and have only phase I and II studies available that show promising alleviation of urinary symptoms. Injectables have not typically surpassed placebo or sham effects, although special cohorts could be exceptions. Thus far, convective water vapor ablation therapy and prostatic urethral lift have shown the most promise, with short- and medium-term data available on phase III studies demonstrating significant improvement in IPSS with minimal impact on sexual function. Many of these technologies are limited in their potential treatment population by prostate size and conformation, whereas other therapies might be more generalizable. Many new technologies aim to treat LUTS from BPH and minimize sexual side effects. Most therapies remain experimental, although prostatic urethral lift and water vapor ablation therapy have been brought to market and show promise. Long-term durability of symptom relief remains to be demonstrated. Gupta NK, Gange SN, McVary KT. New and Emerging Technologies in Treatment of Lower Urinary Tract Symptoms From Benign Prostatic Hyperplasia. Sex Med Rev 2018;7:491-498.

Treatment of Degenerative Lumbar Spondylolisthesis With Fusion or Decompression Alone Results in Similar Rates of Reoperation at 5 Years.

Population-based analysis of administrative discharge records from California, Florida, and New York inpatient, ambulatory, and emergency department settings between 2005 and 2011, utilizing Healthcare Cost and Utilization Project data. We aimed to compare, and characterize rates of reoperation and readmission among patients with degenerative spondylolisthesis treated with surgical decompression alone versus fusion. Degenerative lumbar spondylolisthesis with stenosis can be treated by decompression with or without fusion. Fusion has traditionally been preferred. We hypothesized that rates of reoperation after decompression alone would be higher than after fusion. We undertook a population-based analysis of administrative discharge records from California, Florida, and New York inpatient, ambulatory, and emergency department settings between 2005 and 2011, with Healthcare Cost and Utilization Project data. We identified all patients who had degenerative spondylolisthesis who were treated with decompression alone or with fusion and compared their rates of reoperation at 1, 3, and 5 years from the index operation. We used descriptive statistics and a hierarchical logistic regression model to generate risk-adjusted odds of all-cause readmissions. Our study consisted of 75,024 patients with spondylolisthesis; 6712 (8.95%) of them underwent decompression alone and 68,312 (91.05%) of them underwent fusion. Rates of reoperation were higher for decompression versus fusion at 1 year; 6.87% versus 5.53% (P≤0.001), but at 3 years; 13.86% versus 12.91% (P=0.18) and 5 years; 16.9% versus 17.7% (P=0.398) years rates of reoperation were not statistically different. Patients treated with decompression alone that had a second operation tended to have the operation sooner 512.6 versus 567.4 days (P=0.008). Our study suggests that treatment of degenerative spondylolisthesis with fusion or decompression alone results in similar rates of reoperation at 5 years. This medium term data indicate that decompression alone may be a viable treatment for some patients with degenerative spondylolisthesis.

PUBLIC EXPENDITURES AND GROWTH IN A MONETARY UNION: THE CASE OF WAEMU

The focus of the paper is on how public spending volume, composition (current versus capital) and quality are linked to economic growth in lower-income countries that are members of a monetary union. We specifically investigate the case of the West Africa Economic and Monetary Union (WAEMU) countries, which have fluctuating growth rates and relatively low-income levels compared to other parts of the world. The empirical analysis covers the period 2000-2013. The results indicate that total public spending has a significant impact on growth. While the impact of the capital component is positive and statistically significant, the effect of the current component tends to be negative, but not significant. When the capital component is further split into two: public fixed capital investment and public other capital expenditures, defined as total public capital expenditure minus public fixed capital investment, the results show that not only physical capital formation but also human capital spending is important for growth. While the volatility measure for public investment has a clear negative and statistically significant impact on growth, the quality of public fixed investment has a positive impact. The findings also indicate that fiscal deficits have not been an important constraint to the effectiveness of government spending on growth, reflecting the fiscal discipline achieved in the union. On the other hand, the debt-to-GDP ratio clearly shows a significant negative impact on growth, indicating the risk associated with debt distress. Total fiscal revenue has a significant and positive effect on growth, most likely indicating relatively low levels of fiscal revenues to GDP ratios, partially boosted by natural resources, coupled with grants. In each regression specification, it is observed that the contributions of both trade openness and private investment on growth are positive and significant. The results also indicate that the quality of institutions, measured by an index of bureaucracy quality, is critical to enhancing the positive effect of public spending on growth. The findings are robust to different regression methodologies, as well as the inclusion of short- and medium-term data.

Dengue Fever Surveillance in India Using Text Mining in Public Media.

.Despite the improvement in health conditions across the world, communicable diseases remain among the leading mortality causes in many countries. Combating communicable diseases depends on surveillance, preventive measures, outbreak investigation, and the establishment of control mechanisms. Delays in obtaining country-level data of confirmed communicable disease cases, such as dengue fever, are prompting new efforts for short- to medium-term data. News articles highlight dengue infections, and they can reveal how public health messages, expert findings, and uncertainties are communicated to the public. In this article, we analyze dengue news articles in Asian countries, with a focus in India, for each month in 2014. We investigate how the reports cluster together, and uncover how dengue cases, public health messages, and research findings are communicated in the press. Our main contributions are to 1) uncover underlying topics from news articles that discuss dengue in Asian countries in 2014; 2) construct topic evolution graphs through the year; and 3) analyze the life cycle of dengue news articles in India, then relate them to rainfall, monthly reported dengue cases, and the Breteau Index. We show that the five main topics discussed in the newspapers in Asia in 2014 correspond to 1) prevention; 2) reported dengue cases; 3) politics; 4) prevention relative to other diseases; and 5) emergency plans. We identify that rainfall has 0.92 correlation with the reported dengue cases extracted from news articles. Based on our findings, we conclude that the proposed method facilitates the effective discovery of evolutionary dengue themes and patterns.

SIGNAL DECOMPOSITION AND ANALYSIS FOR THE IDENTIFICATION OF PERIODIC AND ANOMALOUS PHENOMENA IN RADON TIME-SERIES.

This work concerns continuous monitoring of radon and thoron specific activity in soil gas within the framework of identifying possible anomalies. It is based on the analysis of a medium-term data record obtained from soil gas in an area of geophysical interest. The RaMonA spectrometric system is also used to measure the climatic parameters and a specific analysis of the alpha spectra is performed to better determine the alpha lines intensity. Since radon emission is also influenced by meteorological parameters, it is mandatory to differentiate the changes due to the deep phenomena. Different procedures are utilized to reach the above objective: statistical analysis using the Empirical Mode Decomposition technique, the Multiple Linear Regression method and the Remote Radon Estimation by using of the thoron trend to eliminate the locally produced radon fraction. The results of such methods are compared to recognize and to highlight radon anomalies.

Percutaneous heart valve interventions: a South African perspective

Valvular heart disease represents a significant health care challenge in South Africa, mainly due to the prevalence of rheumatic fever. This review discusses the recent advances in percutaneous heart valve treatment, including heart valve replacement, as an alternative to open prosthetic valve replacement and it’s relevance in South Africa. Balloon mitral valvotomy is discussed with emphasis on patient selection, management during pregnancy and management in the presence of left atrial thrombus. Further developments regarding the percutaneous treatment of mitral valve disease include percutaneous treatment of mitral incompetence by annuloplasty via the coronary sinus and edge-to-edge repair with the aid of a mitral clip. Transcatheter aortic valve replacement is the more developed procedure and two valves have the CE mark of approval. Both have good short to medium term data demonstrating efficacy but are technically difficult to insert, very expensive and patient selection remains a major problem. Their use is thus limited to patients turned down for conventional surgery. Percutaneous pulmonary valve replacement has good evidence to show efficacy but its use is largely limited to patients with degenerated pulmonary outflow tract conduits.

Long-term Correction in Sleep Disturbance Is Sustained After Arthroscopic Rotator Cuff Repair

Background: Sleep disturbance is a major complaint of patients with rotator cuff disease that often leads them to seek treatment. The authors previously reported a prospective analysis of patients who underwent rotator cuff repair and found that sleep disturbance significantly improved at 3 months after surgery. That improvement in sleep was maintained at 6 months. Hypothesis: In the current study, the authors sought to gain medium-term data on this same population at greater than 2 years. The hypotheses were that improvement in sleep disturbance after arthroscopic rotator cuff repair is maintained at 2-year follow-up and that the continued use of narcotic pain medication has a negative effect on sleep quality at 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: The original cohort of patients was contacted at a minimum of 24 months after their surgery. Thirty-seven of the 56 patients (66%) involved in the original study were available. Patient outcomes were scored using the Pittsburgh Sleep Quality Index (PSQI), Simple Shoulder Test (SST), visual analog scale (VAS) for pain, and Single Assessment Numeric Evaluation (SANE). The newly obtained scores were compared with prior scores, which ranged from preoperatively to 6 months postoperatively. Results: The statistically significant improvement of the PSQI score demonstrated in our prior analysis at 6 months postoperatively was maintained, with a mean PSQI score of 5.5 for the 37 patients followed beyond 24 months. Of those patients, 41% still had a PSQI score >5, indicative of sleep disturbance. However, even those patients in our study with a PSQI score >5, indicative of sleep disturbance, had an improved mean score of 9.3 at greater than 24 months compared with those patients with a PSQI score >5 at 6 months, who had a mean PSQI score of 11.5 (P = .13). Both the SST and VAS scores displayed continued improvement at greater than 24 months, with both displaying moderate strength correlation to the PSQI score (VAS: Spearman rho = 0.479, P < .001; SST: Spearman rho = −0.505, P < .001). Regression models again demonstrated the continued use of narcotic pain medication correlating with poor sleep as the difference in the mean PSQI score between users and nonusers increased as postoperative time increased. At greater than 24 months after surgery, patients using narcotics had a mean PSQI score that was 7.4 points higher than narcotic nonusers (standard error [SE] = 1.93; P = .00017). Conclusion: At greater than 24 months, 41% of patients still demonstrated sleep disturbance, with both SST and VAS scores showing improvement. The prolonged use of narcotic medication negatively affects sleep, with a greater effect seen over time.

Comparison of an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent for the treatment of coronary artery stenosis (ABSORB II): a 3 year, randomised, controlled, single-blind, multicentre clinical trial

No medium-term data are available on the random comparison between everolimus-eluting bioresorbable vascular scaffolds and everolimus-eluting metallic stents. The study aims to demonstrate two mechanistic properties of the bioresorbable scaffold: increase in luminal dimensions as a result of recovered vasomotion of the scaffolded vessel. The ABSORB II trial is a prospective, randomised, active-controlled, single-blind, parallel two-group, multicentre clinical trial. We enrolled eligible patients aged 18-85 years with evidence of myocardial ischaemia and one or two de-novo native lesions in different epicardial vessels. We randomly assigned patients (2:1) to receive treatment with an everolimus-eluting bioresorbable scaffold (Absorb; Abbott Vascular, Santa Clara, CA, USA) or treatment with an everolimus-eluting metallic stent (Xience; Abbott Vascular, Santa Clara, CA, USA). Randomisation was stratified by diabetes status and number of planned target lesions. At 3 year follow-up, the primary endpoint was superiority of the Absorb bioresorbable scaffold versus the Xience metallic stent in angiographic vasomotor reactivity after administration of intracoronary nitrate. The co-primary endpoint is the non-inferiority of angiographic late luminal loss. For the endpoint of vasomotion, the comparison was tested using a two-sided t test. For the endpoint of late luminal loss, non-inferiority was tested using a one-sided asymptotic test, against a non-inferiority margin of 0·14 mm. The trial is registered at ClinicalTrials.gov, number NCT01425281. Between Nov 28, 2011, and June 4, 2013, we enrolled 501 patients and randomly assigned them to the Absorb group (335 patients, 364 lesions) or the Xience group (166 patients, 182 lesions). The vasomotor reactivity at 3 years was not statistically different (Absorb group 0·047 mm [SD 0·109] vs Xience group 0·056 mm [0·117]; psuperiority=0·49), whereas the late luminal loss was larger in the Absorb group than in the Xience group (0·37 mm [0·45] vs 0·25 mm [0·25]; pnon-inferiority=0·78). This difference in luminal dimension was confirmed by intravascular ultrasound assessment of the minimum lumen area (4·32 mm2 [SD 1·48] vs 5·38 mm2 [1·51]; p<0·0001). The secondary endpoints of patient-oriented composite endpoint, Seattle Angina Questionnaire score, and exercise testing were not statistically different in both groups. However, a device-oriented composite endpoint was significantly different between the Absorb group and the Xience group (10% vs 5%, hazard ratio 2·17 [95% CI 1·01-4·70]; log-rank test p=0·0425), mainly driven by target vessel myocardial infarction (6% vs 1%; p=0·0108), including peri-procedural myocardial infarction (4% vs 1%; p=0·16). The trial did not meet its co-primary endpoints of superior vasomotor reactivity and non-inferior late luminal loss for the Absorb bioresorbable scaffold with respect to the metallic stent, which was found to have significantly lower late luminal loss than the Absorb scaffold. A higher rate of device-oriented composite endpoint due to target vessel myocardial infarction, including peri-procedural myocardial infarction, was observed in the Absorb group. The patient-oriented composite endpoint, anginal status, and exercise testing, were not statistically different between both devices at 3 years. Future studies should investigate the clinical impact of accurate intravascular imaging in sizing the device and in optimising the scaffold implantation. The benefit and need for prolonged dual antiplatelet therapy after bioresorbable scaffold implantation could also become a topic for future clinical research. Abbott Vascular.

Does platelet-rich plasma have a role in the treatment of osteoarthritis?

Platelet-rich plasma (PRP) has been generating considerable attention as an intra-articular treatment to alleviate the symptoms of osteoarthritis. Activated platelets release a host of soluble mediators such as growth factors and cytokines, thereby inducing complex interactions that vary across tissues within the joint. In vivo, PRP may promote chondrocyte proliferation and differentiation. The available data are somewhat conflicting regarding potential effects on synovial cells and angiogenesis modulation. PRP probably exerts an early anti-inflammatory effect, which may be chiefly mediated by inhibition of the NF-κB pathway, a hypothesis that requires confirmation by proof-of-concept studies. It is far too early to draw conclusions about the efficacy of PRP as a treatment for hip osteoarthritis. The only randomized trial versus hyaluronic acid showed no significant difference in effects, and no placebo-controlled trials are available. Most of the randomized trials in knee osteoarthritis support a slightly greater effect in alleviating the symptoms compared to visco-supplementation, most notably at the early stages of the disease, although only medium-term data are available. Many uncertainties remain, however, regarding the best administration regimen. Serious adverse effects, including infections and allergies, seem rare, although post-injection pain is more common than with other intra-articular treatments for osteoarthritis.