Moderate Functional Outcome Research Articles

Late Endovascular Treatment for Ischemic Stroke with Moderate to Large Infarct Volume is Associated with a Better Clinical Prognosis.

The concept of "time is brain" is crucial for the reperfusion therapy of ischemic stroke. However, the Infarct Growth Rate (IGR) varies among individuals, which is regarded as a more powerful factor than the time when determining infarct volume and its association with clinical outcomes. For stroke patients with a similar infarct volume, a longer time from stroke Onset to Imaging (OTI) correlates with a lower IGR, which may indicate a better prognosis. This study aimed to compare the prognoses of patients with anterior circulation stroke who received Endovascular Treatment (EVT), specifically comparing early EVT vs. late EVT. We analyzed 255 patients with acute anterior circulation stroke due to large vessel occlusion and who have successfully undergone recanalization after EVT. All patients were divided into the late (OTI≥6 hours) and early (<6 hours) time window groups and compared. The primary outcome was moderate functional prognosis, defined as a modified Rankin Scale (mRS) ≤3 at 90 days. The secondary outcome was No Significant Infarct Expansion (NSIE), defined as a reduction of less than 2 points on the Alberta Stroke Program Early CT Score (ASPECTS). In the moderate to large infarct subgroup, the late time window EVT was independently associated with a higher rate of moderate functional outcome (P =0.007) and NSIE (P =0.001); mediation analysis showed that NSIE partially mediated the effects of the late time window EVT on moderate functional outcome (coefficient: 0.112, 95% CI: 0.051 to 0.239, P =0.011); however, these associations were not consistent in the small infarct group. For anterior circulation stroke patients who received EVT according to current guidelines, those with moderate to large infarct volume and having a longer OTI had better clinical outcomes than those who had a shorter OTI and were more suitable for EVT.

Functional Outcome of single-stage facial reanimation surgery with radical parotidectomy.

Facial nerve sacrifice during radical parotidectomy impairs quality of life. This study assessed the effectiveness of simultaneous single-stage facial reanimation surgery with radical parotidectomy in restoring facial function. A retrospective analysis was conducted on patients who underwent single-stage facial reanimation with radical parotidectomy. Techniques included selective reinnervation and orthodromic temporalis tendon transfer. Outcomes were measured using modified House-Brackmann and Terzis grades, Emotrics facial assessment, and the Facial Disability Index (FDI). Among thirteen patients (median age 54, 69% male), ten received selective reinnervation. Nine of these patients showed improved results of House-Brackmann grade III and Terzis grade 4-5. The remaining three underwent tendon transfer, achieving moderate functional outcomes. Emotrics analysis indicated balanced facial symmetry in the selective reinnervation group. FDI scores reflected satisfactory physical and social/well-being functions. Single-stage facial reanimation effectively restores facial function in patients undergoing radical parotidectomy. This approach offers significant benefits in early facial function recovery.

Low healing rates and moderate functional outcome after arthroscopic superior capsular reconstruction using a porcine xenograft.

In the absence of arthropathy, symptomatic massive irreparable rotator cuff tears contribute to a therapeutic challenge for orthopedic surgeons. The concept of superior capsular reconstruction (SCR) was introduced as an option for these challenging cases. The purposes of this study were to evaluate the clinical outcome scores when using a decellularized porcine xenograft and to evaluate the graft healing and incorporation. A multicentric retrospective study of consecutive SCR's performed between 2016 and 2019 by four surgeons in four centers. Preoperative and postoperative Constant score, Subjective shoulder value (SSV) and Visual analog scale for pain (VAS) were recorded. Graft healing was evaluated by ultrasound or magnetic resonance imaging (MRI). A total of 28 shoulders were retrospectively analyzed with an average follow-up of 24 ± 9months. One infection and four revisions (14%) to reversed shoulder arthroplasty (RSA) were reported at the final follow-up. The absolute Constant score showed a moderate, but significant improvement from 40 ± 12 to 57 ± 20 (P = 0.001). A significant improvement in pain scores was observed (P < 0.001). For patients undergoing SCR as a primary surgery, an average postoperative Constant score of 62 ± 16 was observed. This was in contrast to 43 ± 22 for patients who underwent SCR after failed rotator cuff repair. Although a strong trend in absolute differences was observed in regard to the Constant score, they did not reach statistical significance. For all other recorded outcome scores, a significant difference was reported between these groups. Graft healing was observed in (7/22) 30% of the patients. In the case of graft incorporation, an absolute constant score of 70 ± 9 was observed compared to 48 ± 21 in the graft failure group (P = 0.003). All cases with graft healing were considered to have a successful clinical outcome. This compared to only (7/15) 47% in the case of graft failure. In these series, SCR with a dermal xenograft successfully alleviated pain, but provided only a moderate improvement in functional outcome. In the case of graft healing, satisfactory clinical outcomes and patient satisfaction were observed. The present study indicates the benefit of performing SCR as a primary surgery, yet warns against using SCR as a salvage option for failed rotator cuff repair. In this group, the use of dermal xenografts is limited by the low healing rates and high complication rate. IV. Retrospective case series, treatment study.

A-115 Does Cognitive Reserve Moderate Functional Outcomes for Collegiate Athletes with Sports-Related Concussion?

Abstract Objective Studies are lacking that examine whether cognitive reserve (CR) plays a role in differential outcomes for individuals in sports-related concussion (SRC), particularly within the acute phase. This study explored the relationship between CR (WTAR FSIQ), concussion severity (total PCSS score), and three separate outcome measures: cognitive functioning, return-to-play (RTP) time, and depression symptoms. Method The total sample included 175 (Males = 131, Females = 44) student-athletes at a Division I University, but only a subset of participants had RTP data available (N = 72; Males = 57, Females = 15). Regression analyses were conducted with CR, PCSS, and their interaction as the main predictor variables for the three separate dependent variables (neurocognitive composite, days to RTP, and BDI-FS total). Sex was found to be significantly related to the neurocognitive variable and the RTP variable and was included in those analyses as a covariate. Results For the first regression predicting neurocognitive performance, sex (t = 4.63, p &amp;lt; 0.001) was the only significant predictor. For the second regression predicting depression symptoms, PCSS (t = 4.52, p &amp;lt; 0.001) was the only significant predictor. For the third regression predicting RTP time, sex (t = 3.77, p &amp;lt; 0.001) was the only significant predictor. Conclusion Our results did not support a significant moderating effect of CR on the relationship between concussion symptom severity and our three outcome measures (cognitive performance, depression symptoms, RTP time). However, sex appeared to be an important predictor for neurocognitive performance, with females performing significantly higher on average than males, and for RTP times, with females having significantly longer RTP times than males.

Outcome Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke in the Elderly.

Pooled data of randomized controlled trials investigating mechanical thrombectomy (MT) to treat anterior circulation large vessel occlusion have demonstrated safety and effectiveness across all age groups, including ≥ 80years of age; however, only afew nonagenarians were in the ≥ 80years subgroup. Therefore, the benefit of MT in nonagenarians is mostly unknown. Two comprehensive stroke centers retrospectively reviewed all acute ischemic stroke patients who underwent MT for anterior circulation large vessel occlusion (LVO) stroke between February 2016 and August 2020. Revascularization TICI2b/3, symptomatic intracranial hemorrhage (ICH), and functional outcome using modified Rankin scale (mRS) were assessed for cases aged < 80 years, 80-89 years, and 90-99years. Favorable functional outcome was defined as mRS 0-2 or reaching the prestroke mRS and moderate as mRS 0-3. The final data set comprised atotal of 736cases. Of these, 466 aged < 80years, 219 aged 80-89years, and 51aged 90-99 years. In nonagenarians, TICI2b/3 revascularization was observed in 84.3% while symptomatic ICH was observed in 4%. These rates were similar to 80-89 years and < 80 years age groups. Favorable and moderate functional outcome as well as death rates differed significantly between nonagenarians and < 80years (19.6%, 29.4%, 51.0% vs 47.9%, 60.7%, 18.7%, respectively, p < 0.001), but were similar between nonagenarians and octogenarians (29.7%, 38.8%, 38.8%, p = 0.112-0.211). Amoderate outcome among nonagenarians was observed in about 30%, while mortality rates were about 50%. Withholding mechanical thrombectomy does not appear justifiable, although the absolute treatment effect among nonagenarians remains unknown.

EVALUATION OF RESULTS OF GRADUAL DISTRACTION TECHNIQUE FOR CORRECTION AND FUNCTIONAL RECOVERY OF NEGLECTED CTEV

INTRODUCTION: Congenital talipes equinovarus (CTEV) or clubfoot is commonest congenital foot deformity. The incidence of Congenital Idiopathic Clubfoot ranges from 0.36/1000 to 6.8/1000 in some populations and about 1.2/1000 births among Caucasians including Indians, with a 1 much higher occurrence in the affected families . More common in male (2:1). Bilateral cases account for about 50%. In unilateral cases right side affected more. The term talipes is derived from talus (ankle bone) and pes (foot). AIMS &amp; OBJECTIVES:To assess the efcacy of gradual differential distraction with JESS as a method of treatment in neglected CTEV. Evaluation of functional recovery of neglected CTEVusing this technique. To assess the morbidity &amp; complication of the technique. MATERIALS AND METHODS: Study area: - The study was institution based, conducted at the Orthopaedics department of I.P.G.M.E.R.&amp; S.S.K.M. Hospital, Kolkata, a tertiary care centre catering to people of West Bengal and adjacent states of Eastern India Study population: Patients attending Orthopedics' O.P.D. of IPGMER &amp; SSKM Hospital. Study period: From May 2016 to Oct 2017 (18 months duration) Sample size: 20 patients (24 feet) Sample design: Patient selection: RESULTS AND ANALYSIS: 2(8.3%) patients exion deformity of toes. 1(4.2%) Persitant cavus, 1(4.2%) had liniar skin necrosis, 1(4.2%) patients had pressure sore, 1(4.2%) had oedema of feet, 1(4.2%) persistent all deformity, 2(8.3%) patients had persistan tequinus, 5(20.8%) patients had persistant heel varus, 2(8.3%) patients had forfoot adduction, 3(12.5%) patients had pin tract infection and 11(45.8%) had no complication. 4(16.7%) patients had excellent functional outcome, 8(33.3%) patients had good functional outcome, 8(33.3%) patients had moderate functional outcome and 4(16.7%) patients had poor functional outcome. CONCLUSION: In our study 12(82.3%) feet had excellent to moderate result, only 4(16.7%) had poor result with limited complication. Few patients left with one or more persistent deformity but the nal outcome was functionally satisfactory. JESS is an excellent technique in the management of neglected cases of CTEV especially when it is done at an early age. Differential distraction by JESS xator for the correction of neglected idiopathic CTEV is an effective and patient-friendly method of management. Therefore the differential distraction with JESS can be considered as a treatment modality for the neglected CTEV.

Factors Influencing the Varus Deformity of Humeral Head in Proximal Humerus Fractures and Its Relation to Functional Outcome.

Fractures of the proximal humerus represent approximately 4% of all fractures and 26% of humerus fractures. Proper reduction, stable internal fixation and early initiation of physiotherapy help to achieve a good functional outcome. Aim of this study was to evaluate varus fixation/malunion of proximal humerus fractures and its relation to functional outcome. We retrospectively evaluated 32 patients with proximal humerus fractures who were surgically treated between 2015 and 2017 at tertiary care hospital. We divided the patients into three groups on the basis of the neck-shaft angle as valgus group, normal group and varus group to observe the influence of neck-shaft angle on efficacy. Patients were evaluated for functional outcome using the Constant-Murley score. Two-part fractures had better functional outcome (Constant score = 75.15) compared to three parts with the moderate functional outcome (Constant score = 68.81) and the four-part fracture had poor functional outcome (Constant score = 52.66). After 6months of follow-up, 13 patients had a neck-shaft angle of less than 126°. The functional outcome is significantly better among patients with normal neck-shaft angle and had a mean Constant score of 76.63 as compared to patients with varus deformity had a mean Constant score 60 (p = 0.001). 10 patients did not have medial support, in which 08 patients had neck-shaft angle less than 126° and 2 had a normal neck-shaft angle. High fracture comminution, improper restoration of medial continuity causes varus deformity of the humeral head and it leads to poor functional outcome. The small sample size is the limitation of our study.

Healthy Lifestyle and Functional Outcomes from Stroke in Women

PurposeWhile a healthy lifestyle has been associated with reduced risk of developing ischemic stroke, less is known about its effect on stroke severity. MethodsWe performed a prospective cohort study among 37,634 women without stroke or missing risk factor data at baseline. The healthy lifestyle index was composed of smoking, physical activity, body mass index, alcohol consumption, and diet (range 0-20, with 20 representing healthiest lifestyle). Possible functional outcomes were no stroke or stroke with modified Rankin Scale score of 0-1 (mild), 2-3 (moderate), or 4-6 (severe). Multinomial logistic regression was used to analyze the association between healthy lifestyle and functional outcomes from stroke. ResultsOver 17.2 years of follow-up, 867 total strokes were confirmed. Compared with the lowest category (0-4), the highest category (17-20) was associated with reductions in risk of total stroke with mild (odds ratio [OR] 0.43; 95% confidence interval [CI], 0.20-0.90), moderate (OR 0.53; 95% CI, 0.27-1.06), and severe (OR 0.48; 95% CI, 0.20-1.18) functional outcomes. Even a modest healthy lifestyle index (5-8 points) was associated with significant decreases in total stroke with severe and moderate functional outcomes. Similar results were seen for ischemic but not hemorrhagic strokes. ConclusionsHighest vs lowest scores on the healthy lifestyle index were associated with reductions in risk of total and ischemic strokes with mild, moderate, and severe functional outcomes among women. The evidence that even modest healthy lifestyle index scores reduced risks of total and ischemic stroke with moderate and severe functional outcomes suggests modest lifestyle changes may reduce risk of disabling stroke events.

Intracerebral haemorrhage in a population-based stroke registry (LuSSt): incidence, aetiology, functional outcome and mortality

Data on incidence of intracerebral haemorrhage (ICH) vary widely. Population-based data on predictors of ICH survival and functional outcome are rare. The Ludwigshafen Stroke Study is a prospective, population-based stroke registry which started in January 2006. All residents of the city of Ludwigshafen, Germany, who suffer from acute stroke or transient ischaemic attack are registered. Patients with first-ever primary intracerebral haemorrhage (FE-pICH) between 2006 and 2010 were included in the present analysis. Between January 1st, 2006 and December 31st, 2010, 152 patients suffered a FE-pICH. Crude and age-adjusted incidence rates per 100,000 for FE-pICH were 18.7 (95 % CI 15.9-21.9) and 11.9 (95 % CI 10.2-14.0), respectively, and remained stable over time. Case-fatality rates for FE-pICH were 27.0, 34.9 and 44.1 % at days 28, 90 and 365, respectively. In 21 patients, an (21.3 %) early do-not resuscitate-order was documented. Excluding these patients from multivariate analyses, National Institute of Health Stroke Scale (NIHSS) (OR 1.22, 95 % CI 1.08-1.36), hypercholesterolemia (OR 0.16, 95 % CI 0.05-0.55) and modified Rankin Scale (mRS) prior to stroke (OR 1.56, 95 % CI 1.06-2.3) were independently associated with risk of 1-year mortality, whereas NIHSS (OR 1.41, 95 % CI 1.20-1.66) and leukocyte count on admission (OR 1.48, 95 % CI 1.16-1.89) were independently associated with good or moderate functional outcome (mRS ≤ 3) after 1 year. Incidence of FE-ICH is in the lower range of those reported from other registries and remained stable over the observation period. Higher treatment rates for hypertension might partly account for this. Stroke severity as indicated by NIHSS was independently associated with mortality and functional outcome after 1 year. We found no association between aetiology and outcome in ICH patients.

Biomarkers and functional outcomes from ischaemic cerebral events in women: a prospective cohort study

Several biomarkers have been associated with an increased risk of ischaemic stroke. However, the association between these biomarkers and functional outcome from cerebral ischaemic events is unclear. We aimed to assess the patterns of association between cardiovascular disease biomarkers and functional outcomes after incident ischaemic cerebral events in women. Prospective cohort study of 27,728 women enrolled in the Women's Health Study who provided information on blood samples and were free of stroke or transient ischaemic attack (TIA) at baseline. Multinomial logistic regression was used to determine the association between elevated biomarker levels and functional outcomes from ischaemic cerebral events. Possible functional outcomes included TIA and ischaemic stroke with modified Rankin Scale (mRS) score of 0-1, 2-3, or 4-6. After a mean follow-up of 15.1 years, 461 TIAs and 380 ischaemic strokes occurred. Elevated levels of total cholesterol were associated with the highest risk of poor functional outcome (mRS 4-6) after incident cerebral ischaemic events (relative risk = 2.02, 95% CI = 1.18-3.46). We observed significant associations between elevated levels of total cholesterol, Lp(a), C-reactive protein, and triglycerides, and mild or moderate functional outcomes after ischaemic cerebral events. Elevations in all other biomarkers were not significantly associated with functional outcomes. Whilst total cholesterol level was associated with highest risks of poor functional outcome after stroke, we overall observed an inconsistent pattern of association between biomarkers linked with an increased risk of vascular events and more impaired functional outcomes from stroke.

Autologous Chondrocyte Implantation for Knee Cartilage Injuries: Moderate Functional Outcome and Performance in Patients With High-impact Activities

Few studies have assessed the results of autologous chondrocyte implantation in patients with high-impact activities. The purpose of this study was to evaluate the early functional outcome and activity level after 2-stage autologous chondrocyte implantation in professional soldiers and athletes. Nineteen patients with an average age of 32.2 years were treated with autologous chondrocyte implantation and followed up for a minimum of 2 years. All patients except 2 had received previous arthroscopic treatment with debridement and/or microfracture. The mean size of the postdebridement defect was 6.54 cm2. Using Novocart technology (B. Braun-Tetec, Reutlingen, Germany), periosteal patch and matrix-assisted autologous chondrocyte implantation was sequentially performed with no randomization. The average subjective knee evaluation score and Lysholm score improved from 39.16 and 42.42, respectively, preoperatively to 62.4 and 69.4, respectively, at latest follow-up. Median Tegner activity score was 8.8 before injury, 3.8 preoperatively, and 6.15 at latest follow-up. Second-look arthroscopy was performed in 11 patients due to persistent pain, decreased range of movement, and mechanical symptoms. Six of 19 (31.5%) patients with professional or recreational athletic activities returned to preinjury levels of athletic performance.This study shows that mid-term results with autologous chondrocyte implantation in high-performance patients are not as good as have been reported with other similar technologies. Motivational issues during prolonged rehabilitation, multiple surgical interventions before autologous chondrocyte implantation, patient age, and large defects can potentially influence the outcome and overall performance in this selected group of patients.

Quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with familial adenomatous polyposis: a matter of adjustment

Favourable outcomes for health-related quality of life (HRQL) have been reported in patients with familial adenomatous polyposis (FAP) after restorative proctocolectomy and ileal pouch-anal anastomosis (RPC). However, less is known about patients' subjective experience and adjustment to postoperative impairment. Using a multidimensional psychometric assessment, we investigated patient-reported HRQL to determine the impact of the patient's subjective experience together with medical, functional and psychosocial factors on HRQL. In this cross-sectional study, 116 FAP patients who had undergone RPC on average 8 years earlier completed standardized and study-specific questionnaires and participated in a personal interview. The impact of medical, functional and psychosocial factors on patients' HRQL was determined by regression analyses. When using a generic psychometric measure, FAP patients' overall HRQL was comparable with that of the general population. Impaired HRQL, however, was found in patients reporting poor pouch function in contrast to those reporting good or moderate functional outcome. Findings from a personalized interview also suggested that a good functional result does not necessarily translate into good HRQL. Personal resources predicted patients' physical and psychological well-being, whereas little variance of HRQL was explained by medical factors and function. Patients' HRQL is, to a substantial degree, the result of adjustment to the adverse impact of RPC. By using personal resources the majority of patients may achieve satisfactory HRQL levels even when bowel function is impaired. A multidimensional assessment that comprises medical, functional and psychosocial aspects is required to ascertain an adequate evaluation of FAP patients after RPC.

Osteosynthese von Zwei-Pfeiler-Frakturen des Azetabulums über den ilioinguinalen Zugang

Open anatomic reduction and stable internal fixation of both-column acetabular fractures by screw and plate osteosynthesis via the ilioinguinal approach. Displaced both-column fractures of the acetabulum with incongruence of the hip joint, central femoral head displacement, unstable hip joint, and/or loss of hip joint congruence without the potential of a secondary congruence (near anatomic fragment orientation due to ligamentotaxis). General contraindications. Displaced fracture of the posterior wall. Extension of the posterior column fracture to the apex of the greater sciatic notch. Indirect open reduction of a both-column fracture of the acetabulum that is typically characterized by a multifragmentary anterior column fracture and a simple posterior column fragment using an ilioinguinal approach. Stepwise reduction and reconstruction of the anterior column according to the "proximal-to-distal" rule. Reduction and fixation of the posterior column fragment against the reconstructed anterior column. Partial weight bearing for 8-12 weeks with 15 kg body weight, beginning on the 2nd postoperative day. Thereafter, pain-dependent weight bearing. Thrombosis prophylaxis. Analysis of 27 patients treated between 1991 and 2005. A high-velocity trauma was the cause of injury in 74.1% of cases. Most patients showed an isolated injury of the acetabulum. In 55.5%, an additional central hip joint displacement was observed. A primary injury to the sciatic nerve was present in 14.8% of cases. Mean fracture gap/step was 14.3 mm. 81.5% of these fractures were anatomically reduced and stabilized; all joints were congruent. At 2-year follow-up, 14 out of 17 patients had no signs of posttraumatic osteoarthritis. Excellent and good functional results according to the Merle d'Aubigné Score were observed in eleven and five cases, respectively. One patient had a moderate functional outcome.