RA Group Research Articles

Robot-assisted minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a retrospective matched-control analysis for clinical and quality-of-life outcomes

Aim: To compare the screw accuracy and clinicaloutcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and open TLIF in the treatment of one-level lumbar degenerative disease. Materials & methods: From May 2018 to December 2019, a consecutive series of patients undergoing robot-assisted minimally invasive one-level lumbar fusion procedures were retrospectively compared with matched controls who underwent one-level open TLIF procedures for clinical and quality-of-life outcomes. Results: A total of 52 patients underwent RA MIS-TLIF procedures (robot-assisted [RA] group) and 52 matched controls received freehand open TLIF procedures (open [OP] group). The RA group had more grade A screws with 96.2% one-time success rate of screw placement (p < 0.05). Besides, the RA group experienced less intraoperative blood loss and shorter length of hospital stay, while the OP group had shorter operative duration and cumulative radiation time (p < 0.001). What is more, the average VAS score for low back pain and ODI score in the RA group were lower than that in the OP group 1 month after operation (p < 0.05). Conclusion: The use of real-time, image-guided robot system may further expand the advantages of MIS-TLIF technique in terms of accuracy and safety.

3-D microarchitectural properties and rod- and plate-like trabecular morphometric properties of femur head cancellous bones in patients with rheumatoid arthritis, osteoarthritis, and osteoporosis.

ObjectivesWe quantify 3-D microarchitectural properties of femoral head cancellous bones from patients with rheumatoid arthritis (RA, n ​= ​12), osteoarthritis (OA, n ​= ​15), osteoporosis (OP, n ​= ​24), or donor controls (CNT, n ​= ​8); and investigate their rod- and plate-like trabecular morphometric properties of trabecular bone tissues and compare these properties between them.MethodsFemoral heads were harvested during total hip replacement surgeries or collected from donors. Four cubic cancellous bone samples produced from each femoral head were micro-CT scanned to quantify their microarchitectural and rod- and plate-like trabecular properties. The samples were then tested in compression to determine mechanical properties.ResultsThe microarchitectural properties of femoral head cancellous bone revealed significant differences among the 4 groups, but not between RA and OA. Bone volume fraction was significantly greater in the RA and the OA than in the OP and the CNT. Structure model index was significantly lower in the RA and the OA than in the OP. Number of rods in the RA was significantly greater than in the other 3 groups. Number of plates and plate volume density in the RA and the OA were significantly greater than in the OP and the CNT. Mechanical properties were significantly greater in the RA and the OA than in the OP. The single best determinant for mechanical properties was bone volume fraction.ConclusionsThis study demonstrates significant differences in 3-D microarchitectural properties and rod- and plate-like trabecular morphometric properties among patients with RA, OA, or OP. The RA and OA cancellous bones displayed similar patterns of microarchitectural degeneration and pronounced different microarchitectures from the OP. The OP group revealed the weakest cancellous bone strength, while the RA and OA groups exhibited a compensatory effect that maintains bone tissues, and hence mechanical properties.The translational potential of this articleThe study enhances the understanding of microarchitectural degeneration of diseased cancellous bone. The OP group had the weakest cancellous bone strength, while the RA and OA groups exhibited a compensatory effect that maintains bone tissues, and hence mechanical properties. These results are particularly important for design and survival of joint prosthesis.

Effectiveness and safety of mycophenolate mofetil in connective tissue disorder associated interstitial lung disease: A real-life experience from India

Aim: To study the effectiveness and safety of mycophenolate mofetil (MMF) in patients with connective tissue disease (CTD) associated interstitial lung disease (ILD). Methods: The retrospective observational study was carried out from Jan 2015 to Feb 2019. Symptomatic CTD-LD patients with (HRCT chest) documented ILD and abnormal pulmonary function test (forced vital capacity, FVC&lt; 70%), who were treated with MMF were included. The treatment response was assessed clinically by pulmonary function test and radiology. Clinical assessment and PFT were done at baseline, 6, 12 and 24 months. HRCT chest was done at baseline and 24 months. Results and analysis: Out of 33 patients, 13 had MCTD, 12 had RA, and remaining 8 belonged to the systemic sclerosis (SSc)-predominant groups (3: diffuse cutaneous SSc, 2: SSc/myositis overlap, and 1 each with Sjogren’s syndrome, SLE/Sjogren’s overlap and interstitial pneumonia with autoimmune features). Increased female predominance was noted (90.9%). The mean FVC at baseline noted in MCTD, RA and SSc-predominant groups were 62±6.17, 64±4.17 and 59±6 respectively. Improvement was reported in 4 patients, each in MCTD and RA groups. Eight patients in the MCTD group and 7 each in RA and SSc- predominant groups had a stable lung disease. One patient each in all the groups reported worsening of the disease. There was a positive trend in FEV1 and FVC with treatment. No significant difference in FEV1 and FVC values with treatment was noted across the three groups. Numerical differences in the mean values of FEV1 and FVC between two groups (NSIP and UIP) were noted, but was not statistically significant. All the subjects completed 24 months of follow-up. They were on 2 g/day of MMF for the first 12 months, followed by a maintenance of 1.5- 2 g/day for the next 12 months. None of the subjects discontinued treatment due to intolerance or adverse effects.

Comparison of Clinical Outcomes After Total Ankle Arthroplasty Between End-Stage Osteoarthritis and Rheumatoid Arthritis.

Total ankle arthroplasty (TAA) is known to be a reliable operative option for end-stage rheumatoid arthritis. However, higher risk of postoperative complications related to chronic inflammation and immunosuppressive treatment is still a concern. With the use of a newer prosthesis and modification of anti-rheumatic medications, we compared clinical outcomes after TAA between patients with osteoarthritis and rheumatoid arthritis. Forty-five patients with end-stage osteoarthritis (OA group) and 19 with rheumatoid arthritis (RA group) were followed for more than 3 years after 3 component mobile-bearing TAA (ZenithTM). Perioperative anti-rheumatic medications were modified using an established guideline used in total hip and knee arthroplasty. Clinical evaluations consisted of American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). In the preoperative and postoperative evaluation at final follow-up, there were no significant differences in AOFAS, FAOS, and FAAM scores between 2 groups. Despite statistical similarity in total scores, the OA group showed significantly better scores in FAOS sports and leisure (mean, 57.4 ± 10.1) and FAAM sports activity (mean, 62.5 ± 13.6) subscales than those in the RA group (mean, 52.2 ± 9.8, P = .004; and 56.4 ± 13.2, P < .001, respectively). There were no significant differences in perioperative complication and revision rates between 2 groups. Patients with end-stage ankle RA had clinical outcomes comparable to the patients with OA, except for the ability related to sports activities. In addition, there were no significant differences in early postoperative complication rates, including wound problem and infection. Level III, prognostic, prospective comparative study.

366 Is acupuncture effective in treating symphysiolysis?

To assess whether acupuncture can decrease symphysiolysis pain and improve functioning in pregnant women with symphysiolysis The study was prospective, randomized, controlled, crossover and observer-blind. Forty of the recruited 56 women with symphysiolisis completed the study. Mean age was 30.1 years (SD 5.13); they were at 24 weeks’ gestation or later (mean 31.1 weeks, SD 5.8); tested positive for straight-leg elevation (SLE); and had pain/sensitivity >5 on the Numeric Rating Scale (NRS).Using a randomized list, the acupuncturist performed real or sham acupuncture (RA or SA). 30 minutes later, the women scored their pain. Improvement under 3 NRS points was defined as failure. Patients were crossed over for the next treatment — those previously given RA receiving SA, and vice versa. Women who scored improvement above 3 points were defined as treatment responders, and continued the same treatment. The main outcome measure was change in pain intensity, assessed by NRS from baseline to treatment end. Secondary outcomes were Modified Oswestry Disability Questionnaire(MODQ) values In baseline values (NRS=7.0 SD), reduced pain intensity was significantly greater for RA than SA (3.5 vs. 6.5, p<0.001). Baseline mean MODQ was 46.7 ± 23.3 in the SA group; 24 hours after the first SA treatment, it was 60.6 ± 13.1 (p=0.19). Pre-treatment mean MODQ in the RA group was 57.3 ± 18.7; 24 hours after the first RA treatment, it was 40.5 ± 12.8 (p=0.01). In pregnant women with symphysiolysis acupuncture is an effective therapeutic approach to decreasing pelvic pain and improving daily functioning.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Decrease of coronary heart disease risk with GLP1-receptor agonists or SGLT2 inhibitors therapy in patients with type 2 diabetes in primary cardiovascular prevention: A 24 months follow-up study

AimsThe aim of this real-world study is to evaluate the effect of glucagon-like peptide1 receptor-agonist (GLP1 RA) and sodium-glucose co-transporter2 inhibitor (SGLT2i) on coronary heart disease (CHD) risk, in patients with type 2 diabetes (T2D) in primary cardiovascular prevention. MethodsData from 312 patients with T2D, without CHD history, starting treatment with GLP1 RA (n = 174) or SGLT2i (n = 138), were retrospectively collected. UKPDS-RE score was used to estimate 10-years risk for CHD before and 6, 12 and 24 months after prescription. ResultsThe 10-year CHD risk significantly decreased over 24 months in both GLP1 RA and SGLT2i groups (p = 0.037 and p < 0.001, respectively), with 3% and 7% CHD risk reduction already obtained after the first 6 months of GLP1 RA and SGLT2i therapy respectively (p < 0.001 in both groups. Analyses by categories of baseline CHD risk showed significant reductions of CHD risk in the severe risk categories of both groups (p < 0.001). CHD risk reduction obtained with SGLT2i was higher than with GLP1 RA at 6 and 12 months but not at 24 months. ConclusionThis real-world study shows that both GLP1 RA and SGLT2i reduce the 10-year risk for cardiovascular disease in patients with T2D in primary cardiovascular prevention.

Mechanism of SMND-309 Against Lung Injury Induced by Chronic Intermittent Hypoxia

Introduction: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder that causes severe physiological disturbance. Lots of evidences showed that OSAHS was an important associated comorbidity that can affect pulmonary fibrosis patient’s survival. Until now, the potential mechanisms by which OSAS accelerate the progression of lung fibrosis are still unclear. Constructing a pathological model of chronic intermittent hypoxia (CIH), the present study aimed to explore the pathological progress and potential mechanism of lung injury caused by OSAHS. Meanwhile, SMND-309 was given for treatment to evaluate its potential therapeutic role in CIH induced lung injury. Methods: The mice were randomly divided into WT+RA group, WT+CIH group, SMND-309+RA group and SMND-309+CIH group. The WT+CIH group and SMND-309+CIH group were exposed in CIH condition for 12 weeks, while the other groups were processed in normal oxygen at the same time. SMND-309+RA group and SMND-309+CIH group were intraperitoneally injected with SMND-309 at the last week of modeling period. After 12 weeks of treatment, 3 mice of each group were perfused through the heart and lung tissues were isolated, fixed, sectioned and stained with HE, Masson and immunofluorescence stain. The rest of lung tissues were harvested for Western blot and Elisa assays. Results: The results showed that CIH treatment increased the expression of pro-inflammatory factor (TNF-α, IL-6), resulting in lung tissue structure disorder, inflammatory cell infiltration, increased pulmonary capillary permeability and pulmonary edema. The activation of NF-κB signaling pathway played a crucial role in the process of inflammation. Noticeably, we observed M2 macrophage accumulation in the lung after CIH exposure, which promoted the epithelial–mesenchymal transition (EMT) phenomenon and pulmonary tissue fibrosis process. Also, Elisa assays showed the increased expression of TGF-β, IL-10, IL-4 in CIH group. SMND-309 could inhibit pulmonary inflammation, reduce the accumulation of M2 macrophage, alleviate collagen deposition, and prevent the development of lung fibrosis. Conclusion: CIH could induce chronic lung inflammation, promote the activation of M2 macrophages, trigger the occurrence of EMT phenomenon and accelerate the deposition of lung collagen, eventually lead to lung tissue damage. This study presents a possible explanation by which interstitial lung diseases and particularly idiopathic pulmonary fibrosis (IPF) with OSAHS are usually associated with fast progress and poor prognosis. SMND-309 showed a good protective effect on CIH induced lung damage.

Stratification of Nuclear Homogeneous Patterns on HEp-2 Cells Based on Neutrophil Nuclear Staining.

Antinuclear antibody (ANA) testing is used to diagnose systemic autoimmune rheumatic disease (SARD). Nuclear homogeneous patterns on ANA-HEp-2 cells can result from anti-double-stranded DNA (dsDNA), anti-nucleosome, anti-histone, anti-Scl-70, or anti-dense fine speckles 70 (DFS70) antibodies (Abs). This study aimed to find a way to discriminate DFS70 Abs from others by way of assessing neutrophil nuclear staining on anti-neutrophil cytoplasmic antibody (ANCA) testing. Nuclear staining on ANCA-neutrophils was assessed to stratify nuclear homogeneous patterns on ANA-HEp-2 cells. Enrolled subjects included (1) young individuals with a dense fine speckled pattern on ANA testing (young non-SARD group, n=71) and patients with (2) systemic lupus erythematosus (SLE group, n=35); (3) rheumatoid arthritis possibly with histone, nucleosome Abs, and others (RA group, n=51); and (4) diffuse systemic sclerosis with Scl-70 Abs (diffuse SSc group, n=19). Negative rates (95% confidence interval) of neutrophil nuclear staining were 97.2% (90.2%–99.7%) in the young non-SARD group, 2.9% (0.1%–14.9%) in the SLE group, 3.9% (0.5%–13.5%) in the RA group, and 47.4% (24.5%–71.1%) in the diffuse SSc group. The negative rate of the young non-SARD group was significantly higher than those of the other groups (all p<0.05). In conclusion, this study suggests that the assessment of nuclear staining on ANCA-neutrophils can help to stratify nuclear homogeneous patterns on ANA-HEp-2 cells and thus to determine whether the ANA pattern is attributed to DFS70 Abs, which can be found in healthy individuals, especially in young individuals.

IL-22 and ACPA Levels and their Relationship to the Disease Activity in Rheumatoid Arthritis Patients

Aim: to determine ACPA IgG and IL-22 levels in RA patients and their relationship to the disease activity Place and duration of the study: A cross sectional study and prospective cohort study was performed from August 2020 to January 2021 in rheumatology outpatient clinic and laboratory of Al- Quwayiyah General hospital. Methodology: Forty five rheumatoid arthritis patients were included and 35 healthy participants free of any diseases considered as control group. The patients in this study met the American College of Rheumatology's 2010 guidelines. RA Disease activity was assessed for rheumatoid patients using DAS28 scoring. Serum samples collected from the patients and control to perform ESR, Hs-CRP, RF factors and also IL22 and ACPA IgG which were detected using sandwich ELISA and indirect solid phase enzyme immunoassay techniques respectively. Results: Out of the 45 RA patients, 34(75.6%) were females and 11(24.4%) were males aged from (28-67years) with median patient age 42 years. There was no statistically significant difference regarding age and sex between RA patients and control. Thirty (66.7%) of the 45 RA patients had low disease activity or remission, while 15 (33.3%) had moderate to extreme disease activity. Thirty two 32(71.1%) patients of the 45 RA patients had erosive disease. The level of ESR, hs-CRP and RF are increased in the patient group than control, in spite that there were significant differences in the Mean± SD among RA group and control group regarding RF, there was no significant statistical differences ESR, hs-CRP. in the study there was an increase in ACPA and IL-22 levels in patients suffering of RA; 21.52±1.29 U/ml and 71.22±10.63 pg\ml. respectively. While among control there was low serum levels; 14.06±2.01U/ml 33.25±2.41pg\ml and respectively. Significant statistical difference was observed regarding IL-22 and ACPA IgG levels among RA patients and control (P=0.038 and P=0.019 respectively). There is a significant positive relationship (positive correlation) detected between ACPA and IL-22 levels, (r=-0.810; p=0.597). The levels of IL-22 and ACPA were significantly associated with DAS 28. Their relationship was strong as the r value was 0.427 and 0.411 respectively. Conclusion: IL-22 and ACPA IgG levels were highly increased among RA patients in comparison to the control group. The IL-22 and ACPA IgG levels were strongly correlated with the rheumatoid disease activity, DAS 28. These results suggest that Il-22 can be used in association with ACPA IgG level as diagnostic and prognostic markers of rheumatoid arthritis

Polymorphisms in IRF5 and TYK2 Genes Are Associated with Rheumatoid Arthritis in a Chinese Han Population.

BackgroundThe IRF5 and TYK2 gene polymorphisms are associated with autoimmune diseases. However, the relationship between the IRF5 and TYK2 gene polymorphisms and RA risk in the Chinese Han population was inconsistent.Material/MethodsA total of 578 RA patients (case group) and 578 healthy controls (control group) were assessed in a case-control study. Genotyping of IRF5 (Exon 6 insertion/deletion (in/de), rs2004640, rs2070197, rs10954213) and TYK2 (rs280500, rs280519, rs280521, rs8108236, rs12720253) was performed by direct sequencing method. Data analysis was performed by SHEsis.ResultsThe rs2004640T allele (P=0.0003) and the dominant (P=0.001) and recessive (P=0.01) models of rs2004640 were associated with RA risk after stringent Bonferroni correction (0.05/4). The IRF5 exon 6 (in), rs2070197 and rs10954213 were not associated with RA (P>0.05). Two haplotypes of IRF5 (DTAT and DTGG) were associated with RA susceptibility (P<0.05). In addition, the frequencies of TYK2 rs280500A, rs280521A, and rs8108236A were significantly higher in the RA group compared with the control group (P<0.05). TYK2 rs280500, rs280521, and rs8108236 were associated with RA susceptibility in the dominant model, but the same was not observed for rs280519 and rs12720253 (P<0.05). Furthermore, 3 risk haplotypes (AAAGT, AGGAT, and GAAAT) and a protective haplotype (GAGGT) of TYK2 gene were associated with RA susceptibility (P<0.05).ConclusionsOur results suggest that IRF5 rs2004640, TYK2 rs280500, rs280521, rs8108236, and haplotypes IRF5 (DTAT and DTGG) and TYK2 (AAAGT, AGGAT, GAAAT, and GAGGT) are susceptible factors for RA in a Chinese Han population.

Robot-assisted S2 screw fixation for posterior pelvic ring injury

BackgroundPercutaneous sacroiliac screw is one of the main methods to treat unstable posterior pelvic ring injury. However, complexity of pelvic anatomical structure increases the difficulty and risk with freehand operation. Besides, S2 screw fixation began to receive attention. The purpose of the current study was to evaluate the safety, accuracy, efficiency and clinical outcome of robot-assisted S2 screw fixation for posterior pelvic ring injury. MethodsWe reviewed 128 cases of unstable posterior pelvic ring injury treated by percutaneous sacroiliac screw fixation in our hospital from January 2016 to January 2020. All cases were divided into robot-assisted S1 group (RAS1), robot-assisted S2 group (RAS2), freehand group S1 group (FHS1) and freehand group S2 group (FHS2). The mean times of fluoroscopy per screw and adjustment per guide wire were used to evaluate radiation exposure and the efficiency of screw placement, respectively. The final position of the screw was evaluated with postoperative CT to illustrate security and accuracy. 108 patients (84.38%) were followed up for 5~24 months and the Majeed scores were compared among groups. ResultsA total of 180 screws were inserted. In comparison of the mean times of fluoroscopy per screw and adjustment per guide wire, RA group was significant less than FH group, further comparison revealed that freehand S2 placement need more fluoroscopy and adjustment times compared with freehand S1 placement, but for robot-assisted procedure, there was no difference between placing S1 and S2. Screw penetration was found in the FHS1(3/48) and FHS2(2/14) and none in RAS1 or RAS2, which means robot-assisted groups were more safety and accurate (P<0.001). The mean Majeed score in RAS1 (83.33±13.47) and RAS2 (82.32±11.42) was higher than in FHS1 (80.43±12.25) and FHS2 (75.08±18.47), but this difference failed to reach significant. ConclusionCompared with the freehand operation, TiRobot increased the safety and accuracy, reduced radiation exposure, and improved the efficiency. TiRobot could reduce the risk of S2 placement and provide a safe and feasible way for clinical practice.

A Cross-Sectional Study Examining the Relationship between Patient Information Level and Patient Participation in Healthcare Decisions and Health Management

Introduction In 2018, Lymphoma Coalition (LC) analysed data from the 2018 LC Global Patient Survey (GPS) on Lymphomas and CLL and determined that 'adequately informed' patients reported more positive healthcare experiences. From the 2018 survey, it was evident that many patients with lymphoma/CLL left their initial diagnosis meeting with a poor understanding of many aspects of their treatment and care plan. This can translate negatively across many areas of the patient experience. LC used the 2020 GPS to further assess correlations relating to information provision and the patient experience. This study examines the relationship between the level of information patients with lymphoma/CLL received at diagnosis, and their level of participation in healthcare decisions and health management. Methodology This study is a sub-analysis of the 2020 LC GPS, which was available in 19 languages and was hosted online from 13 January 2020 until 13 March 2020. Globally, there were 11,878 respondents made up of 9,179 patients and 2,699 caregivers. This study includes patient data only. Patients who felt they received the right amount of information at diagnosis (n=5159) were compared against patients who did not receive enough information (n=3285). Demographics of the two patient groups were examined, and questions relating to patient involvement in healthcare decision-making, disease management, and overall experience were analysed. Differences in proportions were tested using chi-square tests (p=0.05) and odds ratios with 95% CI. Statistical analyses were performed with IBM SPSS v21. Results The two patient groups (right amount of information 'RA', not enough information 'NE') were similar in their distribution of age and area of residence. The majority of patients in both groups were aged 50 years or older (71% RA; 60% NE) and lived in city/urban areas (47% RA; 55% NE). There were slightly more females than males in the NE group (61% female, 39% male) compared to the RA group (55% female, 45% male). Additionally, the majority of patients in the RA group lived in Europe (56%) while the majority of patients in the NE group lived in Asia-Pacific (44%). Patients were asked if they are involved as much as they want to be in decisions about their care and treatment; the majority of patients in both groups said 'yes' (94% RA; 79% NE). However, only 4% of RA patients reported 'no, but I would like to be more involved', compared to 19% of NE patients. Patients were asked to indicate how much they agree or disagree with statements relating to their role in making decisions about their healthcare (see Table 1). Compared to RA patients, NE patients were at least twice as likely to disagree that they seek clarification when they do not understand (OR=2.88), that they are confident in communicating concerns to the doctor (OR=5.17), that they have good conversations with the doctor about their care and treatment plan (OR=8.29), and that they are confident in their ability to positively impact their health (OR=2.12). A greater proportion of RA patients reported agreeing with all of these statements. Further, compared to RA patients, NE patients were twice (OR=2.45) as likely to agree to feeling overwhelmed by managing their health and condition (Table 1). Patients were asked questions relating to disease management and overall patient experience (Table 2). Compared to RA patients, NE patients were more likely to disagree that they are confident in their ability to find reliable information (OR=1.69), or in their ability to get the information they need from their doctor (OR=9.58). NE patients were also more likely to disagree that they are confident in their ability to keep their symptoms/side effects from interfering with the things they want to do (OR=1.86). A greater proportion of RA patients reported agreeing with all of these statements. Conclusion Compared to patients who felt they received the right amount of information at diagnosis, those who did not receive enough information were more likely to report disagreeing with all positive statements relating to involvement in healthcare decision-making, disease management, and overall experience. It was evident that patients who had knowledge surrounding their condition and care plan were more inclined to be confident in taking an active role in managing their health and condition. Access to credible timely information is therefore an important aspect to a successful patient experience. Disclosures Dren: Pfizer Inc: Research Funding; AbbVie Corporation: Research Funding; Takeda Oncology: Research Funding. Warwick:Pfizer Inc: Research Funding; AbbVie Corporation: Research Funding; Takeda Oncology: Research Funding.

Comparison of different access sites (radial, brachial and femoral) for subclavian artery intervention

Abstract Introduction The primary purpose of this multicenter prospective register was to evaluate the success and complication rate of different access sites for subclavian artery intervention. Secondary purpose was to investigate the safety of the distal radial artery access for subclavian artery intervention. Methods The clinical and angiographic data of 223 consecutive patients with symptomatic subclavian and anonym artery stenosis treated via transradial (TR), transbrachial (TB) and transfemoral (TF) access between 2015 and 2019 were evaluated in a multicenter registry. The exclusion criteria of the intervention was the acute proximal subclavian artery thrombosis. Primary endpoint: angiographic outcome of the subclavian and anonym artery intervention, rate of major and minor access site complications. Secondary endpoints: procedural complications, consumption of the angioplasty equipment, cross over rate to another puncture site and hospitalization in days. Results The procedure was successful in 182/184 in TR, in 5/5 in TB and in 32/32 patients in TF group. The cross over rate in the TR, TB and TF group was 0%. Chronic total occlusion recanalization was successful in 75/77 cases in TR, and 15/15 cases in the TF group. Contrast consumption was 152±106 ml in TR, 99±22.5 ml in TB and 152±95 in TF group, respectively (p=ns). Cummulativ dose was 602±1205 mGray in RA, 455±210 mGray in BA and 1089±1674 mGray in FA group (p&amp;lt;0.05). Procedural complications occurred in 1/184 (0.5%) case in RA group, in 0 case (0%) in BA group and in 4/32 cases (12.5%) in the FA group (p&amp;lt;0.05). Major access site complication were detected in 3 patients (1.6%) in RA, in 1 patient in BA (20%) and in 1 patient in FA group (3.1%) (p&amp;lt;0.05). Minor access site complication were encountered in 9 patients in the RA (4.8%), in 1 patient in the BA (20%) and in 8 patients in the FA group (25%) (p&amp;lt;0.05). Distal radial access was used in 29 cases and proximal radial access in 155 patients. The rate of radial artery occlusion in proximal and distal radial group was 5.1% and 0% (p&amp;lt;0.05). Conclusions Subclavian artery intervention can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Femoral and brachial access is associated with more access site complications than radial artery access. Distal radial access is associated with less radial artery occlusion than proximal radial artery access. Funding Acknowledgement Type of funding source: None

Treatment Patterns for Gastroesophageal Junction Adenocarcinoma in the United States.

Despite the increasing incidence of gastroesophageal junction adenocarcinoma (GEJA), the optimal treatment strategy for the disease remains unknown. The objective of this study was to describe treatment patterns for GEJA in the United States. The National Cancer Database was searched to identify all patients who underwent resection of the lower esophagus, abdominal esophagus, and/or gastric cardia for GEJA between 2006 and 2016. Patients were grouped by clinical disease stage: early localized (L; T1-2N0), locally advanced (LA; T3-4N0), regional (R; T1-2N+), or regionally advanced (RA; T3-4N+). The search identified 28,852 GEJA patients. The dominant age range was 60–69 years (39%). Most patients were men (85%), and most were white (92%). Most L patients (69%) underwent upfront surgery, whereas most LA, R, and RA patients received neoadjuvant therapy (NAT; 86%, 80%, and 90%, respectively). Among patients who received NAT, 85% received chemoradiotherapy. Adjuvant therapy was relatively uncommon across all groups (15–20%). In the LA, R, and RA groups, overall survival was greater in patients who received NAT compared to upfront surgery (p < 0.001). With the exception of patients with early localized node-negative disease, most GEJA patients receive neoadjuvant chemoradiotherapy despite the lack of prospective trials reporting survival benefit over chemotherapy alone.

Rs2476601 in PTPN22 gene in rheumatoid arthritis and periodontitis\u2014a possible interface?

BackgroundRheumatoid arthritis (RA) and periodontitis (PD) are proven to share common risk markers, including genetic factors. In the present study we focused on genetic variants in PTPN22 (rs2476601), PADI4 (rs2240340), CTLA4 genes (rs3087243) and its impact on RA and PD.Materials and methodsIn the study 111 RA patients and 256 systemically healthy controls were involved. A subdivision of patients and controls was carried out according the severity of periodontitis (no/level 1 PD vs. level 2 PD).ResultsI. Evaluating the genetic impact on the occurrence of RA the T allele of rs2476601 (PTPN22) (bivariate: p < 0.001; multivariate: p = 0.018) and T allele of rs2240340 (PADI4) (bivariate: p = 0.006; multivariate: p = 0.070) were associated with an increased vulnerability to RA.II. Investigating the genetic influence on level 2 PD the T allele of rs2476601 (PTPN22) was shown to be associated with a higher susceptibility to PD within the RA group (bivariate: p = 0.043; multivariate: p = 0.024).III. The T allele of rs2476601 (PTPN22) was proven to be a significant marker of RA and level 2 PD comorbidity (bivariate: p < 0.001; multivariate: p = 0.028).ConclusionsThese results support the thesis that genetic variations may represent a possible link between PD and RA. The study increases knowledge about disease-specific and cross-disease genetic pattern.

Rheumatoid arthritis increases the risk of pleural empyema.

BackgroundRheumatoid arthritis (RA) can lead to various pulmonary manifestations. Evidence shows the possible association between RA and pleural empyema.MethodsWe conducted a retrospective cohort study to investigate the risk of pleural empyema in patients with RA. The RA group (n = 29,061) included newly diagnosed adult patients between 2000 and 2012. The comparison group (n = 1,16,244) included individuals without RA at a 1:4 ratio of frequency matched by age, gender, and diagnosis year. The occurrence of pleural empyema was monitored until the end of 2013.ResultsPatients with RA had a higher risk of developing pleural empyema than those without RA (23.6 vs 1.82 per 10,000 person-years, adjusted hazard ratio = 11.0, 95% confidence interval [CI] = 8.90–13.5). Furthermore, intensive care unit admission rates of pleural empyema were 37.7% in the RA group and 37.2% in the comparison group (adjusted odds ratio [OR] = 1.02, 95% CI = 0.66−1.57). The 30-day mortality rates of pleural empyema were 11.2% in the RA group and 10.9% in the comparison group (adjusted OR = 1.01, 95% CI = 0.51−1.88).ConclusionPatients with RA are at a greater risk of developing pleural empyema than those without RA.

Comparative effectiveness of glucagon-like peptide-1 receptor agonists versus dipeptidyl peptidase-4 inhibitors on noninvasive indices of hepatic steatosis and fibrosis in patients with type 2 diabetes mellitus

Background and aimsNonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with type 2 diabetes mellitus (T2DM). There is currently no approved treatment for NAFLD. The main aim was the evaluation of the effect of glucagon-like peptide-1 receptor agonists (GLP-1 RA) vs. dipeptidyl peptidase-4 inhibitor (DPP-4i) treatment on noninvasive indices of hepatic steatosis and fibrosis in patients with T2DM. MethodsIn this retrospective study, three noninvasive indices of hepatic steatosis [HSI, NAFLD ridge score, and triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio] and five of fibrosis (APRI, FIB-4, NAFLD fibrosis score, BAAT and BARD) were calculated before and after (6–18 months) the addition of a DPP-4i (n = 152) or a GLP-1 RA (n = 37) in patients with T2DM. ResultsRegarding steatosis indices, NAFLD ridge score was significantly decreased in the GLP-1 RA group (baseline: 0.90 ± 0.34, follow-up: 0.67 ± 0.24; p = 0.001), but not in the DPP-4i group (p = 0.25); the difference for group∗time interaction was significant (p = 0.02). HSI showed a trend between groups, being significantly different at baseline and follow-up (p < 0.001) with no significant difference in group∗time interaction. Indices of fibrosis were not essentially changed within or between groups. ConclusionsNAFLD ridge score was significantly decreased after the addition of GLP-1 RA in patients with T2DM. This study warrants further prospective clinical trials.

Comparison of regional and local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis

BackgroundArteriovenous fistulae (AVF) are the hemodialysis access modality of choice for patients with end-stage renal disease. However, they have a high early failure rate. Good vascular access is essential to manage long-term hemodialytic treatment, but some anesthesia techniques directly affect venous diameter as well as intra- and post-operative blood flow. The main purpose of this meta-analysis was to compare the results of regional and local anesthesia (RA and LA) for arteriovenous fistula creation in end-stage renal disease.MethodsWe conducted a systematic review and meta-analysis to synthesize evidence from 7 randomized controlled trials (565 patients) and 1 observational study (408 patients) with the aim of evaluating the safety and efficacy of RA versus LA in surgical construction of AVF.ResultsPooled data showed that RA was associated with higher primary patency rates than LA (odds ratio [OR], 1.88; 95% confidence interval [CI]: 1.24–2.84; P = 0.003; I2 = 31%). Additionally, brachial artery diameter was significantly increased in the RA versus LA group (mean difference [MD], 0.83; 95% CI: 0.75–0.92; P < 0.001; I2 = 97%) and the need for intra- as well as post-operative pain killers was significantly less (RA, P = 0.0363; LA, P = 0.0318). Moreover, operation duration was significantly reduced using RA versus LA (MD, − 29.63; 95% CI: − 32.78 - -26.48; P < 0.001; I2 = 100%).ConclusionsThis meta-analysis suggests that RA is preferable to LA in patients with end-stage renal disease in guaranteeing AVF patency and increasing brachial artery diameter.

Do rheumatoid arthritis patients have low back pain or radiological lumbar lesions more frequently than the healthy population? – Cross-sectional analysis in a cohort study with age and sex-matched healthy volunteers

BACKGROUND CONTEXTRheumatoid arthritis (RA) can affect the spine; however, the epidemiology of lumbar lesions and/or low back pain (LBP) in RA patients has not been well-studied. PURPOSEThe purpose of this study was to compare the prevalence of lumbar lesions and LBP in RA patients with that in healthy volunteers, and to elucidate the influence of RA on lumbar disease. STUDY DESIGNCross-sectional analysis in a cohort study with age- and sex-matched healthy volunteers. PATIENT SAMPLEThis study included 185 patients with RA and 188 gender/age-matched healthy volunteers without RA. OUTCOME MEASURESLumbar spondylolisthesis and prevalent vertebral fractures were evaluated using plain lateral X-ray images. Thoraco-lumbar scoliosis was evaluated using dual-energy X-ray absorptiometric images. LBP was assessed using the visual analogue scale (VAS) and Rolland-Morris disability questionnaire (RDQ). METHODSThe prevalence of radiological lumbar lesion and LBP was compared between the RA and control groups. In the RA group, factors associated with lumbar lesion and LBP were analyzed using a multiple logistic regression model. RESULTSThe prevalence rates of spondylolisthesis and prevalent vertebral fracture were significantly higher in the RA group than in the control group; the prevalence of thoraco-lumbar scoliosis tended to be higher in the RA group. There was no significant difference in the average LBP-VAS between the groups. However, the percentage of analgesic drug use was significantly higher, and RDQ scores tended to be worse in the RA group than the control group. Multivariate analysis revealed that age and disease activity score were both related to LBP in the RA group. CONCLUSIONSRA patients are more likely to have radiological lumbar lesions. LBP in RA patients is well controlled, similar to the level in the healthy population; however, disease activity was related to LBP in RA patients. These results suggest that disease control is important for lumbar care in RA patients.

Pravastatin attenuates atherosclerosis after myocardial infarction by inhibiting inflammatory Ly6Chigh monocytosis in apolipoprotein E knockout mice.

ObjectiveTo evaluate the protective effect of pravastatin on atherosclerotic development and inflammatory monocyte subset in atherosclerotic apolipoprotein E (ApoE)−/− mice after myocardial infarction (MI).MethodsMale ApoE−/− mice (8 weeks old) were fed a high-fat diet for 14 weeks throughout the experiment. A MI model was produced using 18-week-old ApoE−/− mice. They were randomly divided into three groups: sham group, MI group, and MI+Pra group (40 mg/kg/day pravastatin). After 4 weeks (at the end of the study period), the mice were sacrificed and cardiac function was evaluated by echocardiography. Aortic lesion areas were evaluated using oil red O staining. Plaque macrophage in aortic sinus was analyzed by immunofluorescence staining. Flow cytometry was used to explore the proportions of monocyte subsets in the blood, spleen, and bone marrow．ResultsPravastatin improved cardiac function and reduced lesion areas. It also attenuated the supply of monocytes in spleen, especially the inflammatory Ly6Chigh monocyte subset. Pravastatin also subsequently reduced macrophage accumulation in atherosclerotic lesions.ConclusionsMI accelerated chronic atherosclerosis progress. Pravastatin suppressed atherosclerotic development and inhibited inflammatory monocytosis after MI in ApoE−/− mice.