RP Group Research Articles

Does Remnant Preservation Influence Tibial Tunnel Enlargement or Graft-to-Bone Integration After Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts and Suspensory Fixation? A Computed Tomography and Magnetic Resonance Imaging Evaluation.

Background:Remnant-preserving anterior cruciate ligament (ACL) reconstruction was introduced to improve clinical outcomes and biological healing. However, the influences of remnant preservation on tibial tunnel position and enlargement are still uncertain.Purpose:To evaluate whether remnant-preserving ACL reconstruction influences tibial tunnel position or enlargement and to examine the relationship between tunnel enlargement and graft-to-bone integration in the tibial tunnel.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 91 knees with double-bundle ACL reconstructions were enrolled in this study. ACL reconstruction was performed without a remnant (<25% of the intra-articular portion of the graft) in 44 knees (nonremnant [NR] group) and with remnant preservation in the remaining 47 knees (remnant-preserving [RP] group). Tibial tunnel position and enlargement were assessed using computed tomography (CT). Comparisons between groups were performed. Furthermore, graft-to-bone integration in the tibial tunnel was evaluated using magnetic resonance imaging, and the relationship between tunnel enlargement and graft-to-bone integration at 1 year after ACL reconstruction was assessed.Results:A total of 48 knees (25 in NR group, 23 in RP group) were included; 19 and 24 knees in the NR and RP groups were excluded, respectively, because of graft reruptures and a lack of CT scans. There were no significant between-group differences in tibial tunnel position (P > .05). The degree of posterolateral tunnel enlargement in the axial plane was significantly higher in the RP group than that in the NR group (P = .007) 1 year after ACL reconstruction. The degree of anteromedial tunnel enlargement on axial CT was significantly smaller in knees with graft-to-bone integration than in those without integration (P = .002) 1 year after ACL reconstruction.Conclusion:ACL reconstruction with remnant preservation did not influence tibial tunnel position and did not decrease the degree or incidence of tibial tunnel enlargement. At 1 year postoperatively, tunnel enlargement did not affect graft-to-bone integration in the posterolateral tunnel, but graft-to-bone integration was delayed in the anteromedial tunnel.

New fixation approach for transverse metacarpal neck fracture: a biomechanical study

BackgroundFifth metacarpal neck fracture, also known as boxer’s fracture, is the most common metacarpal fracture. Percutaneous Kirschner-wire (K-wire) pinning has been shown to produce favorable clinical results. However, the fixation power of K-wires is a major concern. Plate fixation is also a surgical option, but it has the disadvantages of tendon adhesion, requirement of secondary surgery for removal of the implant, and postoperative joint stiffness. A fixation method that causes little soft tissue damage and provides high biomechanical stability is required for patients with fifth metacarpal neck fracture for whom surgical intervention is indicated. The present study proposed fixation using K-wires and a cerclage wire to treat fifth metacarpal neck fracture. The fixation power of this new method was compared with that of K-wires alone and plates.MethodsWe used a saw blade to create transverse metacarpal neck fractures in 16 artificial metacarpal bone specimens, which were then treated with four types of fixation as follows: (1) locking plate with five locking bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two K-wires (K group), and (4) two K-wires and a figure-of-eight cerclage wire (KW group). The specimens were tested by using cantilever bending testing on a material testing system. The stiffness of the four fixation types was determined by observing force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the Mann–Whitney exact test was performed to conduct paired comparison between the fixation types.ResultsThe fixation strength levels of the four fixation approaches for treating fifth metacarpal neck fracture were ranked in a descending order of LP group (24.6 ± 5.1 N/mm, median ± interquartile range) > RP group (22.2 ± 5.8 N/mm) ≅ KW group (20.1 ± 3.2 N/mm) > K group (16.9 ± 3.0 N/mm).ConclusionThe fixation strength of two K-wires was significantly higher when reinforcement was provided using a figure-of-eight cerclage wire. The strength of the proposed approach is similar to that of a regular plate with five bicortical screws but weaker than that of a locking plate with the same amount of bicortical screws. Cerclage wire-integrated K-wires can be an alternative method that avoids the excessive soft tissue dissection required for plating in open reduction internal fixation for fifth metacarpal neck fracture.

Fast-track total knee arthroplasty improved clinical and functional outcome in the first 7\xa0days after surgery: a randomized controlled pilot study with 5-year follow-up

IntroductionFast-track protocols (FP) are used more and more to optimize results after total knee arthroplasty (TKA). Many studies evaluating FP in TKA concentrate on clinical outcome and medium to long-term results. Since discharge from hospital after TKA is achieved increasingly quicker worldwide using FP in an increasingly younger and active patient population, the effects of FP on functional outcome in the first days after TKA become more important. The purpose of the current study was to compare FP with a regular joint care protocol (RP), with an emphasis on the first 7 days after surgery.Materials and methodsA non-blinded randomized controlled clinical pilot study was performed with 25 patients assigned to a FP group and 25 patients assigned to a RP group. Primary outcome was functional outcome, clinical outcome, pain, and complications for each day in the first week after surgery. Patients were followed up to 5 years after surgery.ResultsSignificantly lower VAS scores for knee pain, faster Timed-Up and Go test times and more mobility on functional tests were seen on several days in the first week in the FP group compared to the RP group. Few other significant differences were found at 2, 6 weeks, and no significant differences were found at 12 weeks and 1, 2 and 5 years after surgery.ConclusionsFast-track protocol for primary TKA showed significantly lower knee pain scores and improved functional outcome in the first 7 days after TKA compared to a regular protocol.

Overexpression of Salusin-α Inhibits Vascular Intimal Hyperplasia in an Atherosclerotic Rabbit Model.

Inhibiting vascular endothelial foam is the focus of clinical attention. Using SonoVue (an ultrasound contrast agent), the salusin-α gene was transfected into the arterial intima of an atherosclerotic rabbit model induced by a high-fat diet in this study. Subsequently the model of blood lipid indexes, the pathological structure of the intima, and changes in molecules regulating atherosclerosis were investigated. The high-density lipoprotein C and apolipoprotein A values in the salusin-α gene overexpression (P) group were higher than those in the salusin-α gene interference (RP) group (P < 0.05), whereas the total cholesterol, low-density lipoprotein C, and apolipoprotein B values were reversed. Rabbits in the P group showed significantly thinner vascular intimal thickness than that of other experimental groups (P < 0.05). The expression of positive regulators of atherosclerosis (ABCA1, ABCG1) was higher in the P group than that in the RP group (P < 0.05), and the opposite effect was observed for negative regulators (ACAT1, CD36). Thus, our results showed that the overexpression of salusin-α gene inhibited the proliferation of the vascular intima, thereby throwing some light on understanding the mechanism how salusin-α gene expression interfered with the foaming of vascular intimal cells.

ABO-Incompatible Liver Transplantation Using only Rituximab for Patients with Low Anti-ABO Antibody Titer

Background Graft survival after ABO-incompatible living donor liver transplantation (LDLT) has increased due to advances in desensitization methods. We analyzed early outcomes following ABO-incompatible LDLT without plasmapheresis in recipients with low anti-ABO antibody titers (1:32). Methods Ten adult patients underwent ABO-incompatible LDLT between September 2014 and December 2016. All patients were administered a single dose of rituximab (300 mg/m2) prior to LDLT. Three patients with baseline anti-ABO titer >1:32 also underwent multiple sessions of plasmapheresis to reduce titers to 1:32 or lower (rituximab + plasmapheresis, RP). Seven patients with low anti-ABO titer (1:32) did not undergo plasmapheresis (rituximab-only, RO). Adult ABO-compatible LDLT patients during the same period were included for comparison (n=22). Results Post-transplantation titers were significantly lower in the RO than in the RP and showed no rebound rise (POD7 1.14±0.38 vs 28.0±31.7, p=0.04), (POD30 1.26±0.45 vs 108±107, p=0.02). There were no significant differences in rejection, biliary complications, or infection between the RO and RP group. There were no significant differences in outcome between the RO group and ABO-compatible except for rate of infection (RO: 57.1%; ABO-compatible: 9.1%; p=0.02). Conclusions This study shows that recipients with low baseline anti-ABO antibody titer (≤1:32) can undergo ABO-incompatible LDLT using conventional immunosuppression and rituximab alone.

Dexmedetomidine facilitates extubation in children who require intubation and respiratory support after airway foreign body retrieval: a case-cohort analysis of 57 cases.

This study aimed to investigate whether dexmedetomidine had sedative weaning advantage for extubation after airway foreign body (FB) removal in children. A retrospective case-cohort comparison study with total of 57 critical children who required mechanical ventilation after rigid bronchoscopy was performed. After tracheal intubation, group D (received dexmedetomidine 1µg/kg over 10min, followed by an infusion of 0.8µg/kg/h), and group RP (received remifentanil-propofol 6-10µg/kg/h and 1-3mg/kg/h, respectively). The primary outcome was successful extubation rate on first weaning trial. The minor outcomes included weaning time, emergency agitation, coughing score and the incidence of respiratory adverse complications on emergency. All 57 patients were included in the analysis, with 30 patients in group D and 27 controlled cases in group RP. The success rate of first weaning trial in the D group was 96.7 vs 77.8% in the RP group, risk ratio (RR) 1.56, 95% CI [0.78-1.98]. Time for resuming spontaneous breathing after termination infusion was shorter in the D group (median 8min, IQR 15min) vs RP group (median 12min, IQR 19min, P = 0.02, RR 0.56, 95% CI 0.14-6.57). In mechanical ventilation of pediatric patients following rigid bronchoscopy, in comparison to remifentanil-propofol, dexmedetomidine is proved to have high success rate for weaning strategy. WHAT IS ALREADY KNOWN?: Remifentanil is proved to be effective for weaning in ICU patients. Dexmedetomedine can provide similar rates of smooth extubation for pediatric patients who underwent airway surgery. WHAT THIS ARTICLE ADDS?: Invasive ventilation is used for patients with severe comorbidity after airway surgery, but the correct strategy for pediatric extubation after removal of airway foreign body remains unclear. For these patients with short-term mechanical ventilation, dexmedetomedine may improve the extubation rate, when compared with remifentanil-propofol.

Endopyelotomy versus redo pyeoloplasty for management of failed pyeloplasty in children: A single center experience

PurposeWe compared endopyelotomy to redo pyeloplasty for the treatment of failed pyeloplasty in children to identify factors that may have an impact on outcome and favor one procedure over the other. MethodsOf 43 patients with recurrent UPJO, EP was performed in 27 and RP was performed in 16. Age, gender, side, presentation of secondary UPJO, hospital stay, complications and success rates were compared. Success was defined as radiographic relief of obstruction as determined by ultrasound or diuretic renography at latest follow-up. ResultsMean (Range) patient age was 7.2 years (range 6 months to 17 years) in EP (group 1) while 7.4 (range 6 months to 17 years) in RP (group 2). EP technique consisted of retrograde cold-knife in 17 patients, retrograde holmium laser in 8 and antegrade cold-knife in 2. RP was performed in 16 patients. All the patients with failed EP had a stricture greater than 15 mm. Mean length of the narrowed ureteral segment was 17.8 mm in the failed EP group vs 10 mm in the successful group (p < 0.001). Mean Hospital stay was 1 day for the EP group and 5 days for the RP group (p < 0.001). Mean follow-up was 17 months (range 12 to 43) after EP and 21 months (12 to 51) after RP. There was no statistical significance between both groups regarding the postoperative degree of hydronephrosis, parenchymal thickness, split renal functions and renal drainage. The overall success was (86%); the success was nonsignificantly higher in RP (93.8%) vs (81.5%) in EP. ConclusionIn selected children, retrograde endopyelotomy is safe and may give comparable short-term outcomes as open redo pyeloplasty for correction of secondary UPJO after failed pyeloplasty. Narrowed ureteral segment greater than 15 mm and preoperative grade 4 hydronephrosis were factors significantly associated with a poor outcome after EP. A Level-of-Evidence rating for classifying study qualityLEVEL III Retrospective comparative study.

Defect propagation in NiTi rotary instruments: a noncontact optical profilometry analysis.

To evaluate the presence and propagation of defects and their effects on surfaces of nickel-titanium (NiTi) instruments using noncontact, three-dimensional optical profilometry, and to assess the accuracy of this method of investigation. The flute surface areas of instruments from two commercial instrumentation systems, namely Reciproc R25 (n=5) and WaveOne Primary (n=5), were assessed and compared before and after performing two instrumentation cycles in simulated root canals in clear resin blocks. All the analyses were conducted on areas measuring 211×211μm, located 3mm from the tips of the instruments. A quantitative analysis was conducted before and after the first and second instrumentation cycles, using the Sa (average roughness over the measurement field), Sq (root mean square roughness) and Sz (average height over the measurement field) amplitude parameters. All the data were submitted to statistical analysis at a 5% level of significance. There was a significant increase (P=0.007) in wear in both groups, especially between baseline and the second instrumentation cycle, with significantly higher wear values being observed on WaveOne instruments (Sz median values=33.68 and 2.89μm, respectively, for WO and RP groups). A significant increase in surface roughness (P=0.016 and P=0.008, respectively, for Sa and Sq) was observed in both groups from the first to the second instrumentation cycle, mostly in WaveOne specimens. Qualitative analysis revealed a greater number of defects on the flute topography of all the instruments after use. More defects were identified in WaveOne Primary instruments compared to Reciproc R25, irrespective of the evaluation stage. The investigation method provided an accurate, repeatable and reproducible assessment of NiTi instruments at different time-points.

Growth performance, digestion and metabolism to fish meal replacement by rice protein concentrate in Chinese soft-shelled turtle Pelodiscus sinensis

An 8-week feeding trial was conducted to evaluate growth performance, whole-body composition, metabolism and digestion of Chinese soft-shelled turtle Pelodiscus sinensis fed with fish meal replacement by rice protein concentrate and squid paste supplementation diets. Three isonitrogenous and isoenergetic practical diets were formulated with the inclusion of 60% fishmeal (CT), 42% fish meal +18% rice protein concentrate (RP) and 42% fish meal +18% rice protein concentrate +1% squid paste (feeding attractant) (RPS), respectively. Microcapsule lysine was supplemented in RP and RPS diets to balance the amino acid profile. Turtles (initial weight 30.65 g) were fed thrice (6:00, 12:00 and 18:00) daily to apparent satiation. The results showed that growth performance in RP group showed no significant difference with that in CT group (P > .05). In addition, daily squid paste supplementation significantly improved growth performance, nutrients retention and relative feed intake (P < .05). Significantly increased activities of hepatic alanine aminotransferase as well as intestinal protease, γ-glutamyl transpeptidase, aminopeptidase N and carboxypeptidase A were also observed in RPS group (P < .05). The results suggested that rice protein concentrate could replace 18% dietary fish meal in Pelodiscus sinensis with microcapsule lysine supplementation. Besides, diet with squid paste inclusion could improve feed intake and growth performance of Pelodiscus sinensis.

Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma: Results From a Multi-institutional Consortium Study

Gleason score (GS) 10 disease is the most aggressive form of clinically localized prostate adenocarcinoma (PCa). The long-term clinical outcomes and overall prognosis of patients presenting with GS 10 PCa are largely unknown because of its rarity. The study included 112 patients with biopsy-determined GS 10 PCa who received treatment with radical prostatectomy (RP, n = 26), external beam radiation therapy (EBRT, n = 48), or EBRT with a brachytherapy boost (EBRT-BT, n=38) between 2000 and 2013.Propensity scores were included ascovariates for comparative analysis. Overall survival, prostate cancer-specific survival, and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method with inverse probability of treatment weighting to control for confounding. The median follow-up period was 4.9years overall (3.9years for RP, 4.8years for EBRT, and 5.7years for EBRT-BT). Significantly more EBRT patients than EBRT-BT patients received upfront androgen deprivation therapy (98% vs 79%, P<.01 by χ2 test), though the durations were similar (median, 24months vs 22.5months). Of the RP patients, 34% received postoperative EBRT, and 35% received neoadjuvant systemic therapy. The propensity score-adjusted 5-year overall survival rate was 80% for the RP group, 73% for the EBRT group, and 83% for the EBRT-BT group. The corresponding adjusted 5-year prostate cancer-specific survival rates were 87%, 75%, and 94%, respectively. The EBRT-BT group trended toward superior DMFS when compared with the RP group (hazard ratio, 0.3; 95% confidence interval 0.1-1.06; P = .06) and had superior DMFS when compared with the EBRT group (hazard ratio, 0.4; 95% confidence interval 0.1-0.99; P = .048). To our knowledge, this is the largest series ever reported on the clinical outcomes of patients with biopsy-determined GS 10 PCa. These data provide useful prognostic benchmark information for physicians and patients. Aggressive therapy with curative intent is warranted, as >50% of patients remain free of systemic disease 5years after treatment.

Oncological and peri-surgical outcomes of radical prostatectomy for non-metastatic prostate cancer with prostate-specific antigen level of 50 ng/ml or greater

The role of radical prostatectomy in treating non-metastatic prostate cancer patients with high prostate-specific antigen levels remains unclear. We evaluated the feasibility and oncological outcomes of radical prostatectomy in non-metastatic prostate cancer patients with prostate-specific antigen levels of 50 ng/ml or higher. This retrospective study included 31 patients who were diagnosed as very high-risk prostate cancer (clinical stage of any T, N0-1 M0 and PSA levels ≥50 ng/ml) and underwent radical prostatectomy either as a monotherapy or as a component of multimodal therapy (RP group). Surgery-related complications were investigated. Time to castration-resistant prostate cancer, cancer-specific survival, and overall survival were estimated using the Kaplan-Meier method. A total of 47 patients with very high-risk prostate cancer who were treated with androgen deprivation therapy without local therapy served as a control group (ADT group). Survivals were compared between RP group and ADT group in exploratory analyses. The median pretreatment prostate-specific antigen was 87 ng/ml and 100 ng/ml in the RP and ADT groups, respectively (P = 0.67). Surgical complications of Clavien-Dindo Grade 3 were documented in nine patients (29%). Ten-year castration-resistant prostate cancer-free, cancer-specific and overall survivals were 78%, 81% and 77% in RP group, respectively, and they were significantly better than those of ADT group (54%, P = 0.006; 54%, P = 0.006 and 38%, P < 0.001). Exploratory multivariate analysis identified radical prostatectomy as the only significant factor associated with a better cancer-specific survival (hazard ratio: 0.25, P = 0.006). Radical prostatectomy is feasible for non-metastatic prostate cancer patients with prostate-specific antigen levels of 50 ng/ml or higher. Radical prostatectomy is a viable option for select patients with non-metastatic, very high-risk prostate cancer.

Impairment of microcirculation and vascular responsiveness in adolescents with primary Raynaud phenomenon

Background Raynaud’s phenomenon (RP) is a functional vascular disease, presenting with recurrent episodes of ischemia of extremities in response to cold and emotional stress. Investigating cutaneous microcirculation is an important tool in understanding the complex neuro-immuno-vascular interactions in its pathophysiological mechanisms. Since there is no available data on vascular responsiveness in RP in the paediatric population, we investigated skin perfusion and heat-induced hyperaemia in comparison with clinical severity and laboratory parameters of the disease.MethodsFifty two adolescents (27 patients with primary RP and 25 age-matched healthy controls) were investigated in the study. Patients were divided into two groups according to the symptoms existing within the previous 2 months. Following baseline microcirculation measurement with Laser Doppler flowmetry (Periflux 5000 system), all subjects underwent local heating test at 42 °C and 44 °C. Besides routine laboratory parameters, immune-serological tests and the vasoactive sensory neuropeptides somatostatin and pituitary adenylate-cyclase activating polypeptide (PACAP) were measured.ResultsBaseline perfusion measured in perfusion units (PU) at 32 °C was significantly lower in symptomatic RP patients (97.6 ± 22.4 PU) compared with both healthy volunteers (248.3 ± 23.5 PU, p < 0.001) and RP patients without symptoms (187.4 ± 24.9 PU, p < 0.05). After local heating to 42 °C maximum blood flow was significantly reduced in primary RP participants with current symptoms (358.6 ± 43.9 PU, p < 0.001), but not in asymptomatic ones (482.3 ± 28.7 PU, p > 0.05) when compared with healthy subjects (555.9 ± 28.2 PU). Both the area under the response curve and the latency to reach the maximum flow were significantly increased in both RP groups (symptomatic 164.6 ± 7.4 s, p < 0.001, asymptomatic 236.4 ± 17.4 s, p < 0.001) when compared with the control group (101.9 ± 4.7 s). The heat-induced percentage increase from baseline to maximal blood flow was significantly greater in symptomatic RP adolescents in comparison with healthy ones. Laboratory parameters and neuropeptide plasma levels were not altered in any groups.ConclusionTo our knowledge this is the first study in paediatric population to show altered heat-induced cutaneous hyperaemia responses in relation with the clinical severity and symptomatology.

A comparison of desensitization methods: Rituximab with/without plasmapheresis in ABO-incompatible living donor liver transplantation

BackgroundPlasmapheresis is a desensitization method used prior to ABO-incompatible (ABO-I) living donor liver transplantation. However, studies on its usefulness in the rituximab era are lacking. MethodsFifty-six adult patients underwent ABO-I living donor liver transplantation between January 2012 and October 2015. A single dose of rituximab (300 mg/m2) was administered 2 weeks before surgery with plasmapheresis in all patients until February 2014 (RP group, n = 26). Patients were administered rituximab only, without plasmapheresis between March 2014 and October 2015 (RO group, n = 30). ResultsThe 6-, 12- and 18-month overall survival rates were 92.3%, 80.8% and 76.9% in the RP group and 96.6%, 85.4% and 85.4% in the RO group, respectively (P = 0.574). When the initial isoagglutinin titers < 16, neither group showed a rebound rise of isoagglutinin titers. For patients with initial isoagglutinin titers ≥ 16, the rebound rise of isoagglutinin titers was more prominent in the RP group. There was no difference in time-dependent changes in B cell subpopulations and ABO-I-related complications. ConclusionsSufficient desensitization for ABO-I living donor liver transplantation can be achieved using rituximab alone. This desensitization strategy does not affect the isoagglutinin titers, ABO-I-related complications and patient survival.

Efektifitas Penerapan Ideal Include Discuss Educate Asses Listen Discharge Planning terhadap Average Length of Stay AvLOS Hospital Costs pada Pasien Congestive Heart Failure

The aim of the research was to determine the effect of IDEAL Discharge Planning Implementation on Average Length of Stay (AvLOS) and Hospital Cost patients with Congestive Heart Failure (CHF). The research used quasy experiment post test only non equivalent control group design. The sample was 36 respondents consisting of 18 intervention groups and 18 control groups. Data were analyzed using two methods, Mann Withney statistical test for numerical data and Fisher's Exact Test for categorical data.The results showed that there was significant effect of discharge planning implementation on AvLOS and Hospital Cost patients with CHF with p Value < 0.05 where the mean value of AvLOS group of intervention group 4.83 days was much shorter than the mean AvLOS control group extending up to 8.28 days with p 0.015. This also has implications for Hospital Cost where the mean control group is much larger that is Rp. 6,798,659.22 while in the intervention group of Rp. 3,291.54 with significance level p 0.001.

Laser photocoagulation and Cryotherapy for Treatment of Retinopathy of Prematurity

ROP is a neovascular eye disease that affects the developing retina in premature infants and is a leading cause of preventable childhood blindness. Transscleral cryotherapy to the avascular retina was applied in cases with threshold disease may reduce unfavorable outcome to 21.8% compared with the untreated eyes (43%). Early treatment of high-risk pre threshold ROP according to ETROP criteria significantly reduced unfavorable outcomes to a clinically important degree from 15.6% to 9.1%. Analyzing ETROP long term results showed unfavorable results especially in posterior Zone-I and AP-ROP cases. Although anti-VEGF therapy is a promising therapy in these RP group, its use is still controversial.

Custom Implant for Reconstruction of Mandibular Continuity Defect

The purpose of this study was to compare the daily food intake rate and the rate of screw loosening between 2 groups of rabbits with mandibular continuity defects: custom implant (CI) group and 5-hole mini-plate group. Two types of cylindrical implants were printed, and their physical strength was compared. In this study using rabbits, 1 group (n=5) received a CI for the reconstruction of a mandibular continuity defect (CI group) and the other group (n=5) received a 5-hole mini-plate without a bone graft (reconstruction plate [RP] group). After reconstruction, the daily food intake rate and the rate of screw loosening were examined postoperatively. Histologic examination in the CI group was performed 3months after the operation. The design that mimicked the mandible showed greater physical strength. The amount of time required to achieve 50% recovery was shorter in the CI group than in the RP group (P=.011).The total number of loosened screws in the CI group was lower than that in the RP group at 3months postoperatively (P=.008). New bone formation in the porous CI was evident in the CI group. Rabbits with mandibular continuity defects treated with CIs for reconstruction showed faster recovery of the daily food intake rate and fewer loosened screws than those treated with a 5-hole mini-plate without bone graft.

Long Term Outcome of Lenalidomide-Dexamethasone (Rd) Vs Melphalan-Lenalidomide-Prednisone (MPR) Vs Cyclophosphamide-Prednisone-Lenalidomide (CPR) As Induction Followed By Lenalidomide-Prednisone (RP) Vs Lenalidomide (R) As Maintenance in a Community-Based Newly Diagnosed Myeloma Population: Updated Analysis of EMN01 Phase III Study

Introduction : Rd and MPR showed to be effective combinations in elderly newly diagnosed multiple myeloma (NDMM) patients (pts). Cyclophosphamide is a less toxic alkylating alternative agent. EMN01 is the first trial to formally compare these three different Lenalidomide-based combinations. Maintenance with Lenalidomide has been recently approved in patients eligible for autologous stem cell transplant (ASCT). Few data are available about the best combination as maintenance in patients not eligible for ASCT.Methods : 662 pts with NDMM were randomized to receive 9 28-day cycles of Rd (lenalidomide 25 mg/day for 21 days; dexamethasone 40 mg on days 1,8,15 and 22 in pts 65-75 years old and 20 mg in those >75 years), MPR (lenalidomide 10 mg/day for 21 days; melphalan orally 0.18 mg/Kg for 4 days in pts 65-75 years old and 0.13 mg/Kg in >75 years pts; prednisone 1.5 mg/Kg for 4 days) or CPR (lenalidomide 25 mg/day for 21 days; cyclophosphamide orally 50 mg/day for 21 days in pts 65-75 years old and 50 mg every other day in >75 years pts; prednisone 25 mg every other day). After induction, pts were randomized to receive maintenance with lenalidomide alone (R; 10 mg/day for 21 days) or with prednisone (RP; R, 10 mg/day for 21 days and P, 25 mg every other day), until disease progression.Results : Pts characteristics were well balanced in all groups; 217 pts in Rd, 217 in MPR and 220 in CPR arms could be evaluated. After a median follow-up of 63.7 months, median PFS was 23.2 months in MPR, 18.9 months in CPR and 18.6 months in Rd (MPR vs CPR p=0.02; MPR vs Rd p=0.08). Median overall survival (OS) was 79.9 months in MPR, 69.4 months in CPR and 68.1 months in Rd (MPR vs CPR p=0.98; MPR vs Rd p=0.64). The most common grade ≥3 adverse event (AEs) was neutropenia: 64% in MPR, 29% in CPR and 25% in Rd pts (p<0.0001). Grade ≥3 non hematologic AEs were similar among arms. At the end of induction, 402 pts were eligible for maintenance, 198 in the RP and 204 in the R groups. PFS from start of maintenance was 22.2 months in the RP group and 17.6 in the R group, with 20% reduced the risk of death/progression for pts receiving RP maintenance (HR 0.81, p=0.07; Figure 1). A subgroup analysis was performed to determine the consistency of RP vs R treatment effect in different subgroups using interaction terms between treatment and cytogenetic abnormalities, ISS, age, sex, induction treatment and response before maintenance (Figure 1). No difference in OS was observed (HR 1.02, p=0.93) but the OS analysis was limited by the low number of events. Median duration of maintenance was 23.0 months in RP pts and 20.5 months in R pts, 14% and 13% of pts discontinued due to AEs, in RP and R groups, respectively.Conclusion : This phase III trial compared 2 different Lenalidomide-containing induction regimens and 2 different Lenalidomide-containing maintenance regimens in an elderly community-based NDMM population. MPR prolonged PFS by approximately 5 months, yet the higher incidence of hematologic toxicity should be carefully considered. The addition of low-dose prednisone to standard lenalidomide maintenance reduced the risk of death/progression by 20%, with a good safety profile. Updated results will be presented at the meeting. [Display omitted] DisclosuresBringhen:Mundipharma: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria; Celgene: Honoraria; Bristol Myers Squibb: Honoraria; Karyipharm: Membership on an entity's Board of Directors or advisory committees. Offidani:celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Musto:Celgene: Honoraria; Janssen: Honoraria. Gaidano:Gilead: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Roche: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria. De Sabbata:Celgene: Membership on an entity's Board of Directors or advisory committees. Palumbo:Sanofi: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Binding Site: Research Funding; Celgene: Consultancy, Honoraria, Research Funding; Merck: Consultancy, Honoraria, Research Funding; Genmab A/S: Consultancy, Honoraria, Research Funding; Janssen-Cilag: Consultancy, Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding, Speakers Bureau; Takeda: Consultancy, Employment, Equity Ownership, Honoraria, Research Funding. Hájek:Amgen, Takeda, BMS, Celgene, Novartis, Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Consultancy, Honoraria; Pharma MAR: Consultancy, Honoraria. Boccadoro:Novartis: Honoraria, Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; AbbVie: Honoraria; Mundipharma: Research Funding; Sanofi: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Janssen: Honoraria, Research Funding.

Impact of Respiratory Viral Panel Polymerase Chain Reaction Assay Turnaround Time on Length of Stay and Antibiotic Use in Patients With Respiratory Viral Illnesses.

Background: Respiratory viral illnesses account for many hospitalizations and inappropriate antibiotic use. Respiratory viral panels by polymerase chain reaction (RVP-PCR) provide a reliable means of diagnosis. In 2015, the RVP-PCR assay at our institution was switched from respiratory viral panel (RVP) to rapid respiratory panel (rapid RP), which has a faster turnaround time (24 hours vs 12 hours, respectively). The purpose of this study was to evaluate the effect of RVP-PCR tests on duration of antibiotic use and length of stay (LOS) in hospitalized patients. Methods: We performed a retrospective chart review of patients who had a RVP-PCR ordered within a 1-year time period before and after the assay switch. Patients who were pregnant, had received antibiotics within 30 days prior to admission, were not discharged, or had not completed antibiotics by end of study period were excluded. Results: Data were obtained from a total of 140 patients (70 in each group). Of these, 25 (35.7%) in the RVP group and 28 (40.0%) in the rapid RP group had a positive result. The median LOS was 4.5 days (IQR, 3-9 days) in the RVP group and 5 days (IQR, 3-9 days) in the rapid RP group (P = .78). The median duration of antibiotic use was 4 days (IQR, 2-7 days) in the RVP group and 5 days (IQR, 1-7 days) in the rapid RP group (P = .8). Conclusion: Despite faster turnaround time, there was no significant difference in duration of antibiotic use, or LOS between the RVP and rapid RP groups.

Relation Between Tunnel Enlargement and Graft Integration, and the Effect of Remnant-Preserved Technique on Tunnel Enlargement after Double-Bundle Anterior Cruciate Ligament Reconstruction with Semitendinosus Autografts

Tunnel enlargement did not influence graft-tunnel integration at 12 months after ACL reconstruction, and remnant-preserved ACL reconstruction did not decrease the incidence of tibial tunnel enlargement after ACL reconstruction. The relation between the tunnel enlargement and graft-tunnel integration has not been evaluated sufficiently to date. Furthermore, tibial remnant-preserved ACL reconstruction was expected to reduce the tibial tunnel enlargement. The purposes of this study were to evaluate the relation between the tunnel enlargement and the graft-tunnel integration, and to evaluate the effect on remnant-preserved technique for tibial tunnel enlargement after ACL reconstruction. From April 2012 to March 2014, 112 consecutive double-bundle ACL reconstruction using ST grafts were performed. The inclusion criteria were primary ACL reconstruction, and subjects who underwent CTs one week and 12 months postoperatively and MRIs 12 months postoperatively. The exclusion criteria were revision surgery, multiligament lesion, osteoarthritis and chondral lesions requiring treatment. A total of 48 knees were enrolled in this study: 25 knees had ACL reconstruction without preserved remnant (remnant < 25% of intra-articular portion of graft) (NP group), and 23 knees had ACL reconstruction with preserved remnant (remnant > 25%) (RP group). The tunnel measurement was taken digitally at 10mm from the intraarticular outlet of both the femoral and the tibial tunnels in the sagittal and axial views of CT, respectively, perpendicular to the direction of the long axis of the tunnels. The percentage change in the diameter between the scans performed at 1 week and 12 months was defined as the degree of tunnel enlargement. The incidence of tunnel enlargement was determined by the number of femoral or tibial tunnels that enlarged more than 20%. At 12 months after reconstruction, axial (for tibial tunnel integration) and sagittal (for femoral tunnel integration) 1.5-T MRI sections with proton density T2-weighted sequence were obtained. Regarding graft-tunnel interface, positive or negative for synovial fluid presence was assigned to each: 1 and 2. The chi-square test was used to characterize the relationship of tunnel enlargement to tunnel integration at 12 months after ACL reconstruction. Comparison between the NR and RP groups was performed using the chi –square test for the incidence of tibial tunnel enlargement. The incidences of the femoral AM and PL tunnel enlargements were 42.5% and 40.4%, respectively, and those of the tibial AM and PL tunnels were 30.3% and 34.2%, respectively. The incidence of the graft-tunnel integration at 12 months after reconstruction in the negative tunnel enlargement was 62.9%, while that in the positive tunnel enlargement was 61.6%, and there were no significant differences between them =0.98). Furthermore, there were no significant differences of the incidence of tibial tunnel enlargement between the NR and RP groups (NR group: AM; 33.3%, PL; 20.0%, RP group: AM; 33.3%, PL; 53.3%. p=0.24). Tunnel enlargement did not influence graft-tunnel integration at 12 months after ACL reconstruction. Remnant-preserved ACL reconstruction did not decrease the incidence of tibial tunnel enlargement after ACL reconstruction.

Influence of the Diameter of Dental Implants Replacing Single Molars: 3- to 6-Year Follow-Up.

The aim of this study was to evaluate the influence of the implant diameter on marginal bone remodeling around dental implants replacing single molars after a follow-up period of 3 to 6 years. Patients who received dental implants with an external hexagon platform in healed sites to support a single metal-ceramic crown in the molar region were recalled to the office. The implantation sites and implant length information were recorded, and the implants were divided according to the implant diameter: regular (RP) or wide (WP). Each implant was assessed by digital periapical radiography, using a sensor holder for the paralleling technique. The marginal bone remodeling was determined as the distance from the implant platform to the first bone-to-implant contact, and the known implant length was used to calibrate the images in the computer software. The follow-up measurements were compared with those obtained from the radiograph taken at the time of prosthetic loading to determine the late bone remodeling. The independent t test was used to compare data. A total of 67 implants from 46 patients were evaluated with a mean follow-up period of 4.5 ± 1.0 years. The RP group comprised 36 implants from 29 patients (mean age: 58.3 ± 10.6 years), while 31 implants from 17 patients (mean age: 56.9 ± 11.5 years) were included in the WP group. The RP group presented lower survival rates (86.1%) than the WP group (100.0%). Similar marginal bone loss (P < .05) was identified for the RP and WP groups (1.35 ± 0.96 mm and 1.06 ± 0.70 mm, respectively). Although wide-diameter implants exhibited lower incidence failures, the bone levels were similar after the prosthetic loading around regular- and wide-diameter implants supporting single molar crowns.