Three-year Follow-up Research Articles

Intramedullary headless screw fixation for fractures of the proximal phalanges of the hand: a three-year follow-up

ObjectiveThe objective of this study was to evaluate the long-term outcomes of trans-articular intramedullary fixation using cannulated headless screws for proximal phalanx fractures in the hand.BackgroundVarious surgical techniques have been described for the fixation of proximal phalanx fractures, with Kirschner wires, plates, and screws being commonly used. The objective of this study was to evaluate the long-term outcomes of trans-articular intramedullary fixation using cannulated headless screws for proximal phalanx fractures in the hand. Methods Eight patients, with nine proximal phalanx fractures, treated with intramedullary screw fixation, were included for a follow-up visit three years post-surgery. Subjective and objective outcome measures were assessed using the Michigan Hand Questionnaire (MHQ), active range of motion (aROM), grip strength, conventional X-rays, and digital tomosynthesis images.MethodsEight patients, with nine proximal phalanx fractures, treated with intramedullary screw fixation, were included for a follow-up visit three years post-surgery. Subjective and objective outcome measures were assessed using the Michigan Hand Questionnaire (MHQ), active range of motion (aROM), grip strength, conventional X-rays, and digital tomosynthesis images.ResultsWe observed a mean MHQ score of 83%, a total aROM of 216.4°, and a Jamar grip strength of 29.9 kg in the injured hand. Digital tomosynthesis revealed complete fracture consolidation in all cases. Joint arthrosis was detected in only one case, attributed to a misplaced screw.ConclusionsOur findings indicate favorable long-term clinical outcomes, including range of motion, grip strength, patient satisfaction, and prevention of joint damage, with the use of intramedullary headless screw fixation.Level of evidence: Level IV, Therapeutic

Mortality in Amputees with Peripheral Artery Disease during the Post-COVID Era: A Three-Year Analysis.

Patients with peripheral artery disease (PAD) have 40-70% higher three-year mortality after lower limb amputation compared to non-amputees. In this study, we examined the consequences of delayed treatment for patients with PAD during the coronavirus disease 2019 (COVID-19) pandemic. This study employed a retrospective single-centre cohort design at a large tertiary care hospital. We compared amputees with PAD during the initial COVID-19 outbreak period in 2020 with a control group of amputees from 2019 after a three-year follow-up. In total, 134 amputees with PAD were included due to unsuccessful revascularization (n = 84 in 2020 vs. n = 50 in 2019). Patients in 2020 were significantly younger than those in 2019 (p = 0.01) and mostly admitted with advanced stages of PAD (p < 0.03). The proportion of major limb amputations increased significantly in 2020 (p = 0.03). Non-COVID-19-related deaths among patients in 2020 were more than twice as many as those in 2019, and long-term mortality in 2020 was 49% compared to 39% in 2019 (p = 0.04). Diabetes and renal insufficiency had a significantly negative impact on the survival of amputees with PAD (p < 0.01). Delayed treatment in patients with PAD leads to high long-term mortality risk after amputation, especially in PAD patients with diabetes and renal insufficiency. Therefore, in future pandemics, continuously monitoring patients with PAD will be crucial to prevent delayed treatment and severe short-term and long-term consequences.

Unveiling Melanoma: A Deep Dive into Disparities at a Latin-American Cancer Institute.

The worldwide incidence of melanoma has increased in the last 40 years. Our aim was to describe the clinic-pathological characteristics and outcomes of three cohorts of patients diagnosed with melanoma in a Latin-American cancer institute during the last 20 years. We evaluated three retrospective patient cohorts diagnosed with melanoma at Instituto Nacional de Enfermedades Neoplasicas (INEN), a public hospital in Lima, Peru, for the years 2005-2006, 2010-2011, and 2017-2018. Survival rate differences were assessed using the Log-rank test. Overall, 584 patients were included (only trunk and extremities); 51% were male, the mean age was 61 (3-97) years, and 48% of patients resided in rural areas. The mean time to diagnosis was 22.6 months, and the mean Breslow thickness was 7.4 mm (T4). Lower extremity was the most common location (72%). A majority of the patients (55%) had metastases at the time of presentation, with 36% in stage III and 19% in stage IV. Cohorts were distributed as 2005-2006 (n=171), 2010-2011 (n=223), and 2017-2018 (n=190). No immunotherapy was used. Cohort C exhibited the most significant increase in stage IV diagnoses (12.3%, 15.7%, 28.4%, respectively; p<0.01). The median overall survival rates at the three-year follow-up demonstrated a decline over the years for stages II (97%, 98%, 57%, respectively; p<0.05) and III (66%, 77%, 37%; p<0.01). There has been a worsening in the incidence of late-stage metastatic melanoma in Peru throughout the years, coupled with a significant decline in overall survival rates. This is underscored by the fact that half of the population lives in regions devoid of oncological access.

Three-Year Follow-up of PositiveLinks: Higher Use of mHealth Platform Associated with Sustained HIV Suppression

PositiveLinks (PL) is a mHealth platform to support care engagement by people with HIV (PWH). Daily reminders prompt the user to report medication adherence, mood, and daily stress. Higher response rate to PL check-ins has been associated with better suppression of viral load over 6–18 months. We conducted a retrospective chart review for a three-year period collecting demographic information, average mood and stress scores, and all viral loads obtained in usual patient care. We performed multivariable logistic regression modeling to identify factors associated with loss of viral load suppression and a time-to-event survival analysis until first unsuppressed viral load stratified by PL usage. Of the 513 PWH included, 103 had at least one episode of viral non-suppression. Low users of PL were more likely to have an unsuppressed viral load with an adjusted Odds Ratio (aOR) of 5.8 (95% CI 3.0-11.5, p < 0.001). Protective factors included older age (aOR 0.96; 95% CI 0.93–0.98, p = 0.003) and income above the federal poverty level (FPL) (aOR 0.996; 95% CI 0.995–0.998, p < 0.001). High PL use was also associated with better viral load suppression (VLS) over time (p < 0.0001 ((aHR) of 0.437 (95% CI 0.290–0.658, p < 0.001)) after adjusting for age and FPL. High stress scores were related to subsequent loss of viral suppression in an exploratory analysis. High check-in response rate on the PL app, older age, and higher income are associated with sustained VLS over time. Conversely, lack of response to check-ins or increased reported stress may signal a need for additional support.

Effectiveness of OHSAS 18001 in reducing accidents at work. A follow-up study of 13,102 workplaces

IntroductionMany organizations worldwide have adopted certified occupational health and safety management systems (COHSMSs), such as OHSAS 18001. The effectiveness of COHSMSs in improving health and safety at work has become an important question for authorities, companies, and other stakeholders. This study aims to examine whether the adoption of COHSMSs leads to reduced risk of severe accidents at work. MethodWe used a register-based longitudinal design, to compare the risk of severe accidents among adopters to non-adopters of COHSMS in the period 2010 – 2018. We linked a national register of COHSMS adopters with individual-level information on reportable accidents in the Labour Market Insurance (LMI) register to compare the risk of severe accidents at work among 805 adopters of COHSMS with a matched control group of 12,297 non-adopters of COHSMS. Multivariable Poisson regression models were used to calculate rate ratios (RR) with 95% confidence intervals (CI). ResultsThe risk of severe accidents at work was 14% lower among adopters of COHSMS compared to non-adopters already two years before the date of certification (RR 0.86, 95% CI 0.76–0.98), but no further decrease in the rate ratio could be established at three-year follow-up (RR 0.85, 95% CI 0.75–0.97). In addition, we found no decrease in the rate ratio for all reportable accidents at work at three-year follow-up. ConclusionWorkplaces with a lower risk of accidents are more likely to adopt COHSMS, indicating either a self-selection effect or that adopting workplaces have improved safety during the pre-certification phase for obtaining a certificate. Adopters of COHSMS did not reduce reportable severe work accidents further at three-year follow-up after the date of certification. This study did not find support for an effect of COHSMS on reportable severe accidents at work and nor all reportable accidents at work.

Impact of mobile application and outpatient follow-up on renal endpoints and physiological indices in patients with chronic kidney disease: a retrospective cohort study in Southwest China

BackgroundChronic kidney disease (CKD) is a significant public health concern, and patient self-management is an effective approach to manage the condition. Mobile applications have been used as tools to assist in improving patient self-management, but their effectiveness in long-term outpatient follow-up management of patients with CKD remains to be validated. This study aimed to investigate whether using a mobile application combined with traditional outpatient follow-up can improve health outcomes of patients with CKD .MethodsThis retrospective cohort study recruited CKD patients with stage 1–5 who were not receiving renal replacement therapy from a CKD management center. Two groups were established: the APP + outpatient follow-up group and the traditional outpatient follow-up group. Baseline data was collected from January 2015 to December 2019, followed by a three-year long-term follow-up until December 2022. Laboratory data, all-cause mortality, and renal replacement treatment were then collected and compared between the two groups.Results5326 patients were included in the study, including 2492 in the APP + outpatient group and 2834 in the traditional outpatient group. After IPTW virtualization matching, the final matched the APP + outpatient group consisted of 2489 cases (IQR, 33–55) and 2850 (IQR, 33–55) in the traditional outpatient group. By the end of the study, it was observed that the laboratory data of Phosphorus, Sodium, Triglyceride, Hemoglobin showed significant improvements, Furthermore the APP + outpatient group demonstrated superior results compared to the traditional outpatient group (P < .05). And it was observed that there were 34 deaths (1.4%) in the APP + outpatient group and 46 deaths (1.6%) in the traditional outpatient group(P = .49). After matching for renal replacement therapy outcomes, the two groups were found to be comparable (95% CI [0.72–1.08], P = .23), with no significant difference. However, it was noted that the traditional outpatient group had a lower incidence of using temporary catheters during initial hemodialysis (95% CI [8.4-29.8%], P < .001).ConclusionThe development and application of an app combined with outpatient follow-up management can improve patient health outcomes. However, to ensure optimal preparation for kidney replacement therapy, patients in CKD stages 4–5 may require more frequent traditional outpatient follow-ups, and further develop an information-based decision-making support tool for renal replacement therapy.

Volunteer group participation and subsequent health and well-being among older adults in Japan: An outcome-wide longitudinal approach

BackgroundPrior studies have underscored the importance of studying volunteering in the East Asian context. However, no study has conducted a holistic assessment of the relationship between volunteering and the multidimensional health and well-being outcomes of East Asian populations using a strong study design for causal inference. To address this gap, this study examined the associations between volunteer group participation and the subsequent health and well-being of Japanese older adults. MethodsThree waves of data (2013, 2016, and 2019), obtained from the Japan Gerontological Evaluation Study—a nationwide cohort study of physically and cognitively independent older adults, aged ≥ 65 years, in Japan—were utilized. Exposure was evaluated as the frequency of volunteer group participation: ≥ 1/week, 1 − 3 times a month, a few times a year, and none (2016). As outcomes, 40 indicators of health and well-being were assessed across seven domains (2019): physical/cognitive health, health behaviors, mental health, subjective well-being, social well-being, pro-social/altruistic behaviors, and cognitive social capital. We included 47,318 respondents for four outcomes (death, dementia, and functional disability [any level and level 2 or greater]) and 34,187 respondents for the 36 other outcomes. ResultsMore frequent volunteering (≥ 1/week) was associated with higher social well-being outcomes, more frequent pro-social/altruistic behaviors and outings, and fewer depressive symptoms, even after considering multiple testing. ConclusionThroughout the three-year follow-ups, volunteer group participation was beneficial for depressive symptoms, social well-being, and other proximal outcomes.

Developing a prognostic model using machine learning for disulfidptosis related lncRNA in lung adenocarcinoma

Disulfidptosis represents a novel cell death mechanism triggered by disulfide stress, with potential implications for advancements in cancer treatments. Although emerging evidence highlights the critical regulatory roles of long non-coding RNAs (lncRNAs) in the pathobiology of lung adenocarcinoma (LUAD), research into lncRNAs specifically associated with disulfidptosis in LUAD, termed disulfidptosis-related lncRNAs (DRLs), remains insufficiently explored. Using The Cancer Genome Atlas (TCGA)-LUAD dataset, we implemented ten machine learning techniques, resulting in 101 distinct model configurations. To assess the predictive accuracy of our model, we employed both the concordance index (C-index) and receiver operating characteristic (ROC) curve analyses. For a deeper understanding of the underlying biological pathways, we referred to the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) for functional enrichment analysis. Moreover, we explored differences in the tumor microenvironment between high-risk and low-risk patient cohorts. Additionally, we thoroughly assessed the prognostic value of the DRLs signatures in predicting treatment outcomes. The Kaplan–Meier (KM) survival analysis demonstrated a significant difference in overall survival (OS) between the high-risk and low-risk cohorts (p < 0.001). The prognostic model showed robust performance, with an area under the ROC curve exceeding 0.75 at one year and maintaining a value above 0.72 in the two and three-year follow-ups. Further research identified variations in tumor mutational burden (TMB) and differential responses to immunotherapies and chemotherapies. Our validation, using three GEO datasets (GSE31210, GSE30219, and GSE50081), revealed that the C-index exceeded 0.67 for GSE31210 and GSE30219. Significant differences in disease-free survival (DFS) and OS were observed across all validation cohorts among different risk groups. The prognostic model offers potential as a molecular biomarker for LUAD prognosis.

The predictive value of lesion-specific pericoronary fat attenuation index for major adverse cardiovascular events in patients with type 2 diabetes

BackgroundThe purpose of this study was to explore the prognostic significance of the lesion-specific pericoronary fat attenuation index (FAI) in forecasting major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM).MethodsThis study conducted a retrospective analysis of 304 patients diagnosed with T2DM who underwent coronary computed tomography angiography (CCTA) in our hospital from December 2011 to October 2021. All participants were followed for a period exceeding three years. Detailed clinical data and CCTA imaging features were carefully recorded, encompassing lesion-specific pericoronary FAI, FAI of the three prime coronary arteries, features of high-risk plaques, and the coronary artery calcium score (CACS). The MACE included in the study comprised cardiac death, acute coronary syndrome (which encompasses unstable angina pectoris and myocardial infarction), late-phase coronary revascularization procedures, and hospital admissions prompted by heart failure.ResultsWithin the three-year follow-up, 76 patients with T2DM suffered from MACE. The lesion-specific pericoronary FAI in patients who experienced MACE was notably higher compared to those without MACE (–84.87 ± 11.36 Hounsfield Units (HU) vs. –88.65 ± 11.89 HU, p = 0.016). Multivariate Cox regression analysis revealed that CACS ≥ 100 (hazard ratio [HR] = 4.071, 95% confidence interval [CI] 2.157–7.683, p < 0.001) and lesion-specific pericoronary FAI higher than − 83.5 HU (HR = 2.400, 95% CI 1.399–4.120, p = 0.001) were independently associated with heightened risk of MACE in patients with T2DM over a three-year period. Kaplan-Meier analysis showed that patients with higher lesion-specific pericoronary FAI were more likely to develop MACE (p = 0.0023). Additionally, lesions characterized by higher lesion-specific pericoronary FAI values were found to have a greater proportion of high-risk plaques (p = 0.015). Subgroup analysis indicated that lesion-specific pericoronary FAI higher than − 83.5 HU (HR = 2.017, 95% CI 1.143–3.559, p = 0.015) was independently correlated with MACE in patients with T2DM who have moderate to severe coronary calcification. Moreover, the combination of CACS ≥ 100 and lesion-specific pericoronary FAI>-83.5 HU significantly enhanced the predictive value of MACE in patients with T2DM within 3 years.ConclusionsThe elevated lesion-specific pericoronary FAI emerged as an independent prognostic factor for MACE in patients with T2DM, inclusive of those with moderate to severe coronary artery calcification. Incorporating lesion-specific pericoronary FAI with the CACS provided incremental predictive power for MACE in patients with T2DM.

Long-Term Outcomes of Restorelle® Direct Fix Anterior Mesh in the Treatment of Pelvic Organ Prolapse.

Objective The objective of this study was to evaluate the efficacy and long-term outcomes of the use of Restorelle® Direct Fix (Coloplast,Humlebæk,Denmark) anterior mesh for transvaginal surgical management of anterior compartment prolapse. Methods A retrospective case series review was conducted for 123 patients who underwent surgery for Baden-Walker Grade three and four anterior compartment prolapse with the Restorelle Direct Fix anterior mesh between July 1, 2017 and September 30, 2018 in a single center. Follow-up was conducted at one, six, 12, 24, and 36 months after treatment. A standardized questionnaire and pelvic examination were conducted at each visit to assess operative complications and subjective and objective cure rates. Results Sixty patients were included in the analysis with a three-year follow-up rate of 70.0%. At three years post-operatively, subjective and objective cure rates were 97.7% and 95.3% respectively. Seven (11.7%) patients complained of de novo stress urinary incontinence, four (6.7%) complained of de novo urge urinary incontinence and one (1.7%) complained of symptomatic recurrence. Significantly, six (10.0%) patients had transvaginal mesh exposure over the three-year follow-up, mostly presenting within the first year. One (2.4%) patient developed new asymptomatic mesh erosion at the 36-month visit and one patient required mesh loosening one month post-surgery. Conclusions Management of anterior compartment prolapse with transvaginal surgery using the Restorelle® Direct Fix anterior mesh was associated with good subjective and objective cure rates. However, significant rates of post-operative mesh exposure were noted within three years post-surgery, which hinders the recommendation of this device for augmentation of repair for anterior compartment prolapse.

Robotic-assisted patellofemoral arthroplasty provides excellent implant survivorship and high patient satisfaction at mid-term follow-up

PurposeRobotic adoption in knee surgery has yielded several benefits, but its application in patellofemoral arthroplasty (PFA) remains barely reported. The purpose of this study was to determine implant survival, patient satisfaction, and functional outcomes after robotic-assisted PFA at an intermediate follow-up.MethodsThis prospective analysis targeted 18 knees of 16 consecutive patients who underwent robot-aided PFA with three-year minimum follow-up (range, 3 to 6 years). Each patient was evaluated collecting pre-operative and post-operative medical record data, including range of motion, radiographic images, and multiple scores, such as VAS, APKS, and OKS.ResultsAt surgery, the mean age was 55.4 years ± 14.4 (range, 32 to 78 years), and the mean BMI was 26.8 kg/m² ±5.2 (range, 20 to 36). Etiologies of patellofemoral osteoarthritis included idiopathic degeneration (28%), post-traumatic (33%), and dysplasia (39%). Pre-implantation scores were VAS 7.9 ± 1.4, AKPS 34.6 ± 23.3, and OKS 17.3 ± 10.3. One implant was revised with primary total knee arthroplasty for osteoarthritis progression. Clinical and radiographic follow-up showed no signs of loosening or infection. The maximum flexion reached an average of 131.1°±10.5° (range, 110° to 145°), accompanied by significantly improved score results (P-value < 0.01): VAS 1.1 ± 1.4, AKPS 90.2 ± 8.6, and OKS 46.3 ± 1.8.ConclusionsAt 3 years after robotic assisted patellofemoral arthroplasty, excellent implant survival and patient satisfaction rates can be expected along with significantly improved functional and pain control outcomes. Although the limitations imposed by the restricted cohort, these findings indicate that robotic assistance in PFA is both safe and effective at intermediate follow-up.

Two-year safety and effectiveness of hybrid ablation versus catheter ablation in patients with non-paroxysmal AF: mid-term results of the CEASE-AF trial

Abstract Background Hybrid Ablation for atrial fibrillation (AF) combines epicardial and endocardial ablation through a Heart Team approach to target durable, transmural isolation of the pulmonary veins (PV) and left atrial posterior wall (LAPW). While the primary efficacy endpoint at 12 months was met with a significant benefit increase for hybrid ablation, we now report the midterm durability of those results. Purpose To evaluate 24-months safety and effectiveness of Hybrid Ablation with left atrial appendage exclusion (LAAE) versus Catheter Ablation in patients with persistent AF/enlarged left atrium and longstanding persistent AF (LSPAF). Methods CEASE-AF is a prospective, multi-center, 2:1 randomized controlled trial. Eligible patients were 18-75 years of age, had symptomatic, drug-refractory persistent AF and enlarged left atrium (&amp;gt;4 cm) or LSPAF, and were undergoing a first ablation. Hybrid Ablation consisted of two stages: thoracoscopic epicardial radiofrequency (RF) ablation for PV and LAPW isolation and epicardial LAAE followed by endocardial ablation 91-180 days later. Catheter Ablation consisted of minimum PV isolation by endocardial RF ablation, and repeat ablation was allowed between 91-180 days. In both arms, additional lesions were permitted according to institutional practices. Effectiveness was freedom from AF/atrial flutter (AFL)/atrial tachycardia (AT) off anti-arrhythmic drugs (AAD) (except AADs not exceeding doses which previously failed) and was assessed through 48-h Holter monitoring reviewed by an independent core laboratory blinded to the study. Safety was major adverse events throughout the study, adjudicated by an independent Clinical Events Committee. Results There were 102 Hybrid Ablation and 52 Catheter Ablation patients; 26% were female, mean age was 60.7±7.9 years, mean LAD was 4.7±0.4 cm, and 19% had LSPAF with no differences between arms. The 12- and 24-month results are shown for comparison (Table). Through 24-months, effectiveness was 66.3% (63/95) in the Hybrid Arm and 33.3% (17/51) in the Catheter Arm (absolute difference 33.0% [95% CI 14.3%, 48.3%; p&amp;lt;0.001]). Major adverse event rates through 24-months were statistically similar at 10.8% (11/102) in the Hybrid Arm and 9.6% (5/52) in the Catheter Arm (p=1.0). Through 24-months, repeat ablations were performed in 7.4% (7/95) of the Hybrid Arm versus 37.3% (19/51) of the Catheter Arm (p&amp;lt;0.001), and cardioversions were performed in 14.7% (14/95) of the Hybrid Arm versus 29.4% (15/51) of the Catheter Arm (p=0.034) Conclusions: CEASE-AF demonstrated that superior effectiveness of Hybrid Ablation including LAAE versus Catheter Ablation was durable through 24-month follow-up, with 33% absolute improvement in freedom from AF/AFL/AT. Safety rates continued to be similar between arms. Three-year follow-up is ongoing.

Atrial high-rate episodes detected by cardiac implantable electronic devices: arrhythmic burden and progression towards de-novo clinical atrial fibrillation

Abstract Background Atrial high rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) are associated with a higher risk of thromboembolic events, but whether oral anticoagulants (OACs) improve patient outcomes is still debated. On the other hand, OACs benefits in patients with clinical atrial fibrillation (AF) are well established. Therefore, the potential progression of AHRE towards clinical AF should be promptly recognized. Purpose To evaluate the incidence of de-novo clinical AF and its potential predictors. Methods Consecutive CIED patients presenting AHRE (with confirmation of an arrhythmia lasting 5 min–23 h 59 min, atrial rate 175/min, with no AF at 12-lead ECG and no prior clinical AF) were retrospectively enrolled. Potential predictors of incident clinical AF were investigated by building six different multivariable Cox’s regression analyses, and the duration of the single longest AHRE episode during follow-up was used as a time-dependent covariate. Results 126 patients (median age 79.7 (73.8-84.6), 34.1% female) had available follow-up data. Detailed patients' characteristics are provided in Figure 1. Over a median follow-up of 1128 (580-1646) days, 41/126 (32.5%) patients developed incident clinical AF. A single longest AHRE episode lasting ≥ 6 hours (h) was found associated with a higher risk of incident clinical AF after adjusting for HATCH score, female sex, and coronary artery disease (CAD) (Hazard ratio (HR) 2.82; 95%CI 1.32-6.04) and also in the model adjusting for CHA2DS2-VASc score and CKD (HR 3.13; 95%CI 11.57-6.25). Similar results were found for a single longest AHRE episode lasting ≥ 12 hours (HR 4.91; 95%CI 2.31-10.42 and HR 4.90; 95%CI 2.50-9.60, respectively), and lasting ≥ 24h (HR 4.40; 95%CI 1.82-10.60 and HR 4.56; 95%CI 2.05-10.14, respectively) (Figure 2). On the other hand, HATCH score and CHA2DS2-VASc score were independently associated with a higher risk of incident clinical AF only in multivariable models adjusting for episodes of AHRE lasting ≥6 h (HR 1.42; 95%CI 1.02-1.97 and HR 1.37; 95%CI 1.03-1.83, respectively) but this association was not confirmed after adjusting for AHRE of longer duration. Conclusions In patients with AHRE, the incidence of de-novo clinical AF is high in a three-year follow-up. Baseline patients’ characteristics (HATCH and CHA2DS2-VASc scores) and AHRE duration during follow-up may help to intensify monitoring and decision-making, being independently associated with incident clinical AF at follow-up.Baseline characteristicsMultivariate Cox's regression analysis

#2015 Burosumab therapy in adult patients with X-linked hypophosphatemia: a three-year follow-up study

Abstract Background and Aims X-linked hypophosphatemic rickets (XLH) arises from mutations in the PHEX gene, resulting in elevated FGF23 levels, renal phosphate loss, hypophosphatemia, low vitamin D, heightened alkaline phosphatase (AP), and associated bone disorders. In challenging the conventional therapy of vitamin D and phosphate supplements, Burosumab, a monoclonal antibody against FGF23, has shown promise in normalizing phosphate and vitamin D levels in pediatric patients. However, its effectiveness in adult patients with established bone lesions remains an area of investigation. This study aims to present the three-year outcomes of Burosumab therapy on both biochemical and clinical aspects in adult XLH patients. Method The study assessed the efficacy of Burosumab in adult XLH patients (age &amp;gt;18, drug-naïve) before and continuously over three years post-therapy. Monthly assessments of biochemical parameters (phosphatemia, alkaline phosphatase, Tubular Maximum Reabsorption of Phosphate per Glomerular Filtration Rate, TMP/GFR) were conducted before the monthly administration of Burosumab, while clinical improvements were monitored every six months using established tests, including the six-minute walk test, UP and go timed test, and WOMAC Index. Burosumab was administered monthly at a consistent dosage of 1 mg/kg throughout the entire follow-up period. Results In a cohort of five genetically diagnosed XLH patients (average age 45 ± 10 years, average weight 60 ± 10 kg), the average monthly Burosumab dose was 60 ± 10 mg. Baseline values and subsequent changes in Ps, TMP/GFR, WOMAC Index, six-minute walk, and UP and go test are presented in Table 1 and Fig. 1. Importantly, no significant adverse events were reported during the initial year of treatment. Conclusion Burosumab therapy demonstrated excellent tolerability and yielded substantial improvements in biochemical parameters (Ps and TMP/GFR), maintaining stability over the entire three-year follow-up. Alkaline phosphatase levels, initially elevated, exhibited a progressive reduction in the second and third years, eventually reaching values within the normal range. Functional indices, reflective of enhanced strength (improved walk test and UP and go timed test) and diminished pain (optimal WOMAC test score), showcased notable improvements in the first year, persisting with stability during the follow-up period, with the exception of the walk test, which demonstrated a gradual and sustained enhancement. The findings suggest that Burosumab is a well-tolerated and effective therapeutic option for adult XLH patients. The observed reduction in alkaline phosphatase after a year of treatment implies a normalization of bone turnover, while the progressive improvement in the walk test indicates a sustained clinical enhancement likely associated with the chronic positive effects of maintaining biochemical stability.

Head-to-neck screw fixation and radial head arthroplasty result in similar postoperative outcomes for low-comminuted radial head fractures with neck involvement.

Fixation of radial head fractures with neck involvement presents challenges. It remains unclear whether the outcomes of head-to-neck screw fixation are similar to those of arthroplasty in this scenario. We conducted a retrospective cohort study to evaluate the clinical outcomes of these two methods for treating such fractures. Demographic data, fracture type, number of fragments, and concomitant injuries were recorded. Range of motion, Visual Analogue Scale for pain, Mayo Elbow Performance Score, and Quick-Disabilities of the Arm, Shoulder, and Hand at three-year follow-up, complications, and reintervention were compared. A total of 14 patients underwent fixation with head-to-neck screws, and 15 an arthroplasty. Baseline characteristics between groups were similar (P > .05). Satisfactory range of motion (arc > 100°) was achieved in nine patients (64%) in the fixation group, and eight patients (53%) in the arthroplasty group (P = .55). The mean Visual Analogue Scale, Mayo Elbow Performance Score, and Quick-Disabilities of the Arm, Shoulder, and Hand were 1.2 ± 1.2, 91.7 ± 10.7, and 9.1 ± 1, respectively, (P = .651, P = .651, and P = .155). Three patients (21%) in the fixation group underwent a reintervention and three (20%) in the arthroplasty group (P = .639). Head-to-neck screw fixation and radial head arthroplasty result in similar postoperative outcomes for low-comminuted radial head fractures with neck involvement.

Longitudinal Assessment of the Quality of Life in Oral Squamous Cell Carcinoma Patients.

Background Studies evaluating the quality of life (QoL) among oral cancer patients in the Indian population are scarce. Regular follow-ups and QoL assessment in oral squamous cell carcinoma (OSCC) patients can aid in comprehensive support strategies to improve their QoL outcomes. Aim and objectives This study aimed to assess the QoL of oral cancer patients and correlate the QoL with demographic and treatment parameters. Materials and methods The study included oral cancer patients who had previously reported to the Department of Oral and Maxillofacial Surgery. QoL assessment was done using the EORTC QLQ-C30 and QLQ-HN43 questionnaires before and after treatment. The clinico-demographic details, treatment data, follow-up data, and recorded mean QoL were procured from the patient records in Dental Information Archival Software. Assessment of QoL was done before treatment and at intervals of one month, three months, six months, 12 months, 24 months, and 36 monthspostoperatively after treatment. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (released 2015; IBM Corp., Armonk, New York, United States). A repeated measures analysis of variance (ANOVA) was utilized for comparing the average QoL scores and frequency of follow-ups across various intervals. Chi-square tests assessed differences in mean QoL among genders, across different sites, and between primary closure and graft placement. The significance was set at a p-value of less than 0.05. Results A total of 90 OSCC patients had reported to the department. A preoperative assessment of QoL was done for 90 (100%) patients. Out of these patients, surgery has been performed on 41 (45%). Twenty-five out of 41 (60%) patients had responded to regular follow-up, and QoL was assessed for these patients. After the immediate postoperative phase, only 12 (48%) had reported after three months. Only six (24%) had a 12-month follow-up, five (20%) had a two-year follow-up, and one (4%) had a three-year follow-up. There was a constant decrease in the number of follow-ups after the treatment of OSCC (p=0.00). Prior to treatment, the mean QoL index was 4.64. Females had a slightly higher preoperative QoL of 4.76 compared to males, with a score of 4.67 (p=0.157). Immediately after the treatment of OSCC, a decline in QoL scores was noted, with a mean score of 4.25 (p=0.32). Patients who underwent primary closure after excision had a mean post-op QoL score of 4.9, while patients who underwent graft placement had a mean score of 4.6 (p=0.157). Conclusion This study highlights the enduring impact of oral cancer on a patient's quality of life and emphasizes the need for ongoing research to explore specific interventions that can contribute to sustained improvement in QoL. It emphasizes personalized, holistic care approaches for such patients.

Effect of artificial natural light on the development of myopia among primary school-age children in China: a three-year longitudinal study.

To assess the efficacy of artificial natural light in preventing incident myopia in primary school-age children. This is a prospective, randomized control, intervention study. A total of 1840 students from 39 classes in 4 primary schools in Foshan participated in this study. The whole randomization method was adopted to include classes as a group according to 1:1 randomized control. Classrooms in the control group were illuminated by usual light, and classrooms in the intervention group were illuminated by artificial natural light. All students received uncorrected visual acuity and best-corrected visual acuity measurement, non-cycloplegic autorefraction, ocular biometric examination, slit lamp and strabismus examination. Three-year follow-up, the students underwent same procedures. Myopia was defined as spherical equivalent refraction ≤ -0.50 D and uncorrected visual acuity <20/20. There were 894 students in the control group and 946 students in the intervention group with a mean±SD age of 7.50±0.53y. The three-year cumulative incidence rate of myopia was 26.4% (207 incident cases among 784 eligible participants at baseline) in the control group and 21.2% (164 incident cases among 774 eligible participants at baseline) in the intervention group [difference of 5.2% (95%CI, 3.7% to 10.1%); P=0.035]. There was also a significant difference in the three-year change in spherical equivalent refraction for the control group (-0.81 D) compared with the intervention group [-0.63 D; difference of 0.18 D (95%CI, 0.08 to 0.28 D); P<0.001]. Elongation of axial length was significantly different between in the control group (0.77 mm) and the intervention group [0.72 mm; difference of 0.05 mm (95%CI, 0.01 to 0.09 mm); P=0.003]. Artificial natural light in the classroom of primary schools can result in reducing incidence rate of myopia during a period of three years.

Three-year follow-up of the grip concept: an open, prospective, observational registry study on biomechanically calculated abdominal wall repair for complex incisional hernias

PurposeWe studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial.MethodsFrom July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva’s maneuver.ResultsLarger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years.ConclusionsBiomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.

Assessment of Retention of Implant Bearing Mandibular Overdentures with Various Attachments: A Three-Year Follow-Up.

Mandibular dentures are considered dubious in terms of retention in resorbed ridges. Implant bearing overdentures can be a solution to the abovesaid issue. Various attachments in use offer variations in retention and maintenance. The aim was to assess long term durability and retention of implant supported overdenture attachments. Two implant bearing overdentures were placed in 20 patients. Magnet and ball attachment were used and dentures were evaluated over a period of three years at different time intervals. Difference of attachments' performance between intervals was assessed with ANOVA test and Tukey HSD post hoc test and the level of significance was set at p<0.05. There was a decline in retention throughout research period in both categories; the ball and socket batch showed statistically significant (P<0.05) better retention force compared to that of magnet group. There was lesser decline in mean retention force of 10.97N±0.82 to 7.24N±0.903 from one month to three years in magnet attachment retained overdentures. Ball attachments offer better retentive forces than magnet category. Magnet bearing overdentures offer more durability in terms of retention.

Visual Results Following Surgery for Unilateral Congenital Cataract at a Tertiary Public Hospital in Maharashtra

Purpose: This study aimed to assess the visual outcomes of unilateral congenital cataract surgery in children.  Methods: A total of 204 eyes from 204 children, aged 2 to 12 months, undergoing unilateral congenital cataract surgery between December 2022 and March 2024, were included. The study analyzed data from a three-year follow-up and used chi-square tests to assess the relationship between visual outcomes and the age at surgery, considering P &lt; 0.05 as statistically significant.  Results: Of 204 eyes, 64 (31.4%) underwent surgery at 2-3 months and 140 (68.6%) at 3-12 months. Visual acuity was measured postoperatively, revealing significantly poorer outcomes in children aged 3 months or older (P &lt; 0.001) compared to those aged 2-3 months.  Conclusions: It is essential to detect and treat congenital cataracts early, followed by long-term postoperative rehabilitation, to improve visual outcomes in affected children, particularly in cases of unilateral cataract, which are more prone to developing amblyopia.