TTT Group Research Articles

Среднеуретральный синтетический слинг с возможностью ранней мобилизации в лечении недержания мочи при напряжении у женщин.

Introduction. The use of midurethral synthetic slings is currently considered to be the most widespread treatment option for stress urinary incontinence (SUI). The most difficult in the existing approaches is to achieve the optimal tension of the sling, on which the result of treatment directly depends. To solve this problem, sling systems with the possibility of tension adjustment in the early postoperative period were created. A comparative study of the effectiveness and safety of such a system and a sling without the possibility of adjustment seems to be a relevant task. Materials and Methods. The study involved 320 female patients with a mean age of 55.2±11.2 years and a confirmed diagnosis of SUI. The patients were allocated into two groups: the first group underwent a synthetic suburethral sling by the standard technique (TOT); the second group received a suburethral sling with early mobilization (TTT). All patients underwent stress test, uroflowmetry and ultrasound investigation to determine the volume of residual urine. UDI-6, ICIQ-SF, PISQ-12 questionnaires were filled out to assess subjective efficiency. Results. In the second group, 28% of the patients needed to increase the tension of the prosthesis. Due to the possibility of tightening the sling in the early postoperative period, the operation was ineffective at the delayed follow-up stage at 36 months only in 11% of the women in the TTT group and in 32% of the patients in the LTT group, p<0.001. Loosening the sling tension was required in every fourth patient in the TTT group. Signs of obstructive urination at the stage of 36 months persisted in 13 patients in the TOT group and were completely absent in the TTT group. Subjective satisfaction with treatment was higher in the TTT group and amounted to 82%. Conclusion. A synthetic mid-urethral tuneable tension tape is superior to a classic sling without adjustment capability in long-term efficacy and safety.

Analysis of the Effect of Antibiotic Bone Cement in the Treatment of Diabetic Foot Ulcer through Tibia Transverse Transport.

ObjectiveTo explore the efficacy of antibiotic bone cement (ABC) combined with the modified tibial transverse transport (mTTT) on the treatment of severe diabetic foot with infection.MethodsA retrospective cohort study was conducted of 243 patients with TEXAS grade 3/4 stage D diabetic foot ulcers from December 2016 to December 2019. A total of 115 patients treated with mTTT were classified as the mTTT group (78 male and 37 female, mean age: 70.4 ± 6 years) and 128 patients who were treated with ABC combined with mTTT were in the ABC + mTTT group (89 male and 39 female, mean age: 68.9 ± 8 years). Follow‐up records during treatment and 6 months after surgery were collected, including the time required for white blood cells (WBC) and C‐reactive protein (CRP) to return to normal range, wound healing time, pain visual analog scale (VAS), ankle‐brachial index (ABI), foot skin temperature, transcutaneous oxygen pressure measurement (TcPO2), complications, and other indicators. Normally distributed data were compared using the independent sample t‐test, non‐normally distributed data were analyzed by one‐way ANOVA analysis of variance.ResultsThere were 128 cases in the ABC + mTTT group (89 male and 39 female, mean age: 68.9 ± 8 years) treated with ABC and mTTT, and 115 cases in the TTT group (78 male and 37 female, mean age: 70.4 ± 6 years) treated with mTTT alone. The time required for WBC and CRP to return to the normal range and wound healing time in the ABC + mTTT group were significantly shorter than those in the mTTT group (12.9 ± 4.6 vs. 22.6 ± 1.6 days, t = 3.979, p < 0.001; 25.3 ± 1.3 vs. 31.3 ± 2.3 days, t = 4.261, p = 0.001; 11.9 ± 3.8 vs. 15.9 ± 3.9 days, t = 4.539, p < 0.001). There were no significant intergroup differences in the foot skin temperature, VAS score, ABI, and TcPO2 (t = 0.349, 0.542, 0.765, 0.693 while all p > 0.05).ConclusionAlthough the application of ABC with mTTT for treatment of diabetic foot ulcers did not affect the wound healing time and ankle blood supply in the mid‐term, it could control ulcer infection faster and accelerate wound healing.

Tibial cortex transverse transport accelerates wound healing via enhanced angiogenesis and immunomodulation

AimsTreatment for delayed wound healing resulting from peripheral vascular diseases and diabetic foot ulcers remains a challenge. A novel surgical technique named ‘tibial cortex transverse transport’ (TTT) has been developed for treating peripheral ischaemia, with encouraging clinical effects. However, its underlying mechanisms remain unclear. In the present study, we explored the potential biological mechanisms of TTT surgery using various techniques in a rat TTT animal model.MethodsA novel rat model of TTT was established with a designed external fixator, and effects on wound healing were investigated. Laser speckle perfusion imaging, vessel perfusion, histology, and immunohistochemistry were used to evaluate the wound healing processes.ResultsGross and histological examinations showed that TTT technique accelerated wound closure and enhanced the quality of the newly formed skin tissues. In the TTT group, haematoxylin and eosin (H&E) staining demonstrated a better epidermis and dermis recovery, while immunohistochemical staining showed that TTT technique promoted local collagen deposition. The TTT technique also benefited to angiogenesis and immunomodulation. In the TTT group, blood flow in the wound area was higher than that of other groups according to laser speckle imaging with more blood vessels observed. Enhanced neovascularization was seen in the TTT group with double immune-labelling of CD31 and α-Smooth Muscle Actin (α-SMA). The number of M2 macrophages at the wound site in the TTT group was also increased.ConclusionThe TTT technique accelerated wound healing through enhanced angiogenesis and immunomodulation.Cite this article: Bone Joint Res 2022;11(4):189–199.

The incidence, clinical characteristics, and outcome of polytrauma patients with the combination of pulmonary contusion, flail chest and upper thoracic spinal injury

BackgroundChest trauma was the third most common cause of death in polytrauma patients, accounting for 25% of all deaths from traumatic injury. Chest trauma involves in injury to the bony thorax, intrathoracic organs and thoracic medulla. This study aimed to investigate the incidence, clinical characteristics, and outcome of polytrauma patients with pulmonary contusion, flail chest and upper thoracic spinal injury. MethodsPatients who met inclusion criteria were divided into groups: Pulmonary contusion group (PC); Pulmonary contusion and flail chest group (PC + FC); Pulmonary contusion and upper thoracic spinal cord injury group (PC + UTSCI); Thoracic trauma triad group (TTT): included patients with flail chest, pulmonary contusion and the upper thoracic spinal cord injury coexisted. Outcomes were determined, including 30-day mortality and 6-month mortality. ResultsA total 84 patients (2.0%) with TTT out of 4176 polytrauma patients presented to Tongji trauma center. There was no difference in mean ISS among PC + FC group, PC + UTSCI group and TTT group. Patients with TTT had a longer ICU stay (21.4 days vs. 7.5 and 6.2; p<0.01), relatively higher 30-day mortality (40.5% vs. 6.0% and 4.3%; p<0.01), and especially higher 6-month mortality (71.4% vs. 6.5%, 13.0%; p<0.01), compared to patients with PC + FC or with PC + UTSCI. The leading causes of death for patients with TTT were ARDS (44.1%) and pulmonary infection (26.5%) during first 30 days after admission. For those patients who died later than 30 days during the 6 months, the predominant underlying cause of death was MOF (53.8%). ConclusionsLethal triad of thoracic trauma (LTTT) were described in this study, which consisting of pulmonary contusion,flail chest and the upper thoracic spine cord injury. Like the classic “lethal triad”, there was a synergy between the factors when they coexist, resulting in especially high mortality rates. Polytrauma patients with LTTT were presented relatively high 30-day mortality and 6 months mortality. We should pay much more attention to the patients with LTTT for further minimizing complications and mortality.

Comparison of Outcome and Complications in Dogs Weighing Less Than 12 kg Undergoing Miniature Tibial Tuberosity Transposition and Advancement versus Extracapsular Stabilization with Tibial Tuberosity Transposition for Cranial Cruciate Ligament Disease with Concomitant Medial Patellar Luxation.

The aim of this study was to describe a technique for performing miniature tibial tuberosity transposition and advancement (mTTTA). The secondary objective of this study was to compare the short-term outcome and complications in small breed dogs weighing less than 12 kg undergoing surgical correction of cranial cruciate ligament disease with concurrent medial patellar luxation via either extracapsular stabilization with tibial tuberosity transposition (ECS + TTT) or mTTTA. This is a retrospective case comparison study. There was no significant difference in overall outcome between the ECS + TTT group and the mTTTA group when comparing 8-week postoperative radiographic healing scores as well as 2- and 8-week postoperative lameness scores. This study concluded that the mTTTA procedure was feasible and the overall outcome and complications for the dogs that underwent ECS + TTT and those that underwent mTTTA were comparable.

Modified tibial tunnel placement for single-bundle posterior cruciate ligament reconstruction reduces the "Killer Turn" in a biomechanical model.

Background:Our previous three-dimensional finite element analysis found that posterior cruciate ligament (PCL) reconstruction in the modified tibial tunneling placement (MTT, 10 mm inferior and 5 mm lateral to the PCL anatomical insertion) could reduce the peak stress of the graft and may reduce the killer turn. The purpose of the current study was to compare the biomechanical results between MTT and traditional tibial tunneling technique (TTT, PCL anatomical insertion) during transtibial PCL reconstruction.Methods:Fifty-six 3D-printed tibia models and fresh mature porcine flexor digitorum tendons were studied. The PCL reconstruction specimens were randomly divided into TTT group and MTT group based on tibial tunnel placement. A 50 to 300 N cyclic loading was applied using a material testing system. Each specimen completed 2000 cycles at a rate of 200 mm/min and a loading frequency of 80 cycles/min. Load–displacement curves, failure mode, and graft displacement were recorded. Mean maximum contact pressure was measured using a pressure-sensitive film. After cyclic loading test, the surviving grafts were randomly assigned to load-to-failure group or Scanning Electron Microscopy (SEM) group. Ultimate failure load and the appearance of graft abrasion were recorded and analyzed.Result:During the cyclic loading test, 3 samples in the TTT group, and 2 in the MTT group were excluded because of the graft pullout during the test. Mean maximum contact pressure of killer turn was 9.30 ± 0.29 MPa in the TTT group and 7.27 ± 0.25 MPa in MTT group (P < .05). Mean graft displacement was 4.54 ± 0.23 mm in the TTT group and 3.37 ± 3.56 mm in the MTT group (P < .05). Maximum failure load was 1886.0 ± 41.83 N in the TTT group and 2019.30 ± 20.10 N in the MTT group (P < .05). The SEM analysis showed heavy abrasion and fiber discontinuity in graft in the TTT group, while it showed slight abrasion and fiber arrangement disorders in the MTT group.Conclusions:The MTT PCL reconstruction significantly reduced stress concentration and graft abrasion as compared with the TTT PCL reconstruction, and it may be a better choice for the reduction of “killer Turn” effect during transtibial PCL construction.

Timing of invasive septal reduction therapies and outcome of patients with obstructive hypertrophic cardiomyopathy

BackgroundWhether early vs. delayed referral to septal reduction therapies (SRT, alcohol septal ablation or surgical myectomy) bears prognostic relevance in hypertrophic obstructive cardiomyopathy (HOCM) is unresolved. We analyzed the impact of SRT timing on the outcome of HOCM patients. MethodsWe followed 126 patients for 5 ± 4 years after SRT (mean age 53 ± 15 years; 55 post-ASA and 71 post-SM). Based on time-to-treatment (TTT; from HOCM diagnosis to SRT), patients were divided into three groups: “<3” years, N = 50; “3–5” years, N = 25; “>5” years, N = 51. ResultsPatients with TTT > 5 years were younger at diagnosis and more often had atrial fibrillation (AF). Left ventricular outflow tract (LVOT) gradients were comparable in the 3 TTT groups. Two patients died peri-operatively, all with TTT > 5. Long-term, 8 patients died (3 suddenly and 5 due to heart failure). Mortality increased progressively with TTT (2% vs. 4% vs. 12% for TTT “<3”, “3–5”, and “>5” years, p for trend = 0.039). Independent predictors of disease progression (new-onset AF, worsening to NYHA III/IV symptoms, re-intervention or death) were TTT (“3–5” vs. “<3” years: HR: 4.988, 95%CI: 1.394–17.843; “>5” vs. “<3” years: HR: 3.420, 95%CI: 1.258–9.293, overall p-value = 0.025), AF at baseline (HR: 1.896, 95%CI: 1.002–3.589, p = 0.036) and LVOT gradient (HR per mm Hg increase: 1.022, 95%CI: 1.007–1.024, p = 0.023). ConclusionsDelay in SRT referral has significant impact on long-term outcome of patients with HOCM, particularly when >5 years from first detection of gradient, even when successful relief of symptoms and gradient is achieved. Earlier interventions are associated with lower complication rates and better prognosis, suggesting the importance of timely SRT to maximize treatment benefit and prevent late HOCM-related complications.

Evaluating pulmonary function, aerobic capacity, and pediatric quality of life following a 10-week aerobic exercise training in school-aged asthmatics: a randomized controlled trial.

BackgroundIt has been documented that aerobic exercise may increase pulmonary functions and aerobic capacity, but limited data has evaluated a child’s satisfaction and pediatric quality of life (PQoL) with exercise training.ObjectivesThis study aimed to investigate the effects of moderate-intensity exercise training on asthmatic school-aged children.Subjects and methodsThis study included 38 school-aged children with asthma (23 males and 15 females) aged between 8–12 years. They were randomly assigned to two groups, aerobic exercise (AE) and conventional treatment (Con ttt) groups. The AE group received a program of moderate-intensity aerobic exercise for 10 weeks with asthma medications and the Con ttt group received only asthma medications without exercise intervention. A home respiratory exercise was recommended for the two groups. Aerobic capacity was investigated using maximal oxygen uptake (VO2max), 6-minute walk test (6MWT), and fatigue index. PQoL was evaluated using Pediatric Quality of Life Questionnaire (PQoLQ). Also, pulmonary function tests were performed, and the results recorded.ResultsThe findings of this study showed significant improvements in pulmonary functions and VO2max in the two groups; however, this improvement was significantly higher in the AE group than in the Con ttt group (p<0.05). The 6MWT and fatigue index improved in the AE group (p<0.05) but not in the Con ttt group (p>0.05). All dimensions of PQoL significantly improved in the AE group (p<0.05), but there was no significant improvement in the Con ttt group after the 10-week intervention period (p>0.05).ConclusionTen weeks of physical exercise had beneficial effects on pulmonary functions, aerobic capacity, and PQoL in school-aged children with asthma. Effort and awareness should be dedicated to encouraging the active lifestyle among different populations, especially asthmatic children.

Fat accumulation, fatty acids and melting point changes in broiler chick abdominal fat as affected by time of dietary fat feeding and slaughter age

1. This work aims to quantify changes in fatty acid profile, melting point, abdominal fat accumulation and 2-thiobarbituric acid-reactive substances production depending on dietary fat source and age at slaughter, and to estimate the optimal date for the change from an unsaturated fat to a saturated fat diet or vice versa. 2. Treatments established were (1) birds fed 8% tallow from 21 to 49 d (TTT); (2) birds fed 8% tallow from 21 to 37 d and 8% sunflower oil from d 38 to 49 (TSS); (3) birds fed 8% sunflower oil from 21 to 37 d and 8% tallow from d 38 to 49 (STT); (4) birds fed 8% sunflower oil from 21 to 41 d and 8% tallow from d 42 to 49 (SST); (5) birds fed 8% sunflower oil from 21 to 49 d (SSS). Birds from each group were slaughtered on d 21, 29, 38, 40, 42, 44, 46 and 49. 3. The polyunsaturated fatty acids (PUFAs) proportion in the SSS group reached maximum values at d 40 and fitted a quadratic response. This group also showed a decrease in saturated fatty acids (SATs) and monounsaturated fatty acids (MUFAs) of lower intensity than the PUFA increase. The highest synthesis of SAT + MUFA was found in the SSS and TSS groups, whereas these had the lowest body-to-dietary PUFA ratio. 4. A high and quadratic increase in the MUFA proportion was observed during the first 10 d of feeding with the tallow-enriched diet at the expenses of the proportion of PUFA that quadratically decreased (minimum values at d 38). 5. Lipogenic and desaturation capacity decreased with age. 6. The TSS group increased tissue PUFA content faster that the SST group decreased PUFA content after the change in diet which indicates that the earlier feeding has to be taken into consideration for obtaining higher or lower changes in quality parameters. 7. The melting point of the SSS group showed a lower response to the dietary treatment in the initial period when compared to the TTT treatment. 8. The TTT, STT, SST and TSS groups showed similar fat accumulation, and changes in lipid oxidation were related to the day of dietary sunflower oil supplementation. 9. Based on the results, it would be possible to determine the most appropriate dietary programme and optimum slaughter age to obtain chicken meat with the desired quality characteristics.

Validation of Patellar Stabilization Surgical Algorithm Based on Congruence

Background:Multiple algorithms exist for proximal and/or distal stabilisation surgery for patellar instability with no consensus in the literature.Aim:To validate our surgical algorithm based on patellofemoral congruence for patellar instability.Algorithm:Once patellar stabilization surgery is clinically indicated, we determine patellofemoral congruence abnormality based on quadriceps active CT and intraoperative arthroscopic assessment. Arthroscopic lateral release is carried out if indicated. For patients with minimal incongruence post lateral release, MPFL reconstruction alone (MPFL group) is performed, and we perform tibial tubercle transfer and MPFL reconstruction (TTT group) for significant incongruenceMethods:Retrospective study with prospective follow up of patients operated on between 2008 and 2015. We excluded patients with skeletal immaturity, previous patellofemoral surgery, and distalisation of tibial tubercle. Chart review, pre and post operative quadriceps active CT, Kujala score, and patient’s subjective stability analysed.Results:98 patients were reviewed with mean follow up 37 weeks. 14 patients had MPFL alone. Recurrence of instability occurred in 4% of patients, all in TTT group. Reoperation rate was 19%, almost all in TTT group, with removal of hardware being the most common reason. There was no significant difference in TTTG between the two groups on pre operative CT measurement.Conclusion:Patellar stabilization surgical algorithm based on congruence is valid in preventing further instability. Reoperation rate is high due to majority of patients receiving TTT procedure.

CHOROIDAL MELANOMA

To evaluate the efficacy of endoresection after proton beam radiotherapy to prevent neovascular glaucoma (NVG) in patients treated for choroidal melanoma. From a series of 4,867 patients treated for choroidal melanoma were prospectively recorded in the database (Macro Infermed 3.075). One hundred and seventy-one patients presenting a tumor diameter >10 mm and thickness >5 mm treated with proton beam (PB) radiotherapy were selected. One group of 63 patients was treated with PB therapy followed by endoresection (PE) of the scar. This group was compared with 2 historical matched controlled groups: 57 patients treated with PB therapy alone (P) and 51 patients treated with PB therapy followed by transpupillary thermotherapy of the scar (PTTT). Main outcome measures are as follows: age, gender, tumor diameter, tumor thickness, pre- and posttreatment visual acuity, NVG rate, secondary enucleation rate, and 5-year survival. Statistical analysis was performed using R version 2.5.1 software. Correlations between the 3 groups were P = 0.29 for age, P = 4.7×10 for tumor diameter, and P = 6.44×10 for tumor thickness. Comparison between the 3 groups showed that 2-year survival without secondary enucleation was 96.2% for PE, 88.8% for P, and 98% for PTTT (P = 0.203) (95% confidence interval). Two-year survival without NVG (95% confidence interval) was 92.7% (85.1-1.00) for PE, 54.6% for P, and 62.1% for PTTT (P = 0.0001). The difference between the endoresection (PE) group and the PB radiotherapy (P) and PB radiotherapy + TTT (PTTT) groups in terms of reduction of the NVG rate was statistically significant. Relative risk of developing NVG was calculated with the P group as reference, relative risk = 1. The relative risk of the PTTT group was 0.79 (20% reduction of the risk), and the relative risk of the PE group was 0.18 (82% reduction of the risk of developing NVG). This study shows that endoresection of the necrotic scar after PB radiotherapy reduces the risk of NVG and secondary enucleation for selected choroidal melanoma patients.

Improved guideline adherence to pharmacotherapy of chronic systolic heart failure in general practice – results from a cluster‐randomized controlled trial of implementation of a clinical practice guideline

Clinical practice guidelines (CPG) reflect the evidence of effective pharmacotherapy of chronic (systolic) heart failure (CHF) which needs to be implemented. This study aimed to evaluate the effect of a new, multifaceted intervention (educational train-the-trainer course plus pharmacotherapy feedback = TTT) compared with standard education on guideline adherence (GA) in general practice. Thirty-seven participating general practitioners (GPs) were randomized (18 vs. 19) and included 168 patients with ascertained symptomatic CHF [New York Heart Association (NYHA) II-IV]. Groups received CPG, the TTT intervention consisted of four interactive educational meetings and a pharmacotherapy feedback, while the control group received a usual lecture (Standard). Outcome measure was GA assessed by prescription rates and target dosing of angiotensin converting enzyme (ACE) inhibitors (ACE-I) or angiotensin receptor blockers (ARB), beta-blockers (BB) and aldosterone antagonists (AA) at baseline and 7-month follow-up. Group comparisons at follow-up were adjusted to GA, sex, age and NYHA stage at baseline. Prescription rates at baseline (n = 168) were high (ACE-I/ARB 90, BB 79 and AA 29%) in both groups. At follow up (n = 146), TTT improved compared with Standard regarding AA (43% vs. 23%, P = 0.04) and the rates of reached target doses of ACE-I/ARB (28% vs. 15%, P = 0.04). TTT group achieved significantly higher mean percentages of daily target dose (52% vs. 42%, mean difference 10.3%, 95% CI 0.84-19.8, P = 0.03). Despite of pre-existing high GA in both groups and an active control group, the multifaceted intervention was effective in quality of care measured by GA. Further research is needed on the choice of interventions in different provider populations.

Single-blind, randomized, prospective study of sequential itraconazole and terbinafine pulse compared with terbinafine pulse for the treatment of toenail onychomycosis

Objective: Efficacy and safety of sequential pulse therapy with itraconazole and terbinafine were compared with pulse terbinafine alone in the treatment of toenail onychomycosis. Methods: This was a 72-week prospective, single-blind, randomized, multicenter, comparative, parallel group, nonindustry-sponsored trial. A total of 190 patients were recruited from 3 outpatient dermatology offices in North America. Patients were at least 18 years old and had a clinical and mycologic diagnosis of dermatophyte toenail onychomycosis. Patients were randomly assigned to receive sequential pulse therapy (IIT) with 2 pulses of itraconazole followed by 1 or 2 pulses of terbinafine (itraconazole pulse is 200 mg twice daily for 1 week and terbinafine pulse is 250 mg twice daily for 1 week) versus 3 or 4 pulses of terbinafine (TTT). Main outcome measures at week 72 evaluated mycologic cure rate (negative light microscopy and culture), clinical cure (nail appears completely or totally normal), complete cure (clinical and mycologic cure), and effective therapy (mycologic cure and clinical response with at least 5 mm of new, uninvolved nail growth). Results: At week 72, in the IIT versus TTT groups, the mycologic cure rate was 54 of 75 (72.0%) versus 44 of 90 (48.9%), clinical cure rate was 42 of 75 (56.0%) versus 35 of 90 (38.9%), effective therapy 49 of 75 (65.3%) versus 41 of 90 (45.6%), and complete cure 39 of 75 (52.0%) versus 29 of 90 (32.2%), respectively. Both regimens were well tolerated with no new adverse effects being identified. The rate of permanent discontinuation of therapy because of adverse effects was 2 of 81 (2.5%) with IIT and 2 of 95 (2.1%) with TTT. Each of the adverse effects normalized over time. The number of patients who reported an adverse effect in the 2 groups was 12 of 81 (14.8%) versus 22 of 95 (23.2%), respectively. All these adverse effects were reversible and mild to moderate in severity. Conclusion: Sequential pulse therapy with itraconazole and terbinafine is effective and safe for the treatment of dermatophyte toenail onychomycosis. (J Am Acad Dermatol 2001;44:485-91.)