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Khan IA, Cozzarelli NF, Sutton R, Ciesielka KA, Arshi A, Fillingham YA. Patients Requiring Both Total Hip Arthroplasty and Lumbar Spinal Fusion Have Lower Hip Functional Outcome Scores: A Matched Case-Control Study. J Arthroplasty 2024; 39:1291-1297. [PMID: 37952736 DOI: 10.1016/j.arth.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND While patients who undergo both lumbar spinal fusion (LSF) and total hip arthroplasty (THA) have increased complication rates compared to patients who have not undergone LSF, there is a paucity of literature evaluating THA functional outcomes in patients with a history of LSF. This study was conducted to determine whether patients undergoing THA with a history of LSF have inferior functional outcomes compared to patients having no history of LSF. METHODS A retrospective matched case-control study was conducted at an academic center. Patients who underwent both THA and LSF (cases) were matched with controls who underwent THA without LSF. Inclusion criteria required a minimum of 1-year follow-up for the Hip Disability and Osteoarthritis Outcome Score Joint Replacement [HOOS-JR]. Following propensity matching for age, sex, race, body mass index, and comorbidities, 291 cases and 1,164 controls were included, with no demographic differences. RESULTS Patients who underwent both THA and LSF had a significantly lower preoperative HOOS-JR (47 versus 50; P < .001), postoperative HOOS-JR (77 versus 85; P < .001), a significant lower rate of achieving the patient acceptable symptom state (55 versus 67%; P < .001), with no significant difference in delta HOOS-JR (34 versus 34; P = .834). When comparing patients undergoing THA before LSF or LSF before THA, no differences existed for preoperative HOOS-JR (50 versus 47; P = .304), but patients undergoing THA before LSF had lower postoperative HOOS-JR scores (74 versus 81; P = .034), a lower-delta HOOS-JR (27 versus 35; P = .022), and a lower rate of reaching the HOOS-JR minimal clinically important difference (62 versus 76%; P = .031). CONCLUSIONS Patients who have a history of LSF experience a similar improvement in hip function when undergoing THA compared to patients who do not have a history of LSF. However, due to lower preoperative function, they may have a lower postoperative functional outcome ceiling. Additionally, patients undergoing THA before LSF have worse hip functional outcomes than patients undergoing LSF before THA.
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Affiliation(s)
- Irfan A Khan
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopaedics, LSU Health New Orleans, New Orleans, Louisiana
| | - Nicholas F Cozzarelli
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ryan Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kerri-Anne Ciesielka
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Armin Arshi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Yale A Fillingham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Oliver C, Charlesworth M, Pratt O, Sutton R, Metodiev Y. Anaesthetic subspecialties and sustainable healthcare: a narrative review. Anaesthesia 2024; 79:301-308. [PMID: 38207014 DOI: 10.1111/anae.16169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/13/2024]
Abstract
The principles of environmentally sustainable healthcare as applied to anaesthesia and peri-operative care are well documented. Associated recommendations focus on generic principles that can be applied to all areas of practice. These include reducing the use of inhalational anaesthetic agents and carbon dioxide equivalent emissions of modern peri-operative care. However, four areas of practice have specific patient, surgical and anaesthetic factors that present barriers to the implementation of some of these principles, namely: neuroanaesthesia; obstetric; paediatric; and cardiac anaesthesia. This narrative review describes these factors and synthesises the available evidence to highlight areas of sustainable practice clinicians can address today, as well as posing several unanswered questions for the future. In neuroanaesthesia, improvements can be made by undertaking awake surgery, moving towards more reusables and embracing telemedicine in quaternary services. Obstetric anaesthesia continues to present questions regarding how services can move away from nitrous oxide use or limit its release to the environment. The focus for paediatric anaesthesia is addressing the barriers to total intravenous and regional anaesthesia. For cardiac anaesthesia, a significant emphasis is determining how to focus the substantial resources required on those who will benefit from cardiac interventions, rather than universal implementation. Whilst the landscape of evidence-based sustainable practice is evolving, there remains an urgent need for further original evidence in healthcare sustainability targeting these four clinical areas.
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Affiliation(s)
- C Oliver
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
| | - O Pratt
- Department of Anaesthesia, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - R Sutton
- Department of Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK
| | - Y Metodiev
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
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3
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Khan IA, Sutton R, Cozzarelli NF, Ciesielka KA, Parvizi J, Arshi A, Fillingham YA. Patients Who Have Had Three or More Levels Fused During Lumbar Spinal Fusion Have Worse Functional Outcomes After Total Hip Arthroplasty. J Arthroplasty 2023; 38:S330-S335. [PMID: 36893994 DOI: 10.1016/j.arth.2023.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Lumbar spinal fusion (LSF) and total hip arthroplasty (THA) are commonly performed in patients who have concomitant spine and hip pathology. While patients who have three or more levels fused during LSF have increased postoperative opioid consumption after undergoing THA, it is unknown whether the number of levels fused during LSF affects THA functional outcomes. METHODS A retrospective study was conducted at a tertiary academic center for patients who underwent LSF first and then had a primary THA performed with a minimum of one-year follow-up for the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS-JR). Operative notes were reviewed to determine the number of levels fused during LSF. There were 105 patients who underwent one-level LSF, 55 patients underwent two-level LSF, and 48 patients underwent three-or-more-level LSF. No significant differences existed in age, race, body mass index, and comorbidities between the cohorts. RESULTS While preoperative HOOS-JR was similar among the three cohorts, patients who had three-or-more-level LSF had significantly lower HOOS-JR scores than patients who had two-level or one-level LSF (71.4 versus 82.4 versus 78.2; P = .010) and a lower delta HOOS-JR (27.2 versus 39.4 versus 35.9; P = .014). Patients who had three-or-more-level LSF had a significantly lower rate of achieving minimal clinically important difference (61.7% versus 87.2% versus 78.7%; P = .011) and the patient acceptable symptom state (37.5% versus 69.1% versus 59.0%; P = .004) for the HOOS-JR, compared to patients who had two-level or one-level LSF, respectively. CONCLUSIONS Surgeons should counsel patients who have had three-or-more-level LSF that they may have a lower rate of hip function improvement and symptom acceptability after THA, compared to patients who have had a less number of levels fused during LSF.
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Affiliation(s)
- Irfan A Khan
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ryan Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nicholas F Cozzarelli
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kerri-Anne Ciesielka
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Armin Arshi
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Yale A Fillingham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Meyer C, Larghero P, Almeida Lopes B, Burmeister T, Gröger D, Sutton R, Venn NC, Cazzaniga G, Corral Abascal L, Tsaur G, Fechina L, Emerenciano M, Pombo-de-Oliveira MS, Lund-Aho T, Lundán T, Montonen M, Juvonen V, Zuna J, Trka J, Ballerini P, Lapillonne H, Van der Velden VHJ, Sonneveld E, Delabesse E, de Matos RRC, Silva MLM, Bomken S, Katsibardi K, Keernik M, Grardel N, Mason J, Price R, Kim J, Eckert C, Lo Nigro L, Bueno C, Menendez P, Zur Stadt U, Gameiro P, Sedék L, Szczepański T, Bidet A, Marcu V, Shichrur K, Izraeli S, Madsen HO, Schäfer BW, Kubetzko S, Kim R, Clappier E, Trautmann H, Brüggemann M, Archer P, Hancock J, Alten J, Möricke A, Stanulla M, Lentes J, Bergmann AK, Strehl S, Köhrer S, Nebral K, Dworzak MN, Haas OA, Arfeuille C, Caye-Eude A, Cavé H, Marschalek R. The KMT2A recombinome of acute leukemias in 2023. Leukemia 2023; 37:988-1005. [PMID: 37019990 PMCID: PMC10169636 DOI: 10.1038/s41375-023-01877-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
Chromosomal rearrangements of the human KMT2A/MLL gene are associated with de novo as well as therapy-induced infant, pediatric, and adult acute leukemias. Here, we present the data obtained from 3401 acute leukemia patients that have been analyzed between 2003 and 2022. Genomic breakpoints within the KMT2A gene and the involved translocation partner genes (TPGs) and KMT2A-partial tandem duplications (PTDs) were determined. Including the published data from the literature, a total of 107 in-frame KMT2A gene fusions have been identified so far. Further 16 rearrangements were out-of-frame fusions, 18 patients had no partner gene fused to 5'-KMT2A, two patients had a 5'-KMT2A deletion, and one ETV6::RUNX1 patient had an KMT2A insertion at the breakpoint. The seven most frequent TPGs and PTDs account for more than 90% of all recombinations of the KMT2A, 37 occur recurrently and 63 were identified so far only once. This study provides a comprehensive analysis of the KMT2A recombinome in acute leukemia patients. Besides the scientific gain of information, genomic breakpoint sequences of these patients were used to monitor minimal residual disease (MRD). Thus, this work may be directly translated from the bench to the bedside of patients and meet the clinical needs to improve patient survival.
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Affiliation(s)
- C Meyer
- DCAL/Institute of Pharm. Biology, Goethe-University, Frankfurt/Main, Germany
| | - P Larghero
- DCAL/Institute of Pharm. Biology, Goethe-University, Frankfurt/Main, Germany
| | - B Almeida Lopes
- DCAL/Institute of Pharm. Biology, Goethe-University, Frankfurt/Main, Germany
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | - T Burmeister
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Dept. of Hematology, Oncology and Tumor Immunology, Berlin, Germany
| | - D Gröger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Dept. of Hematology, Oncology and Tumor Immunology, Berlin, Germany
| | - R Sutton
- Molecular Diagnostics, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - N C Venn
- Molecular Diagnostics, Children's Cancer Institute, Lowy Cancer Research Centre, UNSW, Sydney, NSW, Australia
| | - G Cazzaniga
- Tettamanti Research Center, Pediatrics, University of Milano-Bicocca/Fondazione Tettamanti, Monza, Italy
| | - L Corral Abascal
- Tettamanti Research Center, Pediatrics, University of Milano-Bicocca/Fondazione Tettamanti, Monza, Italy
| | - G Tsaur
- Regional Children's Hospital, Ekaterinburg, Russian Federation; Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - L Fechina
- Regional Children's Hospital, Ekaterinburg, Russian Federation; Research Institute of Medical Cell Technologies, Ekaterinburg, Russian Federation
| | - M Emerenciano
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | | | - T Lund-Aho
- Laboratory of Clinical Genetics, Fimlab Laboratories, Tampere, Finland
| | - T Lundán
- Department of Clinical Chemistry and Laboratory Division, University of Turku and Turku University Hospital, Turku, Finland
| | - M Montonen
- Department of Clinical Chemistry and Laboratory Division, University of Turku and Turku University Hospital, Turku, Finland
| | - V Juvonen
- Department of Clinical Chemistry and Laboratory Division, University of Turku and Turku University Hospital, Turku, Finland
| | - J Zuna
- CLIP, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - J Trka
- CLIP, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - P Ballerini
- Biological Hematology, AP-HP A. Trousseau, Pierre et Marie Curie University, Paris, France
| | - H Lapillonne
- Biological Hematology, AP-HP A. Trousseau, Pierre et Marie Curie University, Paris, France
| | - V H J Van der Velden
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - E Sonneveld
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - E Delabesse
- Institut Universitaire du Cancer de Toulouse, Toulouse Cedex 9, France
| | - R R C de Matos
- Cytogenetics Department, Bone Marrow Transplantation Unit, National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - M L M Silva
- Cytogenetics Department, Bone Marrow Transplantation Unit, National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - S Bomken
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - K Katsibardi
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - M Keernik
- Genetics and Personalized Medicine Clinic, Tartu University Hospital, Tartu, Estonia
| | - N Grardel
- Department of Hematology, CHU Lille, France
| | - J Mason
- Northern Institute for Cancer Research, Newcastle University and the Great North Children's West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - R Price
- Northern Institute for Cancer Research, Newcastle University and the Great North Children's West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom
| | - J Kim
- DCAL/Institute of Pharm. Biology, Goethe-University, Frankfurt/Main, Germany
- Department of Laboratory Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - C Eckert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Oncology/Hematology, Berlin, Germany
| | - L Lo Nigro
- Centro di Riferimento Regionale di Ematologia ed Oncologia Pediatrica, Azienda Policlinico "G. Rodolico", Catania, Italy
| | - C Bueno
- Josep Carreras Leukemia Research Institute. Barcelona, Spanish Network for Advanced Therapies (RICORS-TERAV, ISCIII); Spanish Collaborative Cancer Network (CIBERONC. ISCIII); University of Barcelona, Barcelona, Spain
- Josep Carreras Leukemia Research Institute. Barcelona, Spanish Network for Advanced Therapies (RICORS-TERAV, ISCIII); Spanish Collaborative Cancer Network (CIBERONC. ISCIII); Department of Biomedicine. University of Barcelona; and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - P Menendez
- Centro di Riferimento Regionale di Ematologia ed Oncologia Pediatrica, Azienda Policlinico "G. Rodolico", Catania, Italy
| | - U Zur Stadt
- Pediatric Hematology and Oncology and CoALL Study Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Gameiro
- Instituto Português de Oncologia, Departament of Hematology, Lisbon, Portugal
| | - L Sedék
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - T Szczepański
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - A Bidet
- Laboratoire d'Hématologie Biologique, CHU Bordeaux, Bordeaux, France
| | - V Marcu
- Hematology Laboratory, Sheba Medical Center, Tel-Hashomer, Israel
| | - K Shichrur
- Molecular Oncology Laboratory, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - S Izraeli
- Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H O Madsen
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - B W Schäfer
- Division of Oncology and Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - S Kubetzko
- Division of Oncology and Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - R Kim
- Hematology Laboratory, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Université Paris Cité, INSERM/CNRS U944/UMR7212, Institut de recherche Saint-Louis, Paris, France
| | - E Clappier
- Hematology Laboratory, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Université Paris Cité, INSERM/CNRS U944/UMR7212, Institut de recherche Saint-Louis, Paris, France
| | - H Trautmann
- Laboratory for Specialized Hematological Diagnostics, Medical Department II, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Brüggemann
- Laboratory for Specialized Hematological Diagnostics, Medical Department II, University Hospital Schleswig-Holstein, Kiel, Germany
| | - P Archer
- Bristol Genetics Laboratory, North Bristol NHS Trust, Bristol, United Kingdom
| | - J Hancock
- Bristol Genetics Laboratory, North Bristol NHS Trust, Bristol, United Kingdom
| | - J Alten
- Department of Pediatrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A Möricke
- Department of Pediatrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Stanulla
- Department of Pediatrics, MHH, Hanover, Germany
| | - J Lentes
- Institute of Human Genetics, Medical School Hannover, Hannover, Germany
| | - A K Bergmann
- Institute of Human Genetics, Medical School Hannover, Hannover, Germany
| | - S Strehl
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - S Köhrer
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Labdia Labordiagnostik, Vienna, Austria
| | - K Nebral
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Labdia Labordiagnostik, Vienna, Austria
| | - M N Dworzak
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Labdia Labordiagnostik, Vienna, Austria
- St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - O A Haas
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Labdia Labordiagnostik, Vienna, Austria
- St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - C Arfeuille
- Genetics Department, AP-HP, Hopital Robert Debré, Paris, France
| | - A Caye-Eude
- Genetics Department, AP-HP, Hopital Robert Debré, Paris, France
- Université Paris Cité, Inserm U1131, Institut de recherche Saint-Louis, Paris, France
| | - H Cavé
- Genetics Department, AP-HP, Hopital Robert Debré, Paris, France
- Université Paris Cité, Inserm U1131, Institut de recherche Saint-Louis, Paris, France
| | - R Marschalek
- DCAL/Institute of Pharm. Biology, Goethe-University, Frankfurt/Main, Germany.
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Sutton R, Wang WL, Abdelfadeel W, Sherman M, Cannada LK, Krueger CA. Are Orthopedic Fellowship Programs Giving Out Too Many Interviews? A Retrospective Analysis Suggests They Are. HSS J 2023; 19:210-216. [PMID: 37065095 PMCID: PMC10090836 DOI: 10.1177/15563316221103585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 04/18/2023]
Abstract
Background: The orthopedic surgery fellowship match process is associated with substantial stress and expense, yet the optimal number of interviews for fellowships to offer has not been evaluated. Purpose: We sought to evaluate the number of orthopedic surgery fellowship interviews given and construct a model to determine the appropriate number of interviews to offer based on specialty and program size. Methods: We conducted a retrospective study of 6 orthopedic fellowship specialties; data were obtained from San Francisco Match and covered the 5-year period from 2014 to 2018. The orthopedic fellowship subspecialties included adult reconstruction/oncology, foot and ankle, pediatrics, spine, sports medicine, and trauma. We excluded shoulder and elbow (less than 5 years of data) and hand and upper extremity (alternative matching process). Parameters included number of programs, number of spots per program, number of ranked applicants per program (mean ± SD), and difference in number of interviews offered and ranked applicants per program (mean ± SD). Multiple regression analysis was used to create an equation for determining the optimal number of interviews for the programs. Results: Of 1377 orthopedic fellowship programs analyzed, 1370 (99.50%) conducted interviews beyond the number of ranked applicants. Programs ranked an overall mean of 20.10 ± 10.17 applicants with an overall mean of 11.60 ± 8.62 additional interviews offered. Sports medicine had the highest mean ranked applicants (23.21 ± 9.77) and pediatrics had the lowest mean ranked applicants (15.74 ± 7.76). The most additional interviews were given in adult reconstruction (14.80 ± 9.92) and the least were given in pediatrics (8.32 ± 7.17). The predictive equation was reported as Y = β1x1 + β2x2 (Y = ranked applicants, x1 = spots open, and x2 = last rank). Conclusion: Programs in 6 orthopedic subspecialties in the fellowship match process appear to consistently offer more interviews than necessary. We have developed a model to help programs predict the optimal number of fellowship applicants to interview. Future studies need to validate the model, especially with anticipated increases of the virtual interview format.
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Affiliation(s)
- Ryan Sutton
- Rothman Orthopaedic Institute,
Philadelphia, PA, USA
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6
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Rivasi G, Brignole M, Groppelli A, Soranna D, Zambon A, Sutton R, Kenny RA, Ungar A, Fedorowski A, Parati G. New definition of hypotension in patients with reflex syncope using 24-hour ambulatory blood pressure monitoring (SynABPM Study). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking.
Purpose
We hypothesized that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM than control subjects and we aimed to define the SBP cut-off values that allow identification of patients with hypotensive susceptibility.
Methods
We compared ABPM data from reflex syncope patients and controls, matched by average 24-hour SBP, age, sex and hypertension. Patients with constitutional hypotension, orthostatic hypotension, predominant cardioinhibition or competing causes of syncope were excluded. Daytime and night-time SBP drops (<110, 100, 90, 80 mmHg) were assessed. Findings were validated in an independent sample.
Results
In the Derivation cohort, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drop <90 mmHg provided the best diagnostic yield (91% specificity, 32% sensitivity, Odds Ratio [OR]=4.6, p=0.001). Two or more-daytime drops <100 mmHg achieved 84% specificity and 40% sensitivity (OR=3.5, p=0.001). Results were confirmed in the Validation cohort: one or more daytime SBP drop <90 mmHg provided 94% specificity and 29% sensitivity (OR=6.2, p<0.001), while two or more daytime SBP drops <100 mmHg achieved 83% specificity and 35% sensitivity (OR=2.6, p<0.001) (Figure 1).
Conclusion
SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Rivasi
- University of Florence , Florence , Italy
| | - M Brignole
- Italian Auxological Institute San Luca Hospital , Milan , Italy
| | - A Groppelli
- Italian Auxological Institute San Luca Hospital , Milan , Italy
| | - D Soranna
- Italian Auxological Institute San Luca Hospital , Milan , Italy
| | - A Zambon
- Italian Auxological Institute San Luca Hospital , Milan , Italy
| | - R Sutton
- Imperial College London , London , United Kingdom
| | - R A Kenny
- Trinity College Dublin , Dublin , Ireland
| | - A Ungar
- University of Florence , Florence , Italy
| | - A Fedorowski
- Karolinska University Hospital , Stockholm , Sweden
| | - G Parati
- Italian Auxological Institute San Luca Hospital , Milan , Italy
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7
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Paziuk T, Sutton R, McEntee R, Farronato D, Krieg J. Lateral femoral distraction is a safe and necessary adjunct for articulator visualization during the operative treatment of tibial plateau fractures. J Orthop 2022; 33:44-47. [PMID: 35833181 PMCID: PMC9272134 DOI: 10.1016/j.jor.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Recent evidence suggests use of lateral femoral distractor (LFD) to aid in visualization during surgery for tibial plateau fractures (TPF) may result in an unacceptably high rate of iatrogenic peroneal nerve palsy. We sought to evaluate femoral distractor use for open reduction internal fixation (ORIF) of TPF and quantify the incidence of peroneal nerve palsy. Methods We retrospectively evaluated all patients undergoing ORIF of TPF between 2014 and 2019 by a single fellowship trained orthopaedic traumatologist at a single Level 1 trauma center. Inclusion criteria were use of a LFD during ORIF of TPF. Exclusion criteria were preoperative neurovascular injury in the operative extremity and distraction via pre-existing external fixator. Parameters included patient demographic variables, intraoperative techniques, postoperative outcomes, and fracture classification. Documented clinical exam was used to evaluate peroneal nerve status and injuries were classified as complete or incomplete. Incomplete injuries were classified as sensory or motor. Results Of 303 patients undergoing ORIF for a TPF, femoral distraction was used in 254 (83.8%) cases, with 201 utilizing applied intraoperative femoral distraction and 53 utilizing pre-existing knee-spanning external fixation for distraction. Three patients were excluded for preoperative sensory peroneal nerve palsy with 175 patients meeting inclusion criteria. The most common fracture type was lateral split depression (n = 130). Zero patients developed complete or incomplete peroneal nerve palsy. Discussion Our study found no incidence of peroneal nerve palsy when using lateral femoral distraction. This study supports the utilization of lateral distraction for articular visualization and reduction during ORIF of TPF.
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Affiliation(s)
- Taylor Paziuk
- Rothman Institute at Thomas Jefferson University, USA
| | - Ryan Sutton
- Rothman Institute at Thomas Jefferson University, USA
| | | | | | - James Krieg
- Rothman Institute at Thomas Jefferson University, USA
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8
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Sutton R, Chisari E, Scaramella A, Krueger CA, Courtney PM. Total Hip and Knee Revisions are Really Outpatient Procedures? Implications of the Removal From the Inpatient Only List. J Arthroplasty 2022; 37:S732-S737. [PMID: 34902514 DOI: 10.1016/j.arth.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In 2021, the Centers for Medicare and Medicaid Services (CMS) removed over 200 procedures from the Inpatient Only (IPO) list including revision total hip (THA) and total knee arthroplasties (TKA). The purpose of this study is to determine if some revision TKA and THA procedures may be appropriate for outpatient status. METHODS We reviewed a consecutive series of 1026 revision THA and TKA patients at our tertiary academic institution from 2015 to 2020. An outpatient procedure was defined as a length of stay of <2 midnights. We queried our prospectively collected arthroplasty database and compared demographics, comorbidities, surgical indication, type of procedure, discharge disposition, readmissions, and complications between the outpatient and inpatient groups. RESULTS There were only 166 revision patients (16%) who met outpatient criteria. Revision THA outpatients were more likely to have a head and liner exchange (49% vs 25%, P < .001) and an indication of instability (93% vs 44%, P < .001). Revision TKA outpatients were more likely to have an isolated liner exchange (34% vs 14%, P < .001) and have an indication of instability (67% vs 25%, P < .001). Patients undergoing a revision for infection and aseptic loosening were more likely to require an inpatient stay than other revision indication (P < .05). CONCLUSION The vast majority of revision TKA and THA patients met CMS inpatient criteria. In addition to a projected decrease in facility reimbursement, concerns exist for the safety of early discharge and access to care for these complex patients if CMS removes all revisions from the Inpatient Only list.
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Affiliation(s)
- Ryan Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Emanuele Chisari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Amira Scaramella
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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9
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Shohat N, Ludwick L, Sutton R, Chisari E, Parvizi J. Aspirin Administered for Venous Thromboembolism Prophylaxis May Protect Against Stiffness Following Total Knee Arthroplasty. J Arthroplasty 2022; 37:953-957. [PMID: 35026368 DOI: 10.1016/j.arth.2022.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Aspirin has become the main agent for venous thromboembolism (VTE) prophylaxis following total knee arthroplasty (TKA). This study assessed whether aspirin is associated with less knee stiffness compared to warfarin and other chemoprophylaxis agents. METHODS This is a retrospective review of all primary and revision TKAs performed between January 2009 and October 2020 at a high volume institution. Demographics, comorbidity data, and operative variables were extracted from medical records. VTE prophylaxis administered during this time period included aspirin, warfarin, and "others" (factor Xa, unfractionated heparin, low-molecular-weight heparin, fondaparinux, adenosine diphosphate receptor inhibitor, and direct thrombin inhibitor). The primary outcome assessed was manipulation under anesthesia (MUA) performed within 6 months of index surgery. Secondary outcome included major bleeding events. Univariate followed by multivariate regression analyses were performed. RESULTS A total of 15,903 cases were included in the study, of which 531 (3.3%) patients developed stiffness that required MUA. The rates of MUA were 2.7% (251/9223) for patients receiving aspirin, 4.2% (238/5709) for patients receiving warfarin, and 4.3% (42/971) for all others (P's < .001). Multivariate regression analysis confirmed that aspirin is associated with lower rates of VTE compared to warfarin (adjusted odds ratio 1.423, 95% confidence interval 1.158-1.747, P < .001) and compared to other anticoagulation medications (adjusted odds ratio 1.742, 95% confidence interval 1.122-2.704, P = .013). Major bleeding events were also significantly lower in patients who received aspirin compared to the other 2 groups (P's = .001). CONCLUSION Aspirin prophylaxis is associated with lower rates of MUA following TKA compared to warfarin and other VTE chemoprophylactic agents when grouped together.
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Affiliation(s)
- Noam Shohat
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Leanne Ludwick
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Ryan Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Emanuele Chisari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Lopes B, Meyer C, Maciel AL, Barbosa T, Venn NC, Sutton R, Fazio G, Cazzaniga G, Marschalek R, Emerenciano M. Unravelling the recombinome of IKZF1 deletions in
B-ALL. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- B Lopes
- Molecular Cancer Study Group, Division of Clinical Research, Instituto
Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de
Janeiro, Brazil
| | - C Meyer
- Institute of Pharmaceutical Biology/DCAL, Goethe-University,
Frankfurt/Main, Germany
| | - AL Maciel
- Molecular Cancer Study Group, Division of Clinical Research, Instituto
Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de
Janeiro, Brazil
| | - T Barbosa
- Molecular Cancer Study Group, Division of Clinical Research, Instituto
Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de
Janeiro, Brazil
| | - NC Venn
- Children's Cancer Institute, Lowy Cancer Research Centre UNSW,
Sydney, New South Wales, Australia
| | - R Sutton
- Children's Cancer Institute, Lowy Cancer Research Centre UNSW,
Sydney, New South Wales, Australia
| | - G Fazio
- Centro Ricerca Tettamanti, Clinica Pediatrica, Dipartimento di Medicina
e Chirurgia, Università degli Studi di Milano-Bicocca, Fondazione MBBM,
Monza, Italy
| | - G Cazzaniga
- Centro Ricerca Tettamanti, Clinica Pediatrica, Dipartimento di Medicina
e Chirurgia, Università degli Studi di Milano-Bicocca, Fondazione MBBM,
Monza, Italy
| | - R Marschalek
- Institute of Pharmaceutical Biology/DCAL, Goethe-University,
Frankfurt/Main, Germany
| | - M Emerenciano
- Molecular Cancer Study Group, Division of Clinical Research, Instituto
Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de
Janeiro, Brazil
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11
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Chisari E, Ashley B, Sutton R, Largoza G, Di Spagna M, Goyal N, Courtney PM, Parvizi J. Dual-Mobility Implants and Constrained Liners in Revision Total Hip Arthroplasty. Arthroplast Today 2022; 13:8-12. [PMID: 34934792 PMCID: PMC8661104 DOI: 10.1016/j.artd.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 09/15/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Instability remains the most common complication after revision total hip arthroplasty (THA). The purpose of this study was to determine whether there was a difference in aseptic revision rates and survivorship between dual-mobility (DM) and constrained liners (CL) in revision THA. METHODS We reviewed a consecutive series of 2432 revision THA patients from 2008 to 2019 at our institution and identified all patients who received either a CL or DM bearing. We compared demographics, comorbidities, indications, dislocations, and aseptic failure rates between the two groups. Bivariate and multivariate regression analyses were used to determine risk factors for failure, and a Kaplan-Meier survivorship analysis was performed with an aseptic re-revision as the endpoint. RESULTS Of the 191 patients, 139 (72%) received a DM bearing, and 52 (28%) had a CL. At a mean follow-up of 14.3 months, there was no statistically significant difference in rates of dislocation (10.4% vs 14.0%, P = .667), aseptic revision (30.9% vs 46.2%, P = .073), or time to revision (3.78 vs 6 months, P = .565) between the two groups. The multivariate analysis revealed CL had no difference in aseptic re-revision rates when compared with DM (odds ratio 1.47, 95% confidence interval 0.84-2.52, P = .177). The survivorship analysis found no difference in aseptic failure between the groups at 12 months (P = .059). CONCLUSION Both CL and DM bearings have high aseptic failure rates at intermediate term follow-up after revision THA. CL did show a higher risk of failure than DM bearings, but it was not statistically significant with the numbers available for this study. Further prospective studies are needed to determine the optimal treatment for recurrent instability.
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Affiliation(s)
- Emanuele Chisari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Blair Ashley
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Garrett Largoza
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Marco Di Spagna
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nitin Goyal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Torabi P, Rivasi G, Hamrefors V, Sutton R, Brignole M, Fedorowski A. Lifelong and mature-onset syncope in older adults may have different mechanisms. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Syncope is a common clinical problem with a sharp rise in the incidence after 70 years. In older patients, syncope is often a diagnostic challenge. It is unclear whether the age at which patients experience syncope for the first time impacts the results of syncope investigation.
Purpose
To study the influence of early-onset vs. mature-onset syncope on clinical characteristics and final head-up tilt (HUT) diagnosis in a large sample of unexplained syncope patients.
Methods
Consecutive patients (n=1928) with unexplained syncope after initial evaluation examined with a standard HUT protocol in a syncope unit were stratified into age groups below and above 60 years. Clinical characteristics and the final HUT diagnosis were analysed in relation to self-reported age at first syncope and age at investigation. The distribution of age at first syncope was bimodal with peaks at 15 and 70 years (Figure 1). In the present analysis, patients aged >60 years (n=836) with early-onset (<30 years) and mature-onset (>60 years) syncope were compared.
Results
Vasovagal syncope (VVS) was more common in early-onset syncope, 39% vs 19% (p<0.001), (Figure 2). Orthostatic hypotension (OH) was more common in mature-onset syncope, 23% vs 7% (p<0.001), as was hypertension, 59% vs 40% (p=0.001). The frequency of carotid sinus syndrome (CSS) was not affected by age at first syncope in patients aged >60 years.Complex syncope etiology (findings suggesting overlap between VVS, OH and/or CSS) was more common among patients with early-onset syncope, 37% vs 26% (p=0.023). No definite HUT-derived diagnosis was more common in mature-onset syncope, 23% vs 13% (p=0.023). Heart failure, 9% vs 2% (p=0.024) and atrial fibrillation, 20% vs 9% (p=0.013) were more common in mature-onset syncope. Prodromes were less common in mature-onset syncope, 26% vs 52% (p<0.001), however there was no significant difference in reported palpitations preceding syncope and dizziness on standing.
Conclusions
Mature-onset syncope was more often associated with absence of prodromes, orthostatic hypotension, inconclusive HUT findings and presence of heart failure and atrial fibrillation suggesting cardiac syncope to be the likely cause. Early-onset syncope was associated with presence of prodromes, vasovagal reflex mechanism and complex syncope diagnosis. Lifelong and mature-onset unexplained syncope may have different pathophysiological mechanisms in older patients and aetiologies other than vasovagal syncope should be carefully considered in patients with first-ever syncope in later life.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish heart and lung foundationCrafoord foundation
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Affiliation(s)
- P Torabi
- Lund University, Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | - G Rivasi
- Careggi University Hospital, Syncope Unit, Division of Geriatrics and Intensive Care Unit, Florence, Italy
| | - V Hamrefors
- Lund University, Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | - R Sutton
- National Heart and Lung Institute Imperial College, London, United Kingdom
| | - M Brignole
- Saint Luca Hospital, IRCCS Istituto Auxologico Italiano, Faint & Fall programme, Ospedale San Luca and Arrhythmolog, Milano, Italy
| | - A Fedorowski
- Lund University, Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden
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13
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Affiliation(s)
- R Sutton
- From the, Department of Cardiology, Hammersmith Hospital Campus, National Heart & Lung Institute, Imperial College, London, UK
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Johansson M, Rogmark C, Sutton R, Hamrefors V, Fedorowski A. Association of incident fragility fractures in patients hospitalised due to unexplained syncope and orthostatic hypotension. Europace 2021. [DOI: 10.1093/europace/euab116.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The study was funded by The Swedish Heart-Lung Foundation, The Greta and Johan Kock Foundation, and an Agreement for Medical Education and Research (ALF) grant by Swedish Research Council funding for clinical research in medicine.
Background
Fragility fractures are caused by low-energy insults such as falls from standing height or less and pose a growing health challenge as their incidence rises with increasing age. Impaired orthostatic blood pressure response and a number of cardiovascular biomarkers have been previously identified as risk factors for fractures. It is likely that severe episodes of syncope and orthostatic hypotension increase the risk of subsequent fragility fractures, however this relationship has not been thoroughly examined.
Purpose
To investigate the relationship of hospital admissions due to unexplained syncope and OH with incident fragility fractures in a middle-aged population.
Methods
We analysed a large population-based prospective cohort of 30,446 middle-aged individuals (age, 57.5 ± 7.6; men, 39.8%). We included patients hospitalised due to unexplained syncope and OH. Cox regression analysis adjusted for age, sex, prevalent fractures, body mass index (BMI) were applied to assess the impact of unexplained syncope/OH hospitalisations on subsequent incident fragility fractures. Prevalent fractures occurring before syncope/OH hospitalisation were excluded (n = 39) as well as cases with no follow-up time after the event of syncope/OH (n= 8).
Results
The mean follow-up from baseline to first incident fracture or end of follow-up was 17.8 + 6.5 years, and 8201 (27%) suffered incident fracture. The mean age of patients with unexplained syncope (n = 493) and OH patients (n = 406) at baseline was 61.5 ± 7.1 years (50.1%, male) and 62.6 ± 6.6 years (49.8% male), respectively. The mean time between baseline and first admission for syncope and OH was 12.3 ± 4.5 years, and the mean age at first hospitalisation was 74.4 ± 7.6 years. In the multivariable-adjusted Cox regression, the risk of subsequent incident fractures was increased among patients hospitalised due to unexplained syncope (HR: 1.20; 95% CI 1.03–1.40; p < 0.02) and OH (HR: 1.40; 95% CI 1.20–1.64; p < 0.001), respectively (Kaplan-Meier curves; Figure 1).
Conclusions
Patients hospitalised due to unexplained syncope and OH demonstrate increased risk of subsequent fragility fractures. We suggest that patients who are hospitalised for unexplained syncope and OH should be clinically assessed for true syncope aetiology, systematically treated against fall risk, and evaluated for additional risk factors for fragility fractures. Abstract Figure 1. Kaplan-Meier curves
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Affiliation(s)
| | - C Rogmark
- Skane University Hospital, Malmo, Sweden
| | - R Sutton
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
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15
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Kharraziha I, Torabi P, Johansson M, Sutton R, Fedorowski A, Hamrefors V. Effect of aging on cerebral tissue oxygenation in relation to reflex syncope. Europace 2021. [DOI: 10.1093/europace/euab116.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Swedish Heart and Lung Foundation, The Swedish Heart and Lung Association, ALF funds, Skåne University Hospital Funds, The Crafoord Foundation.
Background
There is an increased susceptibility to syncope with aging attributed to age-related physiological impairments. Cerebral oximetry non-invasively measures cerebral tissue oxygenation (SctO2) and has been shown to be valuable in syncope evaluation. SctO2 has been found to decrease with aging but it is unknown whether the decrease in SctO2 is related to increased susceptibility to syncope during orthostatic provocation. By measuring SctO2 during head up tilt test (HUT) we can study age-related differences in SctO2 and their impact on developing reflex syncope.
Purpose
To investigate the effect of age on the cerebral tissue oxygenation threshold for syncope and presyncope among patients with vasovagal syncope.
Methods
Non-invasive haemodynamic monitoring and near-infrared spectroscopy (NIRS) were applied during head-up tilt (HUT) in 139 vasovagal syncope patients (mean [SD] 45[17] years, 60% female), and 82 control patients with a normal response to HUT (45[18] years, 61% female). Group differences in SctO2 and systolic blood pressure (SBP) during HUT in supine position, after 3 and 10 min of HUT, 30 seconds prior to syncope ("presyncopal phase") and during syncope in different age groups (<30, 30-60 and >60 years) were compared using one-way ANOVA and Tukey"s multiple comparison test. Associations between age and SctO2 were studied using linear regression models adjusted for sex and concurrent SBP.
Results
Lower SctO2 in supine position was associated with increasing age among controls (B=-0.085, p = 0.010) but not among VVS patients (B=-0.036, p = 0.114). No age-related differences in SctO2 were found after 3 and 10 minutes of HUT and during syncope. Mean SctO2 (%) during the presyncopal phase decreased over the advancing age groups (<30: 66.9 ± 6.2, 30-60: 64.5 ± 6.1, >60: 62.2 ± 5.8; p = 0.009 for inter-group comparison). In contrast, mean SBP during the presyncopal phase did not differ by age groups (<30: 85.6 ± 21.8, 30-60: 77.6 ± 19.7, >60: 77.6 ± 20.8 mmHg, p = 0.133). Age was associated with lower SctO2 during the presyncopal phase after adjusting for sex and SBP (B = 0.096, p = 0.001).
Conclusion
Older VVS patients have lower cerebral tissue oxygenation in the presyncopal phase compared with younger patients independently of systolic blood pressure. These results suggest either that with imminent reflex syncope cerebral tissue oxygenation diminishes more with advancing age or that cerebral deoxygenation is better tolerated by older reflex syncope patients. Abstract Figure.
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Affiliation(s)
| | | | | | - R Sutton
- Imperial College London, National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
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Yacovelli S, Sutton R, Vahedi H, Sherman M, Parvizi J. High Risk of Conversion to THA After Femoroacetabular Osteoplasty for Femoroacetabular Impingement in Patients Older than 40 Years. Clin Orthop Relat Res 2021; 479:1112-1118. [PMID: 33236866 PMCID: PMC8052066 DOI: 10.1097/corr.0000000000001554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/09/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a recognized cause of hip pain and decreased quality of life and has been linked to primary idiopathic hip osteoarthritis (OA). Although the operative indications for FAI have expanded to include older patients, we do not know whether there is an increased risk of conversion to THA after femoroacetabular osteoplasty (FAO) via the mini-open approach for FAI in patients older than 40 years compared with younger patients, after controlling for other confounding variables. QUESTIONS/PURPOSES (1) After matching for gender, BMI, preoperative symptomatic period, surgeon experience, Tönnis grade, and degree of chondral lesion, are patients older than 40 years who undergo FAO for FAI more likely to be revised to THA at a minimum of 2 years' follow-up than are patients younger than 40? (2) Is there a difference in delta (postoperative minus preoperative) improvement in functional outcome scores in those patients who did not go on to THA between patients older than and younger than 40 years? METHODS Between 2003 and 2017, one surgeon performed 281 FAOs via the mini-open approach in patients older than 40 years and 544 of the same procedure in patients younger than 40 years. During that period, the general indications for FAO were the same in both age groups: (1) history and physical exam consistent with FAI, (2) radiographic evidence of focal impingement (cam, pincer, or both), (3) evidence of labral or chondrolabral tears, and (4) minimal to no arthritic changes (all four criteria required). In general, age was not used as a contraindication for surgery. A total of 86% (241 of 281) of patients older than 40 and 91% (494 of 544) of those younger than 40 were available for minimum of 2 years' follow-up, had complete datasets (radiographs as well as preoperative and most recent patient-reported outcomes scores) at a minimum of 2 years after surgery, and were considered eligible for the match. Propensity score matching was used to match for BMI, gender, preoperative symptomatic period, surgeon experience, Tönnis grade, and degree of intraoperative chondral lesion. We matched at a 1:2 ratio 130 patients older than age 40 with 260 patients younger than age 40. The mean ± SD follow-up duration for both groups was 5 ± 2 years. The mean age of the cohort of interest was 47 ± 5 years compared with 28 ± 7 years in the control. Fifty-four percent (70 of 130) of patients older than 40 years were women and 46% (60 of 130) were men; for those younger than 40, 51% (133 of 260) of participants were women and 49% (127 of 260) were men. Tönnis grade distribution for patients older than 40 was as follows: 46% (60 of 130) had Grade 0, 42% (55 of 130) had Grade 1, and 12% (15 of 130) had Grade 2. In comparison, Tönnis grade for patients younger than 40 was as follows: 52% (136 of 260) had Grade 0, 38% (100 of 260) had Grade 1, and 9% (24 of 260) had Grade 2 (p = 0.49). Chondral lesion degree was determined intraoperatively as none, a partial-thickness tear, or a full-thickness tear. Tönnis grade was determined based on preoperative plain AP hip radiographs. We then compared the percentage of patients who converted to THA during the surveillance period (our primary study outcome). We also compared the difference in delta (preoperative minus postoperative) improvement in functional outcome scores using the modified Harris Hip Score (mHHS) between the groups, excluding those who had already been converted to THA. RESULTS In patients older than 40 years, 16% (21 of 130) converted to THA at a mean time to conversion of 2 ± 1 years compared with 7% (17 of 260) at a mean time of 2 ± 2 years in patients younger than 40 years (p = 0.01). At a mean of 5 ± 2 years after FAO, among those patients who had not undergone conversion to THA, the mean delta mHHS score for patients older than 40 was 11 ± 17, compared with 20 ± 26 for patients younger than 40 (p = 0.04). CONCLUSION Since approximately 1 in 6 patients older than 40 years in this series who underwent FAO for FAI opted for early conversion to THA at a mean time of 2 years after the osteoplasty procedure, and the remaining patients who did not undergo THA reported lower improvement in functional outcomes, we recommend surgeons avoid this procedure in patients in this age group until or unless we can better refine our indications. This is especially true because loss to follow-up causes us to believe that, if anything, our estimates of the risk of conversion to THA are conservative. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Steven Yacovelli
- S. Yacovelli, R. Sutton, H. Vahedi, M. Sherman, J. Parvizi, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Sutton R, Yacovelli S, Vahedi H, Parvizi J. Does a History of Slipped Capital Femoral Epiphysis in Patients Undergoing Femoroacetabular Osteoplasty for Femoroacetabular Impingement Affect Outcomes Scores or Risk of Reoperation? Clin Orthop Relat Res 2021; 479:1028-1036. [PMID: 33231940 PMCID: PMC8083843 DOI: 10.1097/corr.0000000000001576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/22/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) can occur after slipped capital femoral epiphysis (SCFE) regardless of slip severity and even after in situ pinning. These patients represent a rare and unique demographic that is largely unreported on. It is important to further characterize the clinical presentation of these patients, associated treatment modalities, and the efficacy of these treatment modalities. QUESTIONS/PURPOSES (1) How do patients with post-SCFE FAI typically present in terms of radiographic and surgical findings? (2) How do their hip-specific and general-health outcomes scores after mini-open femoroacetabular osteoplasty compare with those obtained in a matched group of patients with FAI caused by other etiologies? (3) How do those groups compare in terms of the proportion who undergo conversion to THA? METHODS Between 2013 and 2017, 20 patients had femoroacetabular osteoplasty for post-SCFE FAI. During that time, general indications for this procedure were symptomatic FAI demonstrated on radiographs and physical exam. Of those, none was lost to follow-up before a minimum of 2 years, leaving all 20 available for matching, and all 20 had suitable matches in our database for patients who underwent femoroacetabular osteoplasty for other diagnoses. Matching was performed by surgeon, patient age, patient gender, and BMI. The matching group was drawn from a large database of patients who had the same procedure during the same period. We matched in a 1:3 ratio to arrive at 60 randomly selected control patients in this retrospective, comparative study. Patient demographics, medical history, clinical presentation, radiographic parameters, and intraoperative findings were compared between the two groups. At a minimum of 2 years of follow-up, the latest clinical functional outcome scores (Hip Disability and Osteoarthritis Outcome Score Jr and SF-12) and proportions of conversion to THA were compared between the groups. RESULTS A greater percentage of patients with a history of SCFE than those without prior SCFE demonstrated full chondral lesions intraoperatively (90% [18 of 20] versus 32% [19 of 60], odds ratio 7 [95% confidence interval 1 to 178]; p < 0.01). A greater percentage of patients with a history of SCFE also demonstrated labral calcifications intraoperatively compared with those without prior SCFE (65% [13 of 20] versus 35% [21 of 60], OR 3 [95% CI 1 to 10]; p = 0.04). Radiographically, patients with SCFE had greater preoperative alpha angles than did patients without SCFE (94° ± 13° versus 72° ± 22°; p = 0.01) as well as lower lateral center-edge angles (25° ± 8° versus 31° ± 8°; p = 0.04). There was no difference in postoperative follow-up between patients with a history of SCFE and patients without a history of SCFE (4 ± 2 years versus 4 ± 2 years; p = 0.32). There was no difference in the mean postoperative outcome scores between patients with a history of SCFE and patients without (Hip Disability and Osteoarthritis Outcome Score Jr: 75 ± 28 points versus 74 ± 17 points; p = 0.95; SF-12 physical score: 40 ± 11 points versus 39 ± 8 points; p = 0.79). There was no difference with the numbers available in the percentage of patients who underwent conversion to THA (15% [3 of 20] versus 12% [7 of 60], OR 1.36 [95% CI 0 to 6]; p = 0.71). CONCLUSION Patients with FAI after SCFE present with a greater degree of labral and chondral disease than do patients without a history of SCFE. However, at short-term follow-up, the proportion of patients who underwent conversion to THA and patients' postoperative outcome scores did not differ in this small, comparative series between patients with and without SCFE. Further evaluation with long-term follow-up is needed, especially given the more severe chondral damage we observed in patients with SCFE at the time of surgery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Ryan Sutton
- R. Sutton, S. Yacovelli, H. Vahedi, J. Parvizi, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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18
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Goyal DK, Tarazona DA, Segar A, Sutton R, Motto MA, Divi SN, Galtta MS, Hilibrand AS, Kaye ID, Kurd MF, Radcliff KE, Rihn JA, Anderson DG, Kepler CK, Hsu V, Woods B, Vaccaro AR, Schroeder GD. Lumbar Pedicle Morphology and Vertebral Dimensions in Isthmic and Degenerative Spondylolisthesis-A Comparative Study. Int J Spine Surg 2021; 15:243-250. [PMID: 33900981 PMCID: PMC8059380 DOI: 10.14444/8009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The pedicle screw is the most common device used to achieve fixation in fusion of spondylolistheses. Safe and accurate placement with this technique relies on a thorough understanding of the bony anatomy. There is a paucity of literature comparing the surgically relevant osseous anatomy in patients with a degenerative spondylolisthesis (DS) and an isthmic spondylolisthesis (IS). The goal of this study was to determine the differences in the osseous anatomy in patients with a DS and those with an IS. METHODS A retrospective comparative cohort study was conducted on patients with a single-level, symptomatic L4-L5 DS or a single-level, symptomatic L5-S1 IS. Magnetic resonance imaging for these patients was reviewed. Morphometries of the pedicle and vertebral body were analyzed by 2 independent observers for the levels from L3 to S1, and radiographic parameters were compared between groups. RESULTS A total of 572 levels in 143 patients were studied, including 103 patients with a DS and 40 with an IS. After accounting for confounders, IS and DS had an independent effect on transverse vertebral body width, pedicle height and width, and sagittal pedicle angle. Patients with an IS had a smaller pedicle height (P < .001) and pedicle width (P = .001) than patients with DS. In addition, the angulation of the pedicles varied on the basis of the diagnosis. CONCLUSIONS The osseous anatomy is significantly different in patients with a DS than with an IS. Patients with an IS have smaller pedicles in the lumbar spine. Also, the L4 and L5 pedicles are more caudally angulated and the S1 pedicle is less medialized. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Understanding the differences in pedicle anatomy is important for the safe placement of pedicle screws.
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Affiliation(s)
- Dhruv K.C. Goyal
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel A. Tarazona
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anand Segar
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ryan Sutton
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael A. Motto
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Srikanth N. Divi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S. Galtta
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ian D. Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kris E. Radcliff
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - D. Greg Anderson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victor Hsu
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Barrett Woods
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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19
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Yacovelli S, Abdelaal M, Fillingham Y, Sutton R, Madding R, Parvizi J. Prior Pelvic Osteotomy Affects the Outcome of Subsequent Total Hip Arthroplasty. J Arthroplasty 2021; 36:600-604. [PMID: 32917462 DOI: 10.1016/j.arth.2020.07.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although pelvic osteotomy (PO) is an important surgical procedure that can alleviate symptoms and potentially slow progression of osteoarthritis in patients with development dysplasia of the hip, some patients eventually require conversion to total hip arthroplasty (THA). This study aimed to determine the outcome of conversion THA in patients with prior PO. METHODS Forty nine patients with a history of prior PO who underwent conversion THA at a single institution were matched at a 1:3 ratio based on the date of surgery, age, gender, and body mass index with 147 developmental dysplasia of the hip patients who underwent primary THA without prior PO. A retrospective chart review was performed to compare outcomes at a minimum follow-up of 2 years. RESULTS Patients with prior PO required more supplemental screw fixation for the acetabular component (59.2% vs 38.1%, P = .016), more autologous bone grafting (24.5% vs 11.6%, P = .048), had a longer mean operative time (106.0 vs 79.8 minutes, P < .001), and greater estimated blood loss (350.0 vs 206.8 mL, P = .015). Patients with prior PO had smaller cup version angle (26.0° vs 29.0°, P = .012) and greater discrepancy in the limb length (10.3 vs 7.26 mm, P = .041). Eight hips (16.3%) with prior PO and 6 (4.1%) without osteotomy required reoperation (P = .008). There was no difference in outcome scores at the latest follow-up. CONCLUSION THA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation. CONCLUSION THA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation.
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Affiliation(s)
- Steven Yacovelli
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Mohammad Abdelaal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Yale Fillingham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Ryan Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Rachel Madding
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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20
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Johansson M, Schulte J, Ricci F, Persson M, Sutton R, Hamrefors V, Fedorowski A. Downregulation of growth hormone in postural orthostatic tachycardia syndrome: insights from the SYSTEMA cohort. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular autonomic disorder occurring predominantly in young women. POTS is characterized by an excessive heart rate increase when assuming upright posture accompanied by symptoms of orthostatic intolerance. The pathophysiology of POTS has not been fully established and is believed to be multifactorial.
Purpose
We aimed to investigate the alterations in circulating growth hormone level in POTS.
Methods
We conducted an age-matched case-control study enrolling 42 patients with POTS (age 31±9 years; 36 women) verified by positive head-up tilt testing and cardiovascular autonomic tests, and 46 controls (32±9 years; 35 women) with negative active standing test and no history of syncope, orthostatic intolerance and endocrine disease. We measured plasma levels of growth hormone using a high-sensitivity chemiluminescence immunoassay in relation to presence of POTS diagnosis. All study participants completed the validated Orthostatic Hypotension Questionnaire (OHQ), consisting of two components: the symptoms assessment scale (OHSA) and daily activity scale (OHDAS) to evaluate the burden of symptoms. We applied standard statistical tests for group differences. Growth hormone values were log-transformed and standardized before the group comparison.
Results
POTS patients had significantly lower plasma levels of growth hormone (ng/mL) (median=0.53, IQR, 0.10–2.83 vs. median=2.33, IQR, 0.26–7.2, p=0.04) than controls. Levels of growth hormone were reversely related to OHDAS (p=0.049) among POTS patients. Supine heart rate was significantly higher in POTS patients (69.0±11.1 beats/min vs. 63.3±10.8 beats/min, p=0.02), as well as diastolic blood pressure (72.9±9.1 mmHg vs. 69.0±8.5 mmHg, p=0.04). We observed no significant difference in supine systolic blood pressure (116.6±13.3 mmHg vs. 115.2±10.0 mmHg, p=0.60). POTS patients had a significantly higher composite OHQ score than controls (60.0±18.6 vs. 4.2±7.5, p<0.001), as well as OHSA (36.2±10.0 vs. 3.6±6.4, p<0.001) and OHDAS (23.8±9.7 vs. 0.6±1.3, p<0.001).
Conclusion(s)
Our study shows that patients with POTS have significantly reduced plasma levels of circulating growth hormone. Lower growth hormone levels among POTS patients are associated with increased impairment of daily life activities. Further studies are necessary to confirm our findings in the independent populations and explain the mechanisms behind this alteration.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Crafoord Foundation, Swedish Heart and Lung Foundation
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Affiliation(s)
| | - J Schulte
- SphingoTec GmbH, Hennigsdorf, Germany
| | - F Ricci
- G. d Annunzio University, Chieti, Italy
| | | | - R Sutton
- Imperial College London, London, United Kingdom
| | | | - A Fedorowski
- Lund University, Dept. of Cardiology, Skåne University Hospital, Malmo, Sweden
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21
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Court MW, McAlister S, Pierce JMT, Sutton R. Converting gas-driven ventilators from oxygen to air: environmental implications. Anaesthesia 2020; 76:285-286. [PMID: 32677035 PMCID: PMC7404417 DOI: 10.1111/anae.15214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M W Court
- Wythenshawe Hospital, Manchester, UK
| | - S McAlister
- University of Melbourne, Melbourne, Australia
| | - J M T Pierce
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Sutton
- Royal Manchester Children's Hospital, Manchester, UK
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22
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Affiliation(s)
- R Mukherjee
- Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Leeds Pancreas Unit, Department of Abdominal Medicine and Surgery, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Smith
- Leeds Pancreas Unit, Department of Abdominal Medicine and Surgery, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Sutton
- Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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23
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Ricci F, Patti G, Di Martino G, Renda G, Hamrefors V, Melander O, Sutton R, Gallina S, Engstrom G, De Caterina R, Fedorowski A. P6223Relationship between platelet indices and future cardiovascular events: results from a population-based cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Studies evaluating the relationship between platelet indices and cardiovascular outcome yielded conflicting results. In particular, the evidence from large, population-based, prospective studies with extended follow-up duration is scarce.
Purpose
We investigated the incidence of major adverse events in relation to baseline values of platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) in the prospective cohort of the Malmö Diet and Cancer Study.
Methods
A total of 30,314 middle-aged individuals (mean age 57±8 years; 40% men) were overall included and followed up for a median of 16 years (in total, 468,490 person-years). The following outcome measures were considered: all-cause death, myocardial infarction (MI) and ischemic stroke.
Results
There was no relationship between increase in MPV or PDW values and adverse events during follow-up. In particular, the incidence of all-cause death, MI and stroke in patients in the 4thquartile of MPV was 19.8% (vs. 20.7% in the 1stquartile; p=0.08), 8.5% (vs. 8.2%; p=0.78) and 7.9% (vs. 7.1%; p=0.09), respectively. The rates of all-cause death, MI and stroke in patients in the 4thquartile of PDW were 20.1% (vs. 20.7% in the 1stquartile; p=0.16), 8.7% (vs. 8.1%; p=0.30) and 8.1% (vs. 7.2%; p=0.09), respectively. There was a significant rise in mortality by platelet count increase (log-rank p<0.001). In multivariable analysis, patients in the 4thquartile of platelet count (>264 x 109/L) showed a significantly higher incidence of all-cause death (HR 1.17, 95% CI 1.07–1.28; p=0.001), MI (HR 1.24, 95% CI 1.08–1.43; p=0.003) and stroke (HR 1.20, 95% CI 1.04–1.39; p=0.014) vs the 1stquartile. The higher mortality in the 4thquartile of platelet count was independent of the history of previous stroke, was significant in patients without prior MI (HR 1.18, 95% CI 1.08–1.29; p<0.001) and non-significant in those with prior MI (HR 0.86, 95% CI 0.56–1.33; p=0.51). The risk of MI in the 4thquartile of platelet count was higher regardless of the history of previous MI (p for interaction=0.11). The risk of stroke in the 4thquartile of platelet count was higher regardless of the history of previous stroke (p for interaction=0.15).
Conclusions
In this population-based, prospective, cohort study there was no difference in the incidence of adverse events across various strata of baseline platelet morphology. However, patients with highest platelet count at baseline showed a significantly higher risk of all-cause death, MI and stroke. Whether or not these individuals should be targeted by more aggressive primary prophylactic measures including antiplatelet treatment, remains to be proven.
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Affiliation(s)
- F Ricci
- G. D'Annunzio University, Institute of Cardiology and Center of Excellence on Aging, Chieti, Italy
| | - G Patti
- University of L'Aquila, L'Aquila, Italy
| | | | - G Renda
- G. D'Annunzio University, Institute of Cardiology and Center of Excellence on Aging, Chieti, Italy
| | | | | | - R Sutton
- Imperial College London, London, United Kingdom
| | - S Gallina
- University of Chieti-Pescara, Chieti, Italy
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Jendrisak A, Sutton R, Orr S, Lu D, Schonhoft J, Wang Y. Functional cell profiling (FCP) of ∼100,000 CTCs from multiple cancer types identifies morphologically distinguishable CTC subtypes within and between cancer types. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz269.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Kharraziha I, Medic Spahic J, Ricci F, Persson-Tholin J, Persson M, Firth K, Axelsson J, Sutton R, Fedorowski A, Hamrefors V. P4441Serum activity against specific G-protein coupled receptors is associated with the severity of orthostatic symptoms in patients with POTS. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Postural orthostatic tachycardia syndrome (POTS) is characterised by an excessive heart rate increase upon standing and orthostatic intolerance. Previous studies indicate autoimmune involvement mediated via G-protein coupled receptors (GPCRs) as a possible aetiology.
Purpose
To test if serum from POTS patients and controls activates selected GPCRs and if the activation associates with the severity of symptoms.
Methods
A total of 34 POTS patients (age 28.9 [9.9] years; 29 women) and a population-based control group of 25 healthy subjects (age 30.7 [8.6] years; 21 women) were included. The subjects performed an active standing test and completed the orthostatic hypotension questionnaire (OHQ) including ten items related to orthostatic intolerance. The OHQ composite score was calculated (range 0–10).
Sera were analysed by a FRET-based reporter system (Tango GeneBLAzer, Thermo Fischer) based on a beta-arrestin-linked transcription factor driving transgenic betalactamase transcription. HEK293M-cells over-expressing one of the GPCRs, adrenergic alpha-1 (ADRA1), adrenergic beta-2 (ADRB2), muscarinic type-2 (CHRM2) and opioid-receptor-like 1 (OPRL1) receptor were plated in 96-well optical plates and allowed to re-attach during 48 hrs. The cells were treated with 10% sera diluted in RPMI for 5 hours, followed by addition of the FRET-substrate, incubation for 60 min and quantification analysis in a CLARIOStar multi-purpose plate reader.
Quantification of the activation of the GPCRs was log-transformed and related to the OHQ composite and individual scores in age-adjusted linear regression models. OHQ scores were compared according to the median of sera activation, using independent samples t-test.
Results
Serum ADRA1 activation associated with the OHQ composite score (beta 0.77 OHQ points per SD of activity; p=0.009), whereas there were no significant associations among controls (p=0.953). The association between ADRA1 and total OHQ was significant also after adjusting for heart rate and systolic blood pressure at 3 min (p=0.024). The OHQ composite score was higher in with above median serum ADRA1 activation (Figure 1).
ADRA1 activation associated with a higher score for vision problems (p<0.001) and symptoms during prolonged standing (p=0.037) and walking for short (p=0.042) or long periods (p=0.001).
The activity of ARB2, CHRM2 and OPRL1 did not associate with OHQ composite score in neither POTS patients nor controls.
Figure 1. OHQ according to ADRA1 activation
Conclusions
Activating serum proteins for the adrenergic alpha-1 receptor are associated with the severity of orthostatic symptoms in POTS patients, partly independent of the orthostatic hemodynamic response. Serum activity against alpha1 receptors is related particularly to symptoms of disturbed vision and symptoms during walking or prolonged standing. Serum activity against the adrenergic alpha 1 receptor may be a one factor underlying the orthostatic symptoms in POTS.
Acknowledgement/Funding
The Swedish Heart-Lung Foundation, The Swedish Heart and Lung Association, Solidex, ALF funds, Crafoord Foundation, Ernhold Lundströms Foundation.
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Affiliation(s)
- I Kharraziha
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - J Medic Spahic
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - F Ricci
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - J Persson-Tholin
- Skane University Hospital, The Clinical Research Unit, Malmo, Sweden
| | - M Persson
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - K Firth
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - J Axelsson
- Karolinska University Hospital, Dept. of Stem Cell Therapy and Apheresis, Stockholm, Sweden
| | - R Sutton
- Imperial College London, London, United Kingdom
| | - A Fedorowski
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - V Hamrefors
- Lund University, Department of Clinical Sciences, Malmo, Sweden
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Luvai A, Johnston L, Curtis A, Potter A, Musson S, Pattman S, Kamarrudin S, Weaver J, Arutchevelam V, Anderson M, Burns M, Hopper N, McAnulty C, Sutton R, Neely R, Carey P. High Polygenic Snp Scores Do Not Exclude Monogenic Familial Hypercholesterolaemia. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Mateos M, Trahair T, Mayoh C, Barbaro P, Sutton R, Revesz T, Barbaric D, Giles J, Alvaro F, Mechinaud F, Catchpoole D, Kotecha R, Dalla-Pozza L, Quinn M, MacGregor S, Chenevix-Trench G, Marshall G. Risk factors for symptomatic venous thromboembolism during therapy for childhood acute lymphoblastic leukemia. Thromb Res 2019; 178:132-138. [DOI: 10.1016/j.thromres.2019.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/10/2019] [Accepted: 04/10/2019] [Indexed: 01/19/2023]
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Dickerson LD, Farooq A, Bano F, Kleeff J, Baron R, Raraty M, Ghaneh P, Sutton R, Whelan P, Campbell F, Healey P, Neoptolemos JP, Yip VS. Differentiation of Autoimmune Pancreatitis from Pancreatic Cancer Remains Challenging. World J Surg 2019; 43:1604-1611. [PMID: 30815742 DOI: 10.1007/s00268-019-04928-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Autoimmune pancreatitis (AIP) is an uncommon form of chronic pancreatitis. Whilst being corticosteroid responsive, AIP often masquerades radiologically as pancreatic neoplasia. Our aim is to appraise demographic, radiological and histological features in our cohort in order to differentiate AIP from pancreatic malignancy. METHODS Clinical, biochemical, histological and radiological details of all AIP patients 1997-2016 were analysed. The initial imaging was re-reviewed according to international guidelines by three blinded independent radiologists to evaluate features associated with autoimmune pancreatitis and pancreatic cancer. RESULTS There were a total of 45 patients: 25 in type 1 (55.5%), 14 type 2 (31.1%) and 6 AIP otherwise not specified (13.3%). The median (IQR) age was 57 (51-70) years. Thirty patients (66.6%) were male. Twenty-six patients (57.8%) had resection for suspected malignancy and one for symptomatic chronic pancreatitis. Three had histologically proven malignancy with concurrent AIP. Two patients died from recurrent pancreatic cancer following resection. Multidisciplinary team review based on radiology and clinical history dictated management. Resected patients (vs. non-resected group) were older (64 vs. 53, p = 0.003) and more frequently had co-existing autoimmune pathologies (22.2 vs. 55.6%, p = 0.022). Resected patients also presented with less classical radiological features of AIP, which are halo sign (0/25 vs. 3/17, p = 0.029) and loss of pancreatic clefts (18/25 vs. 17/17, p = 0.017). There were no differences in demographic features other than age. CONCLUSION Despite international guidelines for diagnosing AIP, differentiation from pancreatic cancer remains challenging. Resection remains an important treatment option in suspected cancer or where conservative treatment fails.
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Affiliation(s)
- L D Dickerson
- Pancreas Unit, Department of General Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - A Farooq
- Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - F Bano
- Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - J Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, 06120, Halle (Saale), Germany
| | - R Baron
- Pancreas Unit, Department of General Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - M Raraty
- Pancreas Unit, Department of General Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - P Ghaneh
- Pancreas Unit, Department of General Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - R Sutton
- Pancreas Unit, Department of General Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - P Whelan
- Pancreas Unit, Department of General Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - F Campbell
- Department of Pathology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - P Healey
- Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - J P Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - V S Yip
- Pancreas Unit, Department of General Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
- Department of Hepatobiliary and Pancreas Surgery, 13C Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
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Bachus E, Holm H, Hamrefors V, Melander O, Sutton R, Magnusson M, Fedorowski A. Monitoring of cerebral oximetry during head-up tilt test in adults with history of syncope and orthostatic intolerance. Europace 2019; 20:1535-1542. [PMID: 29036615 DOI: 10.1093/europace/eux298] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 08/31/2017] [Indexed: 11/14/2022] Open
Abstract
Aims We applied near-infrared-spectroscopy (NIRS) to measure absolute frontal cerebral tissue oxygen saturation (SctO2) during head-up tilt test (HUT) in patients investigated for unexplained syncope. Methods and results Synchronized non-invasive beat-to-beat haemodynamic monitoring, ECG, SctO2 (NIRS; normal range: 60-80%), and peripheral oxygen saturation (left hand, SpO2) were applied during HUT in a random sample of patients with unexplained syncope. Tracings of 54 patients (mean-age: 55 ± 19 years, 39% male) with negative HUT, vasovagal syncope (VVS), or orthostatic hypotension (OH) were analysed. In 44 patients HUT was diagnostic, in 10 HUT was negative. Thirty-one experienced VVS. Of these, 6 had spontaneous and 25 nitroglycerin-induced syncope. Thirteen patients had orthostatic hypotension (OH). Although there was no significant change in mean-arterial pressure from baseline to 1 min before syncope or end of passive HUT phase (-1.4 ± 13.9 mmHg; P = 0.45), there was a significant fall in SctO2 during the same period (-3.2 ± 3.2%; P ≤ 0.001). Among patients who experienced syncope, a decrease in SctO2 from 71 ± 5% at baseline to 53 ± 9% (P < 0.001) at syncope was observed. During HUT, there was a significant difference in delta SctO2 between spontaneous VVS (-4.5 ± 3.0%) and negative HUT (-1.3 ± 1.9%; P = 0.021), but not between spontaneous VVS and OH (-5.4 ± 4.2%; P = 0.65). In spontaneous VVS, progressive decrease of SctO2 was independent of mean arterial pressure decrease (P = 0.22). Conclusions Progressive decrease in cerebral tissue oxygenation independent of mean-arterial pressure may precede spontaneous vasovagal reflex during tilt. Patients experience syncope when SctO2 falls below 60%. These data confirm clinical utility of absolute cerebral oximetry monitoring for syncope investigation. We applied NIRS to measure frontal cerebral tissue oxygen saturation (SctO2) during head-up tilt test (HUT) in patients with unexplained syncope. In 44 of 54 patients, HUT was diagnostic. In patients with syncope, a significant SctO2-decrease was observed. Different patterns of SctO2 can be detected.
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Affiliation(s)
- E Bachus
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - H Holm
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - V Hamrefors
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - O Melander
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - R Sutton
- National Heart & Lung Institute, Imperial College, London, UK
| | - M Magnusson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Cardiology, Inga Marie Nilssons gata 46, Skåne University Hospital, 205 02 Malmö, Sweden
| | - A Fedorowski
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.,Department of Cardiology, Inga Marie Nilssons gata 46, Skåne University Hospital, 205 02 Malmö, Sweden
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Abstract
BACKGROUND: Lateral column lengthening and plantarflexion dorsal opening wedge osteotomy of the medial cuneiform are 2 commonly used procedures to address the deformity seen in severe flexible pes planovalgus deformity. Traditionally, iliac crest allograft or autograft has been used to fill the osteotomy sites. Porous metallic wedges can be used as an alternative to avoid the concerns associated with both autograft and allograft. METHODS: We performed a retrospective review of patients who had corrective osteotomies utilizing metallic wedges to address flexible pes planovalgus with at least 2 years of follow-up data. Preoperative radiographic measurements (anteroposterior [AP] and talo-first metatarsal angle, calcaneal pitch, talocalcaneal angle, and talonavicular uncoverage angle) and functional scores (visual analog scale [VAS] pain, Foot and Ankle Ability Measure [FAAM] Activities of Daily Living [ADL], FAAM Sports) were compared to postoperative radiographic measurements and functional scores. RESULTS: There were statistically significant improvements in all radiographic parameters and functional scores. Two nonunions were seen, one of which healed with revision surgery while the other was asymptomatic. At the time of last radiographic follow-up, there were no recurrences of deformity or collapse. CONCLUSION: Porous metallic wedges offer an attractive alternative to autograft and/or allograft in the setting of corrective osteotomies for severe flexible pes planovalgus. Patients who underwent corrective osteotomies using these wedges demonstrated reliable, effective, and stable radiographic correction as well as significant improvements in function and pain. LEVEL OF EVIDENCE: Level IV, case series.
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Affiliation(s)
- Justin Tsai
- 1 Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Elizabeth McDonald
- 1 Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ryan Sutton
- 2 Sidney Kimmel Medical College, Ivyland, PA, USA
| | - Steven M Raikin
- 1 Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Sutton R, Azboy I, Restrepo C, Parvizi J. Ptosis of the hip: a new radiographic finding in patients undergoing femoroacetabular osteoplasty. J Hip Preserv Surg 2019; 5:425-434. [PMID: 30647934 PMCID: PMC6328752 DOI: 10.1093/jhps/hny039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/22/2018] [Accepted: 10/17/2018] [Indexed: 11/13/2022] Open
Abstract
Ptosis is a newly described phenomenon appearing on AP radiographs of patients undergoing femoroacetabular osteoplasty (FAO), and refers to a reverse break down in Shenton’s Line. Thorough characterization of this phenomenon is needed to better understand the hip morphology and pathologic ramifications. Our goal was to define the radiographic hip parameters accompanying a break down in Shenton’s Line and to determine how these values compare with standard values in normal hips. Using two independent readers, we retrospectively reviewed the medical records and preoperative supine radiographs of 630 patients (1260 hips) who underwent FAO by a single surgeon between 2003 and 2016. Prevalence of hip pathology and 28 radiographic parameters in ptosis hips was measured, as well as a comparison between unilateral ptosis hips and contralateral normal hips. Of the 53 patients (106 hips) who fulfilled the criteria for the study, 94 hips had a Shenton’s Line break down of at least 5 mm. Sixty-nine percent of ptosis hips had femoroacetabular impingement (FAI), 70.2% had coxa profunda, and 52.1% had partial joint space narrowing. Ptosis hips had 1.05 mm less lateral subluxation (P = 0.012), 2.28° larger Center-edge angle (P = 0.046), 2.59° smaller Sharp angle (P = 0.011) and 2.49% smaller extrusion index (P = 0.016) compared with contralateral normal hips. FAI is prevalent in patients with a positive ptosis sign. The high prevalence of partial joint space narrowing could suggest eventual osteoarthritis. We believe our results demonstrate the importance of further investigation of a positive ptosis sign on AP pelvic radiographs.
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Affiliation(s)
- Ryan Sutton
- Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA
| | - Ibrahim Azboy
- Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA
| | - Camilo Restrepo
- Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA
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Ricci F, Spahic J, Johansson M, Aung N, Hamrefors V, Melander O, Sutton R, Fedorowski A. P4427Detection of inflammatory biomarkers associated with postural orthostatic tachycardia syndrome: insights from the SYSTEMA cohort. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Ricci
- G. D'Annunzio University, Institute of Cardiology and Center of Excellence on Aging, Chieti, Italy
| | | | | | - N Aung
- Queen Mary University of London, London, United Kingdom
| | | | | | - R Sutton
- Imperial College London, London, United Kingdom
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Johnston L, Potter A, Carey P, Luvai A, McKenna P, Weaver J, Pattman S, Kamaruddin S, Arutchevelam V, Anderson M, Burns M, Hopper N, Sutton R, McAnulty C, Curtis A, Neely R. Mutations in LDLR, APOB, PCSK9 and APOE genes contribute to the genetic spectrum of familial hypercholesterolaemia in the north of England. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Moore D, Sud A, Cheng J, Alves D, Huang W, Sutton R. Clinical measures to capture stratified outcomes of mild, moderate and severe acute pancreatitis. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mukherjee R, Wen L, Zhang X, Bhattacharya P, Huang W, Sutton R. A novel digital method to assess air space loss associated with acute lung injury in experimental acute pancreatitis. Pancreatology 2018; 18:513-515. [PMID: 29784598 DOI: 10.1016/j.pan.2018.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/11/2018] [Accepted: 04/30/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Respiratory dysfunction and/or failure from acute lung injury (ALI) are common in acute pancreatitis (AP), but assessment of ALI in experimental AP has lacked standardisation. METHODS A range of experimental AP models induced in C57BL/6 mice with corresponding controls (n = 6/group). Full double lung or right lung specimens were taken for histopathological assessment and slides analysed by a pre-set pipeline using Aperio Scanner (Leica), ImageJ software and CellProfiler software. Findings were compared to other routinely assessed parameters. RESULTS Overall histopathological changes were similar between both lungs. Mean lung field occupancy was significantly different between moderate and severe CER-AP (21.9% v 27.5%, p < 0.05) and corresponded with lung MPO and local injury severity parameters and was mirrored for all models tested. CONCLUSION We have developed a novel, simple method for assessment of ALI to improve measurement of systemic organ injury in experimental AP and contribute to preclinical drug development.
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Affiliation(s)
- R Mukherjee
- Liverpool Pancreatitis Research Group, Institute of Translational Medicine, University of Liverpool, UK.
| | - L Wen
- Liverpool Pancreatitis Research Group, Institute of Translational Medicine, University of Liverpool, UK; Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
| | - X Zhang
- Liverpool Pancreatitis Research Group, Institute of Translational Medicine, University of Liverpool, UK; Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
| | - P Bhattacharya
- Liverpool Pancreatitis Research Group, Institute of Translational Medicine, University of Liverpool, UK
| | - W Huang
- Liverpool Pancreatitis Research Group, Institute of Translational Medicine, University of Liverpool, UK; Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
| | - R Sutton
- Liverpool Pancreatitis Research Group, Institute of Translational Medicine, University of Liverpool, UK
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Danoff JR, Goel R, Sutton R, Maltenfort MG, Austin MS. How Much Pain Is Significant? Defining the Minimal Clinically Important Difference for the Visual Analog Scale for Pain After Total Joint Arthroplasty. J Arthroplasty 2018; 33:S71-S75.e2. [PMID: 29567002 DOI: 10.1016/j.arth.2018.02.029] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The ability to detect changes in patient-perceived pain after total joint arthroplasty (TJA) is critical to manage postoperative pain. The minimal clinically important difference (MCID) for visual analog scale for pain (VAS-P) has not been investigated in this population. This study investigated the MCID for VAS-P in the TJA population. METHODS Postoperative pain scores were collected on 139 total hip arthroplasty (THA) and 165 total knee arthroplasty (TKA) patients. VAS-P was measured and Likert scores for changes in pain recorded together throughout the hospitalization per patient. Using a linear mixed model, the mean difference between preceding and current VAS-P was calculated and correlated with Likert score, when the patient reported at least slight improvement or worsening in pain, defining the MCID. Minimal detectable change was calculated using the VAS-P standard error of the means for patients reporting "no change." RESULTS For THA, the overall mean and average highest VAS-P were 35.0 mm and 50.4 mm, respectively. For TKA, the overall mean and average highest VAS-P were 42.6 mm and 61.1 mm, respectively. The minimal detectable change in VAS-P was 14.9 mm for THA and 16.1 mm for TKA. The MCID for THA and TKA pain improvement was -18.6 mm and -22.6 mm, respectively, and for worsening was 23.6 mm and 29.1 mm, respectively. CONCLUSION In the postoperative TJA population, VAS-P MCID changes depend on the type of surgical intervention, and whether pain is improving or worsening. Statistically significant VAS-P, improving -18.6 mm and -22.6 mm for THA and TKA patients, respectively, sets a reasonable threshold to identify clinically meaningful pain intervention with high specificity.
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Affiliation(s)
- Jonathan R Danoff
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Rahul Goel
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Ryan Sutton
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | | | - Matthew S Austin
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Abstract
BACKGROUND The relationship between depressive symptoms and patient outcomes after hallux valgus surgery has not been well-studied. We hypothesized that patients with depressive symptoms would have greater subjective dysfunction preoperatively and less functional improvement and satisfaction after surgery when compared with patients without depressive symptoms. METHODS A total of 239 adult patients who had surgical hallux valgus correction over a 2-year period were retrospectively enrolled. A telephone survey was administered prospectively at least 11 months postoperatively inquiring about overall satisfaction level with surgery and satisfaction with postoperative pain level. A scale of 0 to 6 was used, with 0 indicating complete dissatisfaction and 6 indicating complete satisfaction. Patients were divided into 2 groups based on depressive symptoms; a Short Form-12 mental component score (SF-12 MCS) of less than 45.6 points was considered indicative of active depressive symptoms based on literature correlating SF-12 scores with Patient Health Questionnaire-9 for depression. Given the great variability of depressive symptoms in patients with or without self-reported depression and medicated or unmedicated status, we elected to use the MCS classification of depressive symptoms for our analysis. Data from 239 patients were available for analysis, with an average age of 51.6 years and 207 women (87%). Two hundred eighteen patients (91%) completed preoperative functional scores, 160 patients (67%) completed the satisfaction survey at an average of 23 months postoperatively (range 11 to 43 months), and 154 patients (64%) completed postoperative functional scores an average of 21 months postoperatively (range, 11-44 months). Results Thirty-six of 239 patients (15%) with baseline functional scores exhibited depressive symptoms. There was no significant difference in baseline functional scores and pain levels between groups with the exception of the SF-12 MCS ( P < .001). Most outcomes improved significantly over time, including the SF-12 physical component score ( P = .013), Foot and Ankle Ability Measure (FAAM; P = .013), and FAAM Activities of Daily Living ( P = .046). The patients with depressive symptoms generally had lower scores at baseline and final follow-up in all functional scores, with the exception of visual analog scale (VAS). VAS pain scores started higher in the group of patients with depressive symptoms and ended lower. Satisfaction with postoperative pain was lower in the group with depressive symptoms when compared with patients without depressive symptoms (3.6 vs 4.5, P = .042). There was no significant difference in satisfaction after surgery between groups ( P = .251). CONCLUSION Patients with depressive symptoms had greater pain at baseline and less pain postoperatively when compared with patients without depressive symptoms; however, satisfaction levels with postoperative pain were lower in these patients. Furthermore, most functional scores were lower in patients with depressive symptoms, with the exception of the MCS. Reported history of depression was not associated with any significant difference in functional outcome scores or satisfaction. Further study is warranted to determine why patients with depressive symptoms fare worse after surgical hallux valgus correction by most subjective measures. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Rachel Shakked
- 1 Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth McDonald
- 1 Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan Sutton
- 2 Sidney Kimmel Medical College at Thomas Jefferson University, Ivyland, PA, USA
| | | | - Kristen Nicholson
- 1 Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven M Raikin
- 1 Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Sutton R, McDonald E, Shakked R, Raikin S. Determination of minimum clinically important difference (MCID) in visual analog scale for pain scores after hallux valgus correction. Foot & Ankle Orthopaedics 2018. [DOI: 10.1177/2473011418s00473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Category: Bunion Introduction/Purpose: Surgical outcome studies rely on patient reported outcome measurements to assess the effectiveness of treatment. The concept of minimal clinically important difference (MCID) proposes a necessary threshold to achieve clinically significant treatment results, and refers to the smallest change in outcome measure important from the patient’s perspective. In the context of visual analog scale (VAS) questionnaires, MCID refers to a clinically significant change in pain score. Determination of MCID in patient-oriented outcome questionnaires is necessary to further evaluate the effectiveness of hallux valgus surgery. Further, MCID analysis of hallux valgus surgical outcomes could provide improved insight into post-operative patient satisfaction. The purpose of this study was to determine the MCID in pre- to post-operative VAS pain score in patients undergoing surgical treatment of hallux valgus. Methods: Adult patients undergoing surgical treatment of hallux valgus were retrospectively included. Pre- and post-operative VAS pain scores (0-10) and surveys inquiring about satisfaction with pain level after surgery were collected at a minimum of 1-year post-surgery. Patients were categorized as responders or non-responders based upon a completed 6-point pain satisfaction scale. Patients reporting satisfaction scores 0-3 were categorized as non-responders, and 4-6 as responders. Four MCID calculation methods were used that have been described in previous literature: the standard deviation (SD) approach, the average change approach, the minimally detectable change (MDC) approach, and the change difference approach. The total percentage of patients meeting the calculated VAS threshold score for each MCID method was determined. The likelihood of meeting the VAS threshold for each MCID method based on responder status, hallux valgus severity, and correction status of concomitant hammertoe deformity was also determined using bivariate analysis. Results: 170 patients were included with post-operative follow-up averaging 23.6 months. VAS MCID threshold scores were 1.77points (SD approach), 5.21points (average change approach), 1.98points (MDC approach), and 4.27points (change difference approach). The patient percentage meeting the VAS threshold score for each MCID approach was 73.5%, 40.6%, 73.5%, and 48.8%, respectively. Moderate deformity procedures (Ludloff) demonstrated greater likelihood than mild deformity procedures (Chevron, Modified McBride, Aikin, Silver) of meeting the average change, MDC, and change difference approach thresholds (p=0.036, 0.035, 0.034). Severe deformity procedures (Lapidus) demonstrated greater likelihood than mild deformity procedures of meeting the SD approach threshold (p=0.046). Hammertoe correction demonstrated greater likelihood than non-correction of meeting the average change approach threshold (p=0.038). Responders demonstrated greater likelihood than non-responders of meeting all MCID approach thresholds (p<0.001). Conclusion: This study demonstrated marked variability in determining VAS MCID for hallux valgus correction (range 1.77- 5.21 points). This study suggests an association between type of hallux valgus correction and likelihood of post-operative improvement, as there was greater chance of meeting MCID with correction of greater hallux valgus deformity or hammertoe deformity. MCID methods utilizing comparisons of responder status may not be appropriate for hallux valgus patients, as responders tended to improve with time and non-responders tended to decline. Additional investigation of the optimal MCID method for hallux valgus correction is necessary to narrow the range and determine surgical efficacy.
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Karsa M, Failes T, Arndt G, Kees U, Haber M, Norris M, Sutton R, Lock R, Somers K, Henderson M. PO-405 Repositioning existing drugs as novel therapeutics for high-risk paediatric leukaemia. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Hamrefors V, Yasa E, Sutton R, Fedorowski A. P413Aetiology of syncope and orthostatic intolerance in older patients with pacemakers: SYSTEMA cohort. Europace 2018. [DOI: 10.1093/europace/euy015.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Hamrefors
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - E Yasa
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - R Sutton
- Imperial College London, London, United Kingdom
| | - A Fedorowski
- Lund University, Department of Clinical Sciences, Malmo, Sweden
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Fedorowski A, Ricci F, Palermi S, Renda G, Gallina S, Melander O, De Caterina R, Sutton R. 073_16968-G2 Non-Cardiac Syncope and All-Cause Mortality in Adults: A Meta-Analysis of Prospective Studies. JACC Clin Electrophysiol 2017. [DOI: 10.1016/j.jacep.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sau A, Sritharan V, Taraborrelli P, Dirksen A, Dhutia N, Lim CW, Hayat S, Sutton R, Lim PB. 29Refining the diagnostic criteria of the postural orthostatic tachycardia syndrome (POTS) using power spectral indices. Europace 2017. [DOI: 10.1093/europace/eux283.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McDonald E, Tsai J, Raikin S, Sutton R. Correction of Severe Flexible Pes Planovalgus Deformity Using Trabecular Metallic Wedges. Foot & Ankle Orthopaedics 2017. [DOI: 10.1177/2473011417s000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Category: Hindfoot, Midfoot/Forefoot Introduction/Purpose: Lateral column lengthening and a medial cuneiform plantarflexion (Cotton) osteotomy are procedures commonly used in the treatment of symptomatic flexible pes planovalgus. Traditionally, structural autograft or allograft have been used for both osteotomies. While union rates for both types of graft have been shown to be comparably high, the use of allograft or autograft each come with their own set of inherent risks and/or potential complications. A trabecular titanium wedge implant provides an attractive alternative that avoids the concerns associated with autograft and allograft use, and has previously been shown in the literature to demonstrate similar union rates. The purpose of this study was to retrospectively review the radiographic outcomes of corrective osteotomies utilizing trabecular metal wedges to address severe flexible pes planovalgus deformity. Methods: 115 feet in 109 patients who were treated with corrective osteotomies using a trabecular titanium wedges performed by one surgeon were retrospectively reviewed. All patients had symptomatic flexible pes planovalgus, mostly secondary to stage IIB posterior tibialis tendon dysfunction. Other diagnoses included pes planovalgus secondary to the adolescent idiopathic flexible subtype, traumatic posterior tibialis tendon rupture, coalition, or an accessory navicular. Preoperative radiographic parameters assessing severity of deformity were recorded and compared to the postoperative measurements taken at the time of most recent follow up visit to assess for correction. The radiographic measurements included the (1) AP talo-1st metatarsal angle (2) Lateral talo-1st metatarsal angle (3) Calcaneal pitch (4) Lateral talo-calcaneal angle and (5) Talonavicular uncoverage angle. All angles were measured off standard weight-bearing radiographs by one author using our institution’s picture archiving and communication system (PACS) software. All complications were also recorded. Results: At an average follow up time of 40 weeks, there were statistically significant corrective changes in the AP-talo-1st metatarsal angle (-12.56), lateral talo-1st metatarsal angle (+14.15), calcaneal pitch (+5.23), lateral talo-calcaneal angle (-3.87) and talonavicular uncoverage angle (-17.76). There were 3 nonunions (2.6%) confirmed by CT, 2 of which were eventually revised. There were a total of 9 complications (7.8%). Other than the nonunion revisions, none of these complications required a return to the operating room. There were no cases of collapse or loss of correction at the time of followup, as compared to the initial post-operative radiographs. Conclusion: In our study population corrective osteotomies using a trabecular titanium wedge was effective in improving radiographic parameters associated with flexible pes planovalgus deformity. The nonunion and overall complication rates using a trabecular titanium wedge were shown to be comparable or superior to what has previously been reported in the literature using allograft or autograft.
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McDonald E, Shakked R, Sutton R, Raikin S, Lynch MK. Influence of Depression and Anxiety on Hallux Valgus Surgical Outcomes. Foot & Ankle Orthopaedics 2017. [DOI: 10.1177/2473011417s000289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Depression and anxiety can negatively affect outcomes after orthopaedic surgery. The relationship of depression/anxiety with patient outcomes after hallux valgus surgery is not well-studied. The purpose of this study is to evaluate our cohort of patients undergoing hallux valgus surgery and determine whether depression and/or anxiety correlate with different pain and satisfaction levels. We hypothesize that patients with depression/anxiety will have greater subjective dysfunction pre- operatively and less satisfaction after surgery when compared to those patients without depression/anxiety. Methods: This retrospective study included adult patients that had undergone surgical treatment for hallux valgus over a 2-year period. Basic demographic data was collected as well as baseline visual analog scale (VAS), SF-12 mental component, and VR-12 mental component. History of depression and/or anxiety and medications were recorded. All patients were called by phone to administer a 3-question survey at least 9 months after surgery. Data from 267 patients were available for analysis. The average patient age was 51.7 years and there were 232 females (87%). 233 patients (87%) completed preoperative functional scores, and 187 patients (70%) were reached by phone at an average of 21 months post-operatively for a satisfaction survey. Pairwise Wilcoxon tests with correction for multiple tests, unpaired student’s t tests, and a multivariate regression analysis were performed to analyze the data. Results: Of the 267 patients included in the study, 70 patients (26%) reported a history of depression and/or anxiety. Patients with a history of depression/anxiety had similar baseline demographics compared to patients without depression/anxiety including nearly 90% female sex and about 20 months post-operative follow-up (see Table 1). The group with depression/anxiety was older (55.9 years versus 50.2 years, p = 0.003), and a greater proportion of cases had severe deformity (27% versus 16%, p = 0.47). Patients with depression/anxiety scored significantly lower on baseline SF-12 and VR-12 mental scores; VAS was also lower but this was not statistically significant. Post-operative VAS and satisfaction with surgery and post-operative pain level were not statistically different between groups. Conclusion: Although patients with hallux valgus and depression/anxiety may have lower baseline mental scores and higher pain levels, their outcomes after bunion surgery are similar to those patients without depression/anxiety. The group of patients with depression/anxiety had a greater percentage of severe deformities as compared to the unaffected group yet maintained similar outcomes. Depression/anxiety may affect outcomes after certain orthopaedic procedures, however this study failed to show significantly inferior outcomes in this population of patients after hallux valgus surgery.
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Salman MM, Kemp HI, Cauldwell MR, Dob DP, Sutton R. Anaesthetic management of pregnant patients with cardiac implantable electronic devices: case reports and review. Int J Obstet Anesth 2017; 33:57-66. [PMID: 28899734 DOI: 10.1016/j.ijoa.2017.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/03/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Abstract
Heart disease is a leading cause of maternal mortality and morbidity. Pregnant women with structural, conduction or degenerative cardiac disease who require rhythm control or who are at high risk of sudden cardiac death may carry a cardiac implantable electronic device or may occasionally require the insertion of one during their pregnancy. These women are now encountered more frequently in clinical practice, and it is essential that a multidisciplinary approach, beginning from the early antenatal phase, be adopted in their counselling and management. Contemporary cardiac rhythm control devices are a constantly evolving technology with increasingly sophisticated features; anaesthetists should therefore have an adequate understanding of the principles of their operation and the special considerations for their use, in order to enable their safe management in the peripartum period. Of particular importance is the potential adverse effect of electromagnetic interference, which may cause device malfunction or damage, and the precautions required to reduce this risk. The ultimate goal in the management of this patient subgroup is to minimise the disruption to cardiovascular physiology that may occur near the time of labour and delivery and to control the factors that impact on device integrity and function. We present the ante- and peripartum management of two pregnant women with an implantable cardioverter-defibrillator, followed by a review and update of the anaesthetic management of parturients with cardiac implantable electronic devices.
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Affiliation(s)
- M M Salman
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - H I Kemp
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - M R Cauldwell
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - D P Dob
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
| | - R Sutton
- National Heart & Lung Institute, Imperial College, Hammersmith Hospital, London W12 0NN, UK
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Liu T, Huang W, Szatmary P, Abrams ST, Alhamdi Y, Lin Z, Greenhalf W, Wang G, Sutton R, Toh CH. Accuracy of circulating histones in predicting persistent organ failure and mortality in patients with acute pancreatitis. Br J Surg 2017; 104:1215-1225. [PMID: 28436602 PMCID: PMC7938821 DOI: 10.1002/bjs.10538] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/10/2016] [Accepted: 02/14/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Early prediction of acute pancreatitis severity remains a challenge. Circulating levels of histones are raised early in mouse models and correlate with disease severity. It was hypothesized that circulating histones predict persistent organ failure in patients with acute pancreatitis. METHODS Consecutive patients with acute pancreatitis fulfilling inclusion criteria admitted to Royal Liverpool University Hospital were enrolled prospectively between June 2010 and March 2014. Blood samples were obtained within 48 h of abdominal pain onset and relevant clinical data during the hospital stay were collected. Healthy volunteers were enrolled as controls. The primary endpoint was occurrence of persistent organ failure. The predictive values of circulating histones, clinical scores and other biomarkers were determined. RESULTS Among 236 patients with acute pancreatitis, there were 156 (66·1 per cent), 57 (24·2 per cent) and 23 (9·7 per cent) with mild, moderate and severe disease respectively, according to the revised Atlanta classification. Forty-seven healthy volunteers were included. The area under the receiver operating characteristic (ROC) curve (AUC) for circulating histones in predicting persistent organ failure and mortality was 0·92 (95 per cent c.i. 0·85 to 0·99) and 0·96 (0·92 to 1·00) respectively; histones were at least as accurate as clinical scores or biochemical markers. For infected pancreatic necrosis and/or sepsis, the AUC was 0·78 (0·62 to 0·94). Histones did not predict or correlate with local pancreatic complications, but correlated negatively with leucocyte cell viability (r = -0·511, P = 0·001). CONCLUSION Quantitative assessment of circulating histones in plasma within 48 h of abdominal pain onset can predict persistent organ failure and mortality in patients with acute pancreatitis. Early death of immune cells may contribute to raised circulating histone levels in acute pancreatitis.
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Affiliation(s)
- T Liu
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - W Huang
- National Institute for Health Research (NIHR) Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - P Szatmary
- National Institute for Health Research (NIHR) Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - S T Abrams
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Y Alhamdi
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Z Lin
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
| | - W Greenhalf
- National Institute for Health Research (NIHR) Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - G Wang
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - R Sutton
- National Institute for Health Research (NIHR) Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - C H Toh
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Roald Dahl Haemostasis and Thrombosis Centre, Royal Liverpool University Hospital, Liverpool, UK
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Ricci F, Sutton R, Palermi S, Renda G, Gallina S, Melander O, De Caterin R, Fedorowski A. P830Non-cardiac syncope and all-cause mortality in the adult general population: a meta-analysis of prospective studies. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hamrefors V, Medic Spahic J, Nilsson D, Senneby M, Sutton R, Melander O, Fedorowski A. P836Syndromes of orthostatic intolerance and syncope in young adults. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Meyer C, Burmeister T, Gröger D, Tsaur G, Fechina L, Renneville A, Sutton R, Venn NC, Emerenciano M, Pombo-de-Oliveira MS, Barbieri Blunck C, Almeida Lopes B, Zuna J, Trka J, Ballerini P, Lapillonne H, De Braekeleer M, Cazzaniga G, Corral Abascal L, van der Velden VHJ, Delabesse E, Park TS, Oh SH, Silva MLM, Lund-Aho T, Juvonen V, Moore AS, Heidenreich O, Vormoor J, Zerkalenkova E, Olshanskaya Y, Bueno C, Menendez P, Teigler-Schlegel A, Zur Stadt U, Lentes J, Göhring G, Kustanovich A, Aleinikova O, Schäfer BW, Kubetzko S, Madsen HO, Gruhn B, Duarte X, Gameiro P, Lippert E, Bidet A, Cayuela JM, Clappier E, Alonso CN, Zwaan CM, van den Heuvel-Eibrink MM, Izraeli S, Trakhtenbrot L, Archer P, Hancock J, Möricke A, Alten J, Schrappe M, Stanulla M, Strehl S, Attarbaschi A, Dworzak M, Haas OA, Panzer-Grümayer R, Sedék L, Szczepański T, Caye A, Suarez L, Cavé H, Marschalek R. The MLL recombinome of acute leukemias in 2017. Leukemia 2017; 32:273-284. [PMID: 28701730 PMCID: PMC5808070 DOI: 10.1038/leu.2017.213] [Citation(s) in RCA: 464] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/25/2017] [Accepted: 06/21/2017] [Indexed: 12/16/2022]
Abstract
Chromosomal rearrangements of the human MLL/KMT2A gene are associated with infant, pediatric, adult and therapy-induced acute leukemias. Here we present the data obtained from 2345 acute leukemia patients. Genomic breakpoints within the MLL gene and the involved translocation partner genes (TPGs) were determined and 11 novel TPGs were identified. Thus, a total of 135 different MLL rearrangements have been identified so far, of which 94 TPGs are now characterized at the molecular level. In all, 35 out of these 94 TPGs occur recurrently, but only 9 specific gene fusions account for more than 90% of all illegitimate recombinations of the MLL gene. We observed an age-dependent breakpoint shift with breakpoints localizing within MLL intron 11 associated with acute lymphoblastic leukemia and younger patients, while breakpoints in MLL intron 9 predominate in AML or older patients. The molecular characterization of MLL breakpoints suggests different etiologies in the different age groups and allows the correlation of functional domains of the MLL gene with clinical outcome. This study provides a comprehensive analysis of the MLL recombinome in acute leukemia and demonstrates that the establishment of patient-specific chromosomal fusion sites allows the design of specific PCR primers for minimal residual disease analyses for all patients.
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Affiliation(s)
- C Meyer
- Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia (DCAL), Goethe-University, Frankfurt/Main, Germany
| | - T Burmeister
- Charité-Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - D Gröger
- Charité-Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - G Tsaur
- Regional Children Hospital 1, Research Institute of Medical Cell Technologies, Pediatric Oncology and Hematology Center, Ural Federal University, Ekaterinburg, Russia
| | - L Fechina
- Regional Children Hospital 1, Research Institute of Medical Cell Technologies, Pediatric Oncology and Hematology Center, Ural Federal University, Ekaterinburg, Russia
| | - A Renneville
- Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille; INSERM, UMR-S 1172, Cancer Research Institute of Lille, Lille, France
| | - R Sutton
- Children's Cancer Institute Australia, Uinversity of NSW Sydney, Sydney, New South Wales, Australia
| | - N C Venn
- Children's Cancer Institute Australia, Uinversity of NSW Sydney, Sydney, New South Wales, Australia
| | - M Emerenciano
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - M S Pombo-de-Oliveira
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - C Barbieri Blunck
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - B Almeida Lopes
- Pediatric Hematology-Oncology Program-Research Center, Instituto Nacional de Cancer Rio de Janeiro, Rio de Janeiro, Brazil
| | - J Zuna
- CLIP, Department of Paediatric Haematology/Oncology, Charles University Prague, 2nd Faculty of Medicine, Prague, Czech Republic
| | - J Trka
- CLIP, Department of Paediatric Haematology/Oncology, Charles University Prague, 2nd Faculty of Medicine, Prague, Czech Republic
| | - P Ballerini
- Biological Hematology, AP-HP A. Trousseau, Pierre et Marie Curie University, Paris, France
| | - H Lapillonne
- Biological Hematology, AP-HP A. Trousseau, Pierre et Marie Curie University, Paris, France
| | - M De Braekeleer
- Université de Bretagne Occidentale, Faculté de Médecine et des Sciences de la Santé, Laboratoire d'Histologie, Embryologie et Cytogénétique & INSERM-U1078, Brest, France
| | - G Cazzaniga
- Centro Ricerca Tettamanti, Clinica Pediatrica Univ. Milano Bicocca, Monza, Italy
| | - L Corral Abascal
- Centro Ricerca Tettamanti, Clinica Pediatrica Univ. Milano Bicocca, Monza, Italy
| | | | - E Delabesse
- CHU Purpan, Laboratoire d'Hématologie, Toulouse, France
| | - T S Park
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - S H Oh
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
| | - M L M Silva
- Cytogenetics Department, Bone Marrow Transplantation Unit, National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - T Lund-Aho
- Laboratory of Clinical Genetics, Fimlab Laboratories, Tampere, Finland
| | - V Juvonen
- Department of Clinical Chemistry and TYKSLAB, University of Turku and Turku University Central Hospital, Turku, Finland
| | - A S Moore
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - O Heidenreich
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - J Vormoor
- The Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - E Zerkalenkova
- Dmitry Rogachev National Scientific and Practical Center of Pediatric Hematology, Oncology and Immunology, Moscow
| | - Y Olshanskaya
- Dmitry Rogachev National Scientific and Practical Center of Pediatric Hematology, Oncology and Immunology, Moscow
| | - C Bueno
- Josep Carreras Leukemia Research Institute, Department of Biomedicine, School of Medicine, University of Barcelona, Barcelona, Spain.,CIBER de Cancer (CIBERONC), ISCIII, Madrid, Spain.,Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - P Menendez
- Josep Carreras Leukemia Research Institute, Department of Biomedicine, School of Medicine, University of Barcelona, Barcelona, Spain.,CIBER de Cancer (CIBERONC), ISCIII, Madrid, Spain.,Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - A Teigler-Schlegel
- Department of Experimental Pathology and Cytology, Institute of Pathology, Giessen, Germany
| | - U Zur Stadt
- Center for Diagnostic, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - J Lentes
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - G Göhring
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - A Kustanovich
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Republic of Belarus
| | - O Aleinikova
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Republic of Belarus
| | - B W Schäfer
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - S Kubetzko
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - H O Madsen
- Department of Clinical Immunology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - B Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - X Duarte
- Department of Pediatrics, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - P Gameiro
- Hemato-Oncology Laboratory, UIPM, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - E Lippert
- Hématologie Biologique, CHU de Brest and INSERM U1078, Université de Bretagne Occidentale, Brest, France
| | - A Bidet
- Hématologie Biologique, CHU de Brest and INSERM U1078, Université de Bretagne Occidentale, Brest, France
| | - J M Cayuela
- Laboratoire d'hématologie, AP-HP Saint-Louis, Paris Diderot University, Paris, France
| | - E Clappier
- Laboratoire d'hématologie, AP-HP Saint-Louis, Paris Diderot University, Paris, France
| | - C N Alonso
- Hospital Nacional de Pediatría Prof Dr J. P. Garrahan, Servcio de Hemato-Oncología, Buenos Aires, Argentina
| | - C M Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - S Izraeli
- The Chaim Sheba Medical Center, Department of Pediatric Hemato-Oncology and the Cancer Research Center, Tel Aviv, Israel.,Sackler Medical School Tel Aviv University, Tel Aviv, Israel
| | - L Trakhtenbrot
- The Chaim Sheba Medical Center, Department of Pediatric Hemato-Oncology and the Cancer Research Center, Tel Aviv, Israel.,Sackler Medical School Tel Aviv University, Tel Aviv, Israel
| | - P Archer
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - J Hancock
- Bristol Genetics Laboratory, Pathology Sciences, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - A Möricke
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - J Alten
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - M Schrappe
- Department of Pediatrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - M Stanulla
- Department of Pediatrics, MHH, Hanover, Germany
| | - S Strehl
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - A Attarbaschi
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - M Dworzak
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - O A Haas
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - R Panzer-Grümayer
- Children's Cancer Research Institute and St Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - L Sedék
- Department of Microbiology and Immunology, Medical University of Silesia, Zabrze, Poland
| | - T Szczepański
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - A Caye
- Department of Genetics, AP-HP Robert Debré, Paris Diderot University, Paris, France
| | - L Suarez
- Department of Genetics, AP-HP Robert Debré, Paris Diderot University, Paris, France
| | - H Cavé
- Department of Genetics, AP-HP Robert Debré, Paris Diderot University, Paris, France
| | - R Marschalek
- Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia (DCAL), Goethe-University, Frankfurt/Main, Germany
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Virag N, Erickson M, Taraborrelli P, Vetter R, Lim PB, Sutton R. 179Predicting vasovagal syncope from heart rate and blood pressure: a prospective study in 140 subjects. Europace 2017. [DOI: 10.1093/ehjci/eux136.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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