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[PMID]: 26232429
[Au] Autor:Zhang Z; Amorosa LF; Coyle SM; Macor MA; Lubitz SE; Carson JL; Birnbaum MJ; Lee LY; Haimovich B
[Ad] Address:Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903;...
[Ti] Title:Proteolytic Cleavage of AMPKα and Intracellular MMP9 Expression Are Both Required for TLR4-Mediated mTORC1 Activation and HIF-1α Expression in Leukocytes.
[So] Source:J Immunol;195(5):2452-60, 2015 Sep 1.
[Is] ISSN:1550-6606
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:LPS-induced TLR4 activation alters cellular bioenergetics and triggers proteolytic cleavage of AMPKα and HIF-1α expression in leukocytes. In human leukocytes, and more specifically neutrophils, AMPKα cleavage yields 55- and 35-kDa protein fragments. In this study, we address the mechanism by which AMPKα is cleaved and its relevance to human health. Our data indicate that AMPKα cleavage is linked to MMP9 expression and that both are required for mammalian target of rapamycin complex-1 and S6K1 activation and HIF-1α expression in LPS-stimulated human and mice leukocytes. Three key observations support this conclusion. First, no changes in AMPKα and TLR4 signaling intermediates (mammalian target of rapamycin complex-1/S6 kinase 1/HIF-1α) were detected in LPS-stimulated MMP9-deficient mice leukocytes. Second, rMMP9 cleaved human AMPKα ex vivo, producing degradation products similar in size to those detected following LPS stimulation. Third, MMP9 inhibitors prevented AMPKα degradation and HIF-1α expression in LPS-activated human leukocytes, whereas AMPK activators blocked MMP9 and HIF-1α expression. Significantly, AMPKα degradation, MMP9, and TLR4 signaling intermediates were all detected in leukocytes from patients with type 2 diabetes mellitus and patients following cardiopulmonary bypass surgery. Plasma from these two patient cohorts induced AMPKα cleavage and TLR4 signaling intermediates in healthy donor leukocytes and either a TLR4 inhibitor or polymyxin prevented these outcomes. Detection of AMPKα degradation, MMP9 expression, and TLR4 signaling intermediates described in this study in leukocytes, the most readily available human cells for clinical investigation, may provide a powerful tool for further exploring the role of TLR4 signaling in human diseases and lead to identification of new, context-specific therapeutic modalities for precision medicine.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.4049/jimmunol.1500944

  2 / 1479849 MEDLINE  
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[PMID]: 25826802
[Au] Autor:Ji S; Fan X; Paulsen KD; Roberts DW; Mirza SK; Lollis SS
[Ti] Title:Patient Registration Using Intraoperative Stereovision in Image-guided Open Spinal Surgery.
[So] Source:IEEE Trans Biomed Eng;62(9):2177-86, 2015 Sep.
[Is] ISSN:1558-2531
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Despite its widespread availability and success in open cranial neurosurgery, image-guidance technology remains more limited in use in open spinal procedures, in large part, because of patient registration challenges. In this study, we evaluated the feasibility of using intraoperative stereovision (iSV) for accurate, efficient, and robust patient registration in an open spinal fusion surgery. Geometrical surfaces of exposed vertebrae were first reconstructed from iSV. A classical multistart registration was then executed between point clouds generated from iSV and preoperative computed tomography images of the spine. With two pairs of feature points manually identified to facilitate the registration, an average registration accuracy of 1.43mm in terms of surface-to-surface distance error was achieved in eight patient cases using a single iSV image pair sampling 2-3 vertebral segments. The iSV registration error was consistently smaller than the conventional landmark approach for every case (average of 2.02mm with the same error metric). The large capture ranges (average of 23.8mm in translation and 46.0 in rotation) found in the iSV patient registration suggest the technique may offer sufficient robustness for practical application in the operating room. Although some manual effort was still necessary, the manually-derived inputs for iSV registration only needed to be approximate as opposed to be precise and accurate for the manual efforts required in landmark registration. The total computational cost of the iSV registration was 1.5min on average, significantly less than the typical ∼30min required for the landmark approach. These findings support the clinical feasibility of iSV to offer accurate, efficient, and robust patient registration in open spinal surgery, and therefore, its potential to further increase the adoption of image guidance in this surgical specialty.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1109/TBME.2015.2415731

  3 / 1479849 MEDLINE  
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[PMID]: 25539690
[Au] Autor:Steinhilber B; Hoffmann S; Karlovic K; Pfeffer S; Maier T; Hallasheh O; Kruck S; Seibt R; Rieger MA; Heidingsfeld M; Feuer R; Sawodny O; Rothmund R; Sievert KD
[Ad] Address:Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tbingen, Tbingen, Germany, benjamin.steinhilber@med.uni-tuebingen.de.
[Ti] Title:Development of an arm support system to improve ergonomics in laparoscopic surgery: study design and provisional results.
[So] Source:Surg Endosc;29(9):2851-8, 2015 Sep.
[Is] ISSN:1432-2218
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:BACKGROUND: Laparoscopic surgery (LS) induces physical stress to the surgeon that is associated with an increased prevalence of musculoskeletal pain and injury in the shoulder-neck region. The aim of this research project is to develop an arm support system (ASsyst) that reduces physical stress and is applicable to various laparoscopic interventions and operation room settings. METHODS: A systematic approach to develop an ASsyst started in October 2012 consisting of five consecutive steps. In step 1, 14 laparoscopic interventions were observed using subjective and objective measures to determine key indicators for the conception of an ASsyst in LS. In step 2, an expert workshop was held to find and evaluate solutions to generate concepts for a support system based on the results of step 1 and general methods. During the third step, prototypes of ASsyst were tested in an experimental setting. Steps 4 and 5 are currently in process and include the final development of the ASsyst using the most promising concept for the evaluation during simulated LS. RESULTS: Increased levels of physical stress were found in LS. Asymmetric strains were common. Three prototypes of ASsyst emerged from step 1 and 2. These prototypes were a cable construction with a noose for the lower arm, a support from below the elbow and a pneumatic vest supporting the upper arm. The experimental testing of these prototypes demonstrated reduced physical stress when compared to the unsupported environment. The support from below the elbow seemed to be the most practical in terms of implementation in various operation room settings and acceptance by surgeons. Step 4 and 5 are still in process. CONCLUSIONS: Ergonomic problems have been identified in LS that could be addressed by an ASsyst. The concept of supporting the elbow from below has been found to be the most promising approach.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00464-014-3984-x

  4 / 1479849 MEDLINE  
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[PMID]: 24942296
[Au] Autor:Assirelli E; Filardo G; Mariani E; Kon E; Roffi A; Vaccaro F; Marcacci M; Facchini A; Pulsatelli L
[Ad] Address:Laboratory of Immunorheumatology and Tissue Regeneration/RAMSES, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy, elisa.assirelli@ior.it.
[Ti] Title:Effect of two different preparations of platelet-rich plasma on synoviocytes.
[So] Source:Knee Surg Sports Traumatol Arthrosc;23(9):2690-703, 2015 Sep.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: To analyse the modifications induced by two different platelet-rich plasma (PRP) preparations on osteoarthritis (OA) synoviocytes, by documenting changes in gene expression of factors involved in joint physiopathology. METHODS: OA synoviocytes were cultured for 7days in medium with different concentrations of either P-PRP (a pure platelet concentrate without leucocytes but with a limited number of platelets), L-PRP (a higher platelet concentrate containing leucocytes) or platelet-poor plasma (PPP). Gene expression of interleukin (IL)-1beta, IL-6, IL-8/CXCL8, tumour necrosis factor alpha, IL-10, IL-4, IL-13, metalloproteinase-13, tissue inhibitor of metalloproteinase (TIMP)-1, (TIMP)-3, (TIMP)-4, vascular endothelial growth factor, transforming growth factor beta1, fibroblast growth factor (FGF)-2, hepatocyte growth factor (HGF), hyaluronic acid (HA) synthases (HAS)-1, (HAS)-2, and (HAS)-3 was analysed by RT-PCR. HA production was determined in culture supernatants by ELISA. RESULTS: IL-1, IL-8 and FGF-2 were significantly induced by L-PRP compared to both P-PRP and PPP; HGF was down-modulated by L-PRP versus both P-PRP and PPP, and an inverse dose-response influence was shown for all preparations. Expression level of TIMP-4 was lower in the presence of L-PRP compared with P-PRP. HA production and HAS gene expression did not seem to be modulated by PRP. CONCLUSIONS: L-PRP is able to sustain the up-regulation of proinflammatory factors, (IL-1beta, IL-8 and FGF-2), together with a down-modulation of HGF and TIMP-4 expression, two factors that have been recognized as anti-catabolic mediators in cartilage, thus supporting the need to further optimize the PRP preparations to be applied in clinical practice.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-014-3113-3

  5 / 1479849 MEDLINE  
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[PMID]: 24275957
[Au] Autor:Filardo G; Kon E; Roffi A; Di Matteo B; Merli ML; Marcacci M
[Ad] Address:Nano-Biotechnology Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Insitute, Via di Barbiano n. 1/10, 40136, Bologna, Italy.
[Ti] Title:Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration.
[So] Source:Knee Surg Sports Traumatol Arthrosc;23(9):2459-74, 2015 Sep.
[Is] ISSN:1433-7347
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: The aim of this review was to analyze the available evidence on the clinical application of this biological approach for the injective treatment of cartilage lesions and joint degeneration, together with preclinical studies to support the rationale for the use of platelet concentrates, to shed some light and give indications on what to treat and what to expect from intra-articular injections of platelet-rich plasma (PRP). METHODS: All in vitro, in vivo preclinical and clinical studies on PRP injective treatment in the English language concerning the effect of PRP on cartilage, synovial tissue, menisci, and mesenchymal stem cells were considered. A systematic review on the PubMed database was performed using the following words: (platelet-rich plasma or PRP or platelet concentrate or platelet lysate or platelet supernatant) and (cartilage or chondrocytes or synoviocytes or menisci or mesenchymal stem cells). RESULTS: Fifty-nine articles met the inclusion criteria: 26 were in vitro, 9 were in vivo, 2 were both in vivo and in vitro, and 22 were clinical studies. The analysis showed an increasing number of published studies over time. Preclinical evidence supports the use of PRP injections that might promote a favourable environment for joint tissues healing. Only a few high-quality clinical trials have been published, which showed a clinical improvement limited over time and mainly documented in younger patients not affected by advanced knee degeneration. CONCLUSIONS: Besides the limits and sometimes controversial findings, the preclinical literature shows an overall support toward this PRP application. An intra-articular injection does not just target cartilage; instead, PRP might influence the entire joint environment, leading to a short-term clinical improvement. Many biological variables might influence the clinical outcome and have to be studied to optimize PRP injective treatment of cartilage degeneration and osteoarthritis. LEVEL OF EVIDENCE: IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00167-013-2743-1

  6 / 1479849 MEDLINE  
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[PMID]: 26060977
[Au] Autor:Nelson DW; Simianu VV; Bastawrous AL; Billingham RP; Fichera A; Florence MG; Johnson EK; Johnson MG; Thirlby RC; Flum DR; Steele SR; Colorectal Writing Group for the Surgical Care and Outcomes Assessment ProgramComparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative
[Ad] Address:Madigan Army Medical Center, Department of Surgery, Fort Lewis, Washington....
[Ti] Title:Thromboembolic Complications and Prophylaxis Patterns in Colorectal Surgery.
[So] Source:JAMA Surg;150(8):712-20, 2015 Aug 1.
[Is] ISSN:2168-6262
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:IMPORTANCE: Venous thromboembolism (VTE) is an important complication of colorectal surgery, but its incidence is unclear in the era of VTE prophylaxis. OBJECTIVE: To describe the incidence of and risk factors associated with thromboembolic complications and contemporary VTE prophylaxis patterns following colorectal surgery. DESIGN, SETTING, AND PARTICIPANTS: Prospective data from the Washington State Surgical Care and Outcomes Assessment Program (SCOAP) linked to a statewide hospital discharge database. At 52 Washington State SCOAP hospitals, participants included consecutive patients undergoing colorectal surgery between January 1, 2006, and December 31, 2011. MAIN OUTCOMES AND MEASURES: Venous thromboembolism complications in-hospital and up to 90 days after surgery. RESULTS: Among 16 120 patients (mean age, 61.4 years; 54.5% female), the use of perioperative and in-hospital VTE chemoprophylaxis increased significantly from 31.6% to 86.4% and from 59.6% to 91.4%, respectively, by 2011 (P < .001 for trend for both). Overall, 10.6% (1399 of 13 230) were discharged on a chemoprophylaxis regimen. The incidence of VTE was 2.2% (360 of 16 120). Patients undergoing abdominal operations had higher rates of 90-day VTE compared with patients having pelvic operations (2.5% [246 of 9702] vs 1.8% [114 of 6413], P = .001). Those having an operation for cancer had a similar incidence of 90-day VTE compared with those having an operation for nonmalignant processes (2.1% [128 of 6213] vs 2.3% [232 of 9902], P = .24). On adjusted analysis, older age, nonelective surgery, history of VTE, and operations for inflammatory disease were associated with increased risk of 90-day VTE (P < .05 for all). There was no significant decrease in VTE over time. CONCLUSIONS AND RELEVANCE: Venous thromboembolism rates are low and largely unchanged despite increases in perioperative and postoperative prophylaxis. These data should be considered in developing future guidelines.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1001/jamasurg.2015.1057

  7 / 1479849 MEDLINE  
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[PMID]: 26214552
[Au] Autor:Schonberger RB; Dai F; Brandt CA; Burg MM
[Ad] Address:From the *Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut; Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut; Departments of Emergency Medicine and Anesthesiology, Yale School of Medicine, New Haven, Connecticut; and ∥Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
[Ti] Title:Balancing Model Performance and Simplicity to Predict Postoperative Primary Care Blood Pressure Elevation.
[So] Source:Anesth Analg;121(3):632-41, 2015 Sep.
[Is] ISSN:1526-7598
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Because of uncertainty regarding the reliability of perioperative blood pressures and traditional notions downplaying the role of anesthesiologists in longitudinal patient care, there is no consensus for anesthesiologists to recommend postoperative primary care blood pressure follow-up for patients presenting for surgery with an increased blood pressure. The decision of whom to refer should ideally be based on a predictive model that balances performance with ease-of-use. If an acceptable decision rule was developed, a new practice paradigm integrating the surgical encounter into broader public health efforts could be tested, with the goal of reducing long-term morbidity from hypertension among surgical patients. METHODS: Using national data from US veterans receiving surgical care, we determined the prevalence of poorly controlled outpatient clinic blood pressures ≥140/90 mm Hg, based on the mean of up to 4 readings in the year after surgery. Four increasingly complex logistic regression models were assessed to predict this outcome. The first included the mean of 2 preoperative blood pressure readings; other models progressively added a broad array of demographic and clinical data. After internal validation, the C-statistics and the Net Reclassification Index between the simplest and most complex models were assessed. The performance characteristics of several simple blood pressure referral thresholds were then calculated. RESULTS: Among 215,621 patients, poorly controlled outpatient clinic blood pressure was present postoperatively in 25.7% (95% confidence interval [CI], 25.5%-25.9%) including 14.2% (95% CI, 13.9%-14.6%) of patients lacking a hypertension history. The most complex prediction model demonstrated statistically significant, but clinically marginal, improvement in discrimination over a model based on preoperative blood pressure alone (C-statistic, 0.736 [95% CI, 0.734-0.739] vs 0.721 [95% CI, 0.718-0.723]; P for difference <0.0001). The Net Reclassification Index was 0.088 (95% CI, 0.082-0.093); P < 0.0001. A preoperative blood pressure threshold ≥150/95 mm Hg, calculated as the mean of 2 readings, identified patients more likely than not to demonstrate outpatient clinic blood pressures in the hypertensive range. Four of 5 patients not meeting this criterion were indeed found to be normotensive during outpatient clinic follow-up (positive predictive value, 51.5%; 95% CI, 51.0-52.0; negative predictive value, 79.6%; 95% CI, 79.4-79.7). CONCLUSIONS: In a national cohort of surgical patients, poorly controlled postoperative clinic blood pressure was present in >1 of 4 patients (95% CI, 25.5%-25.9%). Predictive modeling based on the mean of 2 preoperative blood pressure measurements performed nearly as well as more complicated models and may provide acceptable predictive performance to guide postoperative referral decisions. Future studies of the feasibility and efficacy of such referrals are needed to assess possible beneficial effects on long-term cardiovascular morbidity.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1213/ANE.0000000000000860

  8 / 1479849 MEDLINE  
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[PMID]: 25990075
[Au] Autor:Zhen YH; Liu XH; Yang Y; Li B; Tang JL; Zeng QX; Hu J; Zeng XN; Zhang L; Wang ZJ; Li XY; Ge HX; Winqvist O; Hu PS; Xiu J
[Ad] Address:Department of Colorectal Surgery, The Affiliated Hospital of Guiyang Medical College, Guiyang, People's Republic of China.
[Ti] Title:Phase I/II study of adjuvant immunotherapy with sentinel lymph node T lymphocytes in patients with colorectal cancer.
[So] Source:Cancer Immunol Immunother;64(9):1083-93, 2015 Sep.
[Is] ISSN:1432-0851
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:Although the development of multi-disciplinary management has improved the survival of colorectal cancer (CRC), the prognosis of metastatic CRC patients remains poor. Accumulating evidence has demonstrated that immunotherapy with cancer vaccines and adoptive T cell transfusions may improve outcomes as an adjuvant to current standard CRC treatment. In this phase I/II study, 71 CRC patients who underwent radical surgery (stage I-III, n=46) or palliative surgery (stage IV with non-resectable synchronous metastases, n=25) were included. In the first part of this study, sentinel lymph nodes (SLNs) were intraoperatively identified in 55 patients (46 with stage I-III CRC and 9 with stage IV CRC). SLN-T lymphocytes were expanded ex vivo for a median of 28.5days (range 23-33days). Thereafter, a median of 153נ10(6) cells (range 20.7-639.0נ10(6)) were transfused. No treatment-related toxicity was observed. In the second part of this study, the stage IV patients were routinely followed. The 24-month survival rate of the SLN-T lymphocyte group was significantly higher than that of the control group: 55.6 versus 17.5% (p=0.02). The median overall survival of the SLN-T lymphocyte and control groups was 28 and 14months, respectively. Our study showed that adjuvant SLN-T lymphocyte immunotherapy is feasible and safe for postoperative CRC patients. Additionally, this therapy may improve the long-term survival of metastatic CRC. Further investigation of the clinical efficacy and anti-tumor immunity is warranted.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s00262-015-1715-3

  9 / 1479849 MEDLINE  
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[PMID]: 26285824
[Au] Autor:Melekie TB; Getahun GM
[Ad] Address:Department of Medical Anesthesiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. tadbel20@gmail.com.
[Ti] Title:Compliance with Surgical Safety Checklist completion in the operating room of University of Gondar Hospital, Northwest Ethiopia.
[So] Source:BMC Res Notes;8:361, 2015.
[Is] ISSN:1756-0500
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Appropriate utilization and compliance of Surgical Safety Checklist reduces occurrence of perioperative surgical complications and improve patient outcomes. However, data on compliance of surgical checklists are scarce in the study area. Therefore, the aim of this study was to evaluate compliance of checklist completion and its barrier for utilization at University of Gondar Hospital, Northwest Ethiopia. METHODS: A prospective observational study was conducted among 282 patients undergoing elective and emergency surgery from January to March 2013. Compliance and completeness rate with implementation of Sign-in, Time-out, and Sign-out domains was computed with SPSS 20 package. RESULTS: A total of 282 operations were performed and checklists were utilized in 39.7% (112/282) of cases. Among these, most checklists were employed during emergency procedures (61.6%) that need general anesthesia (75.9%) in department of surgery (58.9%). The overall compliance and completeness rate were 39.7 and 63.4% respectively. The sign-in, time-out and sign-out were missed in 30.5% (273/896), 35.4% (436/1,232) and 45.7% (307/672) respectively. The main reasons cited for non-user were lack of previous training (45.1%) and lack of cooperation among surgical team members (21.6%). CONCLUSIONS AND RECOMMENDATIONS: The completeness rate was satisfactory but the overall compliance rate was suboptimal. An instrument that is used 40% of the time has been a fairly basic introduction without significant reinforcement training. Moreover, frequent use of the checklist during emergency cases has been deemed to be of value by clinicians. Supplementary training and attention to actual checklist use would be indicated to ensure that this valuable tool could be used more routinely and improve communication. Conducting regular audit of checklist utilization is also recommended.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1186/s13104-015-1338-y

  10 / 1479849 MEDLINE  
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[PMID]: 26286551
[Au] Autor:Lin JC; Liang WM
[Ad] Address:Department of Statistics, National Taipei University, Taipei, Taiwan. cflin.ntpu@gmail.com....
[Ti] Title:Outcomes after fixation for undisplaced femoral neck fracture compared to hemiarthroplasty for displaced femoral neck fracture among the elderly.
[So] Source:BMC Musculoskelet Disord;16:199, 2015.
[Is] ISSN:1471-2474
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: This study compared the rates of mortality, medical complication, and reoperation after fixation surgery for displaced femoral neck fracture with those after hemiarthroplasty surgery for undisplaced femoral neck fracture using competing risk analysis in inpatients aged 60years and above from a population database in Taiwan. METHODS: We identified 13,772 subjects who underwent fixation for undisplaced cervical fracture and 13,772 matched controls who underwent hemiarthroplasty for displaced cervical fracture from 1998 to 2007, and followed them up until the end of 2009. The outcomes of patients who received internal fixation for undisplaced fracture and those of patients who received hemiarthroplasty for displaced fracture were compared. RESULTS: The 3-month, 2-year, and 10-year mortality rates were 4.9%, 22.1%, and 67.1% for fixation, and 5.6%, 23.8%, and 71.0% for hemiarthroplasty, respectively. The 3-month, 2-year, and 10-year cumulative incidence rates of the first reoperation were 7.4%, 18.1%, and 27.7% for fixation and 6.3%, 12.0%, and 22.3% for hemiarthroplasty, respectively. The 3-month cumulative incidence rates of the first medical complication were 14.4% for fixation and 15.4% for hemiarthroplasty, respectively. Hemiarthroplasty had a 1.09 times (95% CI: 1.05-1.12) higher hazard ratio for overall death than fixation. However, fixation had a 1.36 times (95% CI: 1.29-1.43) higher subdistribution hazard ratio for first reoperation than hemiarthroplasty after adjusting for gender, age, and comorbidities. CONCLUSIONS: The short-term overall mortality and medical complication rate of fixation for undisplaced fracture were slightly lower than those of hemiarthroplasty for displaced fracture. However, the short-term cumulative incidence of first reoperation after fixation was significantly higher than that for hemiarthroplasty. Further prospective studies or clinical trials based on the competing risk model, and which include important risk factors, are necessary to quantify the adjusted effects more precisely.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1508
[Cu] Class update date: 150822
[Lr] Last revision date:150822
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1186/s12891-015-0671-6


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