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clinical outcome of open ankle fractures in patients above 70 years of age

World Journal of Orthopedics 2023年第7期14卷 554-561页

作者： Wajiha Zahra Mina Seifo Paul Cool David Ford Tosan Okoro Department of Trauma and Orthopedics Royal Shrewsbury HospitalShrewsbury SY38XQUnited Kingdom Department of Trauma and Orthopedics Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestry SY107AGUnited Kingdom Department of Trauma and Orthopedics Keele UniversityStafford ST55BGUnited Kingdom

BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality.However,data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal.AIM To evaluate the clinical outcomes following open ankle fracture management in patients older than 70.Our secondary aim is to look at predictors of poor outcomes.METHODS Following local research and audit department registration,22 years of prospectively collated data from an electronic database in a district general hospital were assessed.All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified.Demographic information,the nature,and the number of surgical interventions were collated.Complications,including surgical site infection(SSI),venous thromboembolic events(VTEs)during hospital stay,and mortality rate,were reviewed.RESULTS A total of 37 patients were identified(median age:84 years,range:70-98);n=30 females median age:84 years,range:70-97);n=7 males median age:74 years,range:71-98))who underwent surgical intervention after an open ankle fracture.Sixteen patients developed SSIs(43%).Superficial SSIs(n=8)were managed without surgical intervention and treated with antibiotics and regular dressing changes.Deep SSIs(n=8;20%)required a median of 3(range:2-9)surgical interventions,with four patients requiring multiple washouts and one patient having metalwork removed.VTE incidence was 5%during the hospital stay.Eight patients died within 30 d,and mortality at one year was 19%.The 10-year mortality rate was 57%.The presence of a history of stroke,cancer,or prolonged inpatient stay was found to be predictive of lower survivorship in this population(log-rank test:cancer P=0.008,stroke P=0.001,length of stay>33 d P=0.015).The presence of a cardiac history was predictive of wound complications(logistic regression,P=0.045).Age,number of operations,and diabetic history were found to be predictive of an

关键词： Fragility fracture Open fracture clinical outcome Mortality Infection Survival

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Role of Regulatory T cell in clinical outcome of Traumatic Brain Injury

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Chinese Medical Journal 2015年第8期128卷 1072-1078页

作者： Min Li Yun-Peng Lin Jie-Li Chen Hong Li Rong-Cai Jiang Jian-Ning Zhang Department of Neurosurgery Tianjin Neurological Institute Tianjin Medical University General Hospital Tianjin 300052 China Department of Neurology Henry Ford Hospital Detroit MI 48202 USA Department of Neurosurgery Second Hospital of Tianjin Medical University Tianjin 300211 China

Background： Traumatic brain injury （TBI） is a life-threatening disease worldwide. Regulatory T cells （Treg ceils） were involved in the immunological system in central nervous system. It is defined as a subpopulation of CD4＋ cells that express CD25 and transcription lactor forkhead box P3. The level of circulating Treg cells increases in a variety of pathologic conditions. The purpose of this study was to uncover the role of circulating Treg cells in TBI. Methods： A clinical study was conducted in two neurosurgical intensive care units of Tianjin Medical University General Hospital and Second Hospital of Tianjin Medical University （Tianjin, China）. Forty patients and 30 healthy controls were recruited t＇rom August 2013 to November 2013. Circulating Treg cells was detected on the follow-up period of 1,4, 7, 14, and 21 days alter TBI. Blood sample （ 1 ml） was withdrawn in the morning and processed within 2 h. Results： There was no significant difference in the level of circulating Treg cells between TBI patients and normal controls during follow-up. TBI patients exhibited higher circulating Treg level than normal controls on the 1st day after TBI. Treg level was decreased on the 4th day, climbed tip on the 7th day and peaked on 14th day after TBI. Treg cells declined to the normal level on 21th day alter TBI. The level of circulating Treg cells was significantly higher in survival TBI patients when compared to nonsurvival TBI patients. TBI patients with improved conditions exhibited significantly higher circulating Treg level when compared to those with deteriorated conditions. The circulating Treg level was correlated with neurologic recovery after TBI. A better neural recovery and lower hospital mortality were found in TBI patients with circulating Treg cells more than 4.91% in total CD4＋ inononuclear cells as compared to those with circulating Treg cells less than 4.91% in total CD4 mononuclear cells in the first 14 days. Conclusions： The level of circulating Treg cells is positively correlated with clinical

关键词： clinical outcome Dynamic Change Prognostic Marker Regulatory T cell Traumatic Brain Injury

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Fecal calprotectin measurement is a marker of shortterm clinical outcome and presence of mucosal healing in patients with inflammatory bowel disease

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World Journal of Gastroenterology 2017年第41期23卷 7387-7396页

作者： Athanasios Kostas Spyros I Siakavellas Charalambos Kosmidis Anna Takou Joanna Nikou Georgios Maropoulos John Vlachogiannakos George V Papatheodoridis Ioannis Papaconstantinou Giorgos Bamias Department of Gastroenterology University of Athens Medical School Laiko General Hospital Bioche-mistry Department Laiko General Hospital 2nd Department of Surgery University of Athens Medical School Areteion General Hospital

AIM To evaluate the utility of fecal calprotectin(FC) in predicting relapse and endoscopic activity during follow-up in an inflammatory bowel disease(IBD) cohort.METHODS All FC measurements that were obtained during a 3-year period from patients with inflammatory bowel disease in clinical remission were identified. Data regarding the short-term(6 mo) course of the disease were extracted from the medical files. Exclusion criteria were defined as:(1) An established flare of the disease at the time of FC measurement,(2) Loss to follow up within 6 mo from baseline FC measurement, and,(3) Insufficient data on file. Statistical analysis was performed to evaluate whether baseline FC measurement could predict the short term clinical relapse and/or the presence of mucosal healing.RESULTS We included 149 [Crohn's disease(CD) = 113, Ulcerative colitis(UC) = 36, male = 77] IBD patients in our study. Within the determined 6-month period post-FC measurement, 47(31.5%) had a disease flare. Among 76 patients who underwent endoscopy, 39(51.3%) had mucosal healing. Baseline FC concentrations were significantly higher in those who had clinical relapse compared to those who remained in remission during follow up(481.0 μg/g, 286.0-600.0 vs 89.0, 36.0-180.8, P clinical relapse was confirmed by multivariate Cox analysis [HR for 100μg/g: 1.75(95%CI: 1.28-2.39), P = 0.001]. Furthermore, lower FC baseline values significantly correlated to the presence of mucosal healing in endoscopy(69.0 μg/g, 30.0-128.0 vs 481.0, 278.0-600.0, in those with mucosal inflammation, median with IQR, P clinical relapse(261 μg/g with AUC = 0.901, sensitivity 87.2%, specificity 85.3%, P outcome; nevertheless, having

关键词： Fecal calprotectin Biomarker Inflammatory bowel disease Mucosal healing clinical outcome Relapse Ulcerative colitis Crohn’s disease

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A reversed CD4/CD8 ratio of tumor-infiltrating lymphocytes and a high percentage of CD4^(+)FOXP3^(+) regulatory T cells are significantly associated with clinical outcome in squamous cell carcinoma of the cervix

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Cellular & Molecular Immunology 2011年第1期8卷 59-66页

作者： Walayat Shah Xiaofei Yan Li Jing Yi Zhou Hongwei Chen Yili Wang Center for Cancer Research First Affiliated HospitalXi’an Jiaotong UniversityXi’anChina Institute of Basic Medical Sciences Khyber Medical UniversityPeshawarKhyberPakhtoonkhwaPakistan Department of Biochemistry School of MedicineXi’an Jiaotong UniversityXi’anChina Department of Pathology Ningxia Medical UniversityYinchuanChina Department of Pathology Xi’an Medical CollegeXi’anChina

In this study,40 biopsy samples collected from cervical cancer patients at the First Affiliated Hospital of Xi’an Jiaotong University,China,were retrospectively assessed using immunohistochemistry for CD4^(+) and CD8^(+) tumor-infiltrating lymphocytes(TILs)and were analyzed for the expression of FOXP3,OX40,granzyme B(GrB)and perforin(Prf).The proliferating index of the TILs was determined by assessing Ki67 expression.We determined the prognostic value of low and high numbers of TILs on survival by performing Kaplan–Meier analysis using median values as the cut-off points.Except for the number of CD4^(+)FOXP3^(+) regulatory T cells(Tregs)and the CD4/CD8 ratio,none of the CD4^(+),CD8^(+),OX401,GrB^(+) or Prf^(+) TILs were associated with the overall 5-year survival rate.The 5-year survival rate was significantly lower in patients who had a high percentage of Tregs as compared with the those who had a lower percentage(35.3%versus 88.9%,P50.001),while the 5-year survival rate was significantly higher in patients with a high CD4/CD8 ratio as compared with patients who had a low CD4/CD8 ratio(82.4%versus 44.4%,P50.029).When we considered the deaths and surviving cases as separate groups,we found that both the number of CD4^(+) T cells and the CD4/CD8 ratio were significantly lower in patients who died as compared with those who survived(26.33±11.80 versus 47.79±38.18,P=0.023 and 0.60±0.25 versus 1.17±1.02,P=0.019,respectively).In conclusion,decreased proportions of tumor-infiltrating CD4^(+) T cells with high percentages of Tregs and reversed CD4/CD8 ratios were significantly associated with the clinical outcome of patients with cervical carcinoma.

关键词： CD4/CD8 ratio cervical carcinoma clinical outcome tumor-infiltrating lymphocytes

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Comparison of long-term clinical outcome after successful implantation of FIREBIRD and CYPHER sirolimus-eluting stents in daily clinical practice： analysis of a large single-center registry

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Chinese Medical Journal 2011年第7期124卷 990-996页

作者： XU Bo DOU Ke-fei YANG Yue-jin CHEN Ji-lin QIAO Shu-bin WANG Yang LI Jian-jun QIN Xue-wen YAO Min LIU Hai-bo WU Yong-jian CHEN Jue YUAN Jin-qing YOU Shi-jie LI Wei GAO Run-lin Cardiac Catheterization Lab (Xu B) Cardiovascular Institute and Fu Wai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100037 China Department of Cardiology Cardiovascular Institute and Fu Wai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100037 China

Background Recent data have shown that sirolimus-eluting stents （SES） reduced not only the incidences of restenosis but also of target vessel revascularization （TVR）. CYPHER and FIREBIRD stents are both widely used SES in China. However, comparative data concerning differences in long-term safety and efficacy regarding CYPHER and FIREBIRD stents in the Chinese population are still not available.

关键词： clinical outcome sirolimus-eluting stent CYPHER stent FIREBIRD stent

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Association between microRNA-21, microRNA-150, and micro- RNA-451 expression and clinical outcome of patients with acute lymphoblastic leukemia

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Frontiers in Biology 2017年第1期12卷 63-70页

作者： Ali Amin Asnafi Elahe Khodadi Neda Golchin Arash Alghasi Yousef Tavakolifar Najmaldin Saki Health Research Institute Research Center of Thalassemia and Hemoglobinopathy Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran Golestan hospital clinical research development unit Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran

BACKGROUND： Acute lymphoblastic leukemia （ALL） occurs owing to the defective maturation, increased proliferation, and lack of differentiation of lymphoid cells. Evaluation of the expression levels of microRNAs （miRNAs） could help in the prognosis and improve the clinical outcome of ALL patients. Given the role of miR-21, miR-150, and miR-451 as oncogenes and tumor suppressors in lymphocytes, this study explored the relation between the expression levels of these miRNAs and the clinical outcomes of ALL patients. METHODS： cDNA synthesis and RT-PCR were performed for peripheral blood samples from 41 patients with ALL, as well as for U937 and Jurkat cell lines to examine the expression of miR-451, miR-150, and miR-21 after miRNA purification. We also performed an epidemiological analysis in which Mann-Whitney and Chi-square tests were used to investigate the relationship between the expression of miRNAs and other clinical and laboratory data. Binary logistic regression models were used to estimate the odds ratio in univariate and multivariate analyses for clinical outcomes. RESULTS： miR-21 and miR-150 expression was found to be decreased, while miR-451 expression showed no difference compared to the control group. There was a significant relationship between miR-451 expression and hemoglobin （Hb） levels, as well as between miR-150 expression and clinical outcomes of ALL patients. CONCLUSION： Increased expression of miR-451 decreased the Hb levels; reduced expression of miR-150 was associated with increased relapse rate in patients. Age, increased WBC, and decreased Hb levels were associated with increased relapse rates in ALL patients. Therefore, miR-150 could be used as a biomarker to determine the clinical outcome of ALL patients.

关键词： acute lymphoblastic leukemia miRNA clinical outcome

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Two-year clinical outcome after successful implantation of drug-eluting and bare metal stents in diabetic patients： results from a real-world single center registry

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Chinese Medical Journal 2009年第6期122卷 612-616页

作者： DOU Ke-fei XU Bo YANG Yue-jin CHEN Ji-lin QIAO Shu-bin LI Jian-jun QIN Xue-wen LIU Hai-bo WU Yong-jian CHEN Jue YAO Min YOU Shi-jie YUAN Jin-qing DAI Jun GAO Run-lin Department of Cardiology Cardiovascular Institute and Fu Wai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100037 China

Background Drug-eluting stents （DES） have revolutionized the field of interventional cardiology by dramatically improving clinical and angiographic outcomes. Patients with diabetes mellitus （DM） are associated with an increased risk of adverse clinical outcomes after a percutaneous coronary intervention （PCI）. Available information on the efficacy and safety of DES and bare metal stent （BMS） in diabetic patients remains scarce. Methods From April 2004 to October 2006, 1565 patients with diabetes, who successfully underwent elective stenting at Fu Wai Hospital in Beijing, China, were enrolled in this study. All enrolled patients were assigned to a drug eluting stent group and a bare metal stent group. We obtained follow-up data： death, myocardial infarction （MI）, thrombus, target lesion revascularization （TLR）, and target vessel revascularization （TVR） at 30 days and 12 and 24 months, as defined by the Academic Research Consortium （ARC）. We calculated and compared all the unadjusted cumulative frequencies of the various adverse events in the two groups. Cox＇s proportional-hazards models adjusted with the propensity score were used to assess the relative risks of all the outcome measures at 24 months. Results At 24 months, all ARC defined stent thrombosis in the two groups were similar; at 30 days, a more definite thrombosis was found in the BES group （0.08% vs 0.81%, P=0.016）. Patients treated with DES showed a significant lower risk of TLR （3.88% vs 10.89%; hazard ratio （HR） 0.159 （95% CI： 0.151-0.444）, P 〈0.001）, TVR （5.48%vs 11.69%; HR 0.383 （95% CI： 0.232-0.633）, P 〈0.001）, and any revascularization （12.47% vs 18.55%; HR 0.555 （95% CI： 0.370-0.831）, P=0.0004） at 24 months. No significant difference was apparent in terms of all-cause mortality, MI, and all-cause mortality/MI. Conclusions In contemporary society＇s large, diabetic population, the use of DES is associated with long-term significant reductions in the risks of TLR, TVR, and any revascularization. There is no significant difference in all-cause

关键词： clinical outcome diabetes drug-eluting stent bare metal stent

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clinical outcome of CF Patients with CF Related Diabetes: Do We Need to Change Our Policy?

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Open Journal of Pathology 2016年第1期6卷 32-40页

作者： An Jacobs Francois Vermeulen Kris de Boeck Kristina Casteels Marijke Proesmans KU Leuven Belgium Department of Pediatrics University Hospital of Leuven Leuven Belgium Pediatric Pulmonology University Hospital of Leuven Leuven Belgium Pediatric Endocrinology University Hospital of Leuven Leuven Belgium

Background: Many studies have shown that CFRD has a negative impact on CF prognosis. Current guidelines advise to screen for CFRD with an OGTT yearly from the age of 10 - 12. In our center we do not routinely screen for CFRD because the OGTT is cumbersome and not an ideal screening test. We therefore want to exclude unfavourable clinical evolution due to late diagnosis. Methods: 23 CF patients with diagnosis of CFRD clinical evolution (BMI, lung function, and chronic infection treatment burden) was analyzed starting 2 years before until 2 years after diagnosis of CFRD. Results: In the 2 years before diagnosis of CFRD, BMI and LF were similar for both groups while need for IV AB treatment was higher in the CFRD group. In the 2 years following diagnosis and treatment, LF decline was worse in the CFRD despite more IV AB treatments. BMI was still comparable. We conclude that clinical status was comparable between cases and controls in the 2 years preceding the diagnosis of CFRD. However, the need for IV antibiotic treatment seems to precede the faster lung function decline after CFRD diagnosis.

关键词： Cystic Fibrosis Cystic Fibrosis Related Diabetes clinical outcome

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clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study

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World Journal of Gastroenterology 2022年第17期28卷 1845-1859页

作者： Seong Ji Choi Hong Sik Lee Jiyeong Kim Jung Wan Choe Jae Min Lee Jong Jin Hyun Jai Hoon Yoon Hyo Jung Kim Jae Seon Kim Ho Soon Choi Department of Internal Medicine Hanyang University College of MedicineSeoul 04763South Korea Division of Gastroenterology and Hepatology Department of Internal MedicineKorea University College of MedicineSeoul 02841South Korea Lab of Biostatistical Consulting and Research Medical Research Collaborating CenterIndustry-University Cooperation FoundationHanyang UniversitySeoul 04763South Korea

BACKGROUND Ampullary adenoma is a rare premalignant lesion,but its incidence is increasing.Endoscopic papillectomy has become the first treatment of choice for ampullary adenomas due to its safety and effectiveness,thereby replacing surgical resection.However,recurrence rates and adverse events after endoscopic papillectomy were reported in up to 30%of cases.AIM To review the long-term outcomes of endoscopic papillectomy and investigate the factors that affect these outcomes.METHODS We retrospectively analyzed the data of patients who underwent endoscopic papillectomy for ampullary adenoma at five tertiary hospitals between 2013 and 2020.We evaluated clinical outcomes and their risk factors.The definitions of outcomes were as follow:(1)curative resection:complete endoscopic resection without recurrence;(2)endoscopic success:treatment of ampullary adenoma with endoscopy without surgical intervention;(3)early recurrence:reconfirmed adenoma at the first endoscopic surveillance;and(4)late recurrence:reconfirmed adenoma after the first endoscopic surveillance.RESULTS A total of 106 patients were included for analysis.Of the included patients,81(76.4%)underwent curative resection,99(93.4%)had endoscopic success,showing that most patients with noncurative resection were successfully managed with endoscopy.Sixteen patients(15.1%)had piecemeal resection,22 patients(20.8%)had shown positive/uncertain resection margin,11 patients(16.1%)had an early recurrence,13 patients(10.4%)had a late recurrence,and 6 patients(5.7%)had a re-recurrence.In multivariate analysis,a positive/uncertain margin[Odds ratio(OR)=4.023,P=0.048]and piecemeal resection(OR=6.610,P=0.005)were significant risk factors for early and late recurrence,respectively.Piecemeal resection was also a significant risk factor for non-curative resection(OR=5.424,P=0.007).Twenty-six patients experienced adverse events(24.5%).CONCLUSION Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas.Careful selection and follow-up of patients is mandat

关键词： Endoscopic papillectomy Ampullary adenoma clinical outcome Recurrence Adverse event

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Long-Term clinical outcome of Patients Using Risperidone Long-Acting Injectable: The Romanian e-STAR Database

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Open Journal of Psychiatry 2015年第2期5卷 153-164页

作者： Ioana Micluţia Madalina Vrabie Roxana Ciungu Department of Neurosciences Discipline of Psychiatry“Iuliu Hatieganu”University of Medicine&PharmacyEmergency County Hospital ClujSecond Psychiatric ClinicCluj-NapocaRomania Medical Affairs JanssenDivision of Johnson&Johnson RomaniaBucharestRomania

The objectives of e-STAR Romania (NCT00283517) were to collect clinical outcome data of Romania schizophrenia or schizo-affective disorder patients;prospectively to assess the reasons of treatment initiation, medication usage patterns;to document (long-term) clinical efficacy;and to collect safety data, as well as recording 2-year corresponding retrospective data. In total, 378 eligible subjects were enrolled who were initiated either on risperidone long-acting injectable (RLAI) (290) or on an oral antipsychotic (OA) (88) at baseline as required by the local Summary of the Product Characteristics. Data were collected from per patient both retrospectively and prospectively over a 24-month period at 3-month intervals after starting treatment. The results indicated that subjects suffering from schizophrenia or schizo-affective disorder initiated on RLAI were less likely to be hospitalized within the first 24 months after the initiation of treatment. Moreover, subjects treated with RLAI experienced significant improvements in their illness severity and functioning. Discontinuation rates for RLAI were low and doses were stable throughout the 24 months following the initiation of treatment. In addition, the necessity for supplementary concomitant medication was reduced. Adverse events were reported in 20.3% (RLAI) and 11.4% (OA) of the subjects. In general, patients initiated on RLAI and OA at baseline both clinically improved on all assessed parameters but a larger improvement was observed for patients on RLAI. Incidences of reported AEs during the use of RLAI in a naturalistic setting are comparable with those described in clinical studies;however, the incidence of extrapyramidal signs and weight gain was lower than expected.

关键词： Schizophrenia Registry Risperidone Long-Acting Injectable Hospitalizations clinical outcome Safety

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