Abstract
INTRODUCTION
Circumferential lumbar arthrodesis leads to high fusion rates for degenerative lumbar spine. Interspinous posterior fixation pedicle screw fixation as an adjunct to interbody ...graft led to similar fusion rates and patient reported scores in prospective randomized multi-center study. Although commonly used as surrogates of each other it remains unclear whether the fusion scores correlate with patient reported outcomes.
METHODS
Data was collected as part of a prospective multi-center (11 investigators) study of 101 patients receiving single-level antero-lateral lumbar interbody fusion with supplemental interspinous process fixation (ISPF) or pedicle screw fixation (PSF) for the treatment of degenerative disc disease and/or spondylolisthesis. Subjects were randomized 2:1, ISPF to PSF, for posterior fixation. Patients were followed up to 24 months post-op. Patient reported outcome indices (ODI, SF-36) were collected at each follow-up time point. Lumbar x-ray radiographs were taken at 12 and 24 months. Interbody fusion was scored by an independent radiologist using the Brantigan-Stefee Fraser (BSF) criteria (BSF-1: pseudarthrosis; BSF-2: radiographic locked pseudarthrosis; BSF-3: radiographic fusion). A logistic regression model was used to determine whether a relationship existed between quality of fusion (BSF-3 vs. BSF-1&2) and clinical index improvement at 12 and 24 months.
RESULTS
>Change in ODI score at 12 and 24 months was not significantly associated with BSF score (P = 0.78 and P = 0.64, respectively). At 12 months,, BSF-3 patients had on average 1.4 greater reduction in ODI compared to BSF-1&2 (95% CI: -8.61, 11.41). Changes in SF-36 score were not significantly associated with BSF score (P = 0.63 and P = 0.18, respectively). For SF-36 Mental, BSF-3 patients had a 2.21 greater increase compared to BSF-1&2 (95% CI: -6.7, 11.13). Instead in SF-36 Physical, BSF-3 patients had a 4.14 lesser increase compared to BSF-1&2 (95% CI: -10.15, 1.88)
CONCLUSION
Radiological lumbar interbody fusion grading using BSF scale do not correlate with patient reported outcome.
To evaluate the efficacy of adalimumab in the healing of draining fistulas in patients with active Crohn's disease (CD).
A phase III, multicentre, randomised, double-blind, placebo controlled study ...with an open-label extension was conducted in 92 sites.
A subgroup of adults with moderate to severely active CD (CD activity index 220-450) for >or=4 months who had draining fistulas at baseline.
All patients received initial open-label adalimumab induction therapy (80 mg/40 mg at weeks 0/2). At week 4, all patients were randomly assigned to receive double-blind placebo or adalimumab 40 mg every other week or weekly to week 56 (irrespective of fistula status). Patients completing week 56 of therapy were then eligible to enroll in an open-label extension.
Complete fistula healing/closure (assessed at every visit) was defined as no drainage, either spontaneous or with gentle compression.
Of 854 patients enrolled, 117 had draining fistulas at both screening and baseline (70 randomly assigned to adalimumab and 47 to placebo). The mean number of draining fistulas per day was significantly decreased in adalimumab-treated patients compared with placebo-treated patients during the double-blind treatment period. Of all patients with healed fistulas at week 56 (both adalimumab and placebo groups), 90% (28/31) maintained healing following 1 year of open-label adalimumab therapy (observed analysis).
In patients with active CD, adalimumab therapy was more effective than placebo for inducing fistula healing. Complete fistula healing was sustained for up to 2 years by most patients in an open-label extension trial.
Abstract only Introduction After successful reperfusion is achieved (extended Thrombolysis in Cerebral Infarction (eTICI) ≥ 2b50), decision on pursuing additional treatment strategies in order to ...achieve complete reperfusion (eTICI = 2c/3), is multifactorial and depends on patient’s clinical and imaging characteristics. We have developed and validated a clinical decision tool to provide individualized predictions on achieving delayed reperfusion based on individual patient data. Methods Single‐center registry analysis for all consecutive patients admitted between 02/2015 – 12/2020. Primary variable of interest was perfusion imaging outcome in patients with incomplete reperfusion (eTICI 2a‐2c), evaluated on the 24‐hour follow‐up imaging. This variable was dichotomized into delayed reperfusion, in case of non‐observable perfusion deficit, and persistent perfusion deficit, in case of perfusion deficit captured on the final angiography imaging. Final model variable selection was performed via bootstrapped (n = 200) stepwise backwards regression. Model was split into a training and testing set (80:20 ratio), with 10‐fold cross validation resampling. Results 372 patients (50.8% female, mean age 74) were included, with 228 (61.2%) of them having delayed reperfusion. Final model identified seven variables of importance including: age, sex, atrial fibrillation, Intervention‐to‐Follow‐Up time, maneuver count, eTICI and collateral status. Model’s discriminative ability for predicting delayed reperfusion was adequate (AUC 0.83, 95% CI 0.74 –0.92), with an overall adjusted calibration (Brier score 0.17, 95% CI 0.15‐0.18). Conclusions Current model presents a tool that may aid clinical decision‐making process in selection of patients for pursuing additional treatment strategies after incomplete reperfusion has been achieved. This is an important next step towards personalized treatment of stroke patients undergoing mechanical thrombectomy.
Abstract only Introduction The Area Deprivation Index (ADI) is a validated neighborhood‐level measure that utilizes variables such as income, education, and employment to quantify relative ...socioeconomic disadvantages. Here we explore the impact of disparities on EVT access. Methods From our prospectively maintained multi‐hospital registry, we identified patients with LVO AIS from January 2019‐ June 2020. Patient addresses and zip‐codes were validated using US Postal Service codes and matched to census‐tract level ADI scores that were obtained from Neighborhood Atlas. ADI were categorized into high and low using the median ADI as the cuto!. The primary outcome was utilization of EVT and IV tPA and was determined using multivariable logistic regression and expressed as OR 95% CI. All p‐values are two‐sided with p < 0.05 defined as statistically significant. All analyses were conducted using RStudio (Version 1.2.5001). Results Among 637 patients with LVO AIS, median age was 68, 46% were female, 53% were white, 27% were black, and 78% identified as Hispanic. Median state ADI was 5 IQR 5. NIHSS was similar between low/high ADI (mean(SD): 13.3(7.75) vs 13.6(8.62), p‐value 0.69) regions. ADI was significantly associated with race (6.41 vs 4, black vs. white, p‐value 0.03). In the univariable analysis, patients treated with EVT had lower mean ADIs (5.2 vs. 4.6, no EVT vs. EVT, p< 0.02). In multivariable analysis adjusted for age, sex, race, ethnicity and NIHSS, higher ADI was significantly associated with greater rates of IV tPA usage (OR 1.7 1.01‐ 2.98) but not EVT usage (OR 0.63 0.04‐1.0) Conclusions Patients residing in disadvantaged neighborhoods may have reduced rates of reperfusion therapy, despite comparable acute stroke presentation symptoms. These findings are consistent with prior studies demonstrating poorer health outcomes in these populations.
Reply Velez, Federico G; Chang, Melinda Y; Pineles, Stacy L
American journal of ophthalmology,
07/2017, Volume:
179
Journal Article
Peer reviewed
With regard to the variability of horizontal correction between the 2 patients undergoing IRT without medial rectus recession, one potential explanation could be subclinical differences in medial ...rectus restriction, or perhaps the posterior fixation suture was placed slightly differently in the 2 cases. ...there was a variable but small induced...
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