To report clinical and activity-specific outcomes after arthroscopic rotator cuff repair (ARCR) for full-thickness supraspinatus tears in active individuals aged less than or equal to 45 years. The ...pre hoc hypothesis was that patients in this age group would demonstrate significant improvements in clinical outcomes following ARCR along with a significant improvement of athletic abilities.
Patients were included in this study if they were (1) active individuals aged between 18 and 45 years at the time of surgery, (2) had a full-thickness rotator cuff tear of the supraspinatus tendon with or without anterior or posterior extension, and (3) underwent ARCR. Preoperative and postoperative patient-reported outcomes scores including the American Shoulder and Elbow Surgeons (ASES) score; Disabilities of Arm, Shoulder and Hand; Single Assessment Numeric Evaluation; and Short Form-12 Physical Component Summary were prospectively collected and postoperative patient satisfaction (scale of 1-10) was recorded at a minimum of 2 years postoperatively. Attainment of the minimal clinically important difference and patient acceptable symptom state for the ASES was calculated. Athletic activity–specific outcomes and return to activity were investigated prospectively via a custom-made comprehensive questionnaire.
Between November 2005 and June 2020, of 1149 RCRs performed by the senior author, 54 patients (mean age 40.9 years, 13 female; follow-up 69.7 ± 35.2 months in a range of 24.6-179.6 months) were included into the outcomes analysis. Of those, 4 patients (7.4%) had progressed to revision RCR. At a follow-up of 5.8 years, outcome scores had significantly improved compared to preoperative baselines (ASES 55.6 ± 13.8 to 90.1 + 15.8; P < .001; Disabilities of Arm, Shoulder and Hand 38.9 ± 18.4 to 11.9 ± 17.1; P < .001, Single Assessment Numeric Evaluation 60.7 ± 22.7 to 79.3 ± 27.6; P = .001, Short Form-12 Physical Component Summary 41.6 ± 8.3 to 51.9 ± 9.0; P ≤ .001). Ninety three point six percent of the patients reached the minimal clinically important difference and 72.6% reached the patient acceptable symptom state. Median satisfaction was 9.5/10. Eighty six percent of the patients returned to sports, while 67% of the patients returned to a similar level compared to preoperatively. All sport-specific metrics such as shoulder strength and endurance (P < .001), intensity (P < .001), and impairments from pain affecting speed (P = .002), endurance (P = .002), and competition (P < .001) significantly improved postoperatively.
ARCR of full-thickness rotator cuff tear in active individuals aged 45 years or less results in a clinically relevant improvement of outcomes, function, and quality of life at a minimum of 2 years and mean 5.8-year follow-up with a low rate of revision. While 86% of patients were able to return to activity and sport-specific outcome metrics significantly and substantially improved compared to preoperatively, a return to preinjury levels was not reliably achieved in all patients, with particular limitations observed in overhead active individuals. The data support the hypothesis that patients in this age group demonstrate significant improvements in clinical outcomes following ARCR along with significant improvements in athletic abilities.
Excellent results have been reported for anatomic total shoulder arthroplasty (TSA) for the treatment of primary glenohumeral osteoarthritis (GHOA). We aim to assess the recovery curve and ...longitudinal effects of time, age, sex, and glenoid morphology on patient-reported outcomes (PROs) after primary anatomic TSA for primary GHOA.
Patients who underwent primary anatomic TSA over 5 years ago were included: Short-Form 12 Physical Component Summary, American Shoulder and Elbow Surgeons scores, Quick Disabilities of the Arm Shoulder and Hand Score, Single Assessment Numeric Evaluation, and patient satisfaction were assessed. Linear mixed-effects models were used to model progression in PROs longitudinally. Unadjusted models and models controlling for sex and age were constructed.
Eighty-one patients (91 shoulders) were included. Significant improvements from the preoperative period to 1 year postoperatively in the median American Shoulder and Elbow Surgeons (48 to 93; P < .001), Quick Disabilities of the Arm Shoulder and Hand Score (42 to 11; P < .001), Single Assessment Numeric Evaluation (50 to 91; P < .001), and Short-Form 12 Physical Component Summary (35 to 53; P = .004) scores were noted. No significant decrease was observed for any of the outcome scores. Median satisfaction at the final follow-up was 10 out of 10. At 1, 2, 3, 4, 5, 6, and 7 years postoperatively, 77%, 64%, 79%, 57%, 86%, 56%, and 78% of patients, respectively, reported sports participation equal to or slightly below preinjury level. There was no association between the glenoid morphology and functional outcomes.
Patients undergoing anatomic TSA for primary GHOA showed excellent improvement in PROs and satisfaction in the first year, and these results were maintained postoperatively for a minimum of 5 years. Age- and sex-adjusted models or glenoid morphology did not substantially alter any trends in PROs postoperatively.
Insurers can influence their financial ratings Pogorzelski, James D
National underwriter (Property & casualty/risk & benefits management edition),
06/1993, Letnik:
97, Številka:
25
Journal Article
Insurer financial strength is emerging as one of the key issues facing the insurance industry in the 1990s. Many insurance executives think the rating process is beyond their control. However, there ...is much a company can do to improve its chances of obtaining a good rating. Companies can influence their ratings in 3 important ways. First, since an insurer's rating partly reflects confidence in managmenet, insurers should raise that confidence by carefully managing their relationships with rating agencies. Second, most qualitative tests focus on the results of management decisions. Consequently, once management understands the basis for these tests, it can more easily act to influence its rating. Finally, ratings agencies provide insurers all of the quantitive tests they use and the acceptable ranges for these measures.
Background
Nasal polyposis frequently occurs within the clinical picture of aspirin‐exacerbated respiratory disease (AERD).
A derailed arachidonic acid metabolism is regarded to be part of the ...pathophysiology of AERD, and aspirin desensitization is the only causal therapeutic option, so far. The optimal maintenance dose of aspirin desensitization to prevent nasal polyp recurrence on the one hand and to minimize aspirin‐related side‐effects, on the other hand, is still a matter of debate. The aim of this trial was to investigate the efficacy and safety of a low‐dose aspirin desensitization protocol.
Methods
After sinus surgery, 70 individuals with AERD were randomly allocated to a prospective double‐blind placebo‐controlled aspirin desensitization protocol with a maintenance dose of 100 mg daily. The primary outcome was polyp relapse after 36 months. Nasal endoscopy status, quality of life, and patients' symptom score as well as aspirin‐related side‐effects were monitored.
Results
Due to the high dropout rate, only 31 individuals were evaluated. After 36 months, nasal polyp relapse was less frequent (P = 0.0785) and the polyposis score was lower (P = 0.0702) in the therapy group. Quality of life obviously improved (P = 0.0324), clinical complaints (P = 0.0083) were significantly reduced, and no severe aspirin‐related side‐effects were observed.
Conclusion
Aspirin desensitization with a maintenance dose of 100 mg daily has a positive impact on nasal polyp relapse and seems to be a safe and suitable therapy to improve clinical complaints and the quality of life of individuals with AERD.
Purpose
Patients with
BRAF
V600E
-mutant metastatic colorectal cancer (mCRC) have a dismal prognosis. The best strategies in these patients remain elusive. Against this background, we report the ...clinical course of patients with
BRAF
V600E
-mutant mCRC to retrieve the best treatment strategy.
Patients and methods
Clinico-pathological data were extracted from the electronic health records. Kaplan–Meier method was used to estimate overall (OS) and progression-free survival (PFS). Objective response rate (ORR) was assessed according to RECIST 1.1.
Results
In total, 51 patients were enrolled. FOLFOXIRI was administered to 12 patients; 29 patients received FOLFOX or FOLFIRI as first-line treatment. Median OS was 17.6 months. Median PFS with FOLFOXIRI (13.0 months) was significantly prolonged (HR 0.325) as compared to FOLFOX/FOLFIRI (4.3 months). However, this failed to translate into an OS benefit (
p
= 0.433). Interestingly, addition of a monoclonal antibody to chemotherapy associated with superior OS (HR 0.523). A total of 64.7% patients received further-line therapy, which included a BRAF inhibitor in 17 patients. Targeted therapy associated with very favourable OS (25.1 months).
Conclusion
Patients with BRAF
V600E
-mutated mCRC benefit from the addition of an antibody to first-line chemotherapy. Further-line treatment including a BRAF inhibitor has a dramatic impact on survival.
Purpose
Systemic-inflammatory response parameters (SIR) are known prognostic markers in different tumour entities, but have not been evaluated in patients with iCCA treated with systemic ...chemotherapy. Therefore, we evaluated the impact of different SIR markers on the clinical course of patients with advanced iCCA treated at our center.
Methods
SIR markers were retrospectively evaluated in 219 patients with iCCA at the West-German-Cancer-Center Essen from 2014 to 2019. Markers included neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), CRP, and the modified Glasgow-Prognostic-Score (mGPS), which were correlated with clinico-pathological findings, response to chemotherapy (ORR), progression-free (PFS) and overall survival (OS) using Kaplan–Meier analyses, and Cox proportional models.
Results
Median overall survival (OS) of the entire cohort was 14.8 months (95% CI 11.2–24.4). Median disease-free survival (DFS) in 81 patients undergoing resection was 12.3 months (95% CI 9.7–23.1). The median OS from start of palliative CTX (OS
pall
) was 10.9 months (95% 9.4–14.6). A combined Systemic Inflammatory Score (SIS) comprising all evaluated SIR markers correlated significantly with ORR, PFS, and OS
pall
. Patients with a high SIS (≥ 2) vs. SIS 0 had a significantly inferior OS
pall
(HR 8.7 95% CI 3.71–20.38, p < 0.001). Multivariate analysis including known prognostic markers (ECOG, CA19-9, LDH, and N- and M-status) identified the SIS as an independent prognostic factor.
Conclusions
Inflammatory markers associate with inferior survival outcomes in patients with iCCA. A simple SIS may guide treatment decisions in patients treated with systemic chemotherapy.
Background:
Superior capsular reconstruction (SCR) was recently introduced as a treatment for irreparable superior rotator cuff tears in younger patients.
Purpose/Hypothesis:
The purpose was to ...assess the biomechanical strength of 3 methods for fixation of the graft to the glenoid for SCR. It was hypothesized that a 4-anchor technique would provide greater load to failure than 3-anchor techniques.
Study Design:
Controlled laboratory study.
Methods:
Thirty-six cadaveric specimens were randomized into 3 groups of previously established glenoid-side graft fixation techniques: (1) three 3.5-mm knotless screw-in anchors, (2) three 3.0-mm knotless push-in anchors, and (3) a 4-anchor hybrid construct with two 3.0-mm knotted push-in anchors and two 2.9-mm knotless push-in anchors. The repairs were cyclically loaded at 0.5 Hz from 10 to 200 N, then pulled to failure. Elongation, stiffness, maximum load at failure, and mode of failure were recorded and calculated.
Results:
There were no significant differences in graft elongation or stiffness among the 3 techniques (P > .37 and P > .26, respectively). Maximum load to failure was significantly greater in technique 1 (mean ± SD, 427.85 ± 119.70 N) than technique 3 (319.5 ± 57.60 N) (P = 0.024). There were no significant differences in load to failure between techniques 1 and 2 or between techniques 2 and 3.
Conclusion:
Glenoid-side graft fixation with 3 threaded 3.5-mm suture anchors showed a significant superior pull-out strength when compared with a 4-anchor hybrid technique and thus might be recommended in SCR for patients with irreparable superior rotator cuff tears to achieve maximum stability.
Clinical Relevance:
SCR presents a novel alternative for treatment of irreparable superior rotator cuff tears in younger patients. Glenoid fixation is essential to provide adequate fixation of the graft to prevent the humeral head from rising and to restore normal biomechanics.
This study aimed to analyze the effect of water extract of yarrow (Achillea millefolium L.) leaf (WEYL) on tissue oxidative properties, histological indices, gut microbiota composition and activity, ...and production parameters in turkeys. A total of 360 (1-day-old) female poults were randomly assigned to one of three treatments (8 replications × 15 poults each). The turkeys were fed in a four-phase system for 15 weeks: group C (control)—diet that did not contain WEYL; group E1—diet supplemented with 0.05, 0.1, 0.1, and 0.2 g/kg WEYL; and group E2—diet supplemented with 0.1, 0.2, 0.2, and 0.3 g/kg WEYL. The results of the analyses of body weight, feed intake, and feed conversion indicated that WEYL did not have any effect on these parameters (P > 0.05). However, WEYL increased the proportion of skin with subcutaneous fat (P = 0.006), and when supplemented at higher ratios, it reduced the proportion of liver (P = 0.010) and improved slaughter performance (P = 0.044). Furthermore, consumption of WEYL-supplemented diet led to an improvement in the antioxidative status and glutathione peroxidase activity in the blood and breast muscles, and also increased the superoxide dismutase activity in the blood and liver (P < 0.05). Supplementation with WEYL at a lower dose (E1) resulted in reduced malondialdehyde concentration in the blood, while supplementation at a higher dose (E2) caused a reduction in ascorbic acid concentration in the liver (P < 0.05). Turkeys that were fed with WEYL-containing diet had a higher amount of cholinesterase in the blood (P = 0.045), and those fed with the diet containing a higher dose of WEYL (E2) had a higher level of albumins and total protein (P < 0.05). Turkeys from E2 group had the longest villi and shallowest crypts, but the percentage of proliferating nuclei was found to be the highest in the group that received a diet with a lower dose of WEYL (E1) (P < 0.05). Turkeys from E2 group showed a decreased relative abundance of Lactobacillus spp. in the cecal content as well as reduced β-glucosidase activity, while those from the E1 group showed reduced β-galactosidase activity (P < 0.05). In summary, dietary supplementation with WEYL can help improve tissue antioxidative status and modify the enzymatic activity of the cecal microflora in turkeys, with no negative influence on the production outcomes of these birds.
•Water extract of yarrow leaf (WEYL) did not influence turkey performance.•Dietary supplementation with WEYL improved the antioxidant status of turkey tissues.•Turkeys fed diet with WEYL had higher blood concentrations of cholinesterase, albumin, total protein, and cholesterol.•WEYL-supplemented diet reduced the enzymatic activity of cecal bacteria.
