20966 research outputs found
Sort by
The Motown Corkscrew: A Simple Method for Extraction of an Embedded Intra-Articular Foreign Body
No full textCASE: A 17-year-old boy presented after a gunshot wound; computed tomography showed a comminuted posterior-wall acetabular fracture and a bullet 90% embedded. Through a Ganz surgical dislocation, a standard 2.5 mm drill bit was advanced 8 to 10 mm into the projectile, its flutes functioning as a self-tapping screw to rock and extract the bullet en bloc, followed by trochanteric osteotomy fixation. He regained painless full activity by 2 months; 33-month imaging confirmed durable union with no osteolysis.
CONCLUSION: The Motown Corkscrew technique provides a cost-neutral, controlled method to remove bone-embedded intra-articular bullets while preserving articular structures
Variation in KOOS JR improvement across total knee implant designs: a cohort study from Michigan Arthroplasty Registry Collaborative Quality Initiative
No full textBACKGROUND AND PURPOSE: Arthroplasty registries report revision risk, but patient-reported outcomes may also measure implant performance. We aimed to evaluate (i) change in patient-reported outcome measures (PROMs) across multiple total knee arthroplasty (TKA) designs in a regional registry, (ii) the association of patellar resurfacing on the change in PROMs, and (iii) the variation in PROMs change within implants with or without patellar resurfacing.
METHODS: This is a cohort of primary TKAs from Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) performed between January 1, 2017 and September 30, 2021. The dependent measure was change in KOOS JR. Independent variables were implant name and patellar resurfacing. Multivariate modeling adjusted for patient-level factors. A previous report suggests a change of 23 points in KOOS JR as clinically relevant in achieving acceptable pain/function levels. A clinically relevance ratio (CRR) of those achieving the threshold of 23 points to the overall group was calculated for each implant.
RESULTS: 18 implant designs met the inclusion criteria. There were 51,606 cases with complete preoperative and postoperative KOOS JR matched pairs. There was variation in improvement from preoperative to postoperative unadjusted KOOS JR scores across implant designs (P \u3c 0.001), ranging from 18.7 (95% confidence interval [CI] 16.8-20.6) to 27.0 (CI 24.9-29.2). Patellar resurfacing resulted in greater KOOS JR improvement 1.0 (CI 0.5-1.5, P \u3c 0.001). Of the cases with resurfaced patellae, the CRR was 50.2% (CI 49.7-50.7). For cases without resurfaced patellae, the CRR was 47.2% (CI 45.9-48.5). The association of implant design persisted whether the patella was resurfaced or not, evident in the adjusted mean change in KOOS JR (P \u3c 0.001), ranging from 20.1 (CI 17.6-22.6) to 25.5 (CI 24.3-26.7) for resurfaced and from 17.0 (CI 13.9-20.1) to 23.3 (CI 20.3-26.2) for not resurfaced, and the CRR difference (P \u3c 0.001), ranging from 45.8% (CI 42.5-48.6) to 55.8% (CI 50.4-60.8) for resurfaced and from 37.9% (CI 27.4-44.7) to 51.4% (CI 43.9-56.6) for not resurfaced.
CONCLUSION: Implant design and patellar resurfacing both show an association with KOOS JR improvement. Variations in implant design persist whether the patella is resurfaced or not. Implant selection and patellar resurfacing may be associated with patient outcomes
The Individual Impact of Machine Perfusion on Liver and Kidney on Donor Expansion in Simultaneous Liver and Kidney Transplantation
No full textMachine perfusion (MP) use for both organs can increase organ usage in simultaneous liver and kidney transplantation (SLKT). We analyzed 6,956 SLKT performed between 2015 and 2024 using the United Network for Organ Sharing database. The primary outcomes were the 1-year graft survival for kidney and liver. Donor types and MP use for liver and/or kidney were captured and associations with outcomes were evaluated. SLKT from Donation after circulatory death donors (DCD) increased from 4.5% in 2015 to 16% in 2023. The median Kidney Donor Profile Index (KDPI) has increased from 23% in 2015 to 28% in 2023. MP use for kidney and liver also increased from 21% to 51% and 0%-17%, respectively. KDPI \u3e85% was an independent risk factor of 1-year kidney graft failure in the no kidney MP group [HR 2.03, 95% CI 1.20-3.44, p = 0.009], but not in the kidney MP group. DCD was found to be an independent risk factor of 1-year liver graft failure in the no liver MP group [HR 1.56, 95% CI 1.19-2.03, p = 0.001], but not in the liver MP group. MP for both organs may contribute to expanding the donor pool for SLKT without compromising post-transplant outcomes
Reply to \u27Comment on Bertini et al.: area deprivation and PSA screening disparities\u27 and \u27Comment on socioeconomic disparities in prostate cancer screening: the impact of the Area Deprivation Index on PSA screening frequency\u27
No full textThe Impact of Pulmonary Hypertension on Hospitalization Risk in Adults with Respiratory Syncytial Virus Infection
No full textBackground/Objectives: Respiratory syncytial virus (RSV) infection can lead to significant complications, particularly among those with underlying cardiovascular and pulmonary complications. Patients with pulmonary hypertension (PH) are susceptible to clinical deterioration triggered by respiratory infections due to their limited cardiopulmonary reserve. This study aimed to assess the risk of hospitalization in RSV-infected adults with and without PH.
Methods: We conducted a retrospective cohort study using the research network TriNetX to assess the risk of hospitalization in a cohort of patients with RSV infection, comparing those with and without PH. Propensity score matching was performed for demographic variables and RSV risk factors between the two cohorts. The risk of hospitalization was expressed as an adjusted odds ratio (aOR) with a 95% confidence interval (CI).
Results: There were 193,256 patients in the RSV with PH cohort and 2,843,714 in the RSV without PH cohort (all aged \u3e18 years). The mean age of the RSV with PH cohort was 68.2 ± 15.3 years, 50.6% were females, 64% were white, and 64.2% were group 2 PH. The RSV with PH cohort was at an increased risk of hospitalization (aOR 1.89, 95% CI 1.87-1.92, p-value 0.02). There was a significant risk (aOR 1.29, 95% CI 1.27-1.32) for the composite outcome of hospitalization-related complications between the two cohorts. Comorbid conditions (diabetes, cardiovascular disease, chronic lung disease, and chronic kidney disease) increased the risk of hospitalization in the RSV with PH group, with the biggest effect noted with underlying cardiovascular disease. Similarly, those with group 2 PH had a higher risk of hospitalization compared to the other PH groups. Remarkably, all PH groups demonstrated increased hospitalization risk compared to the RSV without PH cohort.
Conclusions: We found that patients \u3e18 years of age with PH and RSV infection were at an increased risk of hospitalization, with subsequently higher rates of RSV-infection-related complications. All PH groups had a higher hospitalization risk compared to the RSV without PH cohort, likely denoting PH as an independent risk factor for worse RSV-infection-related outcomes. RSV vaccination, therefore, may benefit all age groups of patients with PH
Hemodynamic Changes Related To Computed Tomography Annulus Sizing In Tricuspid Valve Transcatheter Edge-to-edge Repair
No full textIntroduction: Tricuspid valve (TV) edge-to-edge repair (TEER) is a novel procedure to treat patients with severe tricuspid regurgitation (TR). Although commercially available, there is a lack of data predicting hemodynamic consequences with deployment of tricuspid TEER clasp devices. Utilizing gated cardiac computed tomography (CCT) for procedural planning may offer benefit. Methods: Retrospective analysis was conducted on twenty patients who underwent TV-TEER between August 2024 and February 2025, with the TriClip (Abbott, USA) device. All patients had pre-procedural imaging with CCT analysis and echocardiogram. Each patient underwent post-procedural transthoracic echocardiogram within 24 hours after TV-TEER. Results: Illustrated in figure 1A is the rise in trans-tricuspid gradient per clip, by baseline CCT-derived annular area. The average rise in gradient in the entire cohort (n=20) was 1.6 mmHg per patient, and 0.8 mmHg per clip. However, the average gradient rise per clip deployed in those patients with an annulus \u3c 1,600 mm2 (n=6) was 1.7 mmHg, while in those patients with an annulus \u3e 1,600 mm2 (n=14) the average gradient rise per clip deployed was 0.5 mmHg. Detailed outcomes of each patient are demonstrated in figure 1B. Conclusions: In our single center experience, patients with CCT-derived tricuspid annular area less than 1,600 mm2 on pre-procedural imaging appeared to demonstrate a more significant rise in TV diastolic gradients per clip deployed during TV-TEER. Pre-procedural CCT is of paramount importance in patients undergoing TV-TEER and aids procedural planning and predicting hemodynamic outcomes. To our knowledge, this is the earliest commercial descriptive data demonstrating the relationship between CCT-derived TV annuli and hemodynamic outcomes. Larger studies are needed to determine further impact, as well as a direct relationship between pre-procedural annular size and post-procedural change in TV diastolic gradients, as our data suggests. [Formula presented
Bridging The Gap: A Comparative Study Of Papi, Transesophageal Echocardiogram, And Cardiac Computed Tomography For Right Ventricular Function In Transcatheter Tricuspid Valve Replacement
No full textIntroduction: The pulmonary artery pulsatility index (PAPi) is a widely used hemodynamic parameter for assessment of right ventricular (RV) function, particularly in patients undergoing cardiac surgery or experiencing cardiogenic shock. In this study, we aim to evaluate the correlation between invasive PAPi and imaging-based assessment of RV size and function using transesophageal echocardiogram (TEE) and ECG-gated cardiac computed tomography (CCT) in patients undergoing transcatheter tricuspid valve replacement (TTVR) with Evoque valve (Edwards Lifesciences, USA). Methods: A retrospective analysis was conducted on 42 patients who underwent TTVR between February 2024 to January 2025. All patients had pre-procedural imaging with TEE and CCT to assess RV size and function. We compared PAPi with various RV parameters obtained from TEE and CCT, including fractional area change (FAC), RV volumetric ejection fraction (EF), fractional shortening, basal fractional shortening, and free wall shortening on CCT. Additionally, baseline RV size, RV function and RV basal diameter were assessed using TEE. Results: A total of 42 patients were analyzed, with the majority (83%) classified as NYHA functional class of III or greater. Multiple regression analysis was performed to compare PAPi with imaging-derived RV parameters. No correlation was found between pre-TTVR invasive PAPi and RV size or function measured by TEE or CCT, with an adjusted R-squared value of \u3c0.05 for all variables. However, a direct comparison of FAC on TEE immediately pre and post TTVR demonstrated a reduction in RV function (Figure 1). Further analysis was conducted on RV size and function using paired T-test which indicated a statistically significant drop in RV function and increase in RV size post-TTVR with a p value of \u3c0.05 for both. Conclusions: In this single-center study, we found no significant correlation between invasive PAPi measurements and CCT or TEE-derived measurements of RV size and function. However, a decline in FAC post-TTVR was observed, likely reflecting the acute change in RV loading conditions following the intervention which aligns with prior studies. These results suggest that CCT and TEE may have limitations in assessing RV reserve. These findings highlight the continued importance of invasive measurements like PAPi for a more comprehensive evaluation of RV function, particularly in patients undergoing tricuspid valve replacement. Further research is needed to determine the clinical implications of these findings. [Formula presented
TCT-1195 Outcomes of Transcatheter Tricuspid Valve Replacement in Patients with Multivalvular Disease: Insights from the TRISCEND II Trial
No full textBackground: The TRISCEND II trial demonstrated safety and effectiveness of EVOQUE transcatheter tricuspid valve replacement (TTVR) in patients with ≥ severe tricuspid regurgitation (TR). The impact and evolution of multivalvular disease (MVD) on outcomes following TR elimination with TTVR is unknown. Methods: Within the TRISCEND II trial, we compared patients with and without MVD (defined as concomitant ≥ mild MVD at baseline). Severe concomitant VHD were excluded in the trial. Change in KCCQ-OS from baseline to 1 year was modeled using ANCOVA, adjusted for baseline KCCQ-OS and tested the interaction of MVD*TTVR, to determine whether MVD modified the previously confirmed health status benefit of TTVR. Results: Among 382 patients randomized to TTVR or optimal medical therapy (OMT), 291 (76.2%) had MVD. Patients with MVD were slightly older, but other demographics and comorbidities were similar between groups. Mean baseline KCCQ-OS was significantly lower in MVD cohort (50.7 ± 21.6 vs. 57.5 ± 21.2, p = 0.008). TR etiology was secondary in 73.3%, primary in 12.6%, and cardiac implantable electronic device-related in 2.1%, with no difference in etiology or severity between groups. Overall, 31.4% had prior left-sided valve surgery/intervention. Severity of each valve disease at baseline assessed by the echocardiography core lab is shown (Table). MVD improved or stayed the same in the majority of patients, regardless of treatment arm (Figure A). No significant interaction was observed between MVD status and TTVR compared with OMT on improvement in 1-year KCCQ-OS score (pinteraction = 0.44) (Figure B). Conclusions: In the TRISCEND II trial, most patients demonstrated improvement or stability of MVD. Preexisting MVD did not modify the significant QOL benefit of TTVR compared to medical therapy alone. Further detailed analysis of clinical, echocardiographic, and health status outcomes will be available at the time of presentation. [Formula presented] [Formula presented
Cultivating Collections: Growing the IR Through Collaboration
No full textThis presentation highlights the mutually beneficial partnership between the University of Tennessee Health Science Center’s Dr. Margaret A. Newman Center for Nursing Theory and the Health Science Historical Collections (HSHC), which includes the campus institutional repository (IR). What began as a one-off project has developed into a long-term, ongoing collaboration that enriches both units while expanding access to scholarly resources. Through this collaboration, two new collections were created within the IR. The first makes available archival resources that support nursing theory curriculum, research, and scholarship, ensuring that faculty, students, and researchers have digital access to unique and historically significant materials. The second provides a means for disseminating the research and scholarship produced by the Dr. Margaret A. Newman Center for Nursing Theory, expanding the reach and impact of the Center’s contributions to the discipline. Together, these collections demonstrate how collaborative partnerships can strengthen institutional repositories. The partnership continues to offer opportunities for growth and engagement between the HSHC and the Newman Center
Performance of chronic liver disease questionnaire-metabolic dysfunction-associated steatohepatitis (CLDQ-MASH) against non-invasive tests
No full textBackground and aims: Patients with more advanced histologic fibrosis due to metabolic dysfunction-associated steatotic liver disease (MASLD) can experience health-related quality of life (HRQL) impairment. Most HRQL instruments that have been validated in MASLD were evaluated against liver biopsy. However, non-invasive tests (NITs) are increasingly being used in clinical practice and clinical research. Our aim was to assess correlations of NIT scores with HRQL scores using a newly validated HRQL instrument for MASH (Chronic Liver Disease Questionnaire – Metabolic Dysfunction-Associated Steatohepatitis, CLDQ-MASH). Method: The data from MASLD MASH patients enrolled in the Global NASH MASH Registry were used, including NIT scores (FIB-4, Enhanced Liver Function or ELF, liver stiffness measurement (LSM) by transient elastography) and HRQL assessed by the CLDQ-MASH (7 domains) instrument. The NIT cutoff values with the strongest association (the greatest effect size) with the total CLDQ-MASH score were identified. Results: There were 8504 MASLD patients with NIT and HRQL data included: mean (SD) age 54 (12) years, 45% male, 62% obesity (BMI \u3e 30), 50% type 2 diabetes, FIB-4 score 1.59 (1.25), ELF score 10.0 (1.0), LSM 12.4 (10.2) kPa. All studied NITs were significantly negatively correlated with Activity (correlation coefficient (r) −0.04 to −0.12), Fatigue (r = −0.04 to −0.06), Sleep (r = −0.04 to −0.05), and Systemic symptoms (r = −0.06 to −0.11) domains of CLDQ-MASH; FIB-4 and LSM were additionally correlated with Worry (r = −0.08 to −0.13), and LSM with Digestive symptoms (r = −0.07) domain scores (all p \u3c 0.01). For FIB-4, the cutoff with the strongest association with HRQL was 1.60 (34% of the sample met the cutoff ); as a result, patients with FIB-4 ≥ 1.60 had significantly lower HRQL scores in 5 7 domains of CLDQ-MASH including Activity, Fatigue, Sleep, Systemic symptoms, and Worry (mean score impairment up to −0.23 on a 1–7 scale, p \u3c 0.0001) while the domains of Digestive symptoms and Emotional health were not associated with FIB-4 at any cutoff (all p \u3e 0.05). For ELF, the cutoff for the strongest association with HRQL was 10.8 (met by 22%): MASLD patients who met the cutoff had lower scores in all 7 domains of CLDQ-MASH (score impairment up to − 0.37, all p \u3c 0.01). For LSM, the cutoff with the greatest effect size for association with HRQL was 26.5 kPa (met by 7%): in patients who met the cutoff, all CLDQ-MASH scores were significantly lower by up to −0.57 (all p \u3c 0.01). Conclusion: NIT scores in MASLD correlate negatively with HRQL as assessed by CLDQ-MASH. This indicates that higher NIT scores consistent with higher disease severity correlate with more HRQL impairment. The NIT cutoffs commonly used for the diagnosis of advanced fibrosis return the strongest association with HRQL impairment in MASLD. This suggests that CLDQ-MASH can be used in conjunction with NITs in clinical research in MASH MASLD