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Patient-Reported and Radiographic Outcomes Following Operative Fixation of Bimalleolar Equivalent Ankle Fractures with Deltoid Ligament Repair
No full textRoutine deltoid ligament repair (DLR) during operative management of ankle fractures remains controversial.
To compare patient-reported outcomes (PROs), complications, and radiographic outcomes in patients with bimalleolar equivalent ankle fractures treated with or without DLR.
Retrospective cohort study.
Adult patients who underwent operative fixation of bimalleolar equivalent ankle fractures at two level 1 trauma centers between 2010 and 2023 were retrospectively identified. The primary outcome was the Olerud-Molander Ankle Score (OMAS). Secondary outcomes included additional PROs, complications, and radiographic measurements. Multivariable logistic regression assessed the association between DLR and the odds of achieving an excellent (≥91) versus non-excellent OMAS.
A total of 260 patients (median age 36.4 years, 38.4% female) were included. Thirty-one (12%) patients underwent DLR and 229 (88%) did not. PROs were obtained from 92 patients (18 DLR, 74 non-repair) at a median of 7.0 years postoperatively. Median OMAS was similar between cohorts (90 vs. 90, P=0.79). DLR was not associated with increased odds of achieving an excellent OMAS (adjusted OR 1.89, 95% CI 0.52–7.08, P=0.335). Secondary PROs and complications were comparable between cohorts. Radiographic measurements in 111 patients (26 DLR, 85 non-repair) revealed a decreased median tibiofibular clear space in the DLR group (4.50 mm vs. 5.09 mm, P=0.012). Medial clear space and tibiofibular overlap were similar between cohorts.
Patients with bimalleolar equivalent ankle fractures had comparable long-term PROs and complication rates regardless of DLR. Radiographic findings suggested adequate restoration of ankle joint congruity and medial stability in both cohorts
Toward a New Appreciation of Alfred Hitchcock Presents, The Alfred Hitchcock Hour, and Shamley Productions
No full textAbstract B058: Development of a potent and selective orally available AVPR1A antagonist for castration resistant prostate cancer
No full textDietary sodium and potassium intake and risk of diabetes in the Million Veteran Program
No full textStudies show an association between elevated blood pressure, obesity, and insulin resistance with an higher risk of developing diabetes. As sodium is closely linked to elevated blood pressure and hypertension, and potassium is a counterbalancing nutrient to sodium, this study examines the association between intake of sodium, potassium, and sodium: potassium (Na:K) ratio and the incidence of diabetes.
Retrospective data analysis of dietary intake measured by a validated food frequency questionnaire in a prospective cohort of veterans participating in the Million Veteran Program (MVP) between 2011 and 2020, who were free of diabetes at baseline.
The main outcome is clinically diagnosed diabetes defined by phenotyping algorithms applied to electronic health records.
In this study of 198,049 veterans (mean age: 63.8 ± 13.1 years, 89% male), 7,260 were diagnosed with diabetes over a mean follow-up of 4.3 years. The mean sodium intake was 1218 mg/day. A higher sodium intake was associated with an 11% higher rate of developing diabetes (hazard ratio, HR) comparing extreme quintiles: 1.11, 95% CI: 1.03-1.20). Gs. The average daily potassium intake was 2589 mg and theighest quintile of potassium intake was associated with a 13% lower rate of diabetes (HR: 0.87, 95% CI: 0.81, 0.94) compared to the lowest quintile of potassium. Highest quintile of Na:K ratio was associated with a 21% higher rate for diabetes (HR:1.21, 95%CI: 1.12, 1.30). The pattern of associations between Na:K ratio and diabetes closely followed the pattern of dietary sodium intake and diabetes associations.
A higher sodium intake and a higher Na:K ratio were associated with a higher risk of diabetes in this large cohort of Veterans. These findings may be applied in future work to identify personalized lifestyle and dietary supports to prevent and treat T2DM
Restoration of Extrinsic Grasp With Supinator to Flexor Digitorum Superficialis and Extensor Carpi Radialis Brevis to Anterior Interosseous Nerve Transfers for Medial Cord Injury of the Brachial Plexus
Get PDFBrachial plexus injuries are among the most challenging clinical scenarios faced by hand surgeons due to the heterogeneity of presentations, the need to reconstruct multiple critical functions, and potentially limited donor options. In this case report, we presented a patient with a medial cord injury of the brachial plexus with a complete lack of grasp. Extrinsic grasp was restored with a double nerve transfer of the extensor carpi radialis brevis to the anterior interosseous nerve, along with the supinator to the flexor digitorum superficialis
Phenotypic POLE variant classification identifies patients who may have favorable prognosis and benefit from immunotherapy
No full textPathogenic POLE mutations (pPOLE) undermine mismatch error correction by POLε during DNA replication and resulting somatic ultramutation predicts response to immunotherapy. Beyond frequently recurrent alleles, historical pPOLE classification has been largely based on exonuclease domain localization. A POLE-specific phenotypic classification model was developed encompassing tumor mutational burden (TMB), mutational signatures, germline frequency, and consideration of co-mutation with other POLE mutations to identify pPOLE. This model was applied to >490,000 samples and identified 29 predicted pPOLE, including 16 not previously reported. 748 tumors (0.2%) had one or more pPOLE, most commonly in endometrial and colorectal cancers, though pPOLE were observed in many additional cancer types. pPOLE were associated with ultramutation (median TMB 186.3 mut/Mb) across tumor types. Concurrent pPOLE and microsatellite instability (MSI) was more common than previously appreciated and produced a synergistic TMB impact, with medians of 135.7 mut/Mb for pPOLE/microsatellite stable samples compared to 325.6 mut/Mb for pPOLE/MSI-High samples. Co-mutation analysis in endometrial and colorectal cancers highlighted associations with homologous recombination (HR) pathway gene mutations that were predominantly monoallelic passengers that are unlikely to predict response to therapies targeting DNA repair deficiencies. pPOLE have been incorporated into treatment guidelines for several malignancies and are an important predictor of immunotherapy response. This study provides biological insight to guide classification and clinical management of patients with tumors harboring pPOLE
Beyond numbers: the missing conceptual foundation in evaluating Mexico's health system performance
No full textFactors influencing immediate post-angiographic occlusion outcomes in intracranial aneurysms treated with the woven endobridge device: a multi-center analysis and predictive model from the WorldWideWEB consortium
No full textThe Woven EndoBridge (WEB) device treats wide-necked bifurcation aneurysms, but occlusion rates vary. This study aims to identify factors associated with immediate WEB device occlusion. Data from patients treated with WEB devices across 36 sites were analyzed. Machine learning algorithms and ordinal regression models were developed to predict immediate incomplete occlusion for ruptured and unruptured aneurysms. The study included 1565 patients, with 436 ruptured and 1129 unruptured aneurysms. Immediate complete occlusion was achieved in 38.3% of ruptured and 32.8% of unruptured aneurysms. For ruptured aneurysms, the CatBoost classifier achieved an AUROC of 0.69. Key predictors of incomplete occlusion included pretreatment mRS, aneurysm diameter, and MCA location. Ordinal regression revealed that smoking history (OR: 1.95,
p
< 0.001), neck diameter (Odds Ratio [OR]: 1.50,
p
< 0.001), and presence of a branch from the aneurysm (OR: 2.06,
p
= 0.016) were associated with incomplete, while bifurcation aneurysms (OR: 0.55,
p
= 0.017) were associated with complete immediate occlusion. For unruptured aneurysms, the CatBoost classifier achieved an AUROC of 0.68. Significant predictors of immediate incomplete occlusion included aneurysm neck width, MCA location, and presence of daughter sac. Ordinal regression revealed that smoking history (OR: 1.29,
p
= 0.032), neck diameter (OR: 1.24,
p
< 0.001), and presence of a daughter sac (OR: 1.53,
p
= 0.005) were associated with incomplete, while bifurcation aneurysms (OR: 0.71,
p
= 0.02) and posterior circulation location (OR: 0.68,
p
= 0.01) were associated with complete immediate occlusion. Careful evaluation of patient demographics and specific aneurysm characteristics may help improve the outcomes of intracranial aneurysms treated with WEB device
Chapter 20 - Sleep health and diabetes: The role of sleep duration, quality, disorders, and circadian rhythm on diabetes
No full textThe current chapter extensively examines the role of sleep health as both a risk and protective factor in relation to diabetes outcomes. It offers a comprehensive review of the existing literature, exploring how various aspects of sleep health, including duration, quality, sleep architecture (such as spindles, rapid eye movement sleep, and slow wave sleep), sleep disorders (such as insomnia and obstructive sleep apnea), and circadian rhythm, influence the likelihood of developing diabetes and its associated cardiometabolic complications, such as unhealthy glucose levels, poor glycemic control, insulin resistance, and elevated hemoglobin A1c levels. Conversely, we also highlight evidence suggesting that certain sleep parameters, when optimized, could potentially mitigate the risk of diabetes and related cardiometabolic outcomes. To provide a thorough understanding of the mechanisms underlying the relationship between sleep and diabetes, we draw upon a wide range of research and evidence, including epidemiological, observational, clinical trials, and experimental studies. By elucidating both the risk and protective effects of sleep health, this chapter aims to inform strategies for diabetes prevention and management in clinical practice and population health management
Inflammatory responses to exercise and related health interventions
No full textA disability determines exercise modality, movement patterns, and the amount of active skeletal muscle mass; these all affect athletic performance and generally reduce the physiological responses to exercise. As a result, people with disabilities are more prone to physical inactivity and are often at increased risk for cardiovascular and inflammation-related diseases. However, due to the wide range of physical disabilities, the physiological response to exercise is not uniform across individuals with a disability. Several factors, such as autonomic dysfunction, the extent to which active skeletal muscle mass is reduced, and the ability to increase body temperature through activity, influence the inflammatory response to exercise. Disabilities such as spinal cord injury, which are characterised by autonomic dysfunction, as well as a limited skeletal muscle mass and physical capacity to raise body temperature through exercise, may hence result in an impaired inflammatory response. Additionally, ageing may further deteriorate the inflammatory state. Whilst chronic studies in populations with disabilities are scarce, the available evidence indicates that the inflammatory resting profile is a modifiable risk factor, and exercise as well as interventions that mimic part of the exercise stimulus have been shown to result in favourable inflammatory responses across the disability spectrum