Cardiopulmonary exercise testing for cardiovascular risk assessment in patients undergoing gastric and oesophageal cancer surgery: results from a prospective interventional cohort study.

BACKGROUND Cardiopulmonary exercise testing (CPET) has shown to be useful for preoperative risk stratification in various types of intra-abdominal and thoracic surgery. However, data about the predictive value of CPET for cardiovascular outcome after gastric or oesophageal cancer surgery are inconclusive. The aim of this study was to evaluate the prognostic value of CPET parameters for the prediction of cardiovascular complications in patients with this type of surgery. METHODS This is a prospective single-centre interventional cohort study including 200 consecutive patients who underwent elective surgery for oesophageal and/or gastric cancer. Symptom-limited CPET was performed preoperatively to evaluate the potential of various test-derived parameters including anaerobic threshold (AT) to predict cardiovascular complications within 30 days after surgery. RESULTS 200 patients (mean age 68±14.2 years) met inclusion and exclusion criteria: oesophageal surgery 54 pts, gastric surgery 132 pts and combined oesophageal/gastric surgery 14 pts. 41/200 pts (20.5%) experienced cardiovascular complications during and within 30 days after surgery including 4 non-fatal myocardial infarctions (2%), 1 stroke (0.5%); 6 dead from cardiovascular causes (3%) and less serious complications in 30 patients (15%) including angina attacks and antiarrhythmic therapy for ventricular arrhythmias or for atrial fibrillation/flutter. Results from preoperative CPET indicate that an AT level below 11 mL/kg/min was highly predictive for any cardiovascular complication (p=0.02, OR 6.33, 95% CI 1.78 to 22.47). An AT level <9.5 had the best predictive accuracy for major perioperative cardiac complications (sensitivity 93%, specificity 68%, positive predicative value 75%, negative predicative value 98.8%). CONCLUSION CPET is a useful perioperative risk assessment tool for patients undergoing surgery for oesophageal and gastric cancer, which carries a particularly high risk for cardiovascular complications. An AT <9.5 mL/kg/min turned out to be the most reliable predictor for major cardiovascular complications

Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures: A randomized study of 50 patients

Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position, the treatment of choice is operation. The type of operation and the choice of implant, however, is a matter of discussion. Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation

Left Ventricular Diastolic Dysfunction Screening by a Smartphone-Case Based on Single Lead ECG.

Aims To investigate the potential of a signal processed by smartphone-case based on single lead electrocardiogram (ECG) for left ventricular diastolic dysfunction (LVDD) determination as a screening method. Methods and Results We included 446 subjects for sample learning and 259 patients for sample test aged 39 to 74 years for testing with 2D-echocardiography, tissue Doppler imaging and ECG using a smartphone-case based single lead ECG monitor for the assessment of LVDD. Spectral analysis of ECG signals (spECG) has been used in combination with advanced signal processing and artificial intelligence methods. Wavelengths slope, time intervals between waves, amplitudes at different points of the ECG complexes, energy of the ECG signal and asymmetry indices were analyzed. The QTc interval indicated significant diastolic dysfunction with a sensitivity of 78% and a specificity of 65%, a Tpeak parameter >590 ms with 63% and 58%, a T value off >695 ms with 63% and 74%, and QRSfi > 674 ms with 74% and 57%, respectively. A combination of the threshold values from all 4 parameters increased sensitivity to 86% and specificity to 70%, respectively (OR 11.7 [2.7-50.9], P < .001). Algorithm approbation have shown: Sensitivity-95.6%, Specificity-97.7%, Diagnostic accuracy-96.5% and Repeatability-98.8%. Conclusion Our results indicate a great potential of a smartphone-case based on single lead ECG as novel screening tool for LVDD if spECG is used in combination with advanced signal processing and machine learning technologies

Hybrid capture data unravel a rapid radiation of pimpliform parasitoid wasps (Hymenoptera: Ichneumonidae: Pimpliformes)

The parasitoid wasp family Ichneumonidae is among the most diverse groups of organisms, with conservative estimates suggesting that it contains more species than all vertebrates together. However, ichneumonids are also among the most severely understudied groups, and our understanding of their evolution is hampered by the lack of a robust higher‐level phylogeny of this group. Based on newly generated transcriptome sequence data, which were filtered according to several criteria of phylogenetic informativeness, we developed target DNA enrichment baits to capture 93 genes across species of Ichneumonidae. The baits were applied to DNA of 55 ichneumonids, with a focus on Pimpliformes, an informal group containing nine subfamilies. Phylogenetic trees were inferred under maximum likelihood and Bayesian approaches, at both the nucleotide and amino acid levels. We found maximum support for the monophyly of Pimpliformes but low resolution and very short branches close to its base, strongly suggesting a rapid radiation. Two genera and one genus‐group were consistently recovered in unexpected parts of the tree, prompting changes in their higher‐level classification: Pseudorhyssa Merrill, currently classified in the subfamily Poemeniinae, is transferred to the tribe Delomeristini within Pimplinae, and Hemiphanes Förster is moved from Orthocentrinae to Cryptinae. Likewise, the tribe Theroniini is resurrected for the Theronia group of genera (stat. rev.). Phylogenetic analyses, in which we gradually increased the numbers of genes, revealed that the initially steep increase in mean clade support slows down at around 40 genes, and consideration of up to 93 genes still left various nodes in the inferred phylogenetic tree poorly resolved. It remains to be shown whether more extensive gene or taxon sampling can resolve the early evolution of the pimpliform subfamilies.This is the pre-peer reviewed version of the following article: Klopfstein, S., Langille, B., Spasojevic, T., Broad, G.R., Cooper, S.J.B., Austin, A.D. and Niehuis, O. (2019), Hybrid capture data unravel a rapid radiation of pimpliform parasitoid wasps (Hymenoptera: Ichneumonidae: Pimpliformes). Syst Entomol, 44: 361-383. , which has been published in final form at doi:10.1111/syen.12333. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving The attached document is the authors’ submitted version of the journal article. You are advised to consult the publisher’s version if you wish to cite from it

Relationship between distal radius fracture malunion and arm-related disability: A prospective population-based cohort study with 1-year follow-up

<p>Abstract</p> <p>Background</p> <p>Distal radius fracture is a common injury and may result in substantial dysfunction and pain. The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability.</p> <p>Methods</p> <p>The prospective population-based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast (55 patients) or external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (concerning disabilities before fracture) and one year after fracture. The 1-year follow-up included the SF-12 health status questionnaire and clinical and radiographic examinations. Patients were classified into three hypothesized severity categories based on fracture malunion; no malunion, malunion involving either dorsal tilt (>10 degrees) or ulnar variance (≥1 mm), and combined malunion involving both dorsal tilt and ulnar variance. Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk (RR) of obtaining DASH score ≥15 and the number needed to harm (NNH) were calculated.</p> <p>Results</p> <p>The mean DASH score at one year after fracture was significantly higher by a minimum of 10 points with each malunion severity category. The RR for persistent disability was 2.5 if the fracture healed with malunion involving either dorsal tilt or ulnar variance and 3.7 if the fracture healed with combined malunion. The NNH was 2.5 (95% CI 1.8-5.4). Malunion had a statistically significant relationship with worse SF-12 score (physical health) and grip strength.</p> <p>Conclusion</p> <p>Malunion after distal radius fracture was associated with higher arm-related disability regardless of age.</p

The Artelon CMC spacer compared with tendon interposition arthroplasty: A randomized, controlled, multicenter study of 109 patients with osteoarthritis followed for 1 year

Background and purpose The Artelon CMC spacer is designed for surgical treatment of osteoarthritis (OA) in the carpometacarpal joint of the thumb (CMC-I). Good results using this degradable device were previously presented in a pilot study. We now present results from a larger randomized, controlled, multicenter study

Injectable Calcium Phosphate Bone Substitute In Distal Radial Fractures

Fractures of the distal end of the radius are common and occur in many different forms. The long-term results after conservative treatment of fracture of the distal end of the radius in younger adults with special reference to degenerative changes and function are investigated in 76 patients (Paper I). After 30 years, 81% of the patients made no difference between the fractured and the non- fractured side. The malunion was obvious with increased dorsal, radial and axial compression. Degenerative changes in radio-carpal and distal radio-ulnar joints were found in higher proportion in the injured wrist and especially in intraarticular fractures compared to the non-injured side. Incongruity of the fracture and radial shortening were in relation with degenerative changes. Patients with degenerative changes in the radio-carpal joints had significantly more complaints. There is a need for an easy and reliable method for distal radial fracture fixation which addresses the problem of compression of cancellous bone. The feasibility of an injectable bone cement, Norian SRS, was evaluated in Paper II. In comparison to external fixation, the patients, treated with Norian SRS, showed earlier recovery of grip strength and mobility. However the fractures were not perfectly stabilized and a mild loss of fracture reduction over time could be observed in both groups, but was larger in patients treated with Norian SRS (Paper III). This instability of the fracture treated with Norian SRS was confirmed by stereometric analysis (RSA) and the need of some other type of fixation in addition to bone substitute emphasized (Paper IV). In an animal study, we found that the instability of the fracture, treated with Norian SRS, is not in relation with the time point for surgery, thus delayed surgery does not reduce the interface strength between the surface of a bone fracture and an injectable hydroxyapatite (Paper V). The need of fracture fixation with Norian SRS, in association with early mobilization was evaluated in Paper VI. We found that, in most cases, surgery can be avoided in the treatment of redislocated distal radial fractures in low demand-patients

Distal radioulnar joint replacement

The resection of the ulnar head, as described by Darrach, has unfortunately become the standard of care despite the frequent problems of ulnar stump instability following this procedure. To offer better treatment to our patients, we have to appreciate the various roles and the importance of the ulnar head for the function of the distal radioulnar joint (DRUJ) in mechanically loaded forearm rotation. The ulnar head forms the load-bearing keystone of the DRUJ and the distal forearm, important for maintaining adequate tension within the radioulnar ligaments and the interosseous membrane. A DRUJ implant replacing the ulnar head should and has to be the fixed point and load-bearing part of the joint and will be exerted to large mechanical loads making a neutralization of these forces necessary. A partial resurfacing implant for the DRUJ can be used for primary procedures. The resection is minimal, and further, the attachments of the stabilizing ligaments, the triangular fibrocartilage complex in particular, are preserved with a maintained anatomy and stability. For revision and salvage procedure, a modular ulnar head can be used, which restores the ulnar head offset and stabilizes the ulnar stump, restoring a pain-free DRUJ. The modularity of these 2 implants addresses the majority of indications for prosthesis in the DRUJ