Relationships Between Standing Frontal-Plane Knee Alignment and Dynamic Knee Joint Loading During Walking and Jogging in Youth Who Are Obese

Abstract Background. Youth who are obese have high risk of poor knee health and cartilage damage. Understanding factors which may affect knee health in youth who are obese is critical for preservation of knee integrity and function. Objective. This study compared standing frontal-plane knee alignment and knee loading patterns between youth who are obese and those of healthy weight and determine the association between knee alignment and knee loading patterns during walking and jogging. Design. This study used a cross-sectional matched pair design. Methods. Twenty youth who were obese and 20 youth who were healthy-weight (ages 11–18 years) were recruited. Three-dimensional motion analysis quantified standing frontal-plane knee alignment as well as frontal- and sagittal-plane knee moments during walking and jogging. Paired t-tests, multiple analysis of covariance, and Spearman's rank correlation coefficients were used for analysis. Results. The youth who were obese demonstrated greater knee valgus in standing (P = 0.02), lower normalized peak external knee adduction moments during walking (P = 0.003), and greater normalized peak external knee extension moments during jogging (P = 0.003) compared with the youth who were healthy-weight. Standing knee alignment did not correlate with knee moments in the youth who were obese. Limitations. Results are limited to small, homogeneous cohorts. The standing alignment methodology is not validated in this population and may limit interpretation of results. Conclusion. Youth who are obese stand in more knee valgus and have altered knee loading patterns during walking and jogging compared with youth who are healthy-weight. Frontal-plane knee alignment does not correlate with frontal-plane knee loading patterns in youth who are obese. A better understanding of other mechanisms related to joint loading in youth who are obese is necessary to maintain long-term joint integrity in this population

Feasibility and Safety of Orbital Atherectomy for the Treatment of In-Stent Restenosis

Background: Debulking and ablative techniques are used for the treatment of in-stent restenosis (ISR). The safety and efficacy of orbital atherectomy (OA) in this cohort of patients has not been reported. Methods: We retrospectively evaluated procedural as well as clinical outcomes in patients treated with OA for ISR secondary to underlying calcific disease at two academic tertiary care centers from Oct 2016 to Sept 2018. Results: A total of 38 patients underwent OA for ISR during the period with mean age 66 +/- 12 yrs; 74% male, 63% diabetic, 39% post-CABG and 61% with a prior incident of ISR. Patients presented with NSTEMI (32%), unstable angina (18%) and stable angina (50%). Implantation of culprit stent occurred between 4 months to 22 years prior to the index procedure. The severity of ISR according to the Mehran classification; type 1 (24%), 2 (26%), 3 (18%) and 4 (32%). Angioplasty prior to OA was performed in 45% of cases and post OA in 95% of cases. Intracoronary imaging was performed in 79% of cases. There was one (3%) periprocedural MI from no reflow phenomenon. There was one (3%) Ellis type II coronary perforation thought to be related to aggressive post OA angioplasty that resulted in no measurable clinical sequelae. There were no reports of equipment malfunction or harmful device/stent interactions. Conclusion: OA can be safely performed as an adjunctive tool in the treatment of ISR. Caution must be taken in these high risk lesions to limit complications and harmful device/stent interactions

Pilot Study of the Juvenile Dermatomyositis Consensus Treatment Plans: A CARRA Registry Study.

OBJECTIVE:To determine the feasibility of comparing the Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans (CTP) in treating moderate new-onset juvenile dermatomyositis (JDM) using the CARRA registry, and to establish appropriate analytic methods to control for confounding by indication and missing data. METHODS:A pilot cohort of 39 patients with JDM from the CARRA registry was studied. Patients were assigned by the treating physician, considering patient/family preferences, to 1 of 3 CTP: methotrexate (MTX) and prednisone (MP); intravenous (IV) methylprednisolone, MTX, and prednisone (MMP); or IV methylprednisolone, MTX, prednisone, and IV immunoglobulin (MMPI). The primary outcome was the proportion of patients achieving moderate improvement at 6 months under each CTP. Statistical methods including multiple imputation and inverse probability of treatment weighting were used to handle missing data and confounding by indication. RESULTS:Patients received MP (n = 13), MMP (n = 18) and MMPI (n = 8). Patients in all CTP had significant improvement in disease activity. Of the 36 patients who remained in our pilot study at 6 months, 16 (44%) of them successfully achieved moderate improvement at 6 months (6/13, 46% for MP; 7/15, 47% for MMP; 3/8, 38% for MMPI). After correcting for confounding, there were no statistically significant pairwise differences between the CTP (P = 0.328-0.88). CONCLUSION:We gained valuable experience and insight from our pilot study that can be used to guide the design and analysis of comparative effectiveness studies using the CARRA registry CTP approach. Our analytical methods can be adopted for future comparative effectiveness studies and applied to other rare disease observational studies