Planning for Bone Excision in Ewing Sarcoma: Post-Chemotherapy MRI More Accurate Than Pre-Chemotherapy MRI Assessment

International audienceBACKGROUND: In determining the level of bone resection in Ewing sarcoma, the most suitable time at which to perform magnetic resonance imaging (MRI) remains controversial. Current guidelines recommend that surgical planning be based on MRI performed prior to neoadjuvant chemotherapy. The goal of this study was to determine whether pre-chemotherapy or post-chemotherapy MRI provides greater accuracy of tumor limits for planning bone excision in the management of Ewing sarcoma.METHODS: This was a single-center, retrospective study. MRI was performed using 3 sequences: T1-weighted, T1-weighted with contrast enhancement by gadolinium injection, and a fluid-sensitive sequence (STIR [short tau inversion recovery] or proton-density-weighted with fat saturation). The tumor extent as assessed on pre-chemotherapy and post-chemotherapy MRI was compared with histological measurement of the resected specimen.RESULTS: Twenty patients with Ewing sarcoma of a long bone were included. In 6 cases, the tumor was located on the femur, in 5, the tibia; in 5, the fibula; and in 4, the humerus. The median patient age at diagnosis was 9.7 years. We found greater accuracy of measurements from MRI scans acquired after chemotherapy than from those acquired before chemotherapy. For both pre-chemotherapy and post-chemotherapy MRI, the greatest accuracy was achieved with the nonenhanced T1 sequence. There was no benefit to gadolinium enhancement. The median difference between T1 MRI and histological measurements was 19.0 mm (interquartile range [IQR], 4.3 to 32.8 mm) before chemotherapy and 5.0 mm (IQR, 2.0 to 13.0 mm) after chemotherapy. Adding a minimum margin of 20 mm to the limit of the tumor on post-chemotherapy T1 MRI always led to safe histological margin.CONCLUSIONS: Post-chemotherapy MRI provided a more accurate assessment of the limits of Ewing sarcoma. Surgical planning can therefore be based on post-chemotherapy MRI. Surgical cuts can be, at minimum, 20 mm from the limits as seen on MRI

Coonrad-Morrey total elbow arthroplasty for patients with rheumatoid arthritis: 54 prostheses reviewed at 7 years' average follow-up (maximum, 16 years)

BACKGROUND: Total elbow arthroplasty is a therapeutic option for severe rheumatoid arthritis. We hypothesized that the semiconstrained characteristics of the Coonrad-Morrey prosthesis do not compromise the survival rate of the implant in a rheumatoid elbow. METHODS: Between 1997 and 2012, there were 54 Coonrad-Morrey total elbow prostheses performed for rheumatoid arthritis in 46 patients. Minimum follow-up was 2 years. There were 35 women and 11 men with a mean age of 60 years (29-83 years). According to the Mayo classification for rheumatoid elbow, there were 30 type IIIA, 21 type IIIB, and 3 type IV. The surgical procedure was the same for all patients. Survivorship was assessed with use of the Kaplan-Meier method, with revision surgery as the end point. RESULTS: The survival rate was 97% (95% confidence interval, 83.6-99.6) at 5 years and 85% (95% confidence interval, 68.3-93.7) at 10 years. At an average of 7 years of follow-up (2-16 years), the mean Mayo Elbow Performance Score was 91 points (55-100 points), and the shortened version of the Disabilities of the Arm, Shoulder, and Hand score was 34 points (0-75 points). There was a significant improvement in Mayo Elbow Performance Score and in all range of motion at latest follow-up in comparison to preoperative values (P < .0001). Radiolucencies were observed in 6 cases around the humeral component and in 6 cases around the ulnar component. Bushing wear was observed in 16 cases (29%). There were 14 complications (26%). Revisions were performed in 6 of them (11%). CONCLUSION: The Coonrad-Morrey prosthesis provides satisfactory results with follow-up. The rate of complications remains high even if the rate of implant revision stayed low

Cryotherapy With Dynamic Intermittent Compression Improves Recovery From Revision Total Knee Arthroplasty

BACKGROUND: The goal of this study was to assess the efficacy of cryotherapy with dynamic intermittent compression (CDIC) in relieving postoperative pain, decreasing blood loss, and improving functional scores after revision total knee arthroplasty (rTKA). METHODS: We conducted a prospective case-control study (level of evidence: I) to evaluate the efficacy of CDIC on postoperative bleeding, pain, and functional outcomes after rTKA. Forty-three cases were included at a single institution and divided in 2 groups: a control group without CDIC (n = 19) and an experimental group with CDIC (n = 24). Bleeding was evaluated by calculating total blood loss, pain at rest was evaluated with a visual analog scale on postoperative day 3, and function was assessed using the Oxford score at 6 months postoperatively. The comparative analysis was performed using the Fisher exact test. RESULTS: The CDIC group had significantly lower total blood loss (260 vs 465 mL; P < .05), significantly less pain on day 3 (1 vs 3; P < .05), and a significantly higher functional score (42 vs 40; P < .05) than the control group. CONCLUSION: This is the first report dealing with the use of CDIC after rTKA. According to our results, it improves the recovery of patients who underwent rTKA; thus, it should be integrated into our daily practice

Gartland types IIB and III supracondylar fractures of the humerus in children: is Blount's method effective and safe?

BACKGROUND: Blount's method is controversial for the treatment of Gartland types IIB and III supracondylar fracture of the humerus (SCFH) in children. The purpose of this study was to evaluate the clinical and radiologic outcomes and the failure and complication rates. METHODS: All types IIB and III SCFH treated with Blount's method from 2003-2013 were included in this retrospective single-center study. Clinical assessment was performed according to Flynn criteria. Baumann angle, anteversion angle, anterior humeral line, and humeroulnar angle were measured for radiographic assessment. RESULTS: Among 447 children with types IIB and III SCHF, 339 were treated according to Blount's method. There were 173 boys (51%), and the mean age was 6.3 years (1-14 years); 71% were type III. Mean time to surgery was 5.7 hours. According to Flynn criteria, results were satisfactory in 91% of cases. No compartment syndrome was encountered. There were 16 (4.7%) secondary displacements requiring surgical revision. Five (1.9%) children developed a cubitus varus deformity. At latest follow-up, the mean Baumann angle was 74.7° (95% confidence interval, 74.1-75.3), the mean anteversion angle was 39.9° (95% confidence interval, 39.5-40.3), the anterior humeral line was normal in 87.6% of cases, and the mean humeroulnar angle was 8.7°. CONCLUSION: Blount's method is appropriate to manage types IIB and III SCFH, provided anatomic and stable reduction is obtained

Associations of microvascular complications with all-cause death in patients with diabetes and COVID-19:the CORONADO, ABCD Covid-19 audit and AMERICADO study groups

AIM: To provide a detailled analysis of the microvascular burden in patients with diabetes hopitalized for COVD‐19. MATERIALS AND METHODS: We analysed data from the French CORONADO initiative and the UK Association of British Clinical Diabetologists (ABCD) COVID‐19 audit, two nationwide multicentre studies, and the AMERICADO, a multicentre study conducted in New York area. We assessed the association between risk of all‐cause death during hospital stay and the following microvascular complications in patients with diabetes hospitalized for COVID‐19: diabetic retinopathy and/or diabetic kidney disease and/or history of diabetic foot ulcer. RESULTS: Among 2951 CORONADO, 3387 ABCD COVID‐19 audit and 9327 AMERICADO participants, microvascular diabetic complications status was ascertained for 1314 (44.5%), 1809 (53.4%) and 7367 (79.0%) patients, respectively: 1010, 1059 and 1800, respectively, had ≥1 severe microvascular complication(s) and 304, 750 and 5567, respectively, were free of any complications. The patients with isolated diabetic kidney disease had an increased risk of all‐cause death during hospital stay: odds ratio [OR] 2.53 (95% confidence interval [CI] 1.66‐3.83), OR 1.24 (95% CI 1.00‐1.56) and OR 1.66 (95% CI 1.40‐1.95) in the CORONADO, the ABCD COVID‐19 national audit and the AMERICADO studies, respectively. After adjustment for age, sex, hypertension and cardiovascular disease (CVD), compared to those without microvascular complications, patients with microvascular complications had an increased risk of all‐cause death during hospital stay in the CORONADO, the ABCD COVID‐19 diabetes national audit and the AMERICADO studies: adjusted OR ((adj)OR) 2.57 (95% CI 1.69‐3.92), (adj)OR 1.22 (95% CI 1.00‐1.52) and (adj)OR 1.33 (95% CI 1.15‐1.53), respectively. In meta‐analysis of the three studies, compared to patients free of complications, those with microvascular complications had an unadjusted OR for all‐cause death during hospital stay of 2.05 (95% CI 1.42‐2.97), which decreased to 1.62 (95% CI 1.19‐2.119) after adjustment for age and sex, and to 1.50 (1.12‐2.02) after hypertension and CVD were further added to the model. CONCLUSION: Microvascular burden is associated with an increased risk of death in patients hospitalized for COVID‐19

Magnetically controlled growing rod in early onset scoliosis: a 30-case multicenter study

PURPOSE: Preliminary results of magnetically controlled growing rods (MCGR) are encouraging. However, only short case series of MCGR for the treatment of early onset scoliosis (EOS) have been reported. Our aim was to evaluate its effectiveness and complications. METHODS: We report a 30-case retrospective, consecutive, multicenter series of MCGR. Effectiveness was judged upon: deformity correction and difficulties to achieve desired distraction. Secondary endpoints included complications and revision surgeries. RESULTS: Median age at surgery was 9.1 years (5-13). Mean follow-up was 18.4 months (12-33.9). Mean Cobb angle was 66° preoperatively and 44° at latest follow-up. MCGR has avoided an average of 2.03 scheduled surgical procedures per patient compared to traditional growing rod (GR). The intended total length gain was 40.1 mm per patient (5-140) and the total measured length gain was 21.9 mm (45.5% discrepancy). There were 24 complications: 7 proximal pull-outs of the hooks, 3 rod breakages, 6 failures of the lengthening of which 4 complete blockages and 2 complete blockages followed by backtracking, 1 proximal junctional kyphosis, 1 wound dehiscence, 1 superficial infection, 1 deep infection requiring implant removal, 1 pulmonary embolism, 1 pulmonary insufficiency, 1 secondary lumbar scoliosis, and 1 painful outpatient distraction. Eight patients had a gradual loss of effectiveness of distractions. There were 13 revision surgeries in 9 patients. CONCLUSIONS: MCGR provides satisfactory deformity correction and avoids repeated surgical procedures for lengthening. However, it has substantial complication rate. Although less frequent than in GR, the law of diminishing returns also applies to MCGR

Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

AIMS/HYPOTHESIS: This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). METHODS: The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. RESULTS: We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th-75th percentile) 28.4 (25.0-32.4) kg/m(2). Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5-14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. CONCLUSIONS/INTERPRETATION: In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04324736

Diabète et insuffisance cardiaque : approche épidémiologique par l’analyse croisée de différentes sources de données de santé

Health data can be categorized into research data and "real-life" data, the latter including medico-administrative and health care setting. Using the link between diabetes and heart failure (HF) as a common theme, we propose three epidemiological analyses based on these sources. First, the SURDIAGENE study, a "classic" prospective cohort of 1349 diabetics patients followed at the University Hospital of Poitiers. We analyzed the link between nutritional biomarkers and the risk of HF requiring hospitalization. Second, the DMC study, based on medico-administrative data from the French National Health System, for more than 3 million people with diabetes between 2012 and 2018, in whom we studied the risk of HF after a serious retinal event. Finally, the GAVROCHE project, an inter-regional analysis of hospital health data warehouses, on the link between glycemic variability on admission and the prognosis of individuals hospitalized for acute HF. This will involve natural language processing methods to extract data from hospital reports. These three projects are an opportunity to illustrate the data management according to data source, the issues related to the information and the consent of patients, and to conclude with proposals for a code of good epidemiological practices in real-life data processing.Les données de santé peuvent être catégorisées en données de recherche et en données de « vie réelle », parmi lesquelles les données médico-administratives et celles issues du soin. Avec pour fil rouge le lien entre deux maladies fréquentes, le diabète et l’insuffisance cardiaque (IC), nous proposons trois analyses épidémiologiques fondées sur ces sources. L’étude SURDIAGENE d’abord, une cohorte prospective « classique » de 1349 personnes diabétiques suivies au CHU de Poitiers, chez qui nous analysons le lien entre des biomarqueurs nutritionnels et le risque d’hospitalisation ou de décès pour IC. L’étude DMC ensuite, sur les données médico-administratives de l’Assurance Maladie de plus de 3 millions de personnes identifiées comme diabétiques entre 2012 et 2018, chez qui nous étudions le risque d’IC après un événement rétinien grave. Enfin, le projet GAVROCHE, une analyse des entrepôts de données de santé hospitaliers à l’échelle inter-régionale, sur le lien entre la variabilité glycémique à l’admission et le pronostic des personnes hospitalisées pour IC aiguë. Cela nécessitera en particulier l’extraction d’informations issues de comptes rendus par traitement automatisé du langage naturel. Ces trois projets nous permettent d’illustrer la gestion des données selon leur source et les enjeux liés à l’information et au consentement des patients, avant de conclure sur des propositions de bonnes pratiques épidémiologiques dans le traitement des données de vie réelle

Diabète et insuffisance cardiaque : approche épidémiologique par l’analyse croisée de différentes sources de données de santé

Health data can be categorized into research data and "real-life" data, the latter including medico-administrative and health care setting. Using the link between diabetes and heart failure (HF) as a common theme, we propose three epidemiological analyses based on these sources. First, the SURDIAGENE study, a "classic" prospective cohort of 1349 diabetics patients followed at the University Hospital of Poitiers. We analyzed the link between nutritional biomarkers and the risk of HF requiring hospitalization. Second, the DMC study, based on medico-administrative data from the French National Health System, for more than 3 million people with diabetes between 2012 and 2018, in whom we studied the risk of HF after a serious retinal event. Finally, the GAVROCHE project, an inter-regional analysis of hospital health data warehouses, on the link between glycemic variability on admission and the prognosis of individuals hospitalized for acute HF. This will involve natural language processing methods to extract data from hospital reports. These three projects are an opportunity to illustrate the data management according to data source, the issues related to the information and the consent of patients, and to conclude with proposals for a code of good epidemiological practices in real-life data processing.Les données de santé peuvent être catégorisées en données de recherche et en données de « vie réelle », parmi lesquelles les données médico-administratives et celles issues du soin. Avec pour fil rouge le lien entre deux maladies fréquentes, le diabète et l’insuffisance cardiaque (IC), nous proposons trois analyses épidémiologiques fondées sur ces sources. L’étude SURDIAGENE d’abord, une cohorte prospective « classique » de 1349 personnes diabétiques suivies au CHU de Poitiers, chez qui nous analysons le lien entre des biomarqueurs nutritionnels et le risque d’hospitalisation ou de décès pour IC. L’étude DMC ensuite, sur les données médico-administratives de l’Assurance Maladie de plus de 3 millions de personnes identifiées comme diabétiques entre 2012 et 2018, chez qui nous étudions le risque d’IC après un événement rétinien grave. Enfin, le projet GAVROCHE, une analyse des entrepôts de données de santé hospitaliers à l’échelle inter-régionale, sur le lien entre la variabilité glycémique à l’admission et le pronostic des personnes hospitalisées pour IC aiguë. Cela nécessitera en particulier l’extraction d’informations issues de comptes rendus par traitement automatisé du langage naturel. Ces trois projets nous permettent d’illustrer la gestion des données selon leur source et les enjeux liés à l’information et au consentement des patients, avant de conclure sur des propositions de bonnes pratiques épidémiologiques dans le traitement des données de vie réelle

Diabetes mellitus and Heart Failure : epidemiological study by cross-analysis of different sources of health data

Les données de santé peuvent être catégorisées en données de recherche et en données de « vie réelle », parmi lesquelles les données médico-administratives et celles issues du soin. Avec pour fil rouge le lien entre deux maladies fréquentes, le diabète et l’insuffisance cardiaque (IC), nous proposons trois analyses épidémiologiques fondées sur ces sources. L’étude SURDIAGENE d’abord, une cohorte prospective « classique » de 1349 personnes diabétiques suivies au CHU de Poitiers, chez qui nous analysons le lien entre des biomarqueurs nutritionnels et le risque d’hospitalisation ou de décès pour IC. L’étude DMC ensuite, sur les données médico-administratives de l’Assurance Maladie de plus de 3 millions de personnes identifiées comme diabétiques entre 2012 et 2018, chez qui nous étudions le risque d’IC après un événement rétinien grave. Enfin, le projet GAVROCHE, une analyse des entrepôts de données de santé hospitaliers à l’échelle inter-régionale, sur le lien entre la variabilité glycémique à l’admission et le pronostic des personnes hospitalisées pour IC aiguë. Cela nécessitera en particulier l’extraction d’informations issues de comptes rendus par traitement automatisé du langage naturel. Ces trois projets nous permettent d’illustrer la gestion des données selon leur source et les enjeux liés à l’information et au consentement des patients, avant de conclure sur des propositions de bonnes pratiques épidémiologiques dans le traitement des données de vie réelle.Health data can be categorized into research data and "real-life" data, the latter including medico-administrative and health care setting. Using the link between diabetes and heart failure (HF) as a common theme, we propose three epidemiological analyses based on these sources. First, the SURDIAGENE study, a "classic" prospective cohort of 1349 diabetics patients followed at the University Hospital of Poitiers. We analyzed the link between nutritional biomarkers and the risk of HF requiring hospitalization. Second, the DMC study, based on medico-administrative data from the French National Health System, for more than 3 million people with diabetes between 2012 and 2018, in whom we studied the risk of HF after a serious retinal event. Finally, the GAVROCHE project, an inter-regional analysis of hospital health data warehouses, on the link between glycemic variability on admission and the prognosis of individuals hospitalized for acute HF. This will involve natural language processing methods to extract data from hospital reports. These three projects are an opportunity to illustrate the data management according to data source, the issues related to the information and the consent of patients, and to conclude with proposals for a code of good epidemiological practices in real-life data processing