Long-term Results of Matrix-assisted Autologous Chondrocyte Transplantation Combined With Autologous Bone Grafting for the Treatment of Juvenile Osteochondritis Dissecans

Background: Osteochondritis dissecans is a pathology affecting young patients that involves the entire osteochondral unit. In the case of unfixable fragments, regenerative cartilage treatments are a viable solution, but little is known about the use of these procedures for the treatment of juvenile osteochondritis dissecans (JOCD). The aim of this study was to evaluate the long-term results offered by matrix-assisted autologous chondrocyte transplantation combined with autologous bone grafting for the treatment of JOCD. Methods: Nineteen patients have been enrolled. The mean age at the time of treatment was 16.8 \ub1 1.5 years, with a mean body mass index of 22.9 \ub12.7. The average size of the defects was 2.8 \ub11.2 cm2. All patients were evaluated prospectively before surgery and at 12, 24, 60, and at a final follow-up of 120 months with International Knee Documentation Committee scores, EuroQol- Visual Analogue Scale, and the Tegner Score. Results: A statistically significant improvement in all clinical scores was observed from baseline evaluation to 120 months of final follow-up. In particular, the International Knee Documentation Committee subjective score improved from the preoperative evaluation of 38.7\ub1 17.3 to 74.0 \ub1 21.8 at 12 months (P< 0.0005), with scores remaining stable for up to 120 months (83.8 \ub120.7), with all follow-ups showing a statistically significant improvement compared with the basal value (P< 0.0005). Three patients failed at 12 months, for a failure rate of 16% at 10 years of follow-up. Lesions >3.5 cm2 obtained worse subjective results. In addition, lesion size and female sex were significantly associated with failures. Conclusions: The matrix-assisted autologous chondrocyte transplantation technique with autologous bone grafting is a valid treatment option for JOCD in case of unfixable fragments. The clinical improvement obtained is significant and stable, with good results maintained for up to 10 years of follow-up and an overall low failure rate. Lesion size and sex could influence the clinical outcome and should be considered in the treatment choice. Level of Evidence: Level IV\u2014case series

Future shape of Widening package & NCP role

Workshop on proposals pre-check/ pre-screening (Future shape of Widening package & NCP role), 21-22 January 2020, Brussels.0. Agenda.-- 1. Kristin Kraav. Proposal pre-screening.-- 2. Anna Vosečková. Proposal check / screening - Czechia.-- 3. Constantina Makri. Exchange of Best Practices and Collaboration with Applicants. The Case of Cyprus..- 4. Natàlia dias. Portugal is widening.-- 5. Katarzyna Walczyk Matuszyk. National system of support. Teaming 2 Centres for Excellence.-- 6. Federica Roffi. SEWP Guidance to Applicants (Tips and tricks and what to avoid).-- 7. Wojciech Adamiak. Pre-screening ERA Chairs & Twinning.-- 8. Stefan Weiers. Future shape of Widening package and NCPs role.N

Impact of baseline gadoxetic acid-enhanced liver magnetic resonance and diffusion-weighted imaging in resectable colorectal liver metastases: A prospective, monocentric study

Background: Liver magnetic resonance imaging (MRI) utilizing hepatocyte-specific contrast agent and diffusion -weighted imaging (DWI) is currently used to properly stage colorectal liver metastases (CRLM) in patients candidate to liver surgery. However, the added value of liver MRI in choosing the treatment strategy in resectable CRLM over computed tomography (CT)-scan is not clear.Patients and methods: This is a prospective monocentric collection of consecutive cases of patients with CRLM conceived with the aim to assess the added value of liver MRI in changing the initial treatment strategy planned according to CT-scan. Potential changes in the initially planned strategy were defined as: -from upfront surgery to perioperative chemotherapy (fluoropyrimidine and oxaliplatin) -from upfront surgery to first-line systemic therapy (doublet or triplet plus a biological agent) -from perioperative chemotherapy to first-line systemic therapy.Hypothesising that MRI may induce a change in the choice of the treatment strategy in the 20% of cases (alternative hypothesis), against a null hypothesis of 5%, with one-tailed alpha and beta errors of 0.05 and 0.20 respectively, 27 patients were needed. The added value of liver MRI would have been considered clinically meaningful if at least 4 changes in the treatment strategy were observed.Results: Among 27 enrolled patients, upfront surgery and perioperative chemotherapy strategies were chosen in 17 (63%) and 10 (37%) cases, respectively, based on CT-scan. After liver MRI, additional liver lesions were found in 8 patients (30%) and the initial strategy was changed in 7 patients (26%) (4 initially deemed candidate to upfront surgery and 3 initially sent to perioperative chemotherapy) that were treated with first-line systemic therapy.Conclusions: Our results support the indication of the current guidelines on the routine use of liver MRI in the initial workup of patients with resectable CRLM with an MRI-driven changes of initial treatment plan in a relevant percentage of cases

On the Track of the Books Scribes, Libraries and Textual Transmission

Aims and Scope This book offers the hint for a new reflection on ancient textual transmission and editorial practices in Antiquity.In the first section, it retraces the first steps of the process of ancient writing and editing. The reader will discover how the book is both a material object and a metaphorical personification, material or immaterial. The second section will focus on corpora of Greek texts, their formation, and their paratextual apparatus. Readers will explore various issues dealing with the mechanisms that are at the basis of the assembling of ancient Greek texts, but great attention will also be given to the role of ancient scholarly work. The third section shows how texts have two levels of authorship: the author of the text, and the scribe who copies the text. The scribe is not a medium, but plays a crucial role in changing the text. This section will focus on the protagonists of some interesting cases of textual transmission, but also on the books they manufactured or kept in the libraries, and on the words they engraved on stones. Therefore, the fresh voices of the contributors of this book, offer new perspectives on established research fields dealing with textual criticism

Impact of chronic kidney disease on platelet aggregation in patients with acute coronary syndrome

AIMS: Chronic kidney disease (CKD) is associated with increased thrombotic events and seems to influence platelet reactivity. Conflicting results have been published on platelet response in CKD patients with stable coronary artery disease. The aim of our study was to investigate the impact of CKD on platelet aggregation in acute coronary syndrome (ACS) patients receiving dual antiplatelet therapy, included the more potent P2Y12 inhibitors. METHODS: We enrolled 206 patients with ACS, divided in two groups, according to the presence or the absence of moderate/severe CKD. Platelet aggregation was performed with light transmission aggregometry and results are expressed as percentage of maximum platelet aggregation. High residual platelet reactivity (HRPR) was defined as maximum platelet aggregation more than 59%. RESULTS: Patients with CKD [estimate glomerular filtration rate (eGFR) < 60 ml/min/1.73 m, n = 28] were prevalent older, diabetic, had previous coronary revascularization. In these patients, platelet aggregation was significantly higher than in those with eGFR ≥ 60 ml/min/1.73 m (ADP 10 μmol/l: 28.46 ± 26.19 vs. 16.64 ± 12.79, P < 0.001; ADP 20 μmol/l: 30.07 ± 25.89 vs. 17.46 ± 12.82, P < 0.001). HRPR was observed in 4.4% of patients, with higher prevalence in those with eGFR less than 60 ml/min/1.73 m [21.4 vs. 1.7%, P < 0.001, odds ratio (OR) [95% confidence interval (CI)] = 15.91 (3.71-68.17), P < 0.001]. At multivariate analysis, after correction for baseline confounders, eGFR [adjusted OR (95% CI) = 0.95 (0.91-0.98), P = 0.007], together with the use of clopidogrel [adjusted OR (95% CI) = 23.59 (4.01-138.82), P < 0.001], emerged as determinants of HRPR. CONCLUSION: In patients with ACS receiving dual antiplatelet therapy, CKD is associated with an increasing ADP-induced platelet aggregation and higher prevalence of HRPR, which is mainly correlated to lopidogrel use

Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or &gt;= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care