Cementless Total Hip Arthroplasty After an Iatrogenic Subtrochanteric Fracture due to Hardware Removal: A Case Report

Introduction: Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure due to possible hardware-related complications. Case presentation: A 78-year-old female with hip osteoarthritis had a proximal femoral osteotomy fixed using a blade plate in the same femur 41 years ago. A two-step approach was planned. After a challenging hardware removal, an iatrogenic subtrochanteric fracture below the degenerated hip occurred after three months. THA with a tapered long stem was successfully performed with no need for additional osteosynthesis, and good results were seen two years later. Discussion: THAs in subtrochanteric fractures are technically demanding but feasible in selected cases. Hardware removal before THA implantation may carry important risks, and the surgical team should be prepared to perform arthroplasty in case of complications. Conclusion: THA in a subtrochanteric fracture below hip osteoarthritis is a feasible option in selected cases

Attitudes of Healthcare Workers toward Influenza Vaccination in the COVID-19 Era

none8Sani, Tommaso; Morelli, Ilaria; Sarti, Donatella; Tassinari, Giovanni; Capalbo, Maria; Espinosa, Emma; Gasperini, Beatrice; Prospero, EmiliaSani, Tommaso; Morelli, Ilaria; Sarti, Donatella; Tassinari, Giovanni; Capalbo, Maria; Espinosa, Emma; Gasperini, Beatrice; Prospero, Emili

Drivers of diversity of arable plant communities in one of their european conservation hotspots

The changes of agriculture led to deep transformations of arable plant diversity. The features of arable plant communities are determined by many anthropic, environmental, and geographic drivers. Understanding the relative importance of such drivers is essential for conservation and restoration purposes. In this work, we assessed the effects of agronomic, climatic, geographic, and landscape features on α-diversity, β-diversity, and composition of winter arable plant communities across continental Italy, a European hotspot of arable plant diversity. Using redundancy analysis and variation partitioning, we observe that the selected groups of variables explained a restrained to moderate proportion of the variation in diversity and composition, depending on the response (5.5–23.5%). We confirm previous evidence that climate and geographic location stand out in determining the features of arable plant communities in the country, followed by the type of rural area. The surrounding landscape has a subordinate influence but affects both α and β-diversity. The α-diversity is higher in traditional agricultural areas and in landscapes rich in woody vegetation, while it is lower in warmer areas. Species composition is determined by climate, latitude, and the type of rural area, but not by landscape. Total β-diversity is mainly explained by climate and latitude, and subordinately by the agricultural context and landscape. Its components are explained by latitude and climate (replacement) and agricultural context and climate (richness difference). The local contribution to β-diversity of single sites suggested a good conservation status of the studied communities. We discuss the implications of our findings in the light of conservation and restoration of vanishing arable plant communities

Prognostic role of aspartate aminotransferase-lymphocyte ratio index in patients with metastatic colorectal cancer: results from the randomized ITACa trial

BACKGROUND: The aim of this study was to investigate the role of pre-treatment aspartate aminotransferase-lynphocyte ratio (ALRI) as a predictor of prognosis and treatment efficacy in patients with metastatic colorectal cancer (mCRC) enrolled in the prospective multicenter randomized ITACa (Italian Trial in Advanced Colorectal Cancer) trial to receive first-line chemotherapy (CT) + bevacizumab (B) or CT alone. PATIENTS AND METHODS: Patients randomly received CT+B or CT alone as first-line therapy. CT consisted of either FOLFOX4 or FOLFIRI at the clinician's discretion. RESULTS: Out of the 284 patients enrolled, increased ALRI levels were associated with shorter PFS and OS (p<0.0001). At baseline, median PFS was 10.3 months (95% CI 9.4-12.0) and 8.0 months (95 % CI 6.8-8.9), and median OS was 25.2 months (95 % CI 21.3-30.2) and 18.8 months (95 % CI 16.6-21.7) for patients with low (<14) and high (≥14) ALRI levels, respectively (HR 1.43, 95% CI 1.12-1.82, p=0.004; HR=1.51, 95% CI 1.17-1.96, p<0.001). Interaction tests on ALRI levels and treatment efficacy in the CT+B and the CT groups were statistically significant for PFS (p=0.0003), but not for OS (p=0.228). CONCLUSION: Our results indicate that ALRI is a good prognostic and predictive marker for mCRC patients candidate for CT+B

Metronomic capecitabine versus best supportive care as second-line treatment in hepatocellular carcinoma: A retrospective study

Preliminary studies suggest that capecitabine may be safe and effective in HCC patients. The aim of this study was to retrospectively evaluate the safety and efficacy of metronomic capecitabine as second-line treatment. This multicentric study retrospectively analyzed data of HCC patients unresponsive or intolerant to sorafenib treatment with metronomic capecitabine or best supportive care (BSC).Median progression free survival was 3.1 months in patients treated with capecitabine (95%CI: 2.7-3.5). Median overall survival was 12.0 months (95% CI: 10.7-15.8) in patients receiving capecitabine, while 9.0 months (95% CI: 6.5-13.9) in patients receiving BSC. The result of univariate unweighted Cox regression model shows a 46% reduction in death risk for patients on capecitabine (95%CI: 0.357-0.829; p=0.005) compared to patients receiving BSC alone. After weighting for potential confounders, death risk remained essentially unaltered (45%; 95%CI: 0.354-0.883; p = 0.013). Metronomic capecitabine seems a safe second-line treatment for HCC patients in terms of management of adverse events, showing a potential anti-tumour activity which needs further evaluation in phase III studies

Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)

Introduction: Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sex differences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes. Methods Data were analyzed from the “Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation” (RAF-study), a prospective, multicenter, international study including only patients with acute stroke and atrial fibrillation. Patients were followed up for 90 days. Disability was measured by the modified Rankin Scale (0–2 favorable outcome, 3–6 unfavorable outcome). Results: Of the 1029 patients enrolled, 561 were women (54.5%) (p < 0.001) and younger (p < 0.001) compared to men. In patients with known atrial fibrillation, women were less likely to receive oral anticoagulants before index stroke (p = 0.026) and were less likely to receive anticoagulants after stroke (71.3% versus 78.4%, p = 0.01). There was no observed sex difference regarding the time of starting anticoagulant therapy between the two groups (6.4 ± 11.7 days for men versus 6.5 ± 12.4 days for women, p = 0.902). Men presented with more severe strokes at onset (mean NIHSS 9.2 ± 6.9 versus 8.1 ± 7.5, p < 0.001). Within 90 days, 46 (8.2%) recurrent ischemic events (stroke/TIA/systemic embolism) and 19 (3.4%) symptomatic cerebral bleedings were found in women compared to 30 (6.4%) and 18 (3.8%) in men (p = 0.28 and p = 0.74). At 90 days, 57.7% of women were disabled or deceased, compared to 41.1% of the men (p < 0.001). Multivariate analysis did not confirm this significance. Conclusions: Women with atrial fibrillation were less likely to receive oral anticoagulants prior to and after stroke compared to men with atrial fibrillation, and when stroke occurred, regardless of the fact that in our study women were younger and with less severe stroke, outcomes did not differ between the sexes

Prediction of early recurrent thromboembolic event and major bleeding in patients with acute stroke and atrial fibrillation by a risk stratification schema: the ALESSA score study

Background and Purposes—This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods—The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00–1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08–2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30–1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632–0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493–0.678; P=0.10) for major bleedings. Results—The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529–0.763; P=0.009) for ischemic outcome events and 0.407 (0.275–0.540; P=0.14) for hemorrhagic outcome events. Conclusions—In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings