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Objective Scapular notching is a unique radiographic sequela of reverse total shoulder arthroplasty (rTSA) with unclear long-term clinical consequences. Methods Our retrospective review of a single surgeon, single implant, primary rTSA database investigates the incidence of scapular notching at 2 and 5-year follow-up. Various patient outcome scores were also obtained. Results Of 158 primary rTSAs performed, 82 (52%) patients completed 2-year and subsequent 5-year follow-up. The incidence of scapular notching at 2 and 5-years was 11.9% and 19.5%, respectively. Conclusion Scapular notching negatively affects validated post-operative outcome scores, active range of motion and total complications, and furthermore increases with time.

A little is known about long-term hemodynamic performance of the transcatheter heart valves (THVs). The aim of the present study was to assess hemodynamic outcome, structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) in patients treated with transcatheter aortic valve replacement (TAVR) five or more years ago. All consecutive patients treated at Bologna and Florence University Hospitals with TAVR between January 2008 and December 2013 were analyzed in a retrospective registry with regards to demographic, procedural and outcome data as well as follow-up data on mortality and echocardiographic characteristics. Standardized definitions were used to define outcomes and durability of the THVs. 400 patients were included in the study, mostly treated with transfemoral TAVR (71.8%), using first generation balloon-expandable (37%) or self-expanding (63%) devices. The 1-year mortality was 21.8% (87 patients) and 5-year mortality was 53.8% (215 patients). Median follow-up was 45.5months (14.0-68.9) totaling 1516.7 patient/years, with the longest follow-up being 10.25years. At least one follow-up echocardiogram was available for 320 patients (80%), SVD occurred in 19 of these patients (5.94%): moderate in 17 patients (5.31%) and severe in two patients (0.63%). The hemodynamic presentation was stenosis in most of the cases (12 patients). Late BVF was registered in 10 patients (3.13%) and this was mainly driven by transcatheter paravalvular leak closure (six patients) with subsequent good long-term outcome. Our results confirm that TAVR appears to be a long-lasting treatment strategy with low rates of structural valve degeneration and valve failure.

Background Nearly 25% of adrenal Cushing syndrome (CS) patients with bilateral adrenal masses have unilateral hypercortisolism, making localization crucial for surgical planning. Since there is no standardized protocol for adrenal venous sampling (AVS) in lateralizing adrenal hypercortisolism, we share our experience with a case of CS with bilateral adrenal masses in which lateralization via AVS permitted unilateral adrenalectomy. Clinical Case A 59-year-old woman with hypertension, hyperlipidemia, and prediabetes was hospitalized for worsening back pain and hypertension. Her BMI was 26.5 kg/m2, BP 173/93 mmHg, HR 73/min, she was anxious, diaphoretic, and hirsute. Glucose was 118 mg/dL and HbA1c 6.6%. Abdominal computed tomography revealed a type B aortic dissection with both right (6.1 x 3.1cm and 3.6 x 2.4cm), and left (largest 1.7 cm) sided adrenal masses. Plasma and 24 hour-urine metanephrine, normetanephrine and catecholamines, as well as plasma renin and aldosterone levels, were normal. AM cortisol on three different occasions was 21.30, 20.70, and 21.30 mcg/dL. Midnight cortisol was 17.8 mcg/dL, and 24-hour urine free cortisol on two occasions was 163 mcg (urine volume 3.4L with creatinine 1.14) and 99.2 mcg (urine volume 1.15L). After 1mg dexamethasone her AM ACTH and cortisol were

PURPOSE: To investigate the long-term efficacy and safety of continuous light-accelerated corneal cross-linking (CXL) in patients with progressive keratoconus. METHODS: This retrospective study analyzed 29 eyes of 29 consecutive patients with progressive keratoconus treated with epithelium-off riboflavin-ultraviolet induced accelerated CXL (30 mW/cm 2 –7.2 joules/cm 2 ). Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, keratometry measurements at 3 and 6 mm (Kmax, Kmin, and Kmean), topographic astigmatism, central corneal thickness, anterior corneal aberrometric analysis (at 3 and 6 mm), endothelial cell density, and central foveal thickness were evaluated before and 24 and 60 months after surgery. RESULTS: UDVA significantly improved at 60 months postoperatively ( P = .028). Kmax and Kmean at 3 mm significantly decreased at 24 ( P = .009 and .006, respectively) and 60 ( P = .017 and .034, respectively) months postoperatively, whereas Kmin significantly decreased only at 24 months postoperatively ( P = .032). Kmax at 6 mm significantly decreased at 24 and 60 months postoperatively ( P = .035 and .027, respectively). Cylinder error significantly decreased at 24 and 60 months postoperatively ( P = .001 and .023, respectively). Wavefront aberration variables remained unchanged after surgery, except for spherical aberration at 6 mm that decreased at 24 and 60 months postoperatively ( P = .038 and .031, respectively) and trefoil at 0° that significantly decreased at 24 months postoperatively ( P < .005). Endothelial cell density and central foveal thickness showed no changes from baseline. CONCLUSIONS: Accelerated CXL was found to be effective in halting keratoconus progression and improving some of the visual, topographic, and wavefront aberration variables evaluated. High energy irradiance did not induce significant changes in corneal transparency, endothelial cell density, and central foveal thickness. [ J Refract Surg . 2020;36(11):724–730.]

Background: Pigmented villonodular synovitis (PVNS) is a rare synovial disease with benign hyperplasia, which has been successfully treated with total knee arthroplasty (TKA). The purpose of this study was to investigate the middle-term follow-up results of cruciate-retaining (CR) total knee arthroplasty (TKA) in PVNS patients.Methods: 17 patients with PVNS were treated with CR TKA between 2012 and 2014. 68 patients with osteoarthritis (OA) who received CR TKA as control group. The two groups matched in a 4:1 ratio based on age,gender, body mass index (BMI) and follow-up time. In the two groups, the range of motion (ROM), Knee Society Score (KSS), revision rate, disease recurrence, complications and the survivorship curve of Kaplan-Meier implant were compared. Results: All patients were followed up at least 7 years. At the last follow-up, no patients with recurrence of PVNS were found. There was no difference in KSS between the two groups, and no patients experienced infection and death. In the PVNS group, 3 patients had stiffness complications but did not need revision. 1 patient underwent revision surgery due to periprosthetic fracture. At 7 years,the implant survivorship was 90.0% in the PVNS group and 96.6% in the control group (p = 0.54).Conclusions: This study demonstrates that the function of PVNS patients who received CR TKA has been significantly improved. The survival rate of implants in PVNS patients is similar to that of OA patients. Consequently, PVNS patients who treated with CR TKA may be an achievable option. However, patients with PVNS should pay more attention to the occurrence of postoperative stiffness complications.

ObjectivePeritoneal endometriosis is the most prevalent yet least diagnosed type due to its unrecognizable nature on imaging modalities especially non- pigmented lesions would escape the surgeons’ eye and experience during diagnostic laparoscopy. We used color adjuvant by the technique called Aqua Blue Contrast Technique (ABCT) to optimize the view and to improve results.Material methodsPatient charts who undergone surgery from 2014 to 2015 and their 5 year follow up data, along with two different control groups, have been analyzed retrospectively. As the first group the patients who had conventional surgery without the use of ABCT) were included, the second group were patients who had ABCT applied on both pelvic side walls but not in cul-de-sac and as the third group the patients who had the surgery with the use of ABCT in all peritoneal cavity have been analyzed. Cases involving ovarian endometriomas and DIE were excluded.ResultsAll patients have been followed up for up to 5 years. In group 1, the recurrence within the postoperative 3 years was 11.9%, and 16.1% after 5 years of surgery. The recurrence of 3 years period and 5 years period for the patients in group 2 were 8.7& and 12.1% respectively. The patients in group 3 recurred 3.2% in the 3 years period and the 4.3% recurrence rate calculated as 4.5% for the following 5 years after surgery.ConclusionResults indicate elimination of high-end spectrum of light using aqua blue contrast technique with hydrodistension of the retroperitoneum enhances the surgeon’s vision, allows lesions otherwise not detected with white light.

Intrastromal corneal ring segments (ICRS) have been found to be useful in correcting keratoconus by decreasing irregular astigmatism, thereby potentially improving visual acuity. However, its long-term effects in keratoconus progression are not completely understood, mainly concerning the effects of age on ICRS implantation results. This study aimed to evaluate long-term effects of ICRS implantation according to age at implantation. We conducted a longitudinal retrospective study, where we evaluated patients with keratoconus who underwent ICRS implantation between 2004 and 2012. We evaluated 34 eyes for 5 years post-operatively. The mean age of the 21 men and 7 women was 20.59 ± 4.65 years. Best spectacle-corrected visual acuity (BSCVA) improved from 0.32 ± 0.19 in the preoperative period to 0.46 ± 0.27 6 months post-operatively. After up to 5 years of follow-up, there was no significant difference in mean visual acuity of the group. As expected, there was a significant decrease in keratometric values after corneal ring implantation, which remained stable over the 5-year follow-up. Among the 34 cases analysed, nine (26%) showed signs of disease progression. In eight of the nine documented progression cases, patients were 21 years old or younger, revealing that these patients were sevenfold more likely to progress than those aged over 21 years. In our series of cases, ICRS implantation was shown to be an excellent treatment to reduce corneal curvature and improve visual acuity at all ages, but it did not stabilize the disease, especially in young patients with more aggressive forms of the keratoconus.

The Tape Locking Screw system (TLS) is a recognised technique used in anterior cruciate ligament reconstruction (ACLR). However, only a few previous studies have reported associated outcomes, all of which had been examined over a short-term period. The aim of this study was to assess the time-dependent changes in the objective and patient-reported outcome measures (PROM) in a group of patients with anterior cruciate ligament deficiency who have been operated on with this technique.Previously reported satisfactory short-term outcomes following TLS persist for several years after the operation.This study was a retrospective observational study including 26 patients, who were followed after unilateral ACLR with TLS. Anterior tibial translation (ATT) was measured in both knees using the KT-1000 arthrometer and two PROMs: International Knee Documentation Committee (IKDC) and Lysholm subjective form scores were examined preoperatively, 6 months postoperatively, and annually for 5 years thereafter in all patients.One patient suffered a rupture of the graft, and one patient had a screw loosening. Two patients were lost for follow-up, so 22 patients were the final study group. Median (25-75%) ATT side-to-side differences between the injured and uninjured sides were 4 (3,5-4)mm preoperatively, 0,75 (0-1)mm 1 year postoperatively, and 0,75 (0-1)mm 5 years after the operation (P0.001). Median (25-75%) IKDC scores were 44.25 (35.6-55.15), 92.55 (87.08-96.6), and 95.4 (90.8-97.7) points preoperatively and 1 year (P0.001) and 5 years postoperatively, respectively. Median (25-75%) Lysholm scores were 52 (38.75-64.5), 95.5 (94.75-99.25), and 97.5 (95-99) points preoperatively and 1 year (P0.001) and 5 years postoperatively, respectively.ACLR with TLS might already achieve favourable outcomes 1 year postoperatively, when measured objectively (ATT) and with PROMs. These outcomes persist 5 year postoperatively. LEVEL OF EVIDENCE IV: retrospective cohort study.

Long-term follow-up of patients treated with open-label placebo (OLP) are nonexistent. In this article, we report a 5-year follow-up of a 3-week OLP randomized controlled trial (RCT) in patients with chronic low back pain. We recontacted the participants of original RCT and reassessed their pain, disability, and use of pain medication. We obtained follow-up data from 55 participants (82% of those who took OLP during the parent RCT), with a mean elapsed time between the end of the 3 weeks placebo trial and the follow-up interview of 55 months (SD = 7.85). We found significant reductions in both pain and disability between the baseline assessment immediately before the 3 weeks trial with placebo pills and the original trial endpoint (P < 0.00001 for the 2 primary outcomes of pain and disability). At the 5-year follow-up, we found no significant differences in either outcome between original trial endpoint and follow-up. Improvements persisted after 5 years and were accompanied by substantial reductions compared with baseline in the use of pain medication (from 87% to 38%), comprising analgesics (from 80% to 31%), antidepressants (from 24% to 11%), and benzodiazepines (from 15% to 5%). By contrast, the use of alternative approaches to pain management increased (from 18% to 29%). Although the reduction in pain and medication is comparable with the improvements that occurred in the original study, a major limitation of this long-term follow-up is the absence of controls for spontaneous improvement and new cointerventions. Nonetheless, our data suggest that reductions in pain and disability after OLP may be long lasting.

ObjectiveTo study changes on MRI of the spine and sacroiliac joint (SIJ) in early axial spondyloarthritis (axSpA) over time.MethodsIn the Devenir des Spondyloarthropathies Indifférenciées Récentes cohort, MRI-spine and MRI-SIJ at baseline and 2 and 5 years were scored by central readers for bone marrow oedema (BME), fatty lesions, erosions, sclerosis, ankylosis and spinal bone spurs. The average mean number of lesions was reported or the agreement of ≥2 out of 3 readers for binary outcomes. Net progression was calculated by subtracting the patients that ‘improved’ from those that ‘worsened’ divided by the total number of patients.ResultsOver 5 years, in 155 patients with axSpA (mean age 33.5 (SD 8.9) years, symptom duration 1.4 (0.8) years, 63% human leucocyte antigen+, 14% modified New York+), BME on MRI-SIJ decreased by a mean Spondyloarthritis Research Consortium of Canada score of 1.4 (SD 6.5) (p=0.009). The largest BME decrease was observed in patients using biological disease-modifying antirheumatic drugs at 5 years. Spinal BME increased by 0.3 (4.6) (p=0.41). Fatty lesions and/or erosions on MRI-SIJ increased by a mean of 1.0 (SD 2.6) (pConclusionOver 5 years, BME on MRI-SIJ decreased and spinal BME remained similar, but numerically, little progression of structural lesions on MRI of the SIJ and spine was seen.

Purpose: To identify the importance of sagittal alignment with self-locked stand-alone cage (SSC) and anterior cage-with-plate (ACP) system after 3-level anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) after minimal 5-year follow-up.Methods: 38 patients with SSC system (SSC group) and 26 with ACP system (ACP group) from February 2007 to September 2013 were enrolled. Cervical alignment were C2-7 lordosis (CL), operated-segment CL (OPCL), upper and lower adjacent-segment CL (UCL and LCL) at preoperation (POP), immediate postoperation (IPO) and final follow-up (FFU). Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score and adjacent segment degeneration (ASD). Patients were divides into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).Results: There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (PConclusion: SSC and ACP both provide long-term efficacy on OPCL correction with little impact on adjacent segment. The improvement of CL after three-level ACDF seems not so essential.

BACKGROUND Small retrospective studies reported that left ventricular (LV) pacing is likely to preserve LV function in children with isolated congenital complete atrioventricular block (CCAVB). The aim of this study was to prospectively evaluate LV contractility and synchrony in a cohort of neonates/infants at pacemaker implantation and follow-up. METHODS Patients with CCAVB who underwent LV pacing were evaluated with electrocardiogram and echocardiogram in a single-center, prospective study. Data were collected at implantation, at 1-month and every year of follow-up, up to 5 years. LV ventricular dimensions (diameters and volumes), systolic function (ejection fraction [EF] and global longitudinal strain [GLS]), and synchrony were evaluated. Data are reported as median (25th-75th centiles). RESULTS Twenty consecutive patients with CCAVB underwent pacemaker implantation (12 single-chamber pacemaker [VVIR] and eight dual-chamber pacemaker [DDD]) with epicardial leads: 17 on the LV apex and three on the free wall. Age at implantation was 0.3 months (1 day-4.5 months). Patients showed good clinical status, normal LV dimensions, preserved systolic function, and synchrony at 60 (30-60) months follow-up. EF increased to normal values in patients with preimplantation EF

Background/objectives: Functional disability (FD) is common after stroke and associated with the occurrence of future adverse events; however, whether FD is as strong a risk factor as comorbid vascular risk factors for cardiovascular events and death is unclear. Methods: Consecutive patients 3–6 months after index ischemic stroke were assessed at baseline and followed up for documented new cardiovascular events (recurrent stroke, acute myocardial infarction, and sudden death) and death within 5 years. Comorbidity of vascular risk factors was stratified as low or intermediate-to-high risk according to the Stroke Prognostic Instrument II. Four mutually exclusive cohorts were identified (1) intermediate-to-high risk only, n = 505, (2) FD only, n = 78, (3) both intermediate-to-high risk and FD, n = 264, and (4) low risk and no FD, n = 240. Results: The incidence of cardiovascular events was lowest in patients free of FD with low risk, followed by patients with FD alone, intermediate-to-high risk alone, and both. Compared with intermediate-to-high risk only, patients free of FD with low risk had a significantly lower adjusted hazard ratio (HR) (HR: 0.56, 95% confidence interval [CI]: 0.33–0.94), patients with FD only had a similar HR (HR: 0.47, 95% CI: 0.19 –1.18), and patients with both FD and intermediate-to-high risk had a significantly higher HR (HR: 2.13, 95% CI: 1.53–2.98) of cardiovascular events. A similar trend but a larger HR was noted for all-cause death. Conclusion: FD 3–6 months after ischemic stroke is a risk equivalent to comorbidity of conventional vascular risk factors for the incidence of cardiovascular events and mortality of all-cause death.

Purpose. The aim of our study was to compare the long-term efficacy and safety of “epi-off” conventional and “epi-off” accelerated corneal cross-linking (CXL) in patients with progressive keratoconus. Methods. “Epithelial-off” (“Epi-off”) CXL using the conventional technique (3 mW/cm2, 30 minutes) was performed in 93 eyes of 93 patients (S-CXL group) and “epi-off” accelerated method (9 mW/cm2, 10 minutes) in 76 eyes of 76 patients with progressive KCN (A-CXL group). Cases with different stages of keratoconus and topographic evidence of progression were included. Main outcomes comprised refraction, keratometry measurements, uncorrected (UCVA) and best-corrected visual acuity (BCVA), and topographical indices. Micromorphological analysis was assessed by anterior segment ocular coherence tomography (AS-OCT). The follow-up period was 5 years. Results. In both groups, Kflat presented similar results: decrease at 1 year (p=0.465), at 2 years (p=0.672), at 3 years (p=0.198), at 4 years (p=0.32), and at 5 years (p=0.864). In both groups, Ksteep presented a similar decrease at 1 year (p=0.709), at 2 years (p=0.455), at 3 years (p=0.43), at 4 years (p=0.57), and at 5 years (p=0.494), with no statistically significant difference. Decrease in Kavg was similar in both groups at all analyzed time points (p=0.18 at 1 year, p=0.093 at 2 years, p=0.57 at 3 years, p=0.154 at 4 years, and p=0.247 at 5 years). Kmax had a similar decrease in both groups at 1 year (p=0.06), at 2 years (p=0.09), at 3 years (p=0.126), at 4 years (p=0.113), and at 5 years (p=0.114). There was no statistically significant difference between the cylinder decrease in both groups (p=0.349 at 1 year, p=0.6782 at 2 years, p=0.299 at 3 years, p=0.0943 at 4 years, and p=0.144 at 5 years). The BCVA values were statistically significantly higher than the preoperative values in both groups at all time points (p<0.05). Topographical indices such as thinnest corneal point (TP), corneal volume (CV), index vertical asymmetry (IVA), index of vertical asymmetry (ISV), index of height asymmetry (IHA), index of height decentration (IHD), Belin/Ambrosio Enhanced Ectasia Display (BAD_D), and Ambrosio retinal thickness (ART Max) were significantly statistically decreased compared with baseline at all time points, in both groups. Conclusion. “Epi-off” accelerated and conventional CXL have the same efficacy in terms of improvement in visual and topographic outcomes.

Background: There is controversy whether nonoperative or operative treatment for Achilles tendon rupture is superior. It is unknown if patients with acute Achilles tendon rupture return to previous sports activity. The purpose of this study was to assess 5-year return to sport and subjective satisfaction, minimum 1-year functional outcomes, and complications in patients following nonoperative treatment of Achilles tendon rupture with early weightbearing rehabilitation. Methods: An institutional review board–approved, retrospective observational study involving 89 patients was performed. Out of 114 consecutive patients, 89 (78%) responded to questionnaires for sports activity. Nonoperative treatment consisted of an equinus cast and rehabilitation boot that enabled early weightbearing. Sports activity at 1-year and 5-year follow-up was compared to the prerupture status. Based on the prerupture Tegner Activity Scale (TAS), patients were divided into low-level (Results: Overall, >70% of the patients returned to their previous sports activity level after a nonoperative early weightbearing treatment. Return-to-sport rate was significantly ( P = .029) higher for patients in the low-level activity group (91%) compared to patients (67%) in the high-level activity group at 5-year follow-up. Subjective satisfaction with treatment was good in both groups (93% and 96%, respectively). The mean Thermann score did not differ between the 2 groups at 1-year follow-up. There were 11 reruptures, 5 deep venous thromboses, and 1 case of complex regional pain syndrome. Conclusion: Nonoperative treatment for Achilles tendon rupture yielded good functional outcome and high patient satisfaction. For patients with a high preinjury activity level, return to previous sporting level (assessed by TAS) was possible in 67% of the patients compared to >90% of patients with low preinjury activity level. Level of Evidence: Level III, retrospective comparative series

Background Implantable cardioverter-defibrillator (ICD) represents the main tool for prevention of sudden cardiac death. Different kinds of postimplant complications have been described; however, little is known about shoulder functional impairment and its impact on quality of life. Methods Patients with standard indications for elective prepectoral subcutaneous ICD insertion were enrolled during a 1-year period. The impact of ICD implantation on shoulder motility, pain, general disability, and quality of life was evaluated prospectively at baseline, and after 2 weeks, 3 months, 1 year, and 5 years using the Constant score, the Numeric Pain Rating Scale, the Disabilities of the Arm, Shoulder, and Hand scale, and the Short Form-36 Health Survey questionnaire. Results A total of 50 patients underwent insertion of single, dual chamber, or biventricular ICDs. Two weeks after implantation, functional impairment and mild pain were observed in ipsilateral shoulder movements, with a reduction in the Short Form-36 Health Survey score. Shoulder functional impairment improved at the third-month evaluations, with almost normalization at 1-year and 5-year assessments, as well as pain and quality of life. Conclusions Prepectoral subcutaneous ICD implantation may be associated with ipsilateral shoulder functional impairment that regresses partially after 3 months and completely at 1-year and 5-year assessments. The less invasive implantation technique and the relatively small size of modern ICDs, independently from types and volumes, may be relevant to the degree of postimplantation shoulder functional impairment and recovery time. Shoulder function should be assessed at routine checks, especially soon after ICD implantation because of potential functional impairment and subsequent impact on quality of life.

Background Reverse shoulder arthroplasty is quickly becoming the most frequently performed glenohumeral joint replacement. The purpose of this study was to evaluate the volumetric and linear wear rates of ultrahigh-molecular-weight polyethylene humeral liners in vivo at a minimum 5-year follow-up. Methods Radiostereometric analysis was used to image 15 patients at terminal range of motion in forward flexion, abduction, external rotation, and internal rotation and with the arm at the side. The relative position and orientation of the glenosphere and polyethylene were identified for each arm position. The apparent intersection of the glenosphere into the polyethylene was recorded as wear. Mean volumetric and linear wear rates were recorded, and Pearson correlation coefficients were applied to the 36-mm liners to assess the relationship between the wear rate and term of service. Results The mean reverse shoulder arthroplasty term of service at the time of imaging was 8 ± 1 years (range, 6-11 years). The mean volumetric and linear wear rates for the 36-mm liners (n = 13) were 42 ± 22 mm3/yr (r = 0.688, P = .009) and 0.11 ± 0.03 mm/yr (r = 0.767, P = .002), respectively. The mean volumetric and linear wear rates for the 42-mm liners (n = 2) were 114 ± 44 mm3/yr and 0.17 ± 0.01 mm/yr, respectively. No single arm position was able to capture all recorded wear individually. Conclusion This study showed volumetric and linear wear rates of approximately 40 mm3/yr and 0.1 mm/yr, respectively, for the 36-mm polyethylene liners. The 42-mm liners showed higher wear rates, although a greater number of subjects is required for conclusive results. In vivo wear of reverse total shoulder arthroplasty is multidirectional and perceptible.

To investigate the effectiveness of the T-score values provided by Radiofrequency Echographic Multi Spectrometry (REMS) in the identification of patients at risk for incident osteoporotic fractures.A population of Caucasian women (30-90 years), enrolled from 2013 to 2016, underwent dual X-ray absorptiometry (DXA) and REMS scans at axial sites. The incidence of fragility fractures was assessed during a follow-up period up to 5 years. Afterwards, patients with and without incident fractures were stratified in two age-matched groups with a 1: 2 proportion (Group F' and Group NF', respectively). The performance of REMS T-score in discriminating between the two groups was quantitatively assessed and compared with DXA.1516 patients were enrolled and 1370 completed the follow-up (mean ± SD: 3.7 ± 0.8 years; range: 1.9-5.0 years). Fracture incidence was 14.0%. Age-matched groups included 175 fractured patients and 350 non-fractured ones, respectively (median age 70.2 [interquartile range: 61.0-73.3] and 67.3 [65.4-69.8] years, p-value ns). The groups resulted also balanced for height, weight and BMI (p-values ns). As expected, the differences in REMS T-score (for vertebral site, -2.9 [-3.6 to -1.9] in Group F', -2.2 [-2.9 to -1.2] in Group NF') and DXA T-score (-2.8 [-3.3 to -1.9] in Group F', -2.2 [-2.9 to -1.4] in Group NF') were statistically significant (p-value0.001). Analogous results were obtained for femoral neck. Considering the T-score cut-off of -2.5, REMS identified Group F' patients with a sensitivity of 65.1% and specificity of 57.7% of (OR = 2.6, 95%CI: 1.77-3.76, p 0.001), whereas DXA showed a sensitivity of 57.1% and a specificity of 56.3% (OR = 1.7, 95%CI: 1.20-2.51, p-value = 0.0032). For femoral neck, REMS sensitivity and specificity were 40.2% and 79.9%, respectively, with an OR of 2.81 (95%CI: 1.80-4.39, p 0.001). DXA, instead, showed a sensitivity and specificity of 42.3% and 79.3%, respectively, with an OR of 2.68 (95%CI: 1.71-4.21, p 0.001).REMS T-score resulted an effective predictor for the risk of incident fragility fractures in a population-based sample of female subjects, representing a promising parameter to enhance osteoporosis diagnosis in the clinical routine.

Objective: Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). Methods: This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. Results: Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p < 0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p < 0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5-]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). Conclusions: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia.

Funding Acknowledgements This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF. Background Left ventricule (LV) function plays an important role in the pathophysiology of decompensation after acute ST elevation myocardial infarction (STEMI). LV remodeling (LVR) after STEMI is associated with development of heart failure, predicting poor clinical outcome therefore its identification is of clinical importance to set up preventive strategies. Prediction of the left ventricular remodeling (LVR) after STEMI in patients treated by primary PCI is challenging. Purpose Finding an echocardiographic parameter that can predict left ventricular remodeling in time after STEMI. Materials and methods In this prospective study we included 30 consecutive patients, median age 60 (37-79), 76% male, with STEMI treated by primary PCI. We performed conventional 2D transthoracic echocardiography for all included patients. In addition to conventional parameters we measured LV global longitudinal strain (GLS) and LV mechanical dispersion using 2D speckle tracking imaging technique. For morphological and functional analysis of LV we used 3D echocardiography (volumes, LVEF) considering its superiority in assessment of LV. All measurements were performed at baseline (up to 7 days after STEMI) and at 5 year follow up. LVR was defined as an increase of over 15% of the LV end diastolic volume (LVEDV) in time, at 5 years after the STEMI. Results We obtained significant differences in time (up to 7 days after STEMI vs at 5 years) between 3D LVEF (46,48 vs 51,68, p = 0.002), LVEDV (97,12 vs 107,76, p = 0.000), 2D global strain (-11.76 vs - 14,1, p = 0.00), and mechanical dispersion (65,06 vs 57,66, p = 0.00) in all patients. LV remodeling at 5 years (15% increase in LVEDV) was observed in 36,6% of the included patients. At 5 years follow up, LVEDV mean value in the remodeling group was 130 ml and in the no remodeling group 90,21 ml (p = 0.002), 3D LVEF was 48,18 vs 54,42 (p = 0.05), global strain was - 12,33 vs -15,35 (p = 0.02) and LV mechanical dispersion 66,27 vs 55,55 (p = 0.05). Therefore patients with LV remodeling in time had lower LVEF, lower global strain and higher LV mechanical dispersion at baseline. Using ROC analysis we identified two cut off values, one of -11.55 for global LV strain measured at baseline (Sb 81.8%, Sp 77%, AUC 0.776, CI 95%, p = 0.022) and the other one of 63.7 for LV mechanical dispersion at admission (Sb 72,7%, Sp 62%, AUC 0.734, p 0.05) to discriminate between patients with or without LV adverse remodeling at 5 years after STEMI. We also found, using regression analysis, that GLS and LV mechanical dispersion are able to predict LV remodeling in time. Conclusion Global longitudinal strain and left ventricular mechanical dispersion measured in the acute phase can predict which patient is likely to undergo LV remodeling at 5 years after STEMI. GLS and LV dispersion could be used as predictors for future LV adverse remodeling after STEMI. Larger scale studies are needed to validate these findings.

To assess the efficacy of radioimmunotherapy (RIT) with 90yttrium-ibrutinib-tiuxetan (90Y-IT) in mantle cell lymphoma, data from 90 patients registered in the RIT Network with a median follow-up (FU) of 5.5 years after RIT were evaluated. 90Y-IT was given as first-line therapy in 45 (50%) (consolidation 44 pts., primary therapy 1 pt.) and at relapse in 45 (50%) patients (consolidation 24 pts., recurrence 12 pts., therapy refractory 3 pts., conditioning 2 pts., other 4 pts.). As a first-line treatment, 30 patients (pts.) (67%) achieved CR, 10 pts. (22%) PR%., 1 pt. (2%) PD, and for 4 pts. (9%) no response data was available. At relapse, CR was achieved in 17 pts. (38%), PR in 6 pts. (13%), SD in 2 pts. (4%), and 6 pts. (13%) had PD, while the response was not documented for 14 pts. (31%). After a median FU of 5.5 years, median PFS for all patients was 2.11 (95%CI: 1.03-2.32) years, and median OS was 4.05 (95%CI 2.79-7.21) years. Eleven pts. (12.2%) developed second malignancy. In conclusion, this is the largest report of MCL pts. treated with 90Y-IT to date. 90Y-IT was most often used as consolidation after first- and second-line chemotherapy and may improve the results achieved using chemoimmunotherapy alone. However, the results are less encouraging compared to treatment with small molecules such as ibrutinib. Disclosures Zinzani: TG Therapeutics: Honoraria, Speakers Bureau; Kyowa Kirin: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Portola: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Immune Design: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sandoz: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen-Cilag: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celltrion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Verastem: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; MSD: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Eusapharma: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sanofi: Consultancy. Jurczak:Sandoz: Membership on an entity's Board of Directors or advisory committees, Research Funding; Loxo: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Research Funding; Roche: Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Research Funding; Bayer: Research Funding; Gilead: Research Funding; MorphoSys: Research Funding; Incyte: Research Funding; Novo Nordisk: Research Funding; Servier: Research Funding; TG Therapeutics: Research Funding; Celtrion: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding. Truemper:Seattle Genetics, Inc.: Research Funding; Takeda: Consultancy, Research Funding; Roche: Research Funding; Nordic Nanovector: Consultancy; Mundipharma: Research Funding; Janssen Oncology: Consultancy. Scholz:Janssen-Cilag: Consultancy; Hexal: Consultancy; Takeda: Consultancy; Novartis: Consultancy; Celgene: Consultancy; Pfizer: Speakers Bureau; Roche: Consultancy; GILEAD: Consultancy, Speakers Bureau; Daiichi Sankio: Consultancy. OffLabel Disclosure: Yttrium 90 (90Y) Ibritumomab Tiuxetan (Zevalin) is approved for treatment of patients with relapsed follicular lymphoma and as consolidation therapy after chemo(immuno)therapy of patients with follicular lymphoma.

Background and Aims: The long-term health effects of the use of electronic cigarettes (ECs) in patients with chronic obstructive pulmonary disease (COPD) are largely unexplored. We present findings from a 5-year prospective assessment of respiratory parameters in a cohort of COPD patients who substantially reduced conventional smoking or achieved abstinence by switching to ECs. Methods: Patients were evaluated prospectively for their measurements of respiratory exacerbations, spirometric indices, quality of life using the COPD assessment tool (CAT), 6-min walk distance (6MWD), as well as conventional cigarette consumption. Baseline measurements prior to switching to EC use were compared with follow-up visits at 12-, 24-, 48- and 60-months. Age- and sex-matched COPD patients reporting to be regular smokers (not using ECs) were the reference group for the analysis. Results: Complete data were available from 39 patients. Those in the EC user group achieved a marked decline in cigarette smoking or abstinence. COPD EC users had a significant diminution in COPD exacerbations; with the mean (±SD) exacerbation rate falling from 2.3 (±0.9) at baseline to 1.1 (±1.0) at 5 years ( p Conclusion: The present study suggests that EC use may ameliorate objective and subjective COPD outcomes, and that the benefits gained appear to persist long term. EC use for abstinence and smoking reduction may ameliorate some of the harm resulting from tobacco smoking in COPD patients.

Objective To assess whether subchondral drilling of acetabular cartilage flaps during femoroacetabular impingement (FAI) surgery improves (1) acetabular dGEMRIC indices and (2) morphologic magnetic resonance imaging (MRI) scores, compared with hips in which no additional treatment of cartilage lesions had been performed; and (3) whether global dGEMRIC indices and MRI scores correlate. Design Prospective cohort study of consecutive patients with symptomatic FAI treated with open surgery between 2000 and 2007. Patients with subchondral drilling of acetabular cartilage flaps were allocated to the study group, those without drilling to the control group. All patients underwent indirect 3-T MR arthrography to assess cartilage quality by dGEMRIC indices and a semiquantitative morphologic MRI score at minimum 5 years after surgery. dGEMRIC indices and morphologic MRI scores were compared between and among groups using analysis of covariance/paired t tests. Results No significant difference was found between the global dGEMRIC indices of the study group (449 ± 147 ms, 95% CI 432-466 ms) and the control group (428 ± 143 ms, 95% CI 416-442 ms; P = 0.235). In regions with cartilage flaps, the study group showed higher dGEMRIC indices (472 ± 160 ms, 95% CI 433-510 ms) compared with the control group (390 ± 122 ms, 95% CI 367-413 ms; P < 0.001). No significant differences were found for the morphologic MRI scores. A strong inversely linear correlation between the dGEMRIC indices and the morphologic MRI scores ( r = −0.727, P < 0.001) was observed. Conclusions Treatment of acetabular cartilage flaps with subchondral drilling leads to better cartilage quality in regions with cartilage flaps at minimum 5 years of follow-up.

Background:Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain. Extracorporeal shock wave therapy (ESWT) has proven to be an effective treatment, but the relationship between therapeutic responses and sports activity levels has not been studied.Purpose:To compare the clinical outcomes of ESWT used to treat IATs between sports-active and nonsports-active patients over 5 years.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective study was conducted on 33 patients with IAT who received ESWT from October 2012 to September 2013. Patients were classified into 2 groups according to their preinjury Tegner activity level: a sports-active group, defined as patients who self-reported to be regular joggers (SA group; Tegner activity level >3; n = 16), and a nonsports-active group (control group; Tegner activity level ≤3; n = 17). The mean age was 31 ± 7 years for the SA group and 37 ± 10 years for the control group. The Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire scores and visual analog scale (VAS) pain scores were used to evaluate the clinical outcomes before treatment, immediately after treatment, and 5 years after treatment. Ultrasonography was also used to assess the insertional Achilles tendon quality.Results:Before treatment, there were no significant differences between the groups with regard to VAS scores, while the VISA-A score in the SA group was higher than that in the control group. After ESWT, both groups had increased VISA-A scores and decreased VAS scores, indicating improvement. At 5-year follow-up, the SA group had a significantly lower mean VAS score (0.3 ± 0.8 vs 1.6 ± 1.3; P = .001) and a significantly higher mean VISA-A score (90 ± 4 vs 78 ± 7; P < .001) compared with the control group. There was no significant difference between the groups regarding the calcification and neovascularization of the Achilles tendon based on ultrasonography.Conclusion:ESWT can improve the symptoms of Achilles tendinopathy, and patients with IAT who had greater sports activity levels had better therapeutic responses than nonsports-active patients after 5-year follow-up.

IntroductionThe choice of implant type for total hip replacement in the treatment of femoral neck fractures remains debated. Some authors advocate for the systematic use of cemented stems, while others do not use dual mobility first-line. We therefore conducted a retrospective study using a dual mobility cup (DMC) and an uncemented collared stem (UCS) in order to: (1) confirm the low dislocation rate in this indication, (2) assess other surgical complications, in particular periprosthetic fractures, (3) ensure that these benefits are maintained over time, at a minimum follow-up of 5 years and, (4) assess the rate of revision of the implants.HypothesisOur hypothesis was that the dual mobility dislocation rate for the treatment of femoral neck fractures was lower than for bipolar hemiarthroplasties or single mobility hip prostheses.Patients and methodsA retrospective study of 244 femoral neck fractures (242 patients) treated with DMC and UCS was conducted, between 2013 and 2014. The mean age was 83±10 years (60-104). The occurrence of dislocation, periprosthetic fracture, infection of the surgical site, loosening, reoperation and revision were investigated. The HOOS Joint Replacement (JR) score was collected. The cumulative incidence with mortality was used as a competing risk.ResultsThe mean follow-up was 6 years±0.5 (5-7). At the last follow-up, 108 patients (50%) had died. Twenty-three patients (9.5%) were lost to follow-up. One case of symptomatic aseptic loosening of DMC was observed. The cumulative incidence of dislocations and periprosthetic fractures at 5 years were 2% (95% CI: 0.9-5.4) and 3% (95% CI: 1.2-6), respectively. The 5-year cumulative incidence of surgical site infections was 3.5% (95% CI: 1.8-7). The cumulative incidence of reoperations at 5 years was 7% (95% CI: 4.5-11). The causes of reoperation were periprosthetic fracture (n=6), infection (n=8), postoperative hematoma (n=2) and cup malposition (n=2). The cumulative incidence of a revision at 5 years was 2.7% (95% CI: 1.2-6). The cumulative incidence of a surgical complication from any cause at 5 years was 9% (95% CI: 6.7-14.8). The mean HOOS JR score was 79±5 (52-92).DiscussionThe cumulative incidence of dislocation at 5 years is low and other surgical complications (including periprosthetic fractures) do not increase during this period for DMC associated with UCS, in femoral neck fractures. The use of this type of implant is reliable in the treatment of femoral neck fractures.Level of evidenceIV; retrospective study without control group.

Background Metal on metal hip resurfacing (MoM-HR) is an alternative to total hip arthroplasty in young and active patients. The purpose was to determine the survivorship of MoM-HR procedures performed in patients aged 45 years and younger assessing patient-reported outcome measures (PROMs) at minimum 5-year follow-up. Methods All 217 patients equal to or younger than 45 years of age at the time of surgical intervention presenting to our center with MoM-HR between May 2002 and May 2011 were prospectively followed. Baseline demographic data, preoperative and postoperative radiographic measurements, and validated PROMs were obtained (Hip Disability and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles Activity Score). Survivorship was calculated using Kaplan-Meier analysis, and risk factors for failure were identified using multivariate regression analysis. Results The overall survivorship excluding septic failures was 94.6% and 93.8% at 5 and 10 years, respectively. Aseptic loosening of the acetabular component was the most common mode of failure (11/20 cases). Gender, head size, and acetabular abduction angle had no significant effect on survivorship. Significant improvements in PROMs were seen for Hip Disability and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles Activity Scale (P Conclusion This study indicates that MoM-HR is a suitable option for young individuals, as demonstrated through improved functional scores and low revision rates. The survivorship of HR in the younger than 45 age-group was similar to that of total hip arthroplasty, as well as HR in older patients. Given the proposed benefits of HR, this procedure may be viewed as a viable option in patients aged younger than 45 years.

Background: Supervised (SE) and home-based exercise (HBE) training regimes are effective on reconditioning patients with familial amyloidotic polyneuropathy (FAP) after liver transplantation, but research of the long-term retention of the benefits attained in patients with FAP has not yet been conducted. Purpose: In this 5-year follow-up study, we aimed to determine whether the exercise training gains in body composition, physical activity, and function promoted by a 24-week SE or HBE training regimes are retained in patients with FAP who resume normal activity. Methodology: Sixteen liver-transplanted patients with FAP were reassessed for body composition (dual X-ray absorptiometry), physical activity (questionnaire), and function (handgrip strength and 6-minute walk test). Results: Total body fat increased with both exercise regimes during follow-up ( P < .05; η2 = 0.432-0.625) as well as femoral neck bone density ( P = .048; η2 = 0.119). However, gains in upper limbs muscle quality during follow-up ( P < .001; η2 = 0.597) were only found in the SE group ( P = .042; η2 = 0.245). Both exercise regimes showed retaining aptitudes in walking capacity ( P < .05; η2 = 0.329-0.460) and muscle mass ( P = .05; η2 = 0.245). Still, none could retain the physical activity levels. Conclusion: Long-term resumption of normal activity following a 24-week SE or HBE regime in patients with FAP resulted in loss of exercise induced increases in physical activity but counterweighted postoperative losses in bone mineral density and substantially retained the benefits in walking capacity, muscle mass, and quality, in particular, in the SE group.

Objective To compare the clinical efficacy of cyclophosphamide (CTX) and cyclosporine A (CSA) in initial treatment of children with steroid-resistant nephrotic syndrome (SRNS). Methods Prospectively maintained databases were reviewed to retrospectively compare two cohorts with SRNS that received peroral administration of 2 to 2.5 mg/kg/d CTX for 3 to 6 months or 1 to 5 mg/kg/d CSA for 2 years until the primary analysis cut-off date during 2007 to 2011. The time to first on-study relapse of SRNS was the primary endpoint. The effective rate was the second endpoint. Results A total of 127 children with SRNS were included (CTX-treated cohort: n = 62; CSA-treated cohort: n = 65), with a mean 5-year follow-up. CTX-treated children showed a significantly delayed time to first on-study relapse of SRNS compared with CSA-treated children (hazard ratio 0.66, 95% confidence interval 0.32–1.75). The relapse rate (rate/year) in CTX-treated children (1.1 ± 0.1) at the 24-month follow-up was significantly higher than that with CSA (0.4 ± 0.2). This difference persisted until the final follow-up. Conclusions CSA is associated with a significantly lower relapse rate and significantly higher effective rate compared with CTX, especially in children with minimal change disease.

Objectives: Evaluate the safety and clinical response of complementary treatment with European mistletoe extracts during chemotherapy. Design: Monocentric controlled trial with 95 patients randomized into three groups. Settings/Location: National Cancer Research Center of Serbia. Subjects: Breast cancer patients (stage T1–3N0–2M0) undergoing surgery and adjuvant chemotherapy with six cycles of cyclophosphamide, adriamycin, and 5-fluorouracil. Interventions: Two different European mistletoe extracts (Helixor A, Iscador M Spez) were injected three times per week during 18 weeks of chemotherapy in the mistletoe group. Five-year follow-up of routine visits was documented in case report forms. Outcome measures: Safety was assessed by measuring adverse events, body temperature during chemotherapy, and probability of relapse or metastasis in a 5-year follow-up. During chemotherapy, the neutrophil count and quality of life according to EORTC QLQ-C30 were assessed. Results: The two patient groups receiving different complementary mistletoe treatments were integrated into one mistletoe group for this safety analysis. Patients in the mistletoe group did not develop more fever symptoms than patients in the control group (two short-term events in each group). No significant differences in probability of relapse or metastasis were measured between the groups (p = 0.7637). The mistletoe group showed a trend toward less neutropenia (p = 0.178) and improved pain and appetite loss scores (p

OBJECTIVEThe authors evaluated the outcomes of sacroiliac joint (SIJ) arthrodesis via an original anterior approach to the upper anterior surface of the SIJ in patients with a minimum of 5 years’ follow-up.METHODSThe authors performed anterior SIJ arthrodesis in 45 patients between 2001 and 2015. Of these patients, 27 (11 men and 16 women; mean age at surgery 49 [24–86] years) were followed up for a minimum of 5 years (average 113 months, range 61–157 months). In the 14 patients in the earlier period of this study, the authors used an anterior approach to expose the SIJ by separating the iliac muscle from the iliac bone and performed internal fixation. In the 13 patients later in the study, the authors changed to a pararectal approach, which involved an incision along the lateral border of the rectus abdominal muscle. Then, extraperitoneally, the upper anterior surface of the SIJ was exposed between the psoas major muscle and the iliac muscle.RESULTSAmong the 27 patients, 21 had unilateral anterior arthrodesis alone, 4 required additional posterior arthrodesis, and 2 required pelvic ring arthrodesis because of later pain on the opposite side. In the 21 patients with a unilateral anterior arthrodesis, outcome according to the modified Macnab criteria was excellent in 7, good in 11, and fair in 3. Outcomes were excellent, good, fair, and poor in 1 patient each among the 4 with additional posterior fusion. Outcomes were good and poor for 1 patient each among those with pelvic ring arthrodesis. All 27 patients demonstrated bone union of the SIJ on CT. Lateral femoral cutaneous neuralgia developed in 7 of the 27 patients; 6 patients had undergone the initial anterior method and 1 the later method.CONCLUSIONSAnterior SIJ arthrodesis was effective in most patients with severe SIJ pain resistant to conservative therapy. This approach has the advantage of direct curettage and bone graft into the wide area of the SIJ, which result in good bone union. In particular, the authors’ current pararectal approach could decrease the potential risk of lateral cutaneous injury.

Defibrillation threshold (DFT) testing is a routine practice in some Asian countries for patients receiving an implantable cardioverter defibrillator (ICD). However, there are few long-term data about the necessity of intraoperative DFT testing in an Asian population. We investigated the safety of DFT testing and the long-term clinical outcomes in Asian patients undergoing ICD implantation. All patients undergoing de novo transvenous ICD implantation were randomized to undergo periprocedural DFT testing. The study included 67 patients (50 males; 51.5 ± 16.9 years) who underwent ICD implantation with (n = 33) or without (n = 34) intraoperative DFT testing between March 2012 and February 2014. We compared first-shock success, composite safety end points (the sum of complications recorded at 30 days), arrhythmic death, and all-cause mortality. The baseline clinical characteristics and the procedural-related adverse event rate (3.0% with DFT vs. 0% with non-DFT, p = 0.214) did not differ between groups. The programmed output of the first shock was lower in the DFT testing group (22.9 ± 4.4 J vs. 25.3 ± 5.4 J, p = 0.007). However, there were no significant differences between groups for all-cause mortality (12.1% vs. 17.6%, p = 0.526) or first-shock success rate for ventricular arrhythmia (100% vs. 88.2%, p = 0.471). There were no between-group differences in periprocedural safety, complications, and long-term clinical outcomes. Our results suggest that DFT testing in Asian patients allows reduction of the programmed output of the first shock, but does not affect long-term clinical outcomes.

CASE A 20-year-old military recruit presented with pain in his left hip. He was referred by the military hospital for osteonecrosis of the femoral head in both hip joints. Plain radiographs and magnetic resonance imaging showed a marked collapse in the left femoral head; however, the patient was diagnosed as having subchondral fatigue fractures of the femoral head (SFFFH) after a thorough review of previous sequential images. Arthroscopic debridement and labral repair were performed. At 3 years after surgery, the patient was symptom-free and second-look hip arthroscopy revealed the articular defect filling with fibrocartilage on the femoral head. CONCLUSION In a young patient, hip arthroscopy can be a successful joint preserving treatment option even for collapsed SFFFH.

Objective To identify biomarkers of treatment change and radiographic progression in patients with RA under remission. Patients and methods RA patients in remission (DAS28-ESR 10.47 (small detectable change). Results Sixty patients were included, 81.6% were ACPA+ and 45% were taking biological DMARDs. At baseline, 66.6% had Power Doppler signal. After 5 years, 73.3% of patients remained in remission. Change of therapy was performed in 20 patients (33.3%) and was associated with BMI [odds ratio (OR) 1.3, 95% CI: 1, 1.7], lack of biological DMARD therapy (OR 24.7, 95% CI: 2.3, 257.2), first-year progression of MRI erosions (OR 1.2, 95% CI: 1, 1.3) and calprotectin serum levels (OR 2.8, 95% CI: 1, 8.2). Radiographic progression occurred in six (10%) patients. These patients had higher first-year progression of MRI erosions (P = 0.03) and bone oedema (P = 0.04). Among 23 patients undergoing synovial biopsy, mast cell density was independently associated with clinical flares. Conclusions One-third of RA patients lost clinical remission and changed therapy throughout the 5 years of follow-up, which was independently associated with BMI, lack of biological DMARDs therapy and first-year progression of MRI erosion score and calprotectin serum levels. Significant radiographic progression was uncommon.

The purpose of this study was to confirm the 5-year efficiency of temporomandibular joint (TMJ) anchorage, using clinical evaluation and magnetic resonance imaging (MRI). We also studied the influence of disc length and position on efficiency and postoperative condylar height. Sixty-one patients (76 joints) undergoing TMJ disc anchorage were followed up for >5 years. Visual analogue scale (VAS) score and maximum mouth-opening pre-and postsurgery were analysed and patient satisfaction recorded. Disc length, condyle height and disc position pre- and postsurgery were measured using MRI. Patients were ranked as A, B or C degree according to postoperative disc condyle position. Mean follow-up time was 71.34 months. Maximum mouth-opening improved by 14.34 ± 5.87 mm, and VAS score decreased by 33.44 ± 20.56 (P

Summary Background A 5-year follow-up study of 633 cutaneous squamous cell cancer (SCC) excisions was performed by collecting data on rates of local recurrence (LR) and lymph node (LN) metastasis. Methods A retrospective analysis of patients was performed across four regional plastic surgery centres (Stoke Mandeville Hospital, Aylesbury; John Radcliffe Hospital, Oxford; Salisbury District Hospital, Salisbury and Queen Alexandra Hospital, Portsmouth) assessing rates of LR and LN metastasis. Results We report 5-year outcomes from 598 SCCs (95% follow-up rate). The total recurrence rate (LR and LN metastasis) was 6.7% (n = 40) at 5 years, with 96% of these occurring within 2 years. Median time to LR was 9 months (1–57), with 76.9% (n = 20) undergoing further wide local excision. Median time to LN metastasis was 5.5 months (1–18 months). There were two cases of disease-related death. Only 15% (n = 6) of incomplete excisions recurred. Interestingly, 19.1% (n = 9) of 47 SCCs with perineural invasion on original histopathology recurred versus only 5.6% (n = 31) of the 551 SCCs without perineural invasion (p = 0.005). Conclusions This study is one of the largest studies to date following up 598 SCC excisions at 5 years with total recurrence rates comparable to those in current published literature. We report perineural invasion as a significant predictor of recurrence and that 96% of total recurrence occurred within 2 years. This is in contrast to current UK guidelines (75% at 2 years, 95% at 5 years), thus suggesting that shorter length of hospital follow-up may be reasonable.

Background The aim of this study was to evaluate the clinical and radiological outcomes of minimally invasive total knee arthroplasty (MIS-TKA) in obese patients. Methods We examined the records of 371 cases of MIS-TKA performed using the mini-midvastus approach from January 2006 to December 2006. According to body mass index (BMI), the cases were classified into group A (BMI < 25 kg/m2, 114 knees), group B (25 kg/m2 ≤ BMI < 30 kg/m2, 179 knees), and group C (BMI ≥ 30 kg/m2, 78 knees). Clinical outcomes were measured with the Hospital for Special Surgery Score and Knee Society Score. Radiological evaluation included measurements of knee alignment. Results MIS-TKA was performed on all patients. The skin incision size in group A, group B, and group C was 8.2 ± 0.8 cm, 8.3 ± 0.8 cm, and 8.5 ± 0.9 cm, respectively, and the operation time was 86.4 ± 10.4 minutes, 85.9 ± 11.3 minutes, and 89.0 ± 11.4 minutes, respectively, indicating no significant difference among the groups (p > 0.05). There was no difference in terms of the accuracy of the tibial implant alignment, with 97.6%, 95.2%, and 93.4% of each group showing 90° ± 3° varus angulation (p > 0.05). With respect to the accuracy of the femorotibial angle, 93.9%, 94.6%, and 90.2% of each group had 6° ± 3° valgus angulation, with group C demonstrating the lowest level of accuracy (p < 0.05). The preoperative range of motion and Knee Society Score of group C were less than those of groups A and B (p < 0.05), but there was no notable difference among groups at the postoperative 3-month and 1-year follow-ups (p > 0.05). Conclusions MIS-TKA in obese patients showed satisfactory clinical and radiological results without significant difference in surgical results compared to nonobese patients.

Purpose To compare the survival, success rates, and biological/technical complications of posterior metal-ceramic (MC) and zirconia fixed partial dentures (FPDs). Materials and methods A total of 40 patients requiring 40 posterior FPDs were randomly assigned to receive 20 zirconia and 20 MC restorations. The restorations were examined 1 week (baseline) and 1, 3, and 5 years after the end of treatment. Technical and biological outcomes were compared. Data were statistically analyzed using the Wilcoxon signed-rank and Mann-Whitney U tests. Results The survival rates of both groups were 100%, and the success rates were 80% (zirconia) and 100% (MC). No biological complications were observed. Minor chipping was found in 20% of the zirconia restorations. No differences in periodontal parameters were observed between groups. Conclusions Zirconia FPDs exhibited the same survival rate (100%) as MC FPDs after 5 years; however, the success rate was 80%, because an increased rate of chipping was observed in zirconia restorations.

Background: Surface replacement arthroplasty (SRA) through a volar approach for the proximal interphalangeal (PIP) joint can preserve the integrity of the extensor tendon, which allows early range of motion (ROM) exercise postoperatively. However, a few reports have shown that the PIP ROM tends to decline with longer follow-up. The goal of this study is to assess the results of at least 5 years of follow-up of SRA through a volar approach and also to investigate the cause of deterioration of ROM with time after SRA through this approach. Methods: Eleven fingers with degenerative osteoarthritis that underwent SRA through the volar approach were examined. ROM of the PIP joint preoperation, 1 year after the surgery, and at final follow-up was measured and statistically analyzed. Also, the relationship between PIP ROM and the osteophyte developed postoperatively was examined. Results: The average follow-up period was 7.3 years. The average PIP ROM of the PIP joints was 52.3° preoperatively, 54.1° at 1 year postoperatively, and 31.1° at the final follow-up. PIP ROM at the final follow-up was significantly decreased compared with that preoperatively or at 1 year postoperatively. Also, the development of an osteophyte was negatively correlated with the ROM of the PIP joint at the final follow-up. Conclusions: PIP ROM after SRA through a volar approach has the tendency to deteriorate with a longer follow-up. Development of an osteophyte is considered to be a main risk factor of deterioration in the cases of SRA through a volar approach.

Background: The effective treatment of chronic lower limb ischemia is one of the most challenging issues confronting vascular surgeons. Current pharmacological therapies play an auxiliary role and cannot prevent disease progression, and new treatment methods are needed. In 2011, a plasmid VEGF65-gene therapy drug was approved in Russia for the treatment of chronic lower limb ischemia ( ClinicalTrials.gov identifier: NCT03068585). The objective of this follow-up study was to evaluate the long-term safety and efficacy of gene therapy in patients with limb ischemia of atherosclerotic genesis. Aims: To evaluate the long-term safety and efficacy of the therapeutic angiogenesis, 36 patients in the treatment group (pl- VEGF165) and 12 patients in the control group participated in a 5-year follow-up study. Planned examinations were carried out annually for 5 years after pl- VEGF165 administration. Results: Differences in the frequency of major cardiovascular events (pl- VEGF165 5/36 versus control 2/12; p = 0.85), malignancies (pl- VEGF165 1/36 versus control 0/12; p = 0.38) and impaired vision (there was none in either group) over the 5-year follow-up period did not achieve statistical significance. The target limb salvage was 95% ( n = 36) and 67% ( n = 12) in the pl- VEGF165 and control groups, respectively. The pain-free walking distance value increased by 288% from 105.7 ± 16.5 m to 384 ± 39 m in the treatment group by the end of the fifth year, with a peak of 410.6 ± 86.1 m achieved by the end of the third year. The ankle-brachial index (ABI) increased from 0.47 ± 0.01 to 0.56 ± 0.02 by the end of the first year, with a subsequent slight decrease to 0.51 ± 0.02 by the fifth year. The maximum increment of transcutaneous oximetry test (tcoO2) by 36%, from 66.6 ± 3.7 mm Hg to 90.7 ± 4.9 mm Hg, was observed by the end of the second year. Conclusion: The therapeutic effect of angiogenesis induction by gene therapy persists for 5 years.

The difficulty in providing stability to the coronal segment makes cervical root fracture one of the most challenging dental traumatic injury. This type of injury is less frequent in children. However, due to their serious consequences and poor prognosis, tooth loss may occur. This report presents the management of a case of cervical root fracture in an 11-year-old patient with epilepsy. The stabilization of the root-fractured tooth with a splint failed due to the recurrent seizures the patient had. Coronal fragment was removed and vital root submergence was performed in order to support the alveolar growth. The natural tooth crown was incorporated into a modified Nance appliance to meet the esthetic and functional requirements of the patient. After 5-year follow-up, this treatment approach has seemed to offer a long-term provisional and satisfactory solution to the consequences of a cervical root fracture injury.

The article presents the results of the 5-years follow-up for the patients who had acute coronary syndrome. The results of the hospital treatment were demonstrated. In addition, the study showed the adherence to the therapy, long-term consequences and clinical outcomes following acute coronary syndrome in the clinical practice in the Republic of Karelia

BACKGROUND To the authors' knowledge, health-related quality of life (HRQOL) outcomes are not well described in patients with medulloblastoma. The use of proton radiotherapy (RT) may translate into an improved HRQOL. In the current study, the authors report long-term HRQOL in patients with proton-treated pediatric medulloblastoma. METHODS The current study was a prospective cohort HRQOL study of patients with medulloblastoma who were treated with proton RT and enrolled between August 5, 2002, and October 8, 2015. Both child report and parent-proxy report Pediatric Quality of Life Inventory (PedsQL) surveys were collected at baseline during RT and annually thereafter (score range on surveys of 0-100, with higher scores indicating better HRQOL). Patients were dichotomized by clinical/treatment variables and subgroups were compared. Mixed-model analysis was performed to determine the longitudinal trajectory of PedsQL scores. The Student t test was used to compare long-term HRQOL measures with published means from a healthy child population. RESULTS Survey data were evaluable for 116 patients with a median follow-up of 5 years (range, 1-10.6 years); the median age at the time of diagnosis was 7.6 years (range, 2.1-18.1 years). At baseline, children reported a total core score (TCS) of 65.9, which increased by 1.8 points annually (P

Introduction: There is a paucity in the literature regarding mid-term results of microfracture in hip arthroscopy. We aim to assess 5-year outcomes of patients who underwent acetabular microfracture for full-thickness chondral lesions as a part of hip arthroscopy. Methods: Between August 2008 and September 2011, data were prospectively gathered for patients undergoing acetabular microfracture during hip arthroscopy with minimum 5-year follow-up. All patients were assessed pre- and postoperatively, with modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score – Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS). International Hip Outcome Tool (iHOT-12) and satisfaction were collected postoperatively. Exclusion criteria included previous hip conditions, or preoperative Tönnis grade ≥2. Results: Fifty three hips were eligible for this study. Of these, 43 (81.1%) hips in 42 patients had follow-up. The study group had a male majority (65.1%) and an average age of 44.4 ± 9.5 years. There was statistically significant improvement in all patient-reported outcomes (PROs) and VAS at follow-up. Patient satisfaction was 7.6 ± 2.6. A comparison of 2-year to minimum 5-year follow-up results identified no statistically significant deterioration in PROs, VAS, and patient satisfaction. Survivorship was 72.1% with 12 patients converted to total hip arthroplasty (THA). 4 patients (10.8%) underwent secondary arthroscopy. Conclusions: In the mid-term, microfracture as a part of hip arthroscopy demonstrated favourable outcomes and 72% survivorship. Careful patient selection is warranted to limit the risk of conversion to THA.

Objective We sought to document our experience in managing a rare complex of traumatic posterolateral atlantoaxial dislocation combined with locked lateral mass and type II odontoid fracture. Method A 30-year-old male patient was referred to the author's department. He complained of a decrease in neck range of motion following a traffic accident. Neurologic examination was normal. Computed tomography and open-mouth radiographs showed a type II odontoid fracture and a posterolateral dislocation with a laterally locked left lateral mass at the C1-C2 level. Considering the difficulty and risk in reduction, due to this rare instability and dislocation, a 2-staged treatment was performed. With up to 11 kg skull traction for 7 days before surgery, the locked lateral mass and the lateral dislocation was finally reduced without any neurologic deficit. And once closed reduction was confirmed by open-mouth and lateral X-ray views in the cervical spine, a second staged C1-C2 surgical fixation and fusion with iliac bone graft was performed to achieve a normal anatomic alignment with a better stability. Result The patient showed significant amelioration of neck symptoms postoperatively, and a successful reduction and fixation of the C1-C2 articulation was achieved. At the 5-year follow-up, solid bone fusion was evident on the computed tomography scan. Conclusion For traumatic posterolateral atlantoaxial dislocation complicated with type II odontoid fracture, a closed reduction of the lateral dislocation before operation is both useful and safe because surgeons do not need to reduce the extremely rare lateral dislocation during the operation. Posterior atlantoaxial stabilization and fusion, rather than the occipitocervical fusion as reported previously, is biomechanically stable enough to achieve solid fusion in this rare trauma while not sacrificing the occipitoatlantal joint.

Objectives This study provides an update and comparison to a 2010 nationwide survey on cardiac electrophysiology (EP), types and numbers of interventional electrophysiological procedures, and training opportunities in 2015. Background In 2010, German cardiology centers performing interventional EP were identified and contacted to provide a survey on cardiac EP. Methods German cardiology centers performing interventional EP in 2015 were identified from quality reports and contacted to repeat the 2010 questionnaire. Results A majority of 131 centers (57%) responded. EP (ablation procedures and device therapy) was mainly part of a cardiology department (89%) and only independent (with its own budget) in 11%. The proportion of female physicians in EP training increased from 26% in 2010 to 38% in 2015. In total, 49,356 catheter ablations (i.e., 81% of reported ablations in 2015) were performed by the responding centers, resulting in a 44% increase compared with 2010 (the median number increased from 180 to 297 per center). Atrial fibrillation (AF) was the most common arrhythmia interventionally treated (47%). At 66% of the centers, (at least) 2 physicians were present during most catheter ablations. A minimum of 50 (75) AF ablations were performed at 80% (70%) of the centers. Pulmonary vein isolation with radiofrequency point-by-point ablation (62%) and cryoablation (33%) were the preferred ablation strategies. About one-third of centers reported surgical AF ablations, with 11 centers (8%) performing stand-alone surgical AF ablations. Only one-third of the responding 131 centers fulfilled all requirements for training center accreditation. Conclusions Comparing 2010 with 2015, an increasing number of EP centers and procedures in Germany are registered. In 2015, almost every second ablation was for therapy for AF. Thus, an increasing demand for catheter ablation is likely, but training opportunities are still limited, and most centers do not fulfil recommended requirements for ablation centers.