Jones type fifth metatarsal fractures pose a challenge to the foot and ankle surgeon,given documented high nonunion rates as well as high complication rates including hardware prominence,nerve injury,and screw breakag...Jones type fifth metatarsal fractures pose a challenge to the foot and ankle surgeon,given documented high nonunion rates as well as high complication rates including hardware prominence,nerve injury,and screw breakage for existing treatment modalities including screw and plantar plate fixation.We call for the design of innovative Jones-fracture specific implants which contour to the natural curve of the fifth metatarsal.Future research should aim to expand upon existing literature for Jones fracture fixation and evaluate efficacy of novel implants which are designed to address unacceptably high complication rates for existing treatment modalities.展开更多
The potential clinical and economic impact of mesenchymal stem cell(MSC)therapy is immense.MSCs act through multiple pathways:(1)as“trophic”cells,secreting various factors that are immunomodulatory,anti-inflammatory...The potential clinical and economic impact of mesenchymal stem cell(MSC)therapy is immense.MSCs act through multiple pathways:(1)as“trophic”cells,secreting various factors that are immunomodulatory,anti-inflammatory,antiapoptotic,proangiogenic,proliferative,and chemoattractive;(2)in conjunction with cells native to the tissue they reside in to enhance differentiation of surrounding cells to facilitate tissue regrowth.Researchers have developed methods for the extraction and expansion of MSCs from animal and human tissues.While many sources of MSCs exist,including adipose tissue and iliac crest bone graft,compact bone(CB)MSCs have shown great potential for use in orthopaedic surgery.CB MSCs exert powerful immunomodulatory effects in addition to demonstrating excellent regenerative capacity for use in filling boney defects.CB MSCs have been shown to have enhanced response to hypoxic conditions when compared with other forms of MSCs.More work is needed to continue to characterize the potential applications for CB MSCs in orthopaedic trauma.展开更多
Background Percutaneous coronary intervention(PCI)for stable ischemic heart disease(SIHD)in older adults requires a metic-ulous assessment of procedural risks and benefits,but contemporary data on outcomes in this pop...Background Percutaneous coronary intervention(PCI)for stable ischemic heart disease(SIHD)in older adults requires a metic-ulous assessment of procedural risks and benefits,but contemporary data on outcomes in this population is lacking.Therefore,we examined the risk of near-term readmission,bleeding,and mortality in high-risk cohort of older adults undergoing inpatient PCI for SIHD.METHODS We analyzed the National Readmissions Database from 2017 to 2018 to identify index hospitalizations in which PCI was performed for SIHD.Patients were stratified into those≥75 years old(older adults)and those<75 years old.The primary outcome was 90-day readmission.Secondary outcomes included in-hospital mortality,hospital length of stay(LOS),and total hospital charge.RESULTS A total of 74,516 patients underwent inpatient PCI for SIHD,of whom 24,075 were older adults.Older adult patients had higher odds of in-hospital mortality(OR=2.00,95%CI:1.68-2.38),intracranial hemorrhage(OR=2.03,95%CI:1.24-3.34),and gastrointestinal hemorrhage(OR=1.72,95%CI:1.43-2.07)during index hospitalization,with longer LOS and in-hospital charge.Older adults also experienced a higher hazard of 90-day readmission for any cause(HR=1.61,95%CI:1.57-1.66)and car-diovascular causes(HR=1.84,95%CI:1.77-1.91).CONCLUSION Older adults undergoing inpatient PCI for SIHD were at increased risk for in-hospital mortality,periprocedural morbidities,higher cost,and readmissions compared with younger adults.Understanding these differences may improve shared decision-making for patients with SIHD being considered for PCI.展开更多
Nonalcoholic fatty liver disease(NAFLD)exhibits sexual dimorphism,with men being more exposed than women to the risk of simple steatosis,nonalcoholic steatohepatitis fibrosis,and hepatocellular carcinoma(HCC),while th...Nonalcoholic fatty liver disease(NAFLD)exhibits sexual dimorphism,with men being more exposed than women to the risk of simple steatosis,nonalcoholic steatohepatitis fibrosis,and hepatocellular carcinoma(HCC),while the protection conferred to women seemingly disappears with aging and reproductive senescence(i.e.,menopause).HCC,the most common primary liver cancer,which carries an ominous prognosis,may result from various genetic and non-genetic risk factors.NAFLD is now projected to become the most common cause of HCC.HCC also exhibits a definite sexual dimorphism in as much as it has a worldwide high male-to-female ratio.In this review article,we focus on sex differences in the epidemiological features of HCC.Moreover,we discuss sex differences in the clinical outcome and molecular pathobiology of NAFLD-HCC.By highlighting the research gaps to be filled,the aim of this review is to prompt future research of sex differences in HCC and facilitate developing personalized cancer prevention strategies,detection,and treatments to achieve better patient outcomes in NAFLD-HCC,considering sex differences in HCC pathobiology.展开更多
文摘Jones type fifth metatarsal fractures pose a challenge to the foot and ankle surgeon,given documented high nonunion rates as well as high complication rates including hardware prominence,nerve injury,and screw breakage for existing treatment modalities including screw and plantar plate fixation.We call for the design of innovative Jones-fracture specific implants which contour to the natural curve of the fifth metatarsal.Future research should aim to expand upon existing literature for Jones fracture fixation and evaluate efficacy of novel implants which are designed to address unacceptably high complication rates for existing treatment modalities.
文摘The potential clinical and economic impact of mesenchymal stem cell(MSC)therapy is immense.MSCs act through multiple pathways:(1)as“trophic”cells,secreting various factors that are immunomodulatory,anti-inflammatory,antiapoptotic,proangiogenic,proliferative,and chemoattractive;(2)in conjunction with cells native to the tissue they reside in to enhance differentiation of surrounding cells to facilitate tissue regrowth.Researchers have developed methods for the extraction and expansion of MSCs from animal and human tissues.While many sources of MSCs exist,including adipose tissue and iliac crest bone graft,compact bone(CB)MSCs have shown great potential for use in orthopaedic surgery.CB MSCs exert powerful immunomodulatory effects in addition to demonstrating excellent regenerative capacity for use in filling boney defects.CB MSCs have been shown to have enhanced response to hypoxic conditions when compared with other forms of MSCs.More work is needed to continue to characterize the potential applications for CB MSCs in orthopaedic trauma.
文摘Background Percutaneous coronary intervention(PCI)for stable ischemic heart disease(SIHD)in older adults requires a metic-ulous assessment of procedural risks and benefits,but contemporary data on outcomes in this population is lacking.Therefore,we examined the risk of near-term readmission,bleeding,and mortality in high-risk cohort of older adults undergoing inpatient PCI for SIHD.METHODS We analyzed the National Readmissions Database from 2017 to 2018 to identify index hospitalizations in which PCI was performed for SIHD.Patients were stratified into those≥75 years old(older adults)and those<75 years old.The primary outcome was 90-day readmission.Secondary outcomes included in-hospital mortality,hospital length of stay(LOS),and total hospital charge.RESULTS A total of 74,516 patients underwent inpatient PCI for SIHD,of whom 24,075 were older adults.Older adult patients had higher odds of in-hospital mortality(OR=2.00,95%CI:1.68-2.38),intracranial hemorrhage(OR=2.03,95%CI:1.24-3.34),and gastrointestinal hemorrhage(OR=1.72,95%CI:1.43-2.07)during index hospitalization,with longer LOS and in-hospital charge.Older adults also experienced a higher hazard of 90-day readmission for any cause(HR=1.61,95%CI:1.57-1.66)and car-diovascular causes(HR=1.84,95%CI:1.77-1.91).CONCLUSION Older adults undergoing inpatient PCI for SIHD were at increased risk for in-hospital mortality,periprocedural morbidities,higher cost,and readmissions compared with younger adults.Understanding these differences may improve shared decision-making for patients with SIHD being considered for PCI.
文摘Nonalcoholic fatty liver disease(NAFLD)exhibits sexual dimorphism,with men being more exposed than women to the risk of simple steatosis,nonalcoholic steatohepatitis fibrosis,and hepatocellular carcinoma(HCC),while the protection conferred to women seemingly disappears with aging and reproductive senescence(i.e.,menopause).HCC,the most common primary liver cancer,which carries an ominous prognosis,may result from various genetic and non-genetic risk factors.NAFLD is now projected to become the most common cause of HCC.HCC also exhibits a definite sexual dimorphism in as much as it has a worldwide high male-to-female ratio.In this review article,we focus on sex differences in the epidemiological features of HCC.Moreover,we discuss sex differences in the clinical outcome and molecular pathobiology of NAFLD-HCC.By highlighting the research gaps to be filled,the aim of this review is to prompt future research of sex differences in HCC and facilitate developing personalized cancer prevention strategies,detection,and treatments to achieve better patient outcomes in NAFLD-HCC,considering sex differences in HCC pathobiology.
