Mangumsnider3080
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Radial neck fracture is a less common injury in childhood and many factors are associated with the final functional outcomes. This study aimed to describe the clinical and radiological results of the patients with radial neck fractures treated surgically and assess the potential risk factors for poor functional outcomes.
This study enrolled 101 children with radial neck fracture and treated surgically at our department. Patients were followed up at least three years and assessed clinically and radiographically. The primary outcome of this study was the functional outcome assessed by using Metaizeau criteria and the secondary outcome was complications of radial head necrosis, postoperative radial nerve palsy, bone union, infection, and skin irritation. Related risk factors for unsatisfactory functional outcomes were recorded and analyzed by multivariable logistic regression.
In total, 101 patients with 101 elbows (44 on the left side, 57 on the right side) were evaluated in our study, including 55 femalecomes.
Closed reduction with intramedullary fixation is a primary treatment for type III and IV radial neck fractures in children. Fracture severity classified as Judet type IV and open surgical method were independent predictors for unsatisfactory functional outcomes.
Microcystic, elongated fragmented (MELF) pattern of myometrial invasion is a distinct histologic feature occasionally seen in low-grade endometrial carcinomas (EC). The prognostic relevance of MELF invasion was uncertain due to conflicting data, and it had not yet appropriately been studied in the context of the molecular EC classification. We aimed to determine the relation of MELF invasion with clinicopathological and molecular characteristics, and define its prognostic relevance in early-stage low/intermediate risk EC.
Single whole tumor slides of 979 (85.8%) out of 1141 (high)intermediate-risk EC of women who participated in the PORTEC-1/-2 trials were available for review. Clinicopathological and molecular features were compared between MELF invasion positive and negative cases. Time-to-event analyses were done by Kaplan-Meier method, log-rank tests and Cox' proportional hazards models.
MELF invasion was found in 128 (13.1%) cases, and associated with grade 1-2 histology, deep myometrial invasion and substantial lymph-vascular space invasion (LVSI). 85.6% of MELF invasion positive tumors were no-specific-molecular-profile (NSMP) EC. NSMP EC with MELF invasion were CTNNB1 wild type in 92.2% and KRAS mutated in 24.4% of cases. Risk of recurrence was lower for MELF invasion positive as compared to MELF invasion negative cases (4.9% vs. 12.7%, p = 0.026). However, MELF invasion had no independent impact on risk of recurrence (HR 0.65, p = 0.30) after correction for clinicopathological and molecular factors.
MELF invasion has no independent impact on risk of recurrence in early-stage EC, and is frequently observed in low-grade NSMP tumors. Routine assessment of MELF invasion has no clinical implications and is not recommended.
MELF invasion has no independent impact on risk of recurrence in early-stage EC, and is frequently observed in low-grade NSMP tumors. Routine assessment of MELF invasion has no clinical implications and is not recommended.
The aim of this study was to determine and compare fracture toughness (K
) and work of fracture (WOF) of a conventional (C) denture base, using the notchless triangular prism (NTP) specimen K
test, with CAD/CAM (milled, M) and 3D-printed (P) materials at 7d and 90d.
Lucitone 199 (C), Lucitone 199 CAD (M) and Lucitone Digital Print (P) (Dentsply, USA) were used to fabricate NTP specimens. Samples were stored in 37°C water for 7d (20/group) and 90d (20/group) and conditioned in 23°C water for 1h prior to testing. For testing, samples were secured in custom-made jigs and loaded in tension until crack arrest/failure. The maximum-recorded load was used to calculate KIC. The results were analyzed by two-way ANOVA, Scheffémultiple mean comparisons (α=0.05), independent t-tests and Weibull. WOF (in KJ/m
) was calculated by dividing the area under the load-displacement graphs by twice the corresponding crack-arrested cross sectional area of the fractured surfaces.
The results have shown that 1) the tested materials had significantly different K
(P>C>M; p<0.005) and WOF at both 7d and 90d; 2) ageing in 37ºC water for 90d resulted in a significant decrease of K
in the C and M groups (p<0.001)and of WOF in all groups.
The tested P denture base exhibited significantly higher K
and WOF, suggesting that it could be more resistant to crack propagation than the C and M materials tested. Water storage for 90 d significantly decreased K
of C and M materials and WOF of all.
The tested P denture base exhibited significantly higher KIC and WOF, suggesting that it could be more resistant to crack propagation than the C and M materials tested. Water storage for 90 d significantly decreased KIC of C and M materials and WOF of all.
To investigate the association between subfertility and risk of cardiovascular disease (CVD) outcomes.
Prospective study.
Population-based cohort.
We studied 31,629 women and 17,630 men participating in the Trøndelag Health Study.
Self-reported subfertility. As men were not directly asked about fertility, male partners of female participants were identified through linkage to the Medical Birth Registry of Norway and assigned the fertility information obtained from their partners.
The primary outcomes were stroke and coronary heart disease in women and men with and without a history of subfertility. The secondary outcomes were myocardial infarction and angina (subgroups of coronary heart disease) and any CVD (stroke or coronary heart disease). Information on CVD was available by linkage to hospital records. We used Cox proportional hazards models adjusted for age at participation in the Trøndelag Health Study (linear + squared), birth year, smoking history, cohabitation, and education. Cardiometabolassification of history of subfertility in analyses of male partners. Despite the large sample size, our results indicate the need for larger studies to obtain precise results in both sexes and determine whether there are true sex differences.
We observed modestly increased risks of CVD outcomes in women and some weak associations in men, although with no strong statistical evidence on sex differences. We acknowledge that we were only able to include men linked to pregnancies ending at 12 completed gestational weeks or later, potentially resulting in selection bias and misclassification of history of subfertility in analyses of male partners. Despite the large sample size, our results indicate the need for larger studies to obtain precise results in both sexes and determine whether there are true sex differences.Computerized classification testing (CCT) commonly chooses items maximizing information at the cut score, which yields the most information for decision-making. PKI 14-22 amide,myristoylated in vitro However, a corollary problem is that all examinees will be given the same set of items, resulting in high test overlap rate and unbalanced item bank usage, which threatens test security. Moreover, another pivotal issue for CCT is time control. Since both the extremely long response time (RT) and large RT variability across examinees intensify time-induced anxiety, it is crucial to reduce the number of examinees exceeding the time limitation and the differences between examinees' test-taking times. To satisfy these practical needs, this paper proposes the novel idea of stage adaptiveness to tailor the item selection process to the decision-making requirement in each step and generate fresh insight into the existing response time selection method. Results indicate that a balanced item usage as well as short and stable test times across examinees can be achieved via the new methods.This SERVE-HF (Treatment of Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients With Heart Failure) sub study analysis evaluated polysomnography (PSG) data in patients with heart failure with reduced ejection fraction (HFrEF) and predominant central sleep apnea (CSA) randomised to guideline-based medical therapy, with or without adaptive servo ventilation (ASV). Patients underwent full overnight PSG at baseline and at 12 months. All PSG recordings were analysed by a core laboratory. Only data for patients with baseline and 3- or 12-month values were included. The sub study included 312 patients; the number with available PSG data differed for each variable (94-103 in the control group, 77-99 in the ASV group). After 12 months, baseline-adjusted respiratory measures were significantly better in the ASV group versus control. Although some between-group differences in sleep measures were seen at 12 months (e.g., better sleep efficiency in the ASV group), these were unlikely to be clinically significant. The number of periodic leg movements during sleep (PLMS) increased in the ASV group (p = 0.039). At 12 months, the respiratory arousal index was significantly lower in the ASV versus control group (p less then 0.001), whilst the PLMS-related arousal index was significantly higher in the ASV group (p = 0.04 versus control). ASV attenuated the respiratory variables characterising sleep apnea in patients with HFrEF and predominant CSA in SERVE-HF. Sleep quality improvements during ASV therapy were small and unlikely to be clinically significant. The increase in PLMS and PLMS-related arousals during ASV warrants further investigation, particularly relating to their potential association with increased cardiovascular risk.
Adrenomedullin is a bioactive peptide with many pleiotropic effects, including mucosal healing and immunomodulation. Adrenomedullin has shown beneficial effects in rodent models of inflammatory bowel disease and, more importantly, in clinical trials including patients with ulcerative colitis. We performed a successive clinical trial to investigate the efficacy and safety of adrenomedullin in patients with Crohn's disease (CD).
This was a multicenter, double-blind, placebo-controlled phase 2a trial that evaluated 24 patients with biologic-resistant CD in Japan. Patients were randomly assigned to three groups and were given an infusion of 10 or 15ng/kg/min of adrenomedullin or placebo for 8h per day for 7days. The primary endpoint was the change in the CD activity index (CDAI) at 8weeks. The main secondary endpoints included changes in CDAI from week 4 to week 24.
No differences in the primary or secondary endpoints were observed between the three groups by the 8th week. Changes in CDAI in the placebo group gradually decreased and disappeared at 24weeks, but those in the adrenomedullin-treated groups (10 or 15ng/kg/min group) remained at steady levels for 24weeks. Therefore, a significant difference was observed between the placebo and adrenomedullin-treated groups at 24weeks (P=0.043) in the mixed-effects model. We noted mild adverse events caused by the vasodilatory effect of adrenomedullin.
In this trial, we observed a long-lasting (24weeks) decrease in CDAI in the adrenomedullin-treated groups. Adrenomedullin might be beneficial for biologic-resistant CD, but further research is needed.
In this trial, we observed a long-lasting (24 weeks) decrease in CDAI in the adrenomedullin-treated groups. Adrenomedullin might be beneficial for biologic-resistant CD, but further research is needed.
