Purpose: Periprosthetic joint infections (PJIs) resulting from total hip arthroplasty (THA) pose significant challenges. Partial two-stage exchange arthroplasty (TSEA) retains either the femoral stem or acetabular cup by preserving bone stock and soft tissue and offers a potential alternative to total TSEA. Our meta-analysis evaluated the pooled success rate of partial TSEA in treating late chronic PJIs in THA. Our study also focused on the outcomes associated with retained prosthetic implant (stem or cup) and the type of prior surgery (primary vs. revision arthroplasty) performed. Materials and Methods: We analyzed data from 355 hips of patients with PJI following THA across 11 studies using a random-effects model to estimate the success rate of partial TSEA and spacer dislocation that occurs during the interval between the first and second stages of partial TSEA. The heterogeneity between the subgroups was also calculated. Results: The overall pooled success rate of partial TSEA in the study cohort was 87% (95% confidence interval [CI] 83-91).Lacking statistical significance (P=0.904), the success rates were 88% for stem-retained and 90% for cup-retained implant cases. The partial TSEA success rates were 88% for primary arthroplasty and 80% for revision arthroplasty, although this was not statistically significant (P=0.193). Spacer dislocation occurred in only 5% of the cases (95% CI 1-9). Conclusion Partial TSEA achieves high success rates comparable to those of total TSEA. Although revision arthroplasty cases carry a high risk of recurrence, partial TSEA remains a viable, tailored treatment option with a low complication rate.

Background: Posterior spinal fusion is performed for severe adolescent idiopathic scoliosis (AIS), with bone graft playing a critical role in achieving solid fusion. Iliac crest bone graft (ICBG) is the gold standard but has donor site morbidity, leading to increased use of non-ICBG. This study compared the effectiveness and safety of ICBG and non-ICBG bone grafts in AIS. Methods: This meta-analysis included 23 studies with 3,350 patients, categorized into ICBG and non-ICBG groups. The primary outcome was fusion rate; secondary outcomes were implant-related complication rate, infection rate, donor site pain, blood loss, and operation time. A proportion meta-analysis was conducted to estimate binary outcomes, and a weighted mean model was used to estimate continuous variables. Results: The fusion rate was 97% (95% confidence interval [CI], 93-99) in ICBG group and 97% (95% CI, 95-98) in non-ICBG group. Implant-related complications occurred in 5% (95% CI, 3-7) and 4% (95% CI, 2-6) of each group, while surgical site infections occurred in 3% (95% CI, 2-7) and 2% (95% CI, 1-3). Donor site pain was observed exclusively in ICBG group, with a prevalence of 49% (95% CI, 3–97). Estimated pooled blood loss was 1,461.10 mL (95% CI, 545.30-2,376.90) in ICBG group and 1,047.45 mL (95% CI, 666.92-1,427.99) in non-ICBG group. The estimated pooled operation time was 246.77 (95% CI, 221.74-271.80) and 232.37 (95% CI, 194.88-269.86) for each group. Conclusions Considering both ICBG and non-ICBG demonstrated high fusion rates and low complication rates, non-ICBG grafts may serve as an effective and safe alternative to ICBG, minimizing morbidity, donor site pain, and blood loss.

Background: Enavogliflozin is a novel sodium-glucose cotransporter-2 inhibitor currently under clinical development. This study evaluated the efficacy and safety of enavogliflozin as an add-on to metformin in Korean patients with type 2 diabetes mellitus (T2DM) against dapagliflozin. Methods: In this multicenter, double-blind, randomized, phase 3 study, 200 patients were randomized to receive enavogliflozin 0.3 mg/day (n=101) or dapagliflozin 10 mg/day (n=99) in addition to ongoing metformin therapy for 24 weeks. The primary objective of the study was to prove the non-inferiority of enavogliflozin to dapagliflozin in glycosylated hemoglobin (HbA1c) change at week 24 (non-inferiority margin of 0.35%) (Clinical trial registration number: NCT04634500). Results: Adjusted mean change of HbA1c at week 24 was –0.80% with enavogliflozin and –0.75% with dapagliflozin (difference, –0.04%; 95% confidence interval, –0.21% to 0.12%). Percentages of patients achieving HbA1c <7.0% were 61% and 62%, respectively. Adjusted mean change of fasting plasma glucose at week 24 was –32.53 and –29.14 mg/dL. An increase in urine glucose-creatinine ratio (60.48 vs. 44.94, P<0.0001) and decrease in homeostasis model assessment of insulin resistance (–1.85 vs. –1.31, P=0.0041) were significantly greater with enavogliflozin than dapagliflozin at week 24. Beneficial effects of enavogliflozin on body weight (–3.77 kg vs. –3.58 kg) and blood pressure (systolic/diastolic, –5.93/–5.41 mm Hg vs. –6.57/–4.26 mm Hg) were comparable with those of dapagliflozin, and both drugs were safe and well-tolerated. Conclusion Enavogliflozin added to metformin significantly improved glycemic control in patients with T2DM and was non-inferior to dapagliflozin 10 mg, suggesting enavogliflozin as a viable treatment option for patients with inadequate glycemic control on metformin alone.

Purpose: Erlotinib has been the only targeted agent to show significantly improved outcomes in pancreatic adenocarcinoma when combined with gemcitabine. We aimed to evaluate whether the addition of oxaliplatin to a combination gemcitabine/erlotinib treatment conferred a clinical benefit in patients with locally advanced unresectable or metastatic pancreatic cancer. Materials and Methods: Chemotherapy-naïve patients with locally advanced or metastatic pancreatic cancer were randomly assigned to receive GEMOX-T [gemcitabine 1000 mg/m2 and oxaliplatin 50 mg/m2 on day 1 (D1) and D8 plus erlotinib 100 mg daily for 3 weeks] or GT (gemcitabine 1000 mg/m2 on D1 and D8 plus erlotinib 100 mg daily for 3 weeks). The primary endpoint was the overall response rate (ORR). Results: Between 2013 and 2016, 65 patients were assigned to a treatment group (33 in the GEMOX-T arm, 32 in the GT arm). The ORR was 18.2% [95% confidence interval (CI), 8.82–27.58] in the GEMOX-T arm and 6.2% (95% CI, 0.34–12.06) in the GT arm (p=0.051). The disease control rate was significantly superior in the GEMOX-T arm compared to the GT arm (72.7% vs. 43.8%, p=0.019). After a median follow-up of 19.7 months, the median progression-free survival (PFS) was 3.9 months for the GEMOX-T arm and 1.4 months for the GT arm (p=0.033). However, this did not translate to an improvement in overall survival. The most common grade 3 or higher hematologic adverse events were neutropenia (16.9%) and anemia (13.8%). Conclusion The addition of oxaliplatin to a first-line gemcitabine/erlotinib regimen demonstrated higher response rates and significantly improved PFS in patients with locally advanced or metastatic pancreatic cancer.

Purpose: Erlotinib has been the only targeted agent to show significantly improved outcomes in pancreatic adenocarcinoma when combined with gemcitabine. We aimed to evaluate whether the addition of oxaliplatin to a combination gemcitabine/erlotinib treatment conferred a clinical benefit in patients with locally advanced unresectable or metastatic pancreatic cancer. Materials and Methods: Chemotherapy-naïve patients with locally advanced or metastatic pancreatic cancer were randomly assigned to receive GEMOX-T [gemcitabine 1000 mg/m2 and oxaliplatin 50 mg/m2 on day 1 (D1) and D8 plus erlotinib 100 mg daily for 3 weeks] or GT (gemcitabine 1000 mg/m2 on D1 and D8 plus erlotinib 100 mg daily for 3 weeks). The primary endpoint was the overall response rate (ORR). Results: Between 2013 and 2016, 65 patients were assigned to a treatment group (33 in the GEMOX-T arm, 32 in the GT arm). The ORR was 18.2% [95% confidence interval (CI), 8.82–27.58] in the GEMOX-T arm and 6.2% (95% CI, 0.34–12.06) in the GT arm (p=0.051). The disease control rate was significantly superior in the GEMOX-T arm compared to the GT arm (72.7% vs. 43.8%, p=0.019). After a median follow-up of 19.7 months, the median progression-free survival (PFS) was 3.9 months for the GEMOX-T arm and 1.4 months for the GT arm (p=0.033). However, this did not translate to an improvement in overall survival. The most common grade 3 or higher hematologic adverse events were neutropenia (16.9%) and anemia (13.8%). Conclusion The addition of oxaliplatin to a first-line gemcitabine/erlotinib regimen demonstrated higher response rates and significantly improved PFS in patients with locally advanced or metastatic pancreatic cancer.

Background and Objectives: The relationship between the hospital percutaneous coronary intervention (PCI) volumes and the in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) remains the subject of debate. This study aimed to determine whether the in-hospital clinical outcomes of patients with AMI in Korea are significantly associated with hospital PCI volumes. Methods: We selected and analyzed 17,121 cases of AMI, that is, 8,839 cases of non-ST-segment elevation myocardial infarction and 8,282 cases of ST-segment elevation myocardial infarction, enrolled in the 2014 Korean percutaneous coronary intervention (K-PCI) registry. Patients were divided into 2 groups according to hospital annual PCI volume, that is, to a high-volume group (≥400/year) or a low-volume group (<400/year). Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as composites of death, cardiac death, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and need for urgent PCI during index admission after PCI. Results: Rates of MACCE and non-fatal MI were higher in the low-volume group than in the high-volume group (MACCE: 10.9% vs. 8.6%, p=0.001; non-fatal MI: 4.8% vs. 2.6%, p=0.001, respectively). Multivariate regression analysis showed PCI volume did not independently predict MACCE. Conclusions Hospital PCI volume was not found to be an independent predictor of in-hospital clinical outcomes in patients with AMI included in the 2014 K-PCI registry.

BACKGROUND AND PURPOSE: Thrombectomy within 24 hours can improve outcomes in selected patients with a clinical-infarct mismatch. We devised an easy-to-use visual estimation tool that allows infarct volume estimation in centers with limited resources. METHODS: We identified 1,031 patients with cardioembolic or large-artery atherosclerosis infarction on diffusion-weighted images (DWIs) obtained before recanalization therapy and within 24 hours of onset, and occlusion of the internal carotid or middle cerebral artery. Acute DWIs were mapped onto a standard template and used to create visual reference maps with known lesion volumes, which were then used in a validation study (with 130 cases) against software estimates of infarct volume. RESULTS: The DWI reference map chart comprises 144 maps corresponding to 12 different infarct volumes (0.5, 1, 2, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mL) in each of 12 template slices (Montreal Neurological Institute z-axis –15 to 51 mm). Infarct volume in a patient is estimated by selecting a slice with a similar infarct size at the corresponding z-axis level on the reference maps and then adding up over all slices. The method yielded good correlations to software volumetrics and was easily learned by both experienced and junior physicians, with approximately 1 to 2 minutes spent per case. The sensitivity, specificity, and accuracy for detecting threshold infarct volumes ( < 21, < 31, and < 51 mL) were very high (all about >90%). CONCLUSIONS: We developed easy-to-use reference maps that allow prompt and reliable visual estimation of infarct volumes for triaging patients to thrombectomy in acute stroke.
Atherosclerosis ; Cerebral Infarction ; Decision Making ; Diffusion Magnetic Resonance Imaging ; Humans ; Infarction ; Medical Staff, Hospital ; Methods ; Middle Cerebral Artery ; Sensitivity and Specificity ; Stroke ; Thrombectomy

No abstract available.
Thrombectomy*

No abstract available.
Intracranial Hemorrhages* ; Stroke*

Acute limb ischemia (ALI) is a serious condition requiring prompt intervention due to a sudden decrease in limb perfusion threatening limb viability. Treatment of ALI depends on the clinical status of the affected limb and patient comorbidities. Surgical therapy has been the historical standard of care for restoring limb perfusion; however, percutaneous endovascular intervention has been shown to be a promising treatment option in selected patients of ALI at high surgical risk. We report on a case of a 75-year-old man with ALI caused by thrombotic occlusion of the suprainguinal artery, successfully treated with endovascular therapy including stent insertion and thrombus aspiration and catheter-directed urokinase infusion in view of the clinical findings and imaging studies.
Aged ; Arteries* ; Comorbidity ; Endovascular Procedures ; Extremities* ; Humans ; Ischemia* ; Lower Extremity ; Perfusion ; Standard of Care ; Stents ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator