Background: This study aims to identify the incidence and risk factors of periprosthetic infections following endoprosthetic reconstruction of femoral metastatic bone disease (MBD). In this population with MBD, the marked impact of infection on the patient’s systemic treatment highlights the importance of understanding both the incidence and associated risk factors. Methods: This retrospective cohort study included a total of 140 patients who underwent endoprosthetic reconstruction for femoral MBD at a tertiary referral hospital in South Korea between 2009 and 2019. Infection-free survival was estimated using the Kaplan-Meier method, and Cox proportional hazards model analyses were performed to evaluate the risk factors associated with periprosthetic infection. Results: The incidence of periprosthetic infection in patients who underwent endoprosthetic reconstruction for femoral MBD was 9% (12 out of 140 patients). Risk factors for periprosthetic infection were hepatocellular carcinoma (HCC) as the primary tumor (hazard ratio [HR], 6.08; 95% CI, 1.63–22.6; p = 0.007) and low preoperative absolute neutrophil count (HR, 6.99; 95% CI, 1.79–27.4; p = 0.005). Conclusions Patients with femoral MBD had a 9% risk of developing a periprosthetic infection. Given their limited life expectancy, this translated to a substantial rate of 58.9 infections per 1,000 person-joint-years. Possible risk factors for periprosthetic infection were low preoperative absolute neutrophil count and HCC as the primary tumor. The high incidence of periprosthetic infection and its associated risk factors should be considered in patients undergoing endoprosthetic reconstruction for femoral MBD.

Background: This study aims to identify the incidence and risk factors of periprosthetic infections following endoprosthetic reconstruction of femoral metastatic bone disease (MBD). In this population with MBD, the marked impact of infection on the patient’s systemic treatment highlights the importance of understanding both the incidence and associated risk factors. Methods: This retrospective cohort study included a total of 140 patients who underwent endoprosthetic reconstruction for femoral MBD at a tertiary referral hospital in South Korea between 2009 and 2019. Infection-free survival was estimated using the Kaplan-Meier method, and Cox proportional hazards model analyses were performed to evaluate the risk factors associated with periprosthetic infection. Results: The incidence of periprosthetic infection in patients who underwent endoprosthetic reconstruction for femoral MBD was 9% (12 out of 140 patients). Risk factors for periprosthetic infection were hepatocellular carcinoma (HCC) as the primary tumor (hazard ratio [HR], 6.08; 95% CI, 1.63–22.6; p = 0.007) and low preoperative absolute neutrophil count (HR, 6.99; 95% CI, 1.79–27.4; p = 0.005). Conclusions Patients with femoral MBD had a 9% risk of developing a periprosthetic infection. Given their limited life expectancy, this translated to a substantial rate of 58.9 infections per 1,000 person-joint-years. Possible risk factors for periprosthetic infection were low preoperative absolute neutrophil count and HCC as the primary tumor. The high incidence of periprosthetic infection and its associated risk factors should be considered in patients undergoing endoprosthetic reconstruction for femoral MBD.

Background: This study aims to identify the incidence and risk factors of periprosthetic infections following endoprosthetic reconstruction of femoral metastatic bone disease (MBD). In this population with MBD, the marked impact of infection on the patient’s systemic treatment highlights the importance of understanding both the incidence and associated risk factors. Methods: This retrospective cohort study included a total of 140 patients who underwent endoprosthetic reconstruction for femoral MBD at a tertiary referral hospital in South Korea between 2009 and 2019. Infection-free survival was estimated using the Kaplan-Meier method, and Cox proportional hazards model analyses were performed to evaluate the risk factors associated with periprosthetic infection. Results: The incidence of periprosthetic infection in patients who underwent endoprosthetic reconstruction for femoral MBD was 9% (12 out of 140 patients). Risk factors for periprosthetic infection were hepatocellular carcinoma (HCC) as the primary tumor (hazard ratio [HR], 6.08; 95% CI, 1.63–22.6; p = 0.007) and low preoperative absolute neutrophil count (HR, 6.99; 95% CI, 1.79–27.4; p = 0.005). Conclusions Patients with femoral MBD had a 9% risk of developing a periprosthetic infection. Given their limited life expectancy, this translated to a substantial rate of 58.9 infections per 1,000 person-joint-years. Possible risk factors for periprosthetic infection were low preoperative absolute neutrophil count and HCC as the primary tumor. The high incidence of periprosthetic infection and its associated risk factors should be considered in patients undergoing endoprosthetic reconstruction for femoral MBD.

Background: This study aims to identify the incidence and risk factors of periprosthetic infections following endoprosthetic reconstruction of femoral metastatic bone disease (MBD). In this population with MBD, the marked impact of infection on the patient’s systemic treatment highlights the importance of understanding both the incidence and associated risk factors. Methods: This retrospective cohort study included a total of 140 patients who underwent endoprosthetic reconstruction for femoral MBD at a tertiary referral hospital in South Korea between 2009 and 2019. Infection-free survival was estimated using the Kaplan-Meier method, and Cox proportional hazards model analyses were performed to evaluate the risk factors associated with periprosthetic infection. Results: The incidence of periprosthetic infection in patients who underwent endoprosthetic reconstruction for femoral MBD was 9% (12 out of 140 patients). Risk factors for periprosthetic infection were hepatocellular carcinoma (HCC) as the primary tumor (hazard ratio [HR], 6.08; 95% CI, 1.63–22.6; p = 0.007) and low preoperative absolute neutrophil count (HR, 6.99; 95% CI, 1.79–27.4; p = 0.005). Conclusions Patients with femoral MBD had a 9% risk of developing a periprosthetic infection. Given their limited life expectancy, this translated to a substantial rate of 58.9 infections per 1,000 person-joint-years. Possible risk factors for periprosthetic infection were low preoperative absolute neutrophil count and HCC as the primary tumor. The high incidence of periprosthetic infection and its associated risk factors should be considered in patients undergoing endoprosthetic reconstruction for femoral MBD.

Background: and Purpose The influence of imaging features of brain frailty on outcomes were investigated in acute ischemic stroke patients with minor symptoms and large-vessel occlusion (LVO). Methods: This was a retrospective analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute (within 24 h) minor (National Institutes of Health Stroke Scale score=0–5) ischemic stroke with anterior circulation LVO (acute minor LVO). Brain frailty was stratified according to the presence of an advanced white-matter hyperintensity (WMH) (Fazekas grade 2 or 3), silent/old brain infarct, or cerebral microbleeds. The primary outcome was a composite of stroke, myocardial infarction, and all-cause mortality within 1 year. Results: In total, 1,067 patients (age=67.2±13.1 years [mean±SD], 61.3% males) were analyzed. The proportions of patients according to the numbers of brain frailty burdens were as follows: no burden in 49.2%, one burden in 30.0%, two burdens in 17.3%, and three burdens in 3.5%. In the Cox proportional-hazards analysis, the presence of more brain frailty burdens was associated with a higher risk of 1-year primary outcomes, but after adjusting for clinically relevant variables there were no significant associations between burdens of brain frailty and 1-year vascular outcomes. For individual components of brain frailty, an advanced WMH was independently associated with an increased risk of 1-year primary outcomes (adjusted hazard ratio [aHR]=1.33, 95% confidence interval [CI]=1.03–1.71) and stroke (aHR=1.32, 95% CI=1.00–1.75). Conclusions The baseline imaging markers of brain frailty were common in acute minor ischemic stroke patients with LVO. An advanced WMH was the only frailty marker associated with an increased risk of vascular events. Further research is needed into the association between brain frailty and prognosis in patients with acute minor LVO.

Background: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. Methods: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. Results: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI;additionally, age (65–74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. Conclusions Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.

BACKGROUND: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited microangiopathy that is caused by mutations in the Notch3 gene. Typical findings from magnetic resonance imaging (MRI) include multiple subcortical lacunae, extensive white-matter change, and multiple cerebral microbleeds (CMBs). CMBs are indicative of bleeding-prone microangiopathy. The rate of intracerebral hemorrhage in CADASIL is higher in Asian patients than in Caucasian patients. However, CMBs have not been thoroughly evaluated in Asian patients. We performed a detailed analysis of the frequency and distribution pattern of CMBs and assessed whether vascular risk factors exert an independent effect on CMBs in Asian CADASIL patients. METHODS: The study population comprised 60 patients who underwent brain MRI, including T2*-weighted gradient-echo sequences. Demographic factors, vascular risk factors, and MRI findings were compared between CADASIL patients with and without CMBs. The impact of vascular risk factors on CMBs, lacunae, and white-matter hyperintensities (WMHs) was assessed by logistic regression analysis. RESULTS: CMBs, which were detected in 34 (56.7%) patients, exhibited a significant predilection for the thalamus (46.7%), subcortical-cortical region (35.0%), and basal ganglia (31.7%). Hypertension, lacunae, and white-matter lesions were more common in patients with CMBs. Hypertension was an independent risk factor for CMBs, lacunae, and WMHs in patients with CADASIL. CONCLUSIONS: This study found that CMBs tended to occur in hypertensive patients with CADASIL. Further studies should focus on elucidating the association between reduced blood pressure and the number of CMBs.
Asian Continental Ancestry Group ; Basal Ganglia ; Blood Pressure ; Brain ; CADASIL* ; Cerebral Hemorrhage ; Demography ; Humans ; Hypertension* ; Leukoencephalopathies ; Logistic Models ; Magnetic Resonance Imaging ; Risk Factors ; Thalamus