Risultati per: Terapia del dolore da osteo-artropatie degenerative

Circulation, Volume 150, Issue Suppl_1, Page A4146218-A4146218, November 12, 2024. Background:Despite the increasing prevalence of degenerative valvular heart disease (VHD), recommended preventive interventions are notably lacking. The cardiovascular-kidney-metabolic (CKM) health approach advocates for multidisciplinary early-stage disease prevention. We aimed to explore sex differences in CKM risk factors associated with VHD.Methods:Using data from UK Biobank, participants without a history of VHD or heart failure at baseline were included. We assessed the sex differences in hazard ratios (HRs) and population-attributable risk (PAR) for incident aortic valve stenosis (AS), aortic valve regurgitation (AR), and mitral valve regurgitation (MR) associated with five CKM risk factors: hypertension, diabetes, obesity, high lipoprotein(a), and chronic kidney disease (CKD).Results:Among 463,496 participants (54.4% women), AS, AR, and MR cases were observed at incidence of 1.05 and 0.52, 0.37 and 0.22, 1.04 and 0.70 events per 1000 person-years for men and women, respectively. Hypertension consistently accounted for the largest attributable risk factor for incident VHD in both sexes, with PARs of 29.96% and 26.61% for AS, 23.51% and 16.02% for AR, and 17.56% and 13.09% for MR in women and men, respectively. Compared to men, obesity, CKD, and hypertension were associated with higher risks of AS, AR, and MR in women (women-to-men ratios of HRs: 1.11[1.09–1.36], 1.62[1.01–2.63], and 1.27[1.09–1.49], respectively).Conclusions:This study offers comprehensive insights into the profiles of CKM risk factors for degenerative VHD among middle-aged individuals. Tailoring the prioritization of risk factors based on gender has the potential to improve the precision and effectiveness of VHD prevention strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4146669-A4146669, November 12, 2024. Background:In advanced severe degenerative mitral regurgitation (asDMR, i.e., C2 to D stage DMR), an overt deterioration of the mitral valve (MV) apparatus and left ventricular (LV) enlargement are typically observed. The negative impacts of a mismatch between the left ventricular end-systolic dimension (LVESD) and MV ring size on mitral regurgitation (MR) recurrence have been established in secondary MR, while its impacts on asDMR prognosis remains unknown.Hypothesis:LVESD/MV ring size ratio may impact on asDMR prognosis.Goals:To verify the impact and to reveal its side effects.Methods:We retrospectively analyzed patients diagnosed with asDMR who underwent mitral valve repair and annuloplasty from 2008 to 2019. Patients were followed up to April 2024. Primary outcomes included 10-year moderate or severe mitral stenosis (MS), recurrent MR, and death. Prosthetic orifice areas (POA) were obtained from official instructions. LVESD/POA was introduced as a novel parameter to identify LV-MV mismatch and non-mismatch.Results:A total of 450 eligible patients were enrolled. During the follow-up of 5.8 ± 2.3 years, 60 recurrent MRs, 71 MSs, and 46 deaths were observed. At 3rd, 5th, and 10th years after surgery, rates of freedom from recurrent MR were 98.1%, 92.4%, and 65.4%, respectively; rates of freedom from MS rates were 99.0%, 94.9%, and 59.4%, respectively; survival rates were 97.8%, 94.9%, and 69.6%, respectively. In multivariable Cox regression analysis, only a larger LVESD/POA ratio (HR: 3.50; 95% CI: 1.98-6.16; p < 0.001) was associated with recurrent MR. ROC curve determined an optimal LVESD/POA cutoff value of 11.52 mm/m2(AUC = 0.88, p < 0.001) for recurrent MR prediction. In subgroup analysis, mismatch group (LVESD/POA > 11.52 mm/m2) had higher cumulative recurrent MR rate (log-rank p < 0.001), MS rate (log-rank p < 0.001), and survival rate (log-rank p < 0.001). In mismatch group, ring cohort exhibited higher cumulative MS rate (log-rank p = 0.027) and higher cumulative recurrent MR rate (log-rank p = 0.013). However, in the non-mismatch group, the cumulative MS and MR rates were comparable between the ring and band cohorts (log-rank p = 0.53).Conclusion:LV-MV mismatch annuloplasty increases the risks of recurrent MR, MS, and death. LVESD/POA ratio effectively predicts recurrent MR in asDMR. In patients with significant LV dilation, a posterior band may be preferable to a complete ring for downsized annuloplasty.

Tumore del sangue che in Italia colpisce 860 persone ogni anno

Studio: è utile non solo per prevenire. Ma attenti agli infortuni

I risultati del progetto Iss “Veterani in Sella”

I risultati del progetto Iss “Veterani in Sella”

Endocrinologi, troppi timori, non si spiegano bene i vantaggi

Introduction
Degenerative lumbar spinal stenosis is a common cause of low back or leg pain and disability in the elderly population. Patients with spinal stenosis who fail to respond to conservative treatment often require surgical interventions. Minimally invasive transforaminal lumbar interbody fusion (TLIF) with microscopic tubular technique (MT-TLIF) is a well-established procedure for lumbar spinal stenosis. Recently, a novel MIS technique, unilateral biportal endoscopic TLIF (UBE-TLIF), has been frequently performed to treat spinal stenosis. However, the efficacy and safety of using UBE-TLIF in this population have not been well examined.

Methods and analysis
A total of 96 patients with lumbar spinal stenosis will be randomly assigned to the UBE-TLIF group or the MT-TLIF group at a 1:1 ratio to receive UBE-TLIF or MT-TLIF treatment respectively. The primary outcome is the Oswestry Disability Index (ODI) score at 1 year after receiving the surgery. Secondary outcomes include the ODI scores at additional time points, Visual Analogue Scale score, 36-Item Short Form Survey questionnaire, EuroQol 5 Dimensions questionnaire, radiological measurements (disc height, lumbar lordosis angles and vertebral fusion rate) and general condition during hospitalisation.

Ethics and dissemination
This protocol is approved by the Medical Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University. All participants of the study will be well informed and written informed consent will be requested. Findings from this trial will be published in peer-reviewed publications, specifically in orthopedic and spinal journals. The completion of this study will not only examine the use of UBE-TLIF in lumbar spinal stenosis but also provide helpful clinical references.

Trial registration number
ChiCTR2300069333.

In aumento, un terzo dei pazienti riceve diagnosi dopo 5 anni