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  • Retrospective Studies  (31)
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  • 1
    Language: English
    In: Pediatrics, November 2006, Vol.118(5), pp.1858-63
    Description: The goals were to isolate and to estimate the genetic susceptibility to retinopathy of prematurity. A retrospective study (1994-2004) from 3 centers was performed with zygosity data for premature twins who were born at a gestational age of 〈 or = 32 weeks and survived beyond a postmenstrual age of 36 weeks. Retinopathy of prematurity was diagnosed and staged by pediatric ophthalmologists at each center. Data analyses were performed with mixed-effects logistic regression analysis and latent variable probit modeling. A total of 63 monozygotic and 137 dizygotic twin pairs were identified and analyzed. Data on gestational age, birth weight, gender, respiratory distress syndrome, retinopathy of prematurity, bronchopulmonary dysplasia, duration of ventilation and supplemental oxygen use, and length of stay were comparable between monozygotic and dizygotic twins. In the mixed-effects logistic regression analysis for retinopathy of prematurity, gestational age and duration of supplemental oxygen use were significant covariates. After controlling for known and unknown nongenetic factors, genetic factors accounted for 70.1% of the variance in liability for retinopathy of prematurity. In addition to prematurity and environmental factors, there is a strong genetic predisposition to retinopathy of prematurity.
    Keywords: Genetic Predisposition to Disease ; Retinopathy of Prematurity -- Genetics
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 2
    Language: English
    In: The Journal of Pediatrics, February 2011, Vol.158(2), pp.234-238.e1
    Description: To assess the genetic contribution to late-onset sepsis in twins in the newborn intensive care unit. A retrospective cohort analysis of twins born from 1994 to 2009 was performed on data collected from the newborn intensive care units at Yale University and the University of Connecticut. Sepsis concordance rates were compared between monozygotic and dizygotic twins. Mixed-effects logistic regression analysis was performed to determine the impact of selected nongenetic factors on late-onset sepsis. The influence of additive genetic and common and residual environmental effects were analyzed and quantified. One hundred seventy monozygotic and 665 dizygotic twin pairs were analyzed, and sepsis identified in 8.9%. Mean gestational age and birth weight of the cohort was 31.1 weeks and 1637 grams, respectively. Mixed-effects logistic regression determined birth weight (regression coefficient, −0.001; 95% CI, −0.003 to 0.000; = .028), respiratory distress syndrome (regression coefficient, 1.769; 95% CI, 0.943 to 2.596; 〈 .001), and duration of total parenteral nutrition (regression coefficient, 0.041; 95% CI, 0.017 to 0.064; 〈 .001) as significant nongenetic factors. Further analysis determined 49.0% ( = .002) of the variance in liability to late-onset sepsis was due to genetic factors alone, and 51.0% ( = .001) the result of residual environmental factors. Our data support significant genetic susceptibility to late-onset sepsis in the newborn intensive care unit population.
    Keywords: Medicine
    ISSN: 0022-3476
    E-ISSN: 1097-6833
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  • 3
    In: Clinical Orthopaedics and Related Research, 2013, Vol.471(9), pp.2899-2905
    Description: BACKGROUND: Musculoskeletal injuries are common in patients with multiple trauma resulting in pain, functional deficits, and disability. Traumatic brain injuries (TBIs) are common in severely injured patients potentially resulting in neurological impairment and permanent disability that would add to that from the musculoskeletal injuries. However, it is unclear to what degree the combination affects impairment. QUESTIONS/PURPOSES: We therefore asked whether added upper extremity injuries or TBI worsened the functional, psychological, and vocational status in multiple trauma patients. METHODS: We retrospectively reviewed 281 patients with multiple trauma: 229 with upper extremity injuries but without TBI (Group I), 32 with concomitant upper extremity injuries and TBI (Group II), and 20 with TBI but no upper extremity injuries (Group III). We assessed patients with the Glasgow Outcome Score (GOS), Hannover Score for Polytrauma Outcome, SF-12 (Physical Component Summary Score and Mental Component Summary Score), medical aid requirements, need of psychological support, and vocational living circumstances. The minimum followup was 10 years (median, 17.5 years; range, 10-28 years). RESULTS: Additional TBI in multiple trauma patients led to reduced function (GOS: Group I: 4.9 ± 0.2, Group II: 4.5 ± 0.7, Group III: 4.5 ± 0.8) resulting in vocational restrictions (job change: Group I: 74%, Group II: 91%, Group III: 90%). The combination of upper extremity and TBIs did not result in worse long-term scores compared with TBI alone. CONCLUSIONS: Rehabilitation and social reintegration in multiple trauma patients with TBI requires particular emphasis to minimize disability and vocational isolation. Musculoskeletal injuries should not be neglected to ensure the maximum extremity function given the impaired cognitive functions after TBI. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Keywords: Brain Injuries -- Patient Outcomes;
    ISSN: 0009-921X
    E-ISSN: 15281132
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  • 4
    In: Spine, 2013, Vol.38(2), pp.169-177
    Description: STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To identify early independent mortality predictors after spine trauma. SUMMARY OF BACKGROUND DATA.: Spine trauma consists of spinal cord and spine column injury. The ability to identify early (within 24 hours) risk factors predictive of mortality in spine trauma has the potential to reduce mortality and improve spine trauma management. METHODS.: Analysis was performed on 215 spine column and/or spinal cord injured patients from July 2008 to August 2011. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, mechanism of injury, blood glucose level, vital signs, brain trauma severity, morbidity before trauma, coagulation profile, neurological status, and spine injuries on the risk of in-hospital death. RESULTS.: Applying a multivariate logistic regression model, there were 7 independent early predictive factors for mortality after spine injury. They were (1) Injury Severity Score more than 15 (odds ratio [OR] = 3.67; P = 0.009), (2) abnormal coagulation profile (OR = 6; P 〈 0.0001), (3) patients 65 years or older (OR = 3.49; P = 0.007), (4) hypotension (OR = 2.9; P = 0.033), (5) tachycardia (OR = 4.04; P = 0.005), (6) hypoxia (OR = 2.9; P = 0.033), and (7) multiple comorbidities (OR = 3.49; P = 0.007). Severe traumatic brain injury was also associated with mortality but was excluded from multivariate analysis because there were no patients with this variable in the comparison group. CONCLUSION.: Mortality predictors for spine trauma patients are similar to those for general trauma patients. Spine injury variables were shown not to be independent predictors of spine trauma mortality.
    Keywords: Aged–Epidemiology ; Australia–Diagnosis ; Cause of Death–Mortality ; Comorbidity–Diagnosis ; Early Diagnosis–Mortality ; Female–Mortality ; Humans–Mortality ; Male–Mortality ; Prognosis–Mortality ; Retrospective Studies–Mortality ; Risk Factors–Mortality ; Spinal Cord Injuries–Mortality ; Spinal Injuries–Mortality ; Survival Rate–Mortality ; Time Factors–Mortality ; Trauma Severity Indices–Mortality ; Vital Signs–Mortality;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 5
    Language: English
    In: Injury, February 2013, Vol.44(2), pp.249-252
    Description: Fractures of the tibial plateau present a treatment challenge and are susceptible to both prolonged operative times and high postoperative infection rates. For those fractures treated with open plating, we sought to identify the relationship between surgical site infection and prolonged operative time as well as to identify other surgical risk factors. We performed a retrospective controlled analysis of 309 consecutive unicondylar and bicondylar tibial plateau fractures treated with open plate osteosynthesis at our institution's level I trauma centre during a recent 5-year period. We recorded operative times, injury characteristics, surgical treatment, and need for operative debridement due to infection. Operative times of infected cases were compared to uncomplicated surgical cases. Multivariable logistic regression analysis was performed to identify independent risk factors for postoperative infection. Mean operative time in the infection group was 2.8 h vs. 2.2 h in the non-infected group (p = 0.005). 15 fractures (4.9%) underwent four compartment fasciotomies as part of their treatment, with a significantly higher infection rate than those not undergoing fasciotomy (26.7% vs. 6.8%, p = 0.01). Open fracture grade was also significantly related to infection rate (closed fractures: 5.3%, grade 1: 14.3%, grade 2: 40%, grade 3: 50%, 〈 0.0001). In the bicolumnar fracture group, use of dual-incision medial and lateral plating as compared to single incision lateral locked plating had statistically similar infection rates (13.9% vs. 8.7%, = 0.36). Multivariable logistic regression analysis of the entire study group identified longer operative times (OR 1.78, = 0.013) and open fractures (OR 7.02, 〈 0.001) as independent predictors of surgical site infection. Operative times approaching 3 h and open fractures are related to an increased overall risk for surgical site infection after open plating of the tibial plateau. Dual incision approaches with bicolumnar plating do not appear to expose the patient to increased risk compared to single incision approaches.
    Keywords: Tibia ; Plateau ; Infection ; Operative Time ; Fasciotomy
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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  • 6
    Language: English
    In: Pediatrics, February 2009, Vol.123(2), pp.669-73
    Description: The most common congenital heart disease in the newborn population, patent ductus arteriosus, accounts for significant morbidity in preterm newborns. In addition to prematurity and environmental factors, we hypothesized that genetic factors play a significant role in this condition. The objective of this study was to quantify the contribution of genetic factors to the variance in liability for patent ductus arteriosus in premature newborns. A retrospective study (1991-2006) from 2 centers was performed by using zygosity data from premature twins born at 〈 or =36 weeks' gestational age and surviving beyond 36 weeks' postmenstrual age. Patent ductus arteriosus was diagnosed by echocardiography at each center. Mixed-effects logistic regression was used to assess the effect of specific covariates. Latent variable probit modeling was then performed to estimate the heritability of patent ductus arteriosus, and mixed-effects probit modeling was used to quantify the genetic component. We obtained data from 333 dizygotic twin pairs and 99 monozygotic twin pairs from 2 centers (Yale University and University of Connecticut). Data on chorioamnionitis, antenatal steroids, gestational age, body weight, gender, respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, oxygen supplementation, and bronchopulmonary dysplasia were comparable between monozygotic and dizygotic twins. We found that gestational age, respiratory distress syndrome, and institution were significant covariates for patent ductus arteriosus. After controlling for specific covariates, genetic factors or the shared environment accounted for 76.1% of the variance in liability for patent ductus arteriosus. Preterm patent ductus arteriosus is highly familial (contributed to by genetic and environmental factors), with the effect being mainly environmental, after controlling for known confounders.
    Keywords: Infant, Premature ; Ductus Arteriosus, Patent -- Genetics
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 7
    In: Journal of the International Neuropsychological Society, 2014, Vol.20(6), pp.663-671
    Description: Abstract Severe traumatic brain injury (TBI) in older age is associated with high rates of mortality. However, little is known about outcome following mild TBI (mTBI) in older age. We report on a prospective cohort study investigating 3 month outcome in older age patients admitted to hospital-based trauma services. First, 50 mTBI older age patients and 58 orthopedic controls were compared to 123 community control participants to evaluate predisposition and general trauma effects on cognition. Specific brain injury effects were subsequently evaluated by comparing the orthopedic control and mTBI groups. Both trauma groups had significantly lower performances than the community group on prospective memory ( d =0.82 to 1.18), attention set-shifting ( d =−0.61 to −0.69), and physical quality of life measures ( d =0.67 to 0.84). However, there was only a small to moderate but non-significant difference in the orthopedic control and mTBI group performances on the most demanding task of prospective memory ( d =0.37). These findings indicate that, at 3 months following mTBI, older adults are at risk of poor cognitive performance but this is substantially accounted for by predisposition to injury or general multi-system trauma. ( JINS , 2014, 20 , 1–9)
    Keywords: Research Articles; Traumatic Injury; Mild Head Injury; Older Age; Orthopedic Injury; Prospective Memory; Cognition; Neuropsychological Outcome
    ISSN: 1355-6177
    E-ISSN: 1469-7661
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  • 8
    Language: English
    In: The Annals of Thoracic Surgery, September 2015, Vol.100(3), pp.827-832
    Description: There are no data on the fate of the preserved bicuspid aortic valve (BAV) in patients with acute type A aortic dissection. We investigated surgical outcomes in BAV patients who had undergone aortic valve resuspension versus replacement for dissection type A. Among 1,500 consecutive patients operated on for acute type A dissection between 1993 and 2013 at 3 tertiary centers, 66 had BAV (68% males, median age 60 ± 15 years). Thirteen BAV resuspension patients were compared with 53 BAV replacement patients. Median follow-up was 5.0 ± 4.7 years. The ages of both groups were similar (resuspension 62 ± 13 vs replacement 57 ± 15 years,  = 0.62), and both presented similar risk-factor profiles. Moderate-to-severe aortic valve regurgitation was observed in 15% of the resuspension and 45% of the replacement patients (  = 0.06). Resuspension patients required shorter cardiopulmonary bypass and cross-clamp times (153 ± 48 vs 224 ± 76 min, 〈 0.01; 106 ± 33 vs 172 ± 57 min, 〈 0.01, respectively). In-hospital mortality was observed in 15.4% of the resuspension and 15.1% of the replacement patients (  = 1). One replacement patient underwent a proximal reoperation. The resuspension group experienced no severe aortic regurgitation, nor any need for proximal reintervention. Overall survival was 68% ± 13% vs 65% ± 7% at 5 years in resuspension and replacement groups, respectively (log- rank,  = 0.97). The BAV resuspension in type A dissection patients showed good short- and mid-term results. It is doable with acceptable results, and full root replacement is not always necessary.
    Keywords: Aorta, Thoracic ; Aortic Diseases -- Complications ; Aortic Valve -- Abnormalities ; Heart Valve Diseases -- Complications;
    ISSN: 0003-4975
    E-ISSN: 1552-6259
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  • 9
    Language: English
    In: The American Journal of Sports Medicine, July 2002, Vol.30(4), pp.607-613
    Description: Background Internal snapping hip is an underdiagnosed cause of hip pain that sidelines many recreational and competitive athletes. It originates from a taut iliopsoas tendon that snaps across bony prominences when the hip is extended from a flexed position. When nonoperative treatment methods fail, fractional tendon-lengthening procedures may be used. Hypothesis Surgical tendon lengthening through a true ilioinguinal approach, which has not been previously reported, will achieve good results in patients with internal snapping hip. Study Design Retrospective cohort study. Methods In 30 patients with symptoms in their anterior hip, internal snapping hip was diagnosed by history and physical examination. All patients were initially treated nonoperatively; 19 (63%) improved and did not require further intervention. Eleven patients (12 hips) whose symptoms were recalcitrant to physical therapy were offered the surgical option of iliopsoas tendon lengthening. The procedure was performed via an ilioinguinal intrapelvic approach. Patients were followed up for an average of 3 years. Results All 11 surgically treated patients (100%) had complete postoperative mitigation of their snapping hip. Nine (82%) reported excellent pain relief. Moreover, nine patients thought that they had greatly benefited from the tendon lengthening and would repeat the surgery. Conclusion Although nonoperative measures are usually successful in the treatment of internal snapping hip, surgical tendon lengthening is a viable approach in cases refractory to nonoperative therapy.
    Keywords: Medicine
    ISSN: 0363-5465
    E-ISSN: 1552-3365
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  • 10
    In: ANZ Journal of Surgery, March 2016, Vol.86(3), pp.167-172
    Description: Byline: Daniel T. Breen, Nuttaya Chavalertsakul, Eldho Paul, Russell L. Gruen, Jonathan Serpell Keywords: blood loss; elective; heparin; low-molecular-weight; surgical procedure; surgical; thromboembolism; warfarin Abstract Background Patients taking warfarin are often given interim anticoagulation in the perioperative period. Institutional guidelines that use low-molecular-weight heparin (LMWH) 'bridging' while the international normalized ratio (INR) is sub-therapeutic are often based on the American College of Chest Physicians Anticoagulation Guidelines. Purpose This study aims to identify if patients at a tertiary referral hospital were anticoagulated in line with these guidelines, and the incidence and nature of bleeding and thromboembolic complications. Methods A retrospective review of the Alfred Hospital General Surgical and 'Hospital at Home' databases was conducted, identifying patients who underwent elective general surgical procedures and received bridging anticoagulation with enoxaparin. Demographics, indication for anticoagulation, bleeding and thromboembolism rates were recorded. Thromboembolic risk was estimated. Results The study identified 108 patients. Three-quarters of all patients were anticoagulated with LMWH doses in accordance with the guidelines. Thirty of the 108 patients suffered bleeding complications. This group was younger, weighed less, received higher doses of enoxaparin and were at higher predicted risk of thromboembolism than non-bleeding patients. Wound haematoma, rectal bleeding and intra-abdominal bleeding were the most frequent complications. The peak time of bleeding was 3.5 days after surgery. Twelve patients returned to theatre, 13 were readmitted and 3 received blood transfusion. One patient suffered pulmonary emboli on the first post-operative day. Conclusion LMWH bridging therapy when prescribed appropriately is associated with low rates of inpatient thromboembolism in elective general surgical patients within our institution, but an unexpectedly high rate of bleeding complications. Article Note: D. T. Breen MBBS; N. Chavalertsakul MBBS; E. Paul MSc; R. L. Gruen MBBS, PhD, FRACS; J. Serpell MB, BS, MD, MEd, FRACS, FACS. This study is based on research presented at the 2012 RACS ASM.
    Keywords: Blood Loss ; Elective ; Heparin ; Low‐Molecular‐Weight ; Surgical Procedure ; Surgical ; Thromboembolism ; Warfarin
    ISSN: 1445-1433
    E-ISSN: 1445-2197
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