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Sarcoma 2024Ewing sarcoma (EwS) is a rare and highly malignant bone tumor primarily affecting children, adolescents, and young adults. The pelvis, trunk, and lower extremities are...
BACKGROUND
Ewing sarcoma (EwS) is a rare and highly malignant bone tumor primarily affecting children, adolescents, and young adults. The pelvis, trunk, and lower extremities are the most common sites, while EwS of the sacrum as a primary site is very rare, and only few studies focusing on this location are published. Due to the anatomical condition, local treatment is challenging in sacral malignancies. We analyzed factors that might influence the outcome of patients suffering from sacral EwS.
METHODS
We retrospectively analyzed data of the GPOH EURO-E.W.I.N.G 99 trial and the EWING 2008 trial, with a cohort of 124 patients with localized or metastatic sacral EwS. The study endpoints were overall survival (OS) and event-free survival (EFS). OS and EFS were calculated using the Kaplan-Meier method, and univariate comparisons were estimated using the log-rank test. Hazard ratios (HRs) with respective 95% confidence intervals (CIs) were estimated in a multivariable Cox regression model.
RESULTS
The presence of metastases (3y-EFS: 0.33 vs. 0.68; < 0.001; HR = 3.4, 95% CI 1.7 to 6.6; 3y-OS: 0.48 vs. 0.85; < 0.001; HR = 4.23, 95% CI 1.8 to 9.7), large tumor volume (≥200 ml) (3y-EFS: 0.36 vs. 0.69; =0.02; HR = 2.1, 95% CI 1.1 to 4.0; 3y-OS: 0.42 vs. 0.73; =0.04; HR = 2.1, 95% CI 1.03 to 4.5), and age ≥18 years (3y-EFS: 0.41 vs. 0.60; =0.02; HR = 2.6, 95% CI 1.3 to 5.2; 3y-OS: 0.294 vs. 0.59; =0.01; HR = 2.92, 95% CI 1.29 to 6.6) were revealed as adverse prognostic factors.
CONCLUSION
Young age seems to positively influence patients` survival, especially in patients with primary metastatic disease. In this context, our results support other studies, stating that older age has a negative impact on survival. Tumor volume, metastases, and the type of local therapy modality have an impact on the outcome of sacral EwS. Level of evidence: Level 2. This trial is registered with NCT00020566 and NCT00987636.
PubMed: 38524902
DOI: 10.1155/2024/4751914 -
Asian Journal of Surgery Jun 2024
Topics: Humans; Chordoma; Sacrococcygeal Region; Spinal Neoplasms; Male; Female; Treatment Outcome; Middle Aged
PubMed: 38519318
DOI: 10.1016/j.asjsur.2024.03.018 -
Intensive & Critical Care Nursing Aug 2024The Braden scale, one of the most widely used risk assessment tools is often criticized when used in the Intensive Care Unit. Most patients in the Intensive Care Unit... (Observational Study)
Observational Study
BACKGROUND
The Braden scale, one of the most widely used risk assessment tools is often criticized when used in the Intensive Care Unit. Most patients in the Intensive Care Unit are at risk of pressure ulcer development meaning that the Braden score will usually indicate high risk for these patients. This study set out to determine the correlation between Sub-Epidermal Moisture measurements and Braden scores among Intensive Care Unit patients.
METHODS
This study employed an observational research design. Braden score was assessed on all study days (1-5), in addition to visual skin assessment and Sub-Epidermal Moisture measurements at the sacrum and heels. Sub-Epidermal Moisture measurements were categorised as low (<0.5), borderline abnormal (≥0.5), and high (≥0.8). Correlation was assessed between Sub-Epidermal Moisture levels and Braden scores.
RESULTS
A total of 53 participants were recruited. The median (interquartile range) baseline Braden score was 9 (9-10) and 81 % (n = 43) of participants were at very high/high risk of pressure ulcer development. Braden scores remained relatively constant over time with little fluctuation in scores. 19 % (n = 10) of patients had normal (<0.5) Sub-Epidermal Moisture delta measurements on enrolment, and all developed abnormal measurements by day 2. There were no significant correlations between Braden scores and Sub-Epidermal Moisture measurements.
CONCLUSION
Although this was not its original intention, a missing link with the Braden scale is that it does not provide information on how patients are responding to the adverse effects of pressure and shear forces. Furthermore, in patients who are critically unwell, most patients are classified as being "at risk" of pressure ulcer development. Therefore, an objective measure of how patients are responding to pressure and shear forces at different anatomical areas is needed.
IMPLICATIONS TO CLINICAL PRACTICE
Sub-Epidermal Moisture measurements can offer more information, not only on identifying those who are at risk, but also how those patients are tolerating this risk at different anatomical sites.
Topics: Humans; Pressure Ulcer; Intensive Care Units; Male; Female; Risk Assessment; Middle Aged; Aged; Risk Factors; Adult
PubMed: 38518456
DOI: 10.1016/j.iccn.2024.103681 -
North American Spine Society Journal Mar 2024The treatment of spine metastases continues to pose a significant clinical challenge, requiring the integration of multiple therapeutic modalities to address the... (Review)
Review
Combination radiofrequency ablation and vertebral cement augmentation for spinal metastatic tumors: A systematic review and meta-analysis of safety and treatment outcomes.
BACKGROUND
The treatment of spine metastases continues to pose a significant clinical challenge, requiring the integration of multiple therapeutic modalities to address the multifactorial aspects of this disease process. Radiofrequency ablation (RFA) and vertebral cement augmentation (VCA) are 2 less invasive modalities compared to open surgery that have emerged as promising strategies, offering the potential for both pain relief and preservation of vertebral stability. The utility of these approaches, however, remains uncertain and subject to ongoing investigation.This systematic review and meta-analysis evaluates the available evidence and synthesize the results of studies that have investigated the combination of RFA and VCA for the treatment of spinal metastases, with the goal of providing a comprehensive and up-to-date assessment of the efficacy and safety of this therapeutic approach.
METHODS
A literature search was conducted using the electronic databases PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus from their inception to May 4th, 2022 in accordance with PRISMA guidelines. Studies were included if they met the following criteria: 1) spine metastases treated with RFA in combination with VCA, 2) available data on at least one outcome (i.e., pain palliation, complications, local tumor control), 3) prospective or retrospective studies with at least 10 patients, and 4) English language. Meta-analyses were conducted in R (R Foundation for Statistical Computing; Vienna, Austria), using the package.
RESULTS
In the 25 included studies, a total of 947 patients (females=53.9%) underwent RFA + VCA for spinal metastatic tumors. Out of 1,163 metastatic lesions, the majority were located in the lumbar region (585/1,163 [50.3%]) followed by thoracic (519/1,163 [44.6%]), sacrum (39/1,163 [3.4%]), and cervical (2/1,163 [0.2%]). 48/72 [66.7%] metastatic lesions expanded into the posterior elements. Preoperative pathologic vertebral fractures were identified in 115/176 [65.3%] patients. Between pre-procedure pain scores and postprocedure pain scores, average follow-up (FU) was 4.41±2.87 months. Pain scores improved significantly at a short-term FU (1-6 months), with a pooled mean difference (MD) from baseline of 4.82 (95% CI, 4.48-5.16). The overall local tumor progression (LTP) rate at short-term FU (1-6 months) was 5% (95% CI, 1%-8%), at mid-term FU (6-12 months) was 22% (95% CI, 0%-48%), and at long-term FU (>12 months) was 5% (95% CI, 0%-11%). The pooled incidence of total complications was 1% (95% CI, 0%-1%), the most frequent of which were transient radicular pain and asymptomatic cement extravasation.
CONCLUSIONS
The findings of this meta-analysis reveal that the implementation of RFA in conjunction with VCA for the treatment of spinal metastatic tumors resulted in a significant short-term reduction of pain, with minimal total complications. The LTP rate was additionally low. The clinical efficacy and safety of this technique are established, although further exploration of the long-term outcomes of RFA+VCA is warranted.
PubMed: 38510810
DOI: 10.1016/j.xnsj.2024.100317 -
Journal of Orthopaedic Surgery and... Mar 2024When needed operative treatment of sacral fractures is mostly performed with percutaneous iliosacral screw fixation. The advantage of navigation in insertion of pedicle...
INTRODUCTION
When needed operative treatment of sacral fractures is mostly performed with percutaneous iliosacral screw fixation. The advantage of navigation in insertion of pedicle screws already could be shown by former investigations. The aim of this investigation was now to analyze which influence iliosacral screw placement guided by navigation has on duration of surgery, radiation exposure and accuracy of screw placement compared to the technique guided by fluoroscopy.
METHODS
68 Consecutive patients with sacral fractures who have been treated by iliosacral screws were inclouded. Overall, 85 screws have been implanted in these patients. Beside of demographic data the duration of surgery, duration of radiation, dose of radiation and accuracy of screw placement were analyzed.
RESULTS
When iliosacral screw placement was guided by navigation instead of fluoroscopy the dose of radiation per inserted screw (155.0 cGy*cm vs. 469.4 cGy*cm p < 0.0001) as well as the duration of radiation use (84.8 s vs. 147.5 s p < 0.0001) were significantly lower. The use of navigation lead to a significant reduction of duration of surgery (39.0 min vs. 60.1 min p < 0.01). The placement of the screws showed a significantly higher accuracy when performed by navigation (0 misplaced screws vs 6 misplaced screws-p < 0.0001).
CONCLUSION
Based on these results minimal invasive iliosacral screw placement guided by navigation seems to be a safe procedure, which leads to a reduced exposure to radiation for the patient and the surgeon, a reduced duration of surgery as well as a higher accuracy of screw placement.
Topics: Humans; Ilium; Sacrum; Surgery, Computer-Assisted; Fracture Fixation, Internal; Spinal Fractures; Pedicle Screws; Fluoroscopy; Fractures, Bone
PubMed: 38491520
DOI: 10.1186/s13018-024-04669-0 -
Asian Journal of Surgery Jul 2024
Topics: Humans; Chordoma; Sacrum; Liver Neoplasms; Spinal Neoplasms; Male; Female; Middle Aged
PubMed: 38490868
DOI: 10.1016/j.asjsur.2024.03.042 -
Cureus Feb 2024Microinvasive squamous cell carcinoma of the cervix develops mainly in young women. As metastases rarely occur, cervical conization to preserve fertility is often...
Microinvasive squamous cell carcinoma of the cervix develops mainly in young women. As metastases rarely occur, cervical conization to preserve fertility is often performed. We report a case of peritoneal recurrence developed after conization. A 31-year-old nulligravid woman with microinvasive squamous cell carcinoma of the cervix was treated with laser conization. Pathology showed a stromal invasion of <1 mm and a longitudinal spread of 3 mm without lymphovascular space involvement. Forty-seven months after conization, a pelvic examination revealed a firm, immobile mass on the right side of the pelvis. Transvaginal ultrasonography and magnetic resonance imaging showed a 3.8-cm solid mass located right of the rectum and anterior to the sacrum. A fine-needle biopsy showed squamous cell carcinoma. The tumor was diagnosed as a metastasis of cervical carcinoma. After salvage concurrent chemoradiation, the patient was well and had no evidence of disease at 90 months after the treatment. In this case, tumor cells appear to spread through the endometrial cavity and the lumen of the fallopian tube.
PubMed: 38487119
DOI: 10.7759/cureus.54091 -
Frontiers in Bioengineering and... 2024Musculoskeletal multibody models of the spine can be used to investigate the biomechanical behaviour of the spine. In this context, a correct characterisation of the...
Musculoskeletal multibody models of the spine can be used to investigate the biomechanical behaviour of the spine. In this context, a correct characterisation of the passive mechanical properties of the intervertebral joint is crucial. The intervertebral joint stiffness, in particular, is typically derived from the literature, and the differences between individuals and spine levels are often disregarded. This study tested if an optimisation method of personalising the intervertebral joint stiffnesses was able to capture expected stiffness variation between specimens and between spine levels and if the variation between spine levels could be accurately captured using a generic scaling ratio. Multibody models of six T12 to sacrum spine specimens were created from computed tomography data. For each specimen, two models were created: one with uniform stiffnesses across spine levels, and one accounting for level dependency. Three loading conditions were simulated. The initial stiffness values were optimised to minimize the kinematic error. There was a range of optimised stiffnesses across the specimens and the models with level dependent stiffnesses were less accurate than the models without. Using an optimised stiffness substantially reduced prediction errors. The optimisation captured the expected variation between specimens, and the prediction errors demonstrated the importance of accounting for level dependency. The inaccuracy of the predicted kinematics for the level-dependent models indicated that a generic scaling ratio is not a suitable method to account for the level dependency. The variation in the optimised stiffnesses for the different loading conditions indicates personalised stiffnesses should also be considered load-specific.
PubMed: 38486868
DOI: 10.3389/fbioe.2024.1372088 -
BMC Geriatrics Mar 2024Aging is associated with muscle atrophy, as typified by sarcopenia. Loss of abdominal muscle strength can cause abdominal wall laxity. The purpose of this study was to...
BACKGROUND
Aging is associated with muscle atrophy, as typified by sarcopenia. Loss of abdominal muscle strength can cause abdominal wall laxity. The purpose of this study was to investigate the relationship between the sacral vertebra-abdominal wall distance (SAD) and movement performance using a simple lateral spine X-ray image for measuring the SAD.
METHODS
In this retrospective study, we included women aged ≥ 65 years who were attending the outpatient clinic for osteoporosis at our hospital. A total of 287 patients (mean age ± SD, 76.8 ± 7.1 years) with measured SAD were included in the analysis. Patients were divided into two groups based on SAD cutoff (160 mm) and age (75 years), respectively. The patients were examined using the two-foot 20 cm rise test, 3 m Timed Up and Go (TUG) test, two-step test, open-eyed one-leg standing time, and spinal alignment. Normally distributed data are expressed as means (standard deviations) and non-normally distributed data as medians (interquartile range), depending on the results of the Kolmogorov-Smirnov test. Student's t-test and χ2 test were used for between-group comparisons. Regression analysis was performed with SAD as the objective variable. A two-sided p < 0.05 was considered statistically significant.
RESULTS
The shorter SAD group performed better in the two-step test, TUG test, and open-eyed one-leg standing time (p < 0.001) as well as in the two-foot 20 cm rise test (p < 0.01) compared to the longer SAD group. Spinal alignment was better in the shorter SAD group than in the longer SAD group, with a shorter sagittal vertical axis (p < 0.001), smaller pelvic tilt (p < 0.001), and greater sacral slope (p < 0.05).
CONCLUSION
SAD was associated with posterior pelvic tilt and movement performance parameters. In addition to testing for osteoporosis, movement performance parameters should be evaluated in women with osteoporosis who are aged ≥ 65 and have greater SAD (≥ 160 mm in this study). The SAD is a new assessment method, and further research is required to verify its validity and reproducibility. This is the first attempt to determine how age and SAD affect movement performance in older adults.
Topics: Humans; Female; Aged; Sacrum; Retrospective Studies; Abdominal Wall; Reproducibility of Results; Osteoporosis
PubMed: 38475741
DOI: 10.1186/s12877-024-04865-x