Biomechanical Study Concerning the Types of Resection in Arthrodesis of First Metatarsophalangeal Joint.

This work concerns a biomechanical study aiming to ascertain the optimal type of joint resection when performing a joint arthrodesis. A 3-dimensional digital model of the first metatarsophalangeal joint including the entire first metatarsal bone and proximal phalanx using CT scans of the forefoot was created. Using this computer model, 4 types of resections; ball-and-socket, flat-on-flat, wedge 90°, and wedge 100° were simulated. Parameters measured using this model were the force necessary to separate the 2 fused surfaces, the surface area of the resected surfaces and the shortening of the first ray. By measuring the reactive force necessary to separate the phalanx from the first metatarsal, the 90° wedge resection was found to be the most stable, with comparable results in the case of the 100° wedge resection. Wedge resections are also more favorable when comparing the shortening of the first ray. Wedge resections, though being more technically difficult to perform prove to be the most stable for metatarsophalangeal joint-1 arthrodesis using this model.

Sequential Treatment with Bevacizumab and Aflibercept for Metastatic Colorectal Cancer in Real-World Clinical Practice.

BACKGROUND: Bevacizumab and aflibercept are currently the mainstay of antiangiogenic therapy for metastatic colorectal carcinoma (mCRC). They are often used in sequence with first- and second-line chemotherapy, especially in patients with RAS-mutated tumours. OBJECTIVE: The aim of the present study was to investigate the outcomes of patients with mCRC treated with the bevacizumab-aflibercept sequence in real-world clinical practice. PATIENTS AND METHODS: Data from a national clinical registry of targeted therapies for mCRC were analysed retrospectively. Overall, there were 366 patients with valid data who received first-line treatment with bevacizumab and chemotherapy followed by aflibercept with chemotherapy. The majority of the patients (n = 296, 80.8%) had RAS mutated tumours. RESULTS: Median cumulative progression-free survival (PFS) from the start of the bevacizumab-containing regimen to progression on aflibercept was 18.2 months (95% CI 16.8-19.5). Median PFS for bevacizumab and aflibercept was 10.6 months (95% CI 9.5-11.7) and 5.6 months (95% CI 5.1-6.1), respectively. Longer PFS on aflibercept was associated with metachronous metastatic disease and longer PFS on bevacizumab. Median overall survival (OS) from the start of first-line bevacizumab was 32.0 months (95% CI 26.6-37.5). The presence of metastatic disease at diagnosis was associated with worse OS. CONCLUSIONS: Patients treated with aflibercept in real-world clinical practice achieved similar survival outcomes as those treated within randomised trials. Cumulative survival data provide a benchmark for future studies and enable indirect comparisons with other treatment sequences used in mCRC.

Magnification of digital hip radiographs differs between clinical workplaces.

Preoperative planning for total hip arthroplasty includes templating on anteroposterior radiographs. It is necessary to consider radiographic magnification in order to scale templates accurately. Studies dealing with hip templating report different values of radiographic magnification. It is not clear if the observed difference in magnification between the studies is caused by variability in studied groups, methodology or instrumentation. We hypothesize that there is a difference in magnification between clinical workplaces. Within this study, radiographic magnification was estimated on 337 radiographs of patients after total hip surgery from five orthopaedic departments in the Czech Republic. Magnification was determined for each patient as a ratio between diameter of implanted femoral head measured on radiogram and its true size. One-way ANOVA revealed significant differences in magnification between workplaces (F(4,332) = 132, p≤0.001). These results suggest that radiographic magnification depends on the workplace where it is taken or more precisely on radiographic device. It indicates potential limits in generalizability of results of studies dealing with preoperative planning accuracy to other institutions.

Outcomes of Patients With Long-Term Treatment Response to Vascular Endothelial Growth Factor-Targeted Therapy for Metastatic Renal Cell Cancer.

BACKGROUND: Although targeted therapies with inhibitors of the vascular endothelial growth factor (VEGF) are the mainstay of treatment for metastatic renal cell carcinoma, there are limited data on the outcome of patients with long-term response to this treatment. PATIENTS AND METHODS: In a retrospective, registry-based study, patients continuously treated with first-line anti-VEGF agents for at least 24 months were included. In total, 219 patients had evaluable data and were included in the outcome analysis. RESULTS: Median progression-free survival (PFS) after initiation of first-line targeted therapy was 39.7 months (95% confidence interval [CI], 35.9-43.5 months), with 5-year PFS of 34.2% (95% CI, 27.2%-41.2%). Median overall survival (OS) reached 79.1 months (95% CI, 65.2-93.0 months) with the 5-year OS of 62.1% (95% CI, 54.5%-69.7%). In this cohort, 28, 103, and 88 patients achieved complete response (CR), partial response (PR), or stable disease (SD) as the best response, respectively. Median PFS and OS were comparable in patients with PR and SD, but significantly longer in patients with CR (log rank test P value for PFS difference < .001 and .009 for OS difference). CONCLUSION: There are marked differences in PFS and OS between patients who receive long-term anti-VEGF treatment, achieving CR and non-CR as the best clinical response. Patients with non-CR experienced a relatively high progression rate shortly after the landmark time point of 2 years.

Biomechanical analysis of INFINITY rehabilitation method for treatment of low back pain.

[Purpose] Low back pain is a pervasive problem in modern societies. Physical rehabilitation in treatment of low back pain should reduce pain, muscle tension and restore spine stability and balance. The INFINITY® rehabilitation method that is based on a figure of eight movement pattern was proved to be effective in low back pain treatment. The aim of the paper is to estimate the effect of a figure of eight motion on the L5/S1 load and lumbar spine muscle activation in comparison to other motion patterns. [Subjects and Methods] Three-dimensional model of lumbar spine musculoskeletal system is used to simulate effect of various load motion pattern induced by displacement of the center of gravity of the upper body. Four motion patterns were examined: lateral and oblique pendulum-like motion, elliptical motion and figure of eight motion. [Results] The simple pendulum-like and elliptical-like patterns induce harmonic muscle activation and harmonic spinal load. The figure of eight motion pattern creates high-frequency spinal loading that activates remodeling of bones and tendons. The figure of eight pattern also requires muscle activity that differs from harmonic frequency and is more demanding on muscle control and could also improve muscle coordination. [Conclusion] The results of the study indicate that complex motion pattern during INFINITY® rehabilitation might enhance the spine stability by influencing its passive, active and neural components.

Locally advanced breast cancer in elderly patients.

BACKGROUND: Although locally advanced breast cancer (LABC) is more common in the elderly population, there is little data on the clinical characteristics and survival of these patients. The aim of the present study was to compare different factors affecting survival in elderly patients with LABC. METHODS: Retrospective analysis was carried out on a cohort of 80 patients aged 70 to 96 years, diagnosed with LABC defined as T3 N1, T4 N0, any N2 or N3, and M0. The prognostic impact of selected clinical parameters including age, comorbidities, tumour grade, HER2 status, tumour stage, local therapies, and systemic treatments was studied. RESULTS: The median age of the patients was 79 years. The majority (n=53; 66%) had at least one significant comorbidity according to the Charlson score evaluation. The median overall survival was 50.6 months. As expected, hormonal therapy was the dominant mode of systemic treatment, but 24% also received at least one line of chemotherapy. Local therapies including surgery and/or radiotherapy were applied in 58% of patients. CONCLUSIONS: The diagnosis of LABC in the elderly is associated with poor prognosis. Age and serious comorbidities were negative prognostic factors.

Effect of patient-specific model scaling on hip joint reaction force in one-legged stance - study of 356 hips.

PURPOSE: Estimation of hip joint loading is fundamental for understanding joint function, injury and disease. To predict patientspecific hip loading, a musculoskeletal model must be adapted to the patient's unique geometry. By far the most common and cost effective clinical images are whole pelvis plain radiographs. This study compared the accuracy of anisotropic and isotropic scaling of musculoskeletal model to hip joint force prediction by taking patient-specific bone geometry from standard anteroposterior radiograms. METHODS: 356 hips from 250 radiograms of adult human pelvis were analyzed. A musculoskeletal model was constructed from sequential images of the Visible Human Male. The common body position of one-legged stance was substituted for the midstance phase of walking. Three scaling methods were applied: a) anisotropic scaling by interhip separation, ilium height, ilium width, and lateral and inferior position of the greater trochanter, b) isotropic scaling by pelvic width and c) isotropic scaling by interhip separation. Hip joint force in one-legged stance was estimated by inverse static model. RESULTS: Isotropic scaling affects all proportions equally, what results in small difference in hip joint reaction force among patients. Anisotropic hip scaling increases variation in hip joint force among patients considerably. The difference in hip joint force estimated by isotropic and anisotropic scaling may surpass patient's body weight. CONCLUSIONS: Hip joint force estimated by isotropic scaling depends mostly on reference musculoskeletal geometry. Individual's hip joint reaction force estimation could be improved by including additional bone geometrical parameters in the scaling method.

Efficacy of Sunitinib in Elderly Patients with Metastatic Renal Cell Carcinoma: Data from Real-World Clinical Practice.

BACKGROUND: Although a significant proportion of patients with metastatic renal cell carcinoma (mRCC) are elderly, the data on the outcomes of targeted therapies in this population are limited. The aim of the present retrospective registry-based study was to analyse efficacy and toxicity of sunitinib as the first-line targeted therapy of elderly mRCC patients. PATIENTS AND METHODS: The national RENal information system registry of mRCC patients treated with targeted agents in the Czech Republic was used as the data source. Of the 1315 patients treated with sunitinib as first-line targeted therapy, 1016 and 299 patients were aged <70 and ≥70 years, respectively. RESULTS: Elderly patients had a significantly longer interval from diagnosis to the initiation of therapy. Median progression-free survival was 10.8 months (95 % confidence interval 9.8-11.8) and 8.8 months (7.2-10.4) for patients aged <70 and ≥70 years, respectively (p = 0.321). Median overall survival was 31.9 months (27.9-35.9) and 26.3 months (21.3-31.2), respectively (p = 0.044). Significantly more elderly patients started on a reduced dose of sunitinib or discontinued the treatment prior to progression because of adverse events. CONCLUSIONS: The differences in patient profile and dose-reduction rates point to a different approach in the management of older and younger patients in daily clinical practice. The lower dose intensity of sunitinib in the elderly population may have translated into inferior survival.