Ten-day decitabine with venetoclax versus intensive chemotherapy in relapsed or refractory acute myeloid leukemia: A propensity score-matched analysis.

BACKGROUND: Relapsed/refractory (R/R) acute myeloid leukemia (AML) has poor outcomes. Although lower-intensity venetoclax-containing regimens are standard for older/unfit patients with newly diagnosed AML, it is unknown how such regimens compare with intensive chemotherapy (IC) for R/R AML. METHODS: Outcomes of R/R AML treated with 10-day decitabine and venetoclax (DEC10-VEN) were compared with IC-based regimens including idarubicin with cytarabine, with or without cladribine, clofarabine, or fludarabine, with or without additional agents. Propensity scores derived from patient baseline characteristics were used to match DEC10-VEN and IC patients to minimize bias. RESULTS: Sixty-five patients in the DEC10-VEN cohort were matched to 130 IC recipients. The median ages for the DEC10-VEN and IC groups were 64 and 58 years, respectively, and baseline characteristics were balanced between the 2 cohorts. DEC10-VEN conferred significantly higher responses compared with IC including higher overall response rate (60% vs 36%; odds ratio [OR], 3.28; P < .001), complete remission with incomplete hematologic recovery (CRi, 19% vs 6%; OR, 3.56; P = .012), minimal residual disease negativity by flow cytometry (28% vs 13%; OR, 2.48; P = .017), and lower rates of refractory disease. DEC10-VEN led to significantly longer median event-free survival compared with IC (5.7 vs 1.5 months; hazard ratio [HR], 0.46; 95% CI, 0.30-0.70; P < .001), as well as median overall survival (OS; 6.8 vs 4.7 months; HR, 0.56; 95% CI, 0.37-0.86; P = .008). DEC10-VEN was independently associated with improved OS compared with IC in multivariate analysis. Exploratory analysis for OS in 27 subgroups showed that DEC10-VEN was comparable with IC as salvage therapy for R/R AML. CONCLUSION: DEC10-VEN represents an appropriate salvage therapy and may offer better responses and survival compared with IC in adults with R/R AML.

Influences on Body Size Perceptions Among Black Women in the Mississippi Delta.

PURPOSE: To identify factors that influence Black women's body size perceptions. DESIGN: Interviews (cognitive mapping exercise) with 25 women; focus group with 7 additional women. SETTING: Mississippi Delta. PARTICIPANTS: Thirty-two black women. MEASURES: Influences on body size perceptions, body mass index, and body satisfaction. ANALYSIS: Interviewee maps were combined and condensed, using matrix addition and qualitative aggregation, to create a social map. The social map was presented to a focus group. A paired sample t test and descriptive statistics were run to assess weight perception accuracy and body satisfaction. RESULTS: The initial social map contained 27 variables. Male preferences (87.5%) and appearance (64%) were believed by most participants to influence perceptions of body size. The focus group identified lack of encouragement, stress, and substance use as factors worth adding to the map. A statistically significant proportion of interviewees possessed an inaccurate weight perception, t(24) = 2.741, P < .05. Furthermore, 76% were dissatisfied with their current weight status and 80% desired a healthy body size. CONCLUSION: These findings provide practitioners with leverage points, beyond diet and physical activity, that may improve the efficacy of weight reduction interventions among black women. Considering the paucity of research regarding influences on body size perceptions, this study also provides researchers with participant-defined variables worthy of further examination.

Bridle procedure combined with a subtalar implant: a case series and review of the literature.

BACKGROUND: The bridle procedure is a tritendon anastomosis between the tibialis posterior, peroneus longus, and tibialis anterior, utilized in the treatment of drop foot. Concerned about the potential for acquired flatfoot deformity following the bridle procedure, the authors hypothesized that placing a sinus tarsi implant would prevent this potential sequela. MATERIALS AND METHODS: Over a 10-year period, 15 patients (16 feet) were treated with a bridle procedure for drop foot, and 9 of these feet also had a subtalar arthroereisis implanted; 8 patients (9 feet) positively responded to requests for long-term follow-up evaluation and returned for subjective evaluation with the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Scale and Short Form (SF)-36 forms and objective clinical and radiographic measurements. RESULTS: At an average follow-up of 61 months, the 8 patients (9 feet) who returned for long-term evaluation maintained a plantigrade foot, were able to dorsiflex above neutral both actively and passively, and did not develop a flatfoot deformity at long-term follow-up. There were no significant differences between those who had a sinus tarsi implant (6 feet) and those who did not (3 feet). Although 7 of the 9 feet evaluated in this study wore a brace preoperatively, none continued to use a brace after surgery. The major complaints were occasional pain at the subtalar arthroereisis site and a feeling that the great toe was dragging. CONCLUSION: The bridle procedure provided excellent outcomes in patients with drop foot, with patients achieving long-term success in being free from brace wear. The ability to actively dorsiflex the foot during gait was also restored, reestablishing a normal heel-to-toe gait pattern. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case series.

Talar neck fractures treated with closed reduction and percutaneous screw fixation:a case series.

Talus fractures are relatively rare injuries, accounting for approximately 3% of all foot fractures. Fractures of the talar neck account for almost 50% of all talus fractures. Diagnosis and treatment of these fractures play an important role in patients' outcomes. Treatment of talar neck fractures has slowly evolved from closed treatment to open reduction and internal fixation. Treatment of type I and type II talar neck fractures is debated in the orthopedic community. Choosing which treatment to perform depends on injury severity, associated injuries, and surgeon experience and preference. In this article, we report on our retrospective review of all talar neck fractures treated with closed reduction and percutaneous fixation between 1996 and 2001 at the Pennsylvania State University Milton S. Hershey Medical Center.

Estrogen receptor expression in posterior tibial tendon dysfunction: a pilot study.

BACKGROUND: The pathophysiology of posterior tibial tendon dysfunction (PTTD) is poorly understood. It has been theorized that changes in hormone physiology may be a factor influencing tendon health. Estrogen's influence on the fibroblast has been studied in other musculoskeletal tissues. Gender differences in anterior cruciate ligament (ACL) injuries have been studied and it has been discovered that the Estrogen receptor (ER) as well as Progesterone receptor (PR) are expressed in the ACL. MATERIAL AND METHODS: Eight patients with PTTD requiring surgery were enrolled in our pilot study. The mean patient age was 52.4 (range, 18 to 73) years. There were five female and three male patients. Tendon samples were harvested from diseased PTT. Tendon samples harvested from healthy PTT and healthy flexor digitorum longus (FDL) tendon were used as controls. Tendon samples were processed using specific protocols for total RNA isolation from hypocellular, dense connective tissues. ERα and ERß transcripts were quantified using real time RT-PCR. Quantitative values were obtained from the threshold cycle (Ct) number at which the increase in fluorescent signal associated with an exponential increase of PCR products can be detected. RESULTS: Transcripts of both ERα and ERß were reproducibly detected in RNA samples isolated from our tendon samples. There was no difference in receptor expression between diseased and control tendon samples. There was no difference in receptor expression between male and female patients. CONCLUSION: We found that the tenocyte of the PTT and FDL tendons express ERα and ERß. Normal and diseased tendons of both male and female patients expressed both estrogen receptors. CLINICAL RELEVANCE: Identifying ERα and ERß gene expression in the fibroblast was an initial step in discovering whether tenocytes are targets for estrogen function. Estrogen receptors were identified indirectly by measuring receptor gene expression but we were unable to show a significant difference between diseased and control tendons.

Unusual orientation of talar osteochondral fragment: a case report.

The identification of the correct orientation of an osteochondral fragment can be challenging. Orthopaedists have been able to take advantage of advanced imaging techniques to provide guidance to the appropriate surgical intervention. Many advancements have been made in imaging modalities specific to articular cartilage [Fischbach F, Bruhn H, Unterhauser F, Ricke J, Wieners G, Felix R, et al. Magnetic resonance imaging of hyaline cartilage defects at 1.5T and 3.0T: comparison of medium T2-weighted fast spin echo, T1-weighted two-dimensional and three-dimensional gradient echo pulse sequences. Acta Radiol 2005;46(1):67-73 [Erratum in: Acta Radiol 2005;46(April (2)):218]] Furthermore, with the increasing use of bioabsorbable fixation pins, it is imperative that careful attention is paid to the correct orientation of the fragment that is to be fixed. Without awareness of the orientation, it is possible that the 180° displaced fragment could potentially be fixed in this position. At the time of this report, the patient in this case was 6 weeks postoperative and reported 0/10 pain with full painless range of motion without instability. Our goal with this case report is to promote awareness among orthopaedists and radiologists alike regarding the importance of recognizing the orientation of an osteochondral fragment and/or defect of the talus. The patient was informed that data concerning the case would be submitted for publication, and he consented.

Shock wave therapy compared with intramedullary screw fixation for nonunion of proximal fifth metatarsal metaphyseal-diaphyseal fractures.

BACKGROUND: The current "gold standard" for treatment of chronic fracture nonunion in the metaphyseal-diaphyseal region of the fifth metatarsal is intramedullary screw fixation. Complications with this procedure, however, are not uncommon. Shock wave therapy can be an effective treatment for fracture nonunions. The purpose of this study was to evaluate the safety and efficacy of shock wave therapy as a treatment of these nonunions. METHODS: Twenty-three patients with a fracture nonunion in the metaphyseal-diaphyseal region of the fifth metatarsal received high-energy shock wave therapy (2000 to 4000 shocks; energy flux density per pulse, 0.35 mJ/mm(2)), and twenty other patients with the same type of fracture nonunion were treated with intramedullary screw fixation. The numbers of fractures that were healed at three and six months after treatment in each group were determined, and treatment complications were recorded. RESULTS: Twenty of the twenty-three nonunions in the shock wave group and eighteen of the twenty nonunions in the screw fixation group were healed at three months after treatment. One of the three nonunions that had not healed by three months in the shock wave group was healed by six months. There was one complication in the shock wave group (post-treatment petechiae) and eleven complications in the screw-fixation group (one refracture, one case of cellulitis, and nine cases of symptomatic hardware). CONCLUSIONS: Both intramedullary screw fixation and shock wave therapy are effective treatments for fracture nonunion in the metaphyseal-diaphyseal region of the fifth metatarsal. Screw fixation is more often associated with complications that frequently result in additional surgery.

The safety of forefoot metatarsal pins in external fixation of the lower extremity.

BACKGROUND: External fixation is widely used for trauma and reconstruction of the lower extremity. External fixator devices spanning the ankle or portions of the foot often utilize pins placed across the metatarsal bases. While this forefoot fixation is occasionally necessary to achieve reduction and alignment, it is also useful to prevent an equinus contracture. We undertook an anatomical study to evaluate the safety of pins placed across the bases of the first and second metatarsals, spanning the first intermetarsal space. METHODS: Under fluoroscopy, a single 4.0-mm Schanz pin was advanced percutaneously from medial to lateral across the bases of the first and second metatarsals in ten cadaver feet. This was accomplished in a fashion identical to the application of typical forefoot external fixation as described in the literature. Specimens were then dissected. Injury to the deep plantar branch of the dorsalis pedis artery, when present, was recorded. When injury was not present, the distance from the pin to the deep plantar branch was recorded. RESULTS: In five of the ten feet, the deep plantar branch of the dorsalis pedis artery was lacerated by the transmetatarsal pin. In four feet, the pin contacted the artery but did not visibly damage it. In the remaining foot, the pin was noted to be only 4 mm from the artery. Any pin with a starting point within 18 mm of the first metatarsocuneiform joint placed the artery at risk. CONCLUSIONS: Placement of external fixation pins through the proximal bases of the first and second metatarsals, within 2 cm of the first tarsometatarsal joint, consistently places the deep plantar branch of the dorsalis pedis artery at risk. Given the clinical importance of this artery, transmetatarsal pinning in this fashion is not advised. Other methods of obtaining forefoot or midfoot external fixation are recommended in order to avoid vascular injury.

Connecting multiple open wounds to a single negative-pressure dressing.

We present a new technique for connecting open wounds to a negative-pressure device. In this technique, a flexible, small-diameter intravenous tube is used to bridge the gap between open wounds on the same extremity. After these connections are made, the first layer of plastic is placed, and only 1 fenestrated connection is made to the device. This technique allows use of multiple sponges with only 1 fenestrated cap and 1 connection to the device. The smaller intravenous tube must not be placed directly on skin, as it may cause a pressure ulcer underneath.

Medial clavicular epiphyseal fracture with ipsilateral acromioclavicular dislocation: a case report of panclavicular fracture dislocation.

The authors report a case of a complete posterior dislocation of the acromioclavicular (AC) joint with an ipsilateral medial epiphyseal clavicular fracture in a 20-year-old male. Open reduction was indicated because a maintained closed reduction of the AC joint was unsuccessful, and the described treatment maintained a successful reduction.