Citations

Objectives: We aimed to construct a predictive model for one‐year mortality in patients undergoing invasive coronary evaluation and to examine the impact of bivalirudin on survival according to the level of baseline risk.Background: Compared to heparin plus GP IIb/IIIa inhibitors (HEP/GPI), bivalirudin decreases bleeding complications in a range of clinical presentations. The impact of preprocedural risk assessment on survival and whether this is modified by bivalirudin, has not been investigated in detail.Methods: We examined patient‐level data from the REPLACE‐2, ACUITY, and HORIZONS‐AMI trials (n = 18,819) to construct a risk‐adjusted mortality model using baseline clinical variables.Results: One‐year mortality occurred in 287 patients (3.1%) assigned to bivalirudin and 336 patients (3.6%) assigned to HEP/GPI (HR 0.85; 95% CI, 0.73–1.00; P = 0.048). Using 11 highly significant predictors of mortality, we developed an integer‐risk score to classify patients into risk tertiles. High‐risk patients had a rate of 1‐year mortality over 9‐fold greater than low‐risk patients. Consequently, the absolute mortality reduction attributed to bivalirudin was more marked in high‐risk patients: 3.1% (−0.8% to 7.0%) in the overall cohort, 4.8% (0.5% to 9.2%) in the PCI cohort (P‐interaction versus intermediate and low risk categories, 0.09 and P = 0.02, respectively).Conclusions: In patients undergoing invasive coronary evaluation, 1‐year mortality can be predicted using baseline variables. Bivalirudin treatment (versus HEP/GPI) conferred a survival benefit. © 2015 Wiley Periodicals, Inc.

Abstract Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all‐inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. Technique Video video See video under supplementary data.

This article provides nomenclature recommendations developed by an international workgroup to increase transparency and standardization of pharmacogenetic (PGx) result reporting. Presently, sequence variants identified by PGx tests are described using different nomenclature systems. In addition, PGx analysis may detect different sets of variants for each gene, which can affect interpretation of results. This practice has caused confusion and may thereby impede the adoption of clinical PGx testing. Standardization is critical to move PGx forward.

Children and adolescents can experience significant disability from frequent migraine. A number of tools have been developed to help quantify the impact of migraine in this population. Many preventative medications used in adults are routinely used to prevent migraines in children, although there has been less rigorous study. This article reviews the indications and evidence for the use of migraine preventatives, such as antidepressants, antihypertensives, anticonvulsants, antihistamines, and botulinum toxin, in this population.

The strong male predominance in Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) remains inadequately explained, but sex hormones might be involved. We hypothesized that single nucleotide polymorphisms (SNPs) in the androgen pathway influence risk of developing BE and EAC. This genetic‐epidemiological analysis included 14 studies from Australia, Europe and North America. Polymorphisms in 16 genes coding for the androgen pathway were analyzed using a gene‐based approach: versatile gene‐based test association study. This method evaluates associations between a trait and all SNPs within a specific gene rather than each SNP marker individually as in a conventional GWAS. The data were stratified for sex, body‐mass index, waist‐to‐hip ratio, tobacco smoking and gastroesophageal reflux status. Included were data from 1,508 EAC patients, 2,383 BE patients and 2,170 control participants. SNPs within the gene CYP17A1 were associated with risk of BE in the sexes combined (p = 0.002) and in males (p = 0.003), but not in females separately (p = 0.3). This association was found in tobacco smokers (p = 0.003) and in BE patients without reflux (p = 0.004), but not in nonsmokers (p = 0.2) or those with reflux (p = 0.036). SNPs within JMJD1C were associated with risk of EAC in females (p = 0.001). However, none of these associations replicated in a subsequent sample. Fourteen other genes studied did not reach statistically significant levels of association with BE, EAC or the combination of BE and EAC, after correcting for the number of genes included in the analysis. In conclusion, genetic variants in the androgen‐related genes CYP17A1 and JMJD1C might be associated with risk of BE and EAC, respectively, but replication data with larger sample sizes are needed.

Background: Patients with patellar instability and a tibial tubercle–trochlear groove (TT-TG) distance ≥20 mm may be candidates for distal tubercle realignment surgery. Although this variable has proven valuable in predicting recurrent dislocations, it is not individualized to patient size, bony structure, or patellofemoral mechanics. Purpose: To develop a patellar instability ratio (PIR) that predicts the risk of recurrent instability based on the TT-TG distance to patient-specific anatomy. Study Design: Cohort study; Level of evidence, 3. Methods: On magnetic resonance imaging scans of 59 knees with patellar instability, the TT-TG distance, tibial tubercle–posterior cruciate ligament (TT-PCL) distance, sagittal patellar length (PL), sagittal trochlear length (TL), axial patellar width (PW), and axial trochlear width (TW) were calculated by 2 observers in a blinded and randomized fashion. Patients were divided into 2 groups: those with a single dislocation and those with multiple (≥2) dislocations. The ability of the TT-TG and TT-PCL distances as well as the 8 different ratios to predict recurrent instability was assessed by calculating odds ratios (ORs), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each measure. Results: Twelve knees (20%) experienced a single dislocation, while 47 (80%) sustained multiple dislocations. A TT-TG distance ≥20 mm was predictive of recurrent instability, with a sensitivity, specificity, and PPV of 21%, 100%, and 100%, respectively. The OR for TT-TG ≥20 mm was 5.38 ( P = .29), while the highest ORs for recurrent instability were noted for a TT-TG/PW ≥0.4 (OR, 7.37; P = .02) and a TT-TG/TW ≥0.5 (OR, 8.88; P = .04). The sensitivity, specificity, and PPV of a TT-TG/PW ≥0.4 were 62%, 83%, and 94%, respectively, while those of a TT-TG/TW ≥0.5 were 45%, 92%, and 95%, respectively. Conclusion: Two novel PIRs (TT-TG/TW and TT-TG/PW) were identified and found to more effectively predict recurrent instability than the TT-TG distance alone. Each ratio takes into account patient-specific anatomy and can be measured in an accurate and reliable fashion by clinicians. These PIRs are a step toward overcoming some of the limitations of using the TT-TG distance in isolation. Further investigation into the clinical applications and utility of the TT-TG/TW is warranted.