Archive for category: News

Tapered and cylindrical implants offer comparable clinical performance, suggests a study published in the Journal of Prosthetic Dentistry.

Graeme Hoit et al conducted a study to compare outcomes following early compared with delayed reconstruction in patients with multi ligament knee injury (MLKI).

A retrospective cohort analysis of patients with MLKI was conducted at St. Michael’s Hospital, Unity Health, Toronto, Ontario, Canada. Patients who underwent a reconstructive surgical procedure with more than12 months of postoperative follow-up were included. Patients were stratified into early reconstruction (<6 weeks after the injury) and delayed reconstruction (12 weeks to 2 years after the injury). Multivariable regression models with inverse probability of treatment weighting (IPTW) were utilized to compare the timing of the surgical procedure with the primary outcome (the Multiligament Quality of Life questionnaire [MLQOL]) and the secondary outcomes (manipulation under anesthesia [MUA], Kellgren-Lawrence [KL] osteoarthritis grade, knee laxity, and range of motion).

Key findings of the study were:

• A total of 131 patients met the inclusion criteria, with 75 patients in the early reconstruction group and 56 patients in the delayed reconstruction group.

• The mean time to the surgical procedure was 17.6 days in the early reconstruction group compared with 280 days in the delayed reconstruction group.

• The mean postoperative follow-up was 58 months.

• The early reconstruction group, compared with the delayed reconstruction group, included more lateral-sided injuries (49 patients [65%] compared with 23 [41%]; standardized mean difference [SMD], 0.44) and nerve injuries (36 patients [48%] compared with 9 patients [16%]; SMD, 0.72), and had a higher mean Schenck class (SMD, 0.57).

• After propensity adjustment, there was no difference between early and delayed reconstruction across the 4 MLQOL domains (p > 0.05).

• Patients in the early reconstruction group had higher odds of requiring MUA compared with the delayed reconstruction group (24 [32%] compared with 8 [14%]; IPTW-adjusted odds ratio [OR], 3.85 [95% confidence interval (CI), 2.04 to 7.69]; p < 0.001) and had less knee flexion at the most recent follow-up (b, 6.34_ [95% CI, 0.91_ to 11.77_]; p = 0.023).

• Patients undergoing early reconstruction had lower KL osteoarthritis grades compared with patients in the delayed reconstruction group (OR, 0.46 [95% CI, 0.29 to 0.72]; p < 0.001). There were no differences in clinical laxity between groups.

The authors concluded that – “Early reconstruction of MLKIs likely increases the likelihood of postoperative arthrofibrosis compared with delayed reconstruction, but it may be protective against the development of osteoarthritis. When considering the timing of MLKI reconstruction, surgeons should consider the benefit that early reconstruction may convey on long-term outcomes but should caution patients regarding the possibility of requiring an MUA.

Level of Evidence: Therapeutic Level III.

Further reading:

Early Compared with Delayed Reconstruction in Multiligament Knee Injury

A Retrospective Propensity Analysis

Graeme Hoit et al

J Bone Joint Surg Am. 2024;106:1903-9

http://dx.doi.org/10.2106/JBJS.23.00795

Healthy lifestyle behaviors, such as good nutrition, smoking cessation and being physically active, along with routine health screenings and managing risk factors for cardiovascular disease and stroke with medication, can help prevent individuals from having a first stroke. Screening for stroke risk and educating people on how to lower their chances of having a stroke ideally begin with their primary care professional and include evidence-based recommendations, according to a new clinical guideline from the American Stroke Association, a division of the American Heart Association, and published today in the Association’s journal Stroke.

A stroke occurs when blood flow to the brain is interrupted after a blood vessel becomes blocked by a blood clot or ruptures. The result is the brain does not receive the oxygen it needs to properly function. Stroke causes brain damage that can lead to significant disability, including difficulty thinking, talking, walking and interacting with one’s environment. In the U.S., stroke is currently the fifth leading cause of death, resulting in nearly 160,000 deaths annually. Every year, more than 600,000 people in the U.S. have a first stroke, even though up to 80% of strokes are preventable.

“The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke—referred to as primary prevention,” said Chair of the guideline writing group, Cheryl D. Bushnell, M.D., M.H.S., FAHA, professor and vice chair of research in the department of neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina. “Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk.”

The “2024 Guideline for the Primary Prevention of Stroke” replaces the 2014 version and is a resource for clinicians in implementing a variety of prevention strategies for individuals with no prior history of stroke. The new guideline provides evidence-based recommendations for strategies to support brain health and prevent stroke throughout a person’s lifespan by improving healthy lifestyle behaviors and getting preventive care.

“This guideline is important because new discoveries have been made since the last update 10 years ago. Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke,” said Bushnell.

Key stroke prevention recommendations include regular health screenings, identifying risk factors, lifestyle interventions and medications, when indicated.

Identifying and Managing Risk Factors

Unidentified and unmanaged cardiovascular disease risk factors can cause damage to arteries, the brain and the heart years before cardiovascular disease and stroke occur. Primary care health professionals should promote brain health for patients through stroke prevention education, screenings and addressing risk factors from birth to old age.

Modifiable risk factors for stroke, such as high blood pressure, overweight and obesity, elevated cholesterol and elevated blood sugar, can be identified with physical exams and blood tests. These conditions should be addressed with healthy lifestyle and behavioral changes and may include medications for select patients. Antihypertensive medications to reduce blood pressure and statin medications to lower cholesterol can help to reduce the risk of first stroke in adults with increased cardiovascular disease risk and those receiving CVD care. A new recommendation is consideration of glucagon-like protein-1 (GLP-1) receptor agonist medications, which are FDA-approved to reduce the risk of cardiovascular disease in people with overweight or obesity and/or Type 2 diabetes.

Healthy Lifestyle Behaviors

The most common, treatable lifestyle behaviors that can help reduce stroke risk are detailed in the Association’s Life’s Essential 8 cardiovascular health metrics. They include healthy nutrition, regular physical activity, avoiding tobacco, healthy sleep and weight, controlling cholesterol, and managing blood pressure and blood sugar. The guideline recommends that adults with no prior cardiovascular disease, as well as those with increased risk, follow a Mediterranean dietary pattern. Mediterranean dietary programs have been shown to reduce the risk of stroke, especially when supplemented with nuts and olive oil.

Physical activity is also essential for stroke risk reduction and overall heart health. Physical activity can help to improve important health measures such as blood pressure, cholesterol, inflammatory markers, insulin resistance, endothelial function and weight. The guideline urges health care professionals to routinely screen patients for sedentary behavior, a confirmed risk factor for stroke, and counsel them to engage in regular physical activity. The Association reinforces the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion’s recommendation that adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week.

Health Equity and Stroke Risk

New to the guideline is an emphasis on social determinants of health and the impact they have on stroke risk. Social determinants of health are non-medical factors, including education, economic stability, access to care, discrimination, structural racism and neighborhood factors (such as the lack of walkability, lower availability of healthy food and fewer health resources), that contribute to inequities in care and influence overall health. Health care professionals should ensure patient education is available for various educational and language levels, and advocate for their patients by choosing treatments and medications that are effective and affordable.

Health care professionals are also encouraged to connect patients to resources that help address health-related social needs such as food and housing insecurity, refer them to programs that support healthy lifestyle changes and direct them to support programs that may help defray health care costs including medication expenses.

New Sex- and Gender-Specific Recommendations

The guideline also includes some new gender- and sex-specific recommendations for women. Health professionals should screen for conditions that can increase a woman’s risk of stroke, including use of oral contraceptives, high blood pressure during pregnancy, other pregnancy complications such as premature birth, endometriosis, premature ovarian failure and early onset menopause. Treatment of elevated blood pressure during pregnancy and within six weeks of delivery is recommended to reduce the risk of maternal intracerebral hemorrhage.

Transgender women and gender-diverse individuals taking estrogens for gender affirmation may also be at an increased risk of stroke. Evaluation and modification of any existing risk factors are needed to reduce the risk of stroke for these individuals.

“Implementing the recommendations in this guideline would make it possible to significantly reduce the risk of people having a first stroke. Most strategies that we recommend for preventing stroke will also help reduce the risk of dementia, another serious health condition related to vascular issues in the brain,” said Bushnell.

The writing group notes that writing recommendations focused on preventing a first stroke was challenging. There are limitations to some of the evidence that informed the guideline, including that many clinical trials enrolled adults who have already had a cardiovascular event that may include a stroke. The writing group also identified knowledge gaps to help inform topics for future research.

The guideline highlights the need for risk assessment in primary stroke prevention and includes the use of risk prediction tools to estimate risk for atherosclerotic cardiovascular disease so that patients receive timely prevention and treatment strategies. The Association has recently developed a new Predicting Risk of Cardiovascular Disease Events (PREVENT) risk calculator as a screening tool that can help inform preventive treatment decisions. The PREVENT calculator can estimate 10-year and 30-year stroke and heart disease risk in individuals starting at age 30—a decade earlier than the Pooled Cohort Equations, another CVD risk calculator.

According to the American Stroke Association, learning the warning signs of stroke and preventative measures are the best way to avoid strokes and keep them from happening again. The abbreviation F.A.S.T.-for face drooping, arm weakness, speech difficulty, time to call 911 — is a useful tool to recognize the warning signs of stroke and when to call for help.

This guideline was prepared by the volunteer writing group on behalf of the American Stroke Association and is endorsed by the Preventive Cardiovascular Nurses Association and the Society for Vascular Surgery. The American College of Obstetricians and Gynecologists supports the clinical value of this document as an educational tool.

Since 1990, the American Stroke Association has translated scientific evidence into clinical practice guidelines with recommendations to improve cerebrovascular health. The “2024 Guideline for the Primary Prevention of Stroke” replaces the 2014 “Guidelines for the Primary Prevention of Stroke.” This updated guideline is intended to be a resource for clinicians to use to guide various prevention strategies for individuals with no history of stroke. The Association supports the development and publication of clinical practice guidelines without commercial support, and members volunteer their time to the writing and review efforts.

Reference:

Cheryl Bushnell, Walter N. Kernan, Anjail Z. Sharrief, Seemant Chaturvedi, John W. Cole, William K. Cornwell III, Christine Cosby-Gaither, 2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association, Stroke, https://doi.org/10.1161/STR.0000000000000475

A new study published in the journal of Public Library of Science found that the triglyceride levels of individuals with major depressive disorder (MDD) were markedly higher. Cardiovascular disease is more common in those who are depressed. Young individuals who self-reported feeling melancholy or having bad mental health days had higher rates of strokes, heart attacks, and heart disease risk factors than their counterparts without mental health concerns. According to literature, this can be the case since sadness can promote hazardous lifestyle choices including smoking, consuming alcohol, sleeping less, and not exercising, as well as an increase in blood pressure and heart rate.

Triglycerides are thought to be a risk factor in and of itself for atherosclerosis, which causes myocardial infarction and ischemic stroke. This research hypothesized that there is a substantial change in triglyceride levels in patients with depression when compared to healthy controls. Since a previous study revealed that lipid metabolites might vary between patients with severe depressive disorder and healthy participants. To evaluate peripheral blood triglyceride levels between MDD patients and healthy controls, Di-Ru Xu and team made the decision to carry out a new study.

Until March 2023, the studies were searched in the Cochrane, EMBASE, PsycINFO, and PubMed databases. The standardized mean difference (SMD) was calculated by extracting the mean (±SD) for TG concentrations and combining them quantitatively using random-effects meta-analysis. Meta-regression and subgroup analysis were used to investigate the heterogeneity resource.

38 studies that measured peripheral blood TG concentrations in 3272 HCs and 2604 MDD patients were included. According to the findings of the meta-analysis, the patients with MDD had significantly higher TG levels than HCs. There was evidence of heterogeneity (χ2 = 269.97, p < 0.01, I2 = 85%). Subgroup analysis revealed that there were no differences across groups, although there were significant variations in TG levels between patients with MDD and HCs based on age, body mass index, and medication usage (p < 0.05). Additionally, meta-regression revealed no significant factors. Overall, these results point to the need to measure the possible advantages of a low-triglyceride diet in MDD patients and look into the possible roles of triglycerides in the pathophysiology of depression.

Source:

Xu, D.-R., Gao, X., Zhao, L.-B., Liu, S.-D., Tang, G., Zhou, C.-J., & Chen, Y. (2024). Association between triglyceride and depression: A systematic review and meta-analysis. In Md. R. Islam (Ed.), PLOS ONE (Vol. 19, Issue 10, p. e0311625). Public Library of Science (PLoS). https://doi.org/10.1371/journal.pone.0311625

High blood pressure (hypertension) causes thickening of the blood vessels and hardening of the arteries (arteriosclerosis). A study conducted by Brazilian researchers has shown for the first time that a similar phenomenon occurs in the lungs. High blood pressure hardens the bronchi and increases airway resistance, impairing respiratory capacity.

The study sample comprised 731 men and women over 60, both with and without high blood pressure. It was designed to investigate the effects of hypertension on lung mechanics, detecting where and how high blood pressure impaired lung function. An article reporting the findings is published in the journal Advances in Respiratory Medicine. The study was supported by FAPESP.

“Our analysis showed that subjects who practiced regular physical activities appeared to be partially protected against hardening of the bronchi,” Rodolfo de Paula Vieira, last author of the article, told Agência FAPESP. Vieira heads the Pulmonary Immunology and Exercise Laboratory at the Federal University of São Paulo’s Institute of Science and Technology (ICT-UNIFESP) in São José dos Campos, São Paulo state, Brazil.

The researchers conducted spirometry tests to gauge respiratory function, and assessed lung mechanics by impulse oscillometry, a technique that uses sound waves to measure resistance to the normal movement of air in and out of the lungs when breathing at rest.

General muscle strength was measured using a hand grip dynamometer, and respiratory muscle strength was evaluated using a manovacuometer to gauge maximal inspiratory and expiratory pressure. The participants answered questionnaires on the intensity and frequency of physical activity, as well as items associated with the quality of life.

According to Vieira, the findings highlight the need to assess respiratory function in patients with high blood pressure, which affects around 1 billion people worldwide. “Hypertension has long been known to impair lung function, but until now the mechanism involved wasn’t clearly understood. Our findings show that physicians should refer patients diagnosed with high blood pressure to a specialist for tests to assess lung function and mechanics, especially older patients. They should also be given guidance on the importance of an active lifestyle to avoid loss of lung function due to high blood pressure,” Vieira said.

Prior research showed that lung function is closely linked to the ability of the lungs to expand and revert to their previous state (elastance and resistance), and that this was most altered in older patients with hypertension.

“Changes in lung mechanics are expected as a natural result of the aging process, but basically the study shows that hypertension accelerates the hardening of the bronchi and that physical exercise keeps this process partially at bay,” Vieira said.

“This is very important as the more hardened the bronchi become, the more difficult it becomes for air to enter and leave the lungs. In the long run, this accelerated process of hardening of the bronchi makes breathing difficult for older people. Worse still, it’s a cycle: lower oxygen saturation accelerates the aging process throughout the organism.”

The consequences do not stop there. “Acceleration of aging increases the risk of cancer, non-transmissible chronic diseases such as diabetes, heart attack, and thrombosis. This highlights the importance of including care of the lungs in the treatment of hypertension,” he said.

Exercise for heart and lungs

In another study that has not yet been published, the same researchers analyzed the relationship between physical exercise and protection against hardening of the arteries and bronchi due to hypertension in a different group of 150 older volunteers, focusing on the extent to which the degree of rigidity could affect blood flow and lead to aneurysms or thrombosis (hemodynamics). The volunteers were submitted to a three-month training protocol comprising three exercise sessions per week.

“Physical exercise all but eliminated these cardiovascular alterations. This proves once again that physical activity must be part of the lives of older people. There’s no such thing as healthy aging with sedentarism,” Vieira said. 

Reference:

Brandao-Rangel, M.A.R.; Brill, B.; de Souza Carvalho, E.; Melamed, D.; Moraes-Ferreira, R.; Silva-Reis, A.; Leonardo, P.S.; Frison, C.R.; De Angelis, K.; Vieira, R.P. Physically Active Lifestyle Attenuates Impairments on Lung Function and Mechanics in Hypertensive Older Adults. Adv. Respir. Med. 2024, 92, 278-290. https://doi.org/10.3390/arm92040027