PURPOSE OF THE STUDY In the last number of years, the anatomic hemiarthoplasty has gradually been pushed out of clinical practice by modern reverse shoulder arthroplasty (RSA) designs. This is due to the clear excellent functional results of RSAs in a wide spectrum of indication criteria. Nevertheless, RSAs have several possible complications that cannot occur in an anatomic hemiarthroplasty. In anatomic hemiarthoplasty, the importance of correct indication criteria and observing correct operative technique including soft tissue reconstruction is much more important than in RSA. Furthermore, there is a clear recent trend of increased use of humeral components fixed only in the proximal metaphyseal cancellous bone. Our aim was to summarise our six-year experience with the SMR® Stemless (LimaCorporate, Italy) system which is one of the most modern ones. MATERIAL AND METHODS Twenty cases of SMR® Stemless anatomic shoulder hemiarthroplasty performed between 2016 and 2021 were included in the study. All patients were followed up prospectively. The function was evaluated preoperatively and at the last follow-up. We evaluated the range of active elevation, classic Constant Score (CS) and pain level according to the visual analogue scale (VAS). Statistical evaluation was performed by using basic statistical methods and the statistical significance of the results was assessed with a paired t-test. Level of statistical significance was set at p= 0.01. RESULTS The mean follow-up in our cohort was 3.01 years (range 0.32-5.69, Median 2.82, SD 1.56) All cases were indicated for surgery due to primary osteoarthritis with a limitation of movement and pain. The mean postoperative CS was 85.7 (range 70-96, Median 86, SD 6.83). The mean active elevation postoperatively was 143° (range 100-170°, Median 150°, SD 20.76). Mean postoperative pain according to VAS was 1.05 (range 0-4, Median 1, SD 1.02). The mean preoperative elevation was 60.5° (range 30-100°, Median 65°, SD 18.83). After surgery the mean elevation increased to 143° (range 100-170°, Median 150°, SD 20.76). Statistical evaluation showed a statistically significant increase in the CS (41.7 preoperatively to 85.7 postoperatively), range of active elevation (60.5° preoperatively to 143° postoperatively) and a statistically significant decrease in pain (VAS 6.95 preoperatively to 1.05 postoperatively). We observed no cases of failure or loosening of the implant. A statistically significant increase in post-operative range of motion was demonstrated. DISCUSSION Most modern shoulder arthroplasty designs now include implants allowing for proximal humerus metaphyseal fixation in hemiarthroplasty and even RSA designs. The advantage of metaphyseal fixation without the use of a longer stem is clear. Notably, treatment of periprosthetic humeral fractures is simpler, extraction of the implant for any reason is easier and the preoperative anatomic position of the humeral head can be respected. As with any anatomic shoulder arthroplasty, the functional result is dependent on correct indication criteria, precise surgical technique, correct humeral head position and soft tissue reconstruction - primarily the rotator cuff. CONCLUSIONS Between 2016 and 2021, we performed 20 SMR® stemless shoulder hemiarthroplasties for primary osteoarthritis. The mean follow up was 3 years. The shoulder function improved significantly post-operatively in all patients. There were no cases of implant loosening or failure. Radiographic evaluation showed no implant loosening or change in implant position in the humeral metaphysis. Key words: shoulder joint replacement, reverse shoulder arthroplasty, SMR, stemless, total shoulder arthroplasty, shoulder hemiarthroplasty, EPOCA, wear.
- MeSH
- artroplastika ramenního kloubu * škodlivé účinky metody MeSH
- hemiartroplastika * škodlivé účinky MeSH
- hlavice humeru MeSH
- lidé MeSH
- osteoartróza * chirurgie MeSH
- pooperační bolest etiologie MeSH
- ramenní kloub * chirurgie MeSH
- rameno MeSH
- rozsah kloubních pohybů MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
svazky
- MeSH
- sexuální dysfunkce fyziologická * MeSH
- Publikační typ
- periodika MeSH
- Konspekt
- Hygiena. Lidské zdraví
- NLK Obory
- sexuologie
Cíl studie: Cílem studie bylo zjistit závažnost stavu dětí hospitalizovaných na jednotkách intenzivní a resuscitační péče nemocnic v České republice, zjistit skutečnou a predikovanou mortalitu a jejich poměr (SMR – Standartized Mortality Ratio). Typ studie: Prospektivní observační multicentrická studie v období od 1.1.2001 do 1.1.2002. Název a místo pracoviště: 11 jednotek intenzivní a resuscitační pediatrické péče nemocnic ČR (viz Poznámka). Materiál a metodika: Všechny děti, které byly v průběhu roku 2001 hospitalizovány na jednotkách intenzivní a resuscitační pediatrické péče zúčastněných pracovišť.U všech dětí bylo stanoveno příjmové PRISMskóre, určena predikovaná mortalita a sledována skutečná mortalita a jejich poměr (SMR – Standartised Mortality Ratio). Dále byla určena predikovaná mortalita, sledována skutečná mortalita aSMRpro jednotlivé kategorie pacientů podle výšky příjmového PRISMskóre (0–4,5–9,10–14, 15–19, 20–24, 25–29, ≥ 30). Výsledky: Celkem 2934 dětí bylo zařazeno do studie s průměrnou délkou hospitalizace 5,4 dne a průměrným PRISM skóre 5,6. Predikovaná mortalita odvozená od PRISM skóre byla 4,6% (predikováno bylo úmrtí 135 pacientů). Skutečná mortalita činila 3,1 % – zemřelo 92 pacientů. Poměr skutečné a predikované mortality (SMR) je 0,68. Rovněž ve všech kategoriích podle výšky PRISM skóre byla skutečná mortalita menší než predikovaná (SMR < 1). Závěr: Průměrné PRISM skóre dětí hospitalizovaných na JIP ve sledovaném období bylo 5,6, což predikuje mortalitu 4,6 %. Skutečná mortalita byla 3,1 % a jejich poměr (SMR) 0,68. Tyto údaje dokazují velmi dobrou úroveň kvality péče, kterou pracoviště pediatrické intenzivní péče poskytují.
Objective: The aim of this study was to evaluate the severity of illness of children admitted to paediatric intensive care units in the Czech Republic and to evaluate mortality, predicted mortality and their ratio (SMR – Standardized Mortality Ratio). Design: Prospective observational multicentre study between January 1, 2001 and January 1, 2002. Setting: Eleven paediatric intensive care units in the Czech Republic. Material and Methods: All children admitted to the paediatric intensive care units of involved hospitals during 2001 were enrolled. The admission PRISM score was calculated in all children. A predicted mortality was determined and a real mortality and SMR ratio was recorded. Moreover all these parameters were determined for particular categories of patients according to the level of the admission PRISM score (0–4, 5–9, 10–14, 15–19, 20–24, 25–29, ≥ 30). Results: 2934 consecutive patients were enrolled in the study with a mean length of stay of 5.4 days and a mean PRISM score 5.6. Predicted mortality calculated from PRISM score was 4.6 % (135 deaths were predicted). The real mortality was 3.1 %, 92 patients died. The Standardized Mortality Ratio was 0.68. The real mortality was lower than predicted in all groups of patients according to the level of the admission PRISM score (SMR < 1). Conclusion: The mean PRISM score of children admitted to paediatric intensive care units in the followed period was 5.6, which predicted a mortality of 4.6 %. The real mortality was 3.1%and Standardized Mortality Ratio 0.68. These data support the evidence of a very good quality of care in paediatric intensive care units.
- MeSH
- dítě MeSH
- jednotky intenzivní péče pediatrické MeSH
- lidé MeSH
- mortalita MeSH
- péče o pacienty v kritickém stavu MeSH
- řízení kvality MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: The Pooled Uranium Miners Analysis (PUMA) study draws together information from cohorts of uranium miners from Canada, the Czech Republic, France, Germany and the USA. METHODS: Vital status and cause of death were ascertained and compared with expectations based upon national mortality rates by computing standardized mortality ratios (SMRs) overall and by categories of time since first hire, calendar period of first employment and duration of employment as a miner. RESULTS: There were 51 787 deaths observed among 118 329 male miners [SMR = 1.05; 95% confidence interval (CI): 1.04, 1.06]. The SMR was elevated for all cancers (n = 16 633, SMR = 1.23; 95% CI: 1.21, 1.25), due primarily to excess mortality from cancers of the lung (n = 7756, SMR = 1.90; 95% CI: 1.86, 1.94), liver and gallbladder (n = 549, SMR = 1.15; 95% CI: 1.06, 1.25), larynx (n = 229, SMR = 1.10; 95% CI: 0.97, 1.26), stomach (n = 1058, SMR = 1.08; 95% CI: 1.02, 1.15) and pleura (n = 39, SMR = 1.06; 95% CI: 0.75, 1.44). Lung-cancer SMRs increased with duration of employment, decreased with calendar period and persisted with time since first hire. Among non-malignant causes, the SMR was elevated for external causes (n = 3362, SMR = 1.41; 95% CI: 1.36, 1.46) and respiratory diseases (n = 4508, SMR = 1.32; 95% CI: 1.28, 1.36), most notably silicosis (n = 814, SMR = 13.56; 95% CI: 12.64, 14.52), but not chronic obstructive pulmonary disease (n = 1729, SMR = 0.98; 95% CI: 0.93, 1.02). CONCLUSIONS: Whereas there are important obstacles to the ability to detect adverse effects of occupational exposures via SMR analyses, PUMA provides evidence of excess mortality among uranium miners due to a range of categories of cause of death. The persistent elevation of SMRs with time since first hire as a uranium miner underscores the importance of long-term follow-up of these workers.
- MeSH
- kohortové studie MeSH
- lidé MeSH
- nádory plic * MeSH
- nemoci z povolání * MeSH
- pracovní expozice * škodlivé účinky MeSH
- radon * MeSH
- uran * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, U.S. Gov't, P.H.S. MeSH
- Geografické názvy
- Evropa MeSH
- Francie MeSH
- Kanada MeSH
- Německo MeSH
- Severní Amerika MeSH
The energy costs of self-maintenance (standard metabolic rate, SMR) vary substantially among individuals within a population. Despite the importance of SMR for understanding life history strategies, ecological sources of SMR variation remain only partially understood. Stress-mediated increases in SMR are common in subordinate individuals within a population, while the direction and magnitude of the SMR shift induced by interspecific competitive interactions is largely unknown. Using laboratory experiments, we examined the influence of con- and heterospecific pairing on SMR, spontaneous activity, and somatic growth rates in the sympatrically living juvenile newts Ichthyosaura alpestris and Lissotriton vulgaris. The experimental pairing had little influence on SMR and growth rates in the smaller species, L. vulgaris. Individuals exposed to con- and heterospecific interactions were more active than individually reared newts. In the larger species, I. alpestris, heterospecific interactions induced SMR to increase beyond values of individually reared counterparts. Individuals from heterospecific pairs and larger conspecifics grew faster than did newts in other groups. The plastic shift in SMR was independent of the variation in growth rate and activity level. These results reveal a new source of individual SMR variation and potential costs of co-occurrence in ecologically similar taxa.
AIMS: To determine the incidence of malignancies in renal transplant recipients (RTRs) and to analyze the association between the risk of skin cancer and immunosuppressive regiments used in the posttransplant period. MATERIALS AND METHODS: A cohort study was performed on 797 RTRs. Standardized morbidity ratio (SMR) was calculated for the most common types of cancer developed in the posttransplant period and different types of immunosuppressive therapy used in the cohort. RESULTS: 192 cases of malignancies were diagnosed in 86 RTRs (10.8%). Nonmelanoma skin cancer (NMSC) was the most frequent type of cancer (SMR = 6.42, p = 0.000), followed by renal cancer (SMR = 5.9, p = 0.000), malignant melanoma (SMR = 2.59, p = 0.080), and prostate cancer (SMR = 1.21, p = 0.593). The risk to develop NMSC was significantly higher in the group where cyclosporine has been used besides tacrolimus, mycophenolatemophetil and steroids as well as in the group treated with the combination without cyclosporine (SMR = 9.62, p = 0.001 and SMR = 5.18, p = 0.000). Furthermore, the risk was significantly higher in RTRs receiving anti-thymocyte globulin within induction therapy (SMR = 4.14, p = 0.000). CONCLUSION: The preliminary results indicate that the risk of NMSC in RTRs is significantly higher than in the general population and thus emphasize the need to improve preventive strategies in the Czech transplant population.
- MeSH
- časové faktory MeSH
- dítě MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- imunokompromitovaný pacient MeSH
- imunosupresiva škodlivé účinky MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory kůže diagnóza epidemiologie imunologie MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- transplantace ledvin škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
This paper assesses the coverage probability of commonly used confidence intervals for the standardized mortality ratio (SMR) when death certificates are missing. It also proposes alternative confidence interval approaches with coverage probabilities close to .95. In epidemiology, the SMR is an important measure of risk of disease mortality (or incidence) to compare a specific group to a reference population. The appropriate confidence interval for the SMR is crucial, especially when the SMR is close to 1.0 and the statistical significance of the risk needs to be determined. There are several ways to calculate confidence intervals, depending on a study characteristics (ie, studies with small number of deaths, studies with small counts, aggregate SMRs based on several countries or time periods, and studies with missing death certificates). This paper summarizes the most commonly used confidence intervals and newly applies several existing approaches not previously used for SMR confidence intervals. The coverage probability and length of the different confidence intervals are assessed using a simulation study and different scenarios. The performance of the confidence intervals for the lung cancer SMR and all other cancer SMR is also assessed using the dataset of French and Czech uranium miners. Finally, the most appropriate confidence intervals to use under different study scenarios are recommended.
- MeSH
- interval spolehlivosti * MeSH
- lidé MeSH
- mortalita * MeSH
- nádory plic mortalita MeSH
- nemoci z povolání mortalita MeSH
- pravděpodobnost MeSH
- rizikové faktory MeSH
- statistické modely MeSH
- úmrtní listy * MeSH
- uran MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
- Francie epidemiologie MeSH
