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OBJECTIVES Compare bypass surgery and endovascular revascularization of the femoropopliteal segment in patients with peripheral arterial disease (PAD) and critical limb-threatening ischemia (CLTI). METHODS Single center study including patients undergoing first-time lower extremity intervention with peripheral bypass surgery or percutaneous transluminal angioplasty with or without stenting (PTA/S) of the femoropopliteal segment due to CLTI from 2011 to 2015. Based on prospective entered data from the Danish Vascular Registry and primary endpoints were amputation free survival, overall mortality and re-interventions RESULTS A total of 679 CLTI-patients, were included of which 35% (n=239) were treated with percutaneous transluminal angioplasty with or without stenting (PTA/S) 54% (n=363) with vein bypass, and 11% (n=77) with synthetic bypass. After three years, amputation free survival was significantly better with a vein bypass (41.8% (95% CI 35-48.4)) compared to both PTA/S (29.7% (95% CI 22.7-37) ) and synthetic bypass (31.7% (95% CI 19-45.1)). Overall, the endovascular treated patients faced more than 50% increased risk of major amputation or death compared to that of a vein bypass, after adjusting for co-morbidity and TASC-classification (HR 1.56 (95% CI 1.21-2.05)). As expected, postoperative complications, length of hospital stay (LOS) and reinterventions were more frequent in the bypass groups. CONCLUSION In this non-randomized study, autologous vein bypass was superior to both PTA/S and synthetic bypass in regard to amputation free survival and overall mortality. Despite the increased frequency of surgical complications, a vein bypass appears justified in both shorter (TASC B-C) and longer (TASC D) femoropopliteal lesions. The elderly rheumatoid arthritis (RA) population consists of both elderly-onset RA that manifests after the age of 60 and individuals diagnosed with RA early in life who age naturally to become members of this group. The elderly RA population is expanding due to both increased life expectancy and an increased incidence of elderly onset RA. Elderly onset RA seems to have a characteristic clinical pattern and perhaps biological profile different to that of early onset RA. The management of RA in elderly patients can be challenging, as robust treat-to-target approaches must be balanced against the adverse events due to increased comorbidities in old age. This produces a tendency to prefer less aggressive treatment in elderly RA patients in clinical practice. Despite the concerns about adverse events, there is limited evidence on the best way to approach RA in this population, as elderly patients are often not well presented in the clinical trials. Herein, we review the literature to assess the efficacy and safety of RA therapies in this age group. We then suggest a tailored approach that can be adopted in clinical practice, based on the disease severity and risk profiles of elderly RA patients. Background Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a monogenic disorder characterized by early onset fatal multi-system autoimmunity due to loss-of-function mutations in the gene encoding the forkhead box P3 (FOXP3) transcription factor which is crucial for the development, maturation, and maintenance of CD4+ regulatory T (T-reg) cells. Various autoimmune phenomena such as enteropathy, endocrinopathies, cytopenias, renal disease, and skin manifestations are characteristic findings in patients affected by IPEX syndrome. Objectives In this systematic review, we focus on both clinical and demographic characteristics of IPEX patients, highlighting possible genotype-phenotype correlations and address prognostic factors for disease outcome. Methods We performed a literature search to systematically investigate the case reports of IPEX which were published before August 7th, 2017. Results A total of 75 articles (195 patients) were identified. All IPEX patients included had Conclusion We report the most comprehensive summary of demographic and clinical profiles derived from a total of 195 IPEX patients with deleterious mutations in FOXP3. Analysis of our findings provide new insights into genotype/phenotype correlations, and clinical and genetic factors associated with increased risk of death and response to treatment strategies. V.BACKGROUND Postoperative hypocalcemia because of hypoparathyroidism is the most common complication of total thyroidectomy in children. We hypothesized that most children with postoperative hypocalcemia would be eucalcemic by 12 mo and sought to define risk factors for permanent hypoparathyroidism. METHODS We retrospectively reviewed children who underwent total thyroidectomy at a single children's hospital from 2012 to 2019. Patients with prior neck surgery were excluded. Indication for operation, final pathologic diagnosis, and postoperative serum calcium up to 12 mo were recorded. Permanent hypoparathyroidism was defined as supplemental calcium requirement beyond 1 y postoperatively. Trilaciclib mouse RESULTS Sixty-eight patients underwent total thyroidectomy. Graves' disease was the most common benign indication for surgery (38 patients). Twenty-six patients (38%) had cancer on final pathology. Central lymph node dissection (CLND) was performed in 12 cancer patients. Twenty-eight patients (41%) had postoperative hypocalcemia. Eight patients (12%) had hypocalcemia at 6 mo. Risk factors for hypoparathyroidism at 6 mo were a cancer diagnosis (odds ratio [OR] 6.7; P = 0.02), CLND (OR 12.6; P less then 0.01), and parathyroid tissue in the surgical specimen on pathologic analysis (OR 19.5; P less then 0.01). Only two patients (3%) developed permanent hypoparathyroidism, both of whom had thyroidectomy for cancer and underwent CLND. CONCLUSIONS Children with thyroid cancer are at high risk for postoperative hypocalcemia after total thyroidectomy. The risk is further increased by CLND, which should be performed selectively. A majority of patients with hypoparathyroidism at 6 mo postoperatively regain normal parathyroid function by 1 y. Permanent hypoparathyroidism in children after total thyroidectomy at a pediatric endocrine surgery center is rare.
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