XACERBATIONS OF RESPIRATORY symptoms in chronic obstructive pulmonary disease (COPD) are of major importance because of their profound and longlasting adverse effects on patients. 1,2 Frequent episodes accelerate loss of lung function, 3 affect the quality of life of the patients, 4,5 and are associated with poor survival. 6-8 In general, exacerbations become more frequent with increasing disease severity, but the single best predictor of exacerbations in all grades of COPD is a previous exacerbation, suggesting the existence of a phenotype susceptible to exacerbations independent of degree of airflow limitation. 9 However, when predicting risk of future exacerbations based on previous events, the positive predictive value remains low, 9 indicating that additional determinants of exacerbation susceptibility remain to be identified. Exacerbations are often caused by respiratory tract infections, 10 and during the acute episode, levels of circulating acute phase proteins and inflammatory cells are elevated. 11,12 However, some patients with COPD also have evidence of low-grade systemic inflammation with increased levels of such inflammatory biomarkers during stable conditions, 13 and previous studies have found that elevated levels of inflammatory biomarkers like Creactive protein (CRP), fibrinogen, and For editorial comment see p 2390.
BackgroundSurgeon-dependent factors such as optimal implant alignment are thought to play a significant role in outcome following primary total knee arthroplasty (TKA). Exact definitions and references for optimal alignment are, however, still being debated. This overview of the literature describes different definitions of component alignment following primary TKA for (1) tibiofemoral alignment in the AP plane, (2) tibial and femoral component placement in the AP plane, (3) tibial and femoral component placement in the sagittal plane, and (4) rotational alignment of tibial and femoral components and their role in outcome and implant survival.MethodsWe performed a literature search for original and review articles on implant positioning following primary TKA. Definitions for coronal, sagittal, and rotational placement of femoral and tibial components were summarized and the influence of positioning on survival and functional outcome was considered.ResultsMany definitions exist when evaluating placement of femoral and tibial components. Implant alignment plays a role in both survival and functional outcome following primary TKA, as component malalignment can lead to increased failure rates, maltracking, and knee pain.InterpretationBased on currently available evidence, surgeons should aim for optimal alignment of tibial and femoral components when performing TKA.
Simultaneously elevated levels of CRP, fibrinogen, and leukocyte count are associated with a two- to fourfold increased risk of major comorbidities in COPD. These biomarkers may be an additional tool for clinicians to conduct stratified management of comorbidities in COPD.
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