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Background: Operative treatment of fragility fractures of the pelvis has become a gold standard. Preoperative planning, including the assessment of the pathway for iliosacral screws, is crucial. The anchorage of the screw depends on the bone quality. Some recent studies have concentrated on assessing bone mineral density (BMD) with the use of Hounsfield unit (HU) values obtained from CT scans. The aim of the present study is to determine the best sacral levels of S1-S3 on the pathway of iliosacral screws for sacroiliac joint fixation. Methods: Patients admitted to the Independent Public Healthcare Center in Rypin between 1 of September and 1 of December in 2023, who had CT scans of the pelvis performed on them for different reasons, were included in this study. In total, 103 patients-56 men and 47 women-were enrolled in the study and consecutively separated into two groups of different ages: 18-60 years old (group A) and above 60 years old (group B). The volumetric bone density expressed in HU values was measured with sacral levels of S1, S2 and S3. Apart from the bodies of sacral vertebrae S1-S3, our measurements involved the ala of the ilium in the vicinity of the sacroiliac joint and the wing of the sacrum. All the measurements were performed on the pathway of presumptive iliosacral screws to stabilize the sacroiliac joint. Results: In group A (58 patients) the highest bone density in sacral bodies was found in S1 that gradually decreased to S3, while the opposite tendency was demonstrated in the ala of ilium. The HU values in the wing of the sacrum did not display statistical significance. In group B (45 patients), the highest bone density was also found in the sacral body S1 that decreased toward S3 but in the ala of ilium, the highest bone density was found with level S1 and lowest with level S2. In both groups, the highest bone density referred to the wing of the sacrum. Conclusion: While the perfect construct for posterior pelvic ring fixation remains unclear, our findings may imply that sacroiliac joint screws inserted into the wing of the sacrum of greater bone density could provide much more successful fixation in comparison to those anchored in the body of sacral vertebra of lesser bone density.

In the course of psoriatic arthritis (PsA), depression occurs much more often than in the general population. Depression can be considered a poor prognostic factor. The aim of the study was to assess the relationships between the occurrence of depression and the levels of proinflammatory cytokines in patients with PsA. The study included 86 (47F/39M) patients with PsA. Only patients with high disease activity (DAPSA > 28) were enrolled in the study. The severity of depressive symptoms was assessed using the Beck Depression Inventory II (BDI-II) for all patients. Additionally, sociodemographic data were collected. All patients were also assessed for the levels of interleukins (IL): IL-1, IL-6, IL-17A, IL-23, and tumor necrosis factor alpha (TNF-α) using the enzyme-linked immunosorbent assay (ELISA) test. In the study group, depression (BDI-II ≥ 14) was diagnosed in 45 patients (52%). Patients with coexisting depression reported higher levels of pain and disease activity on the visual analogue scale compared to patients without depression (8.5 vs. 7.7, p < 0.001 and 9.3 vs. 8.4, p < 0.001, respectively). The mean levels of proinflammatory cytokines [pg/ml], IL-1 and IL-6, were also higher in the group of patients with depression (46.4 vs. 4.7, p < 0.001 and 10.5 vs. 4.9, p < 0.001, respectively). The coexistence of depression in the course of Psoriatic Arthritis (PsA) is associated with higher levels of IL-1 and IL-6. Depression has a negative impact on the perception of the underlying disease and is linked to reduced social and occupational activity., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background : There are three main methods of mechanical thrombectomy (MT): using a stent retriever (SR) only (SO), aspiration catheter (AC) only (AO) and the combined method (CM) using both the SR and AC. This paper describes a real-life, single-center experience using SO, AO and CM during 276 consecutive MTs. Methods : The primary endpoint was the frequency of first-pass complete (FPE TICI3). The secondary endpoints were final mTICI 2b-3, procedure duration, clinical outcome and the total number of device passes. The third aim of this study was to test the association between the clinical outcomes in patients treated with each method and various factors. Results : There was a significant difference ( p = 0.016) between the groups' FPE TICI3 rates with 46% mTICI 3 in the AO group, 41% in the CM group and 21% in the SO group. AO resulted in procedure time shortening to a mean duration of 43 min, and the scores were 56 min for CM and 63 min for SO ( p < 0.0001). There were no significant differences in clinical outcomes or in-hospital mortality. The analysis showed a correlation between good clinical outcomes and the administration of IVT: OR 1.71 (1.03-2.84) p = 0.039. Patients ≥66 years old had higher odds of a bad outcome compared to younger patients in general (OR, 1.99 95% CI, 1.17-3.38; p = 0.011). FPE TICI3 was associated with good functional outcomes in the whole treated cohort (OR, 1.98; 95% CI, 1.21-3.25; p = 0.006). Conclusions : In our series, AO proved to be the best starting point in most cases. It demonstrates good technical efficacy regarding FPE, it is fast and clinical outcomes seem to be the least age- and FPE TICI3-dependent. It can be easily converted into the combined method, which had the second-best outcomes in our cohort.