bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Fluid Bolus Therapy on Renal Perfusion, Oxygenation, and Function in Early Experimental Septic Kidney Injury
Authors: Lankadeva Yugeesh R. , Kosaka Junko , Iguchi Naoya , Evans Roger G. , Booth Lindsea C. , Bellomo Rinaldo , May Clive N
Published: November 2018

Objectives:

To examine the effects of fluid bolus therapy on systemic hemodynamics, renal blood flow, intrarenal perfusion and oxygenation, Po
2, renal function, and fluid balance in experimental early septic acute kidney injury.

Design:

Interventional study.

Setting:

Research institute.

Subjects:

Adult Merino ewes.

Interventions:

Implantation of flow probes on the pulmonary and renal arteries and laser Doppler oxygen-sensing probes in the renal cortex, medulla, and within a bladder catheter in sheep. Infusion of Escherichia coli to induce septic acute kidney injury (n = 8). After 24, 25, and 26 hours of sepsis, fluid bolus therapy (500 mL of Hartmann’s solution over 15 min) was administered.

Measurements and Main Results:

In conscious sheep, infusion of Escherichia coli decreased creatinine clearance and increased plasma creatinine, renal blood flow (+46% ± 6%) and cortical perfusion (+25% ± 4%), but medullary perfusion (–48% ± 5%), medullary Po
2 (–56% ± 4%), and urinary Po
2 (–54% ± 3%) decreased (p < 0.01). The first fluid bolus therapy increased blood pressure (+6% ± 1%), central venous pressure (+245% ± 65%), cardiac output (+11% ± 2%), medullary Po
2 (+280% ± 90%), urinary Po
2 (+164% ± 80%), and creatinine clearance (+120% ± 65%) at 30 minutes. The following two boluses had no beneficial effects on creatinine clearance. The improvement in medullary oxygenation dissipated following the third fluid bolus therapy. Study animals retained 69% of the total volume and 80% of sodium infused. Throughout the study, urinary Po
2 correlated significantly with medullary Po
2.

Conclusions:

In early experimental septic acute kidney injury, fluid bolus therapy transiently improved renal function and medullary Po
2, as also reflected by increased urinary Po
2. These initial effects of fluid bolus therapy dissipated within 4 hours, despite two additional fluid boluses, and resulted in significant volume retention.
The Effect of Propofol and Dexmedetomidine Sedation on Norepinephrine Requirements in Septic Shock Patients: A Crossover Trial
Authors: Morelli Andrea , Sanfilippo Filippo , Arnemann Philip , Hessler Michael , Kampmeier Tim G. , D’Egidio Annalia , Orecchioni Alessandra , Santonocito Cristina , Frati Giacomo , Greco Ernesto , Westphal Martin , Rehberg Sebastian W. , Ertmer Christian
Published: November 2018

Objectives:

Propofol-based sedation may increase hemodynamic instability by decreasing vascular tone and venous return. Incremental exogenous catecholamines doses may be required to counteract such effects, aggravating the deleterious effects of sympathetic overstimulation. α-2 adrenergic agonists have been reported to decrease norepinephrine requirements in experimental septic shock. The aim of the present study is to test the hypothesis that switching from sedation with propofol to the α-2 agonist dexmedetomidine may decrease norepinephrine doses in septic shock.

Design:

Prospective open-label crossover study.

Settings:

University hospital, ICU.

Patients:

Thirty-eight septic shock patients requiring norepinephrine to maintain adequate mean arterial pressure and needing deep sedation with propofol and remifentanil to maintain a Richmond Agitation-Sedation Scale score between –3 and –4.

Interventions:

An initial set of measurements including hemodynamics, norepinephrine doses, and depth of sedation were obtained during sedation with propofol. Propofol was then replaced by dexmedetomidine and a second set of data was obtained after 4 hours of dexmedetomidine infusion. Sedation was switched back to propofol, and a final set of measurements was obtained after 8 hours. A Richmond Agitation-Sedation Scale score between –3 and –4 was maintained during the study period.

Measurements and Main Results:

Norepinephrine requirements decreased from 0.69 ± 0.72 μg/kg/min before dexmedetomidine to 0.30 ± 0.25 μg/kg/min 4 hours after dexmedetomidine infusion, increasing again to 0.42 ± 0.36 μg/kg/min while on propofol 8 hours after stopping dexmedetomidine (p < 0.005). Dexmedetomidine dosage was 0.7 ± 0.2 μg/kg/hr. Before and after dexmedetomidine infusion, sedative doses remained unchanged (propofol 2.6 ± 1.2 vs 2.6 ± 1.2 mg/kg/hr; p = 0.23 and remifentanil 1.27 ± 0.17 vs 1.27 ± 0.16 μg/kg/hr; p = 0.52, respectively). Richmond Agitation-Sedation Scale was –4 (–4 to –3) before, –4 (–4 to –3) during, and –4 (–4 to –4) after dexmedetomidine (p = 0.07).

Conclusions:

For a comparable level of sedation, switching from propofol to dexmedetomidine resulted in a reduction of catecholamine requirements in septic shock patients.
The Fragility and Reliability of Conclusions of Anesthesia and Critical Care Randomized Trials With Statistically Significant Findings: A Systematic Review*
Authors: Grolleau François , Collins Gary S. , Smarandache Andrei , Pirracchio Romain , Gakuba Clément , Boutron Isabelle , Busse Jason W. , Devereaux P. J. , Le Manach Yannick
Published: November 2018

Objectives:

The Fragility Index, which represents the number of patients responsible for a statistically significant finding, has been suggested as an aid for interpreting the robustness of results from clinical trials. A small Fragility Index indicates that the statistical significance of a trial depends on only a few events. Our objectives were to calculate the Fragility Index of statistically significant results from randomized controlled trials of anesthesia and critical care interventions and to determine the frequency of distorted presentation of results or “spin”.

Data Sources:

We systematically searched MEDLINE from January 01, 2007, to February 22, 2017, to identify randomized controlled trials exploring the effect of critical care medicine or anesthesia interventions.

Study Selection:

Studies were included if they randomized patients 1:1 into two parallel arms and reported at least one statistically significant (p < 0.05) binary outcome (primary or secondary).

Data Extraction:

Two reviewers independently assessed eligibility and extracted data. The Fragility Index was determined for the chosen outcome. We assessed the level of spin in negative trials and the presence of recommendations for clinical practice in positive trials.

Data Synthesis:

We identified 166 eligible randomized controlled trials with a median sample size of 207 patients (interquartile range, 109–497). The median Fragility Index was 3 (interquartile range, 1–7), which means that adding three events to one of the trials treatment arms eliminated its statistical significance. High spin was identified in 42% (n = 30) of negative randomized controlled trials, whereas 21% (n = 20) of positive randomized controlled trials provided recommendations. Lower levels of spin and recommendations were associated with publication in journals with high impact factors (p < 0.001 for both).

Conclusions:

Statistically significant results in anesthesia and critical care randomized controlled trials are often fragile, and study conclusions are frequently affected by spin. Routine calculation of the Fragility Index in medical literature may allow for better understanding of trials and therefore enhance the quality of reporting.
Comparison of Methods for Identification of Pediatric Severe Sepsis and Septic Shock in the Virtual Pediatric Systems Database*
Authors: Lindell Robert B. , Nishisaki Akira , Weiss Scott L. , Balamuth Fran , Traynor Danielle M. , Chilutti Marianne R. , Grundmeier Robert W. , Fitzgerald Julie C.
Published: November 2018

Objectives:

To compare the performance of three methods of identifying children with severe sepsis and septic shock from the Virtual Pediatric Systems database to prospective screening using consensus criteria.

Design:

Observational cohort study.

Setting:

Single-center PICU.

Patients:

Children admitted to the PICU in the period between March 1, 2012, and March 31, 2014.

Interventions:

None.

Measurements and Main Results:

During the study period, all PICU patients were prospectively screened daily for sepsis, and those meeting consensus criteria for severe sepsis or septic shock on manual chart review were entered into the sepsis registry. Of 7,459 patients admitted to the PICU during the study period, 401 met consensus criteria for severe sepsis or septic shock (reference standard cohort). Within Virtual Pediatric Systems, patients identified using “Martin” (n = 970; κ = 0.43; positive predictive value = 34%; F1 = 0.48) and “Angus” International Classification of Diseases, 9th Edition, Clinical Modification codes (n = 1387; κ = 0.28; positive predictive value = 22%; F1 = 0.34) showed limited agreement with the reference standard cohort. By comparison, explicit International Classification of Diseases, 9th Edition, Clinical Modification codes for severe sepsis (995.92) and septic shock (785.52) identified a smaller, more accurate cohort of children (n = 515; κ = 0.61; positive predictive value = 57%; F1 = 0.64). PICU mortality was 8% in the reference standard cohort and the cohort identified by explicit codes; age, illness severity scores, and resource utilization did not differ between groups. Analysis of discrepancies between the reference standard and Virtual Pediatric Systems explicit codes revealed that prospective screening missed 66 patients with severe sepsis or septic shock. After including these patients in the reference standard cohort as an exploratory analysis, agreement between the cohort of patients identified by Virtual Pediatric Systems explicit codes and the reference standard cohort improved (κ = 0.73; positive predictive value = 70%; F1 = 0.75).

Conclusions:

Children with severe sepsis and septic shock are best identified in the Virtual Pediatric Systems database using explicit diagnosis codes for severe sepsis and septic shock. The accuracy of these codes and level of clinical detail available in the Virtual Pediatric Systems database allow for sophisticated epidemiologic studies of pediatric severe sepsis and septic shock in this large, multicenter database.
Low Low-Density Lipoprotein Levels Are Associated With, But Do Not Causally Contribute to, Increased Mortality in Sepsis*
Authors: Walley Keith R. , Boyd John H. , Kong HyeJin Julia , Russell James A.
Published: November 2018

Objectives:

Low low-density lipoprotein levels are associated with increased mortality in sepsis. Whether low low-density lipoprotein levels contribute causally to adverse sepsis outcome is unknown.

Design:

Retrospective analysis of two sepsis patient cohorts using a Mendelian Randomization strategy.

Setting:

Sepsis patients enrolled into clinical research cohorts at tertiary care teaching hospitals.

Patients:

The first cohort included 200 sepsis patients enrolled in an observational study in a hospital Emergency Department. The second cohort included genotyped patients enrolled in the Vasopressin and Septic Shock Trial.

Interventions:

Retrospective analysis of these patient datasets. In 632 patients enrolled in Vasopressin and Septic Shock Trial, Proprotein Convertase Subtilisin/Kexin type 9, and 3-Hydroxy-3-Methylglutaryl-CoA Reductase single nucleotide polymorphisms known to be associated with low-density lipoprotein levels were genotyped, and a genetic score related to low-density lipoprotein levels was calculated.

Measurements and Main Results:

In the first cohort, we replicated the finding that low low-density lipoprotein levels are associated with increased 28-day mortality. In genotyped patients in the Vasopressin and Septic Shock Trial trial, we found that the 3-Hydroxy-3-Methylglutaryl-CoA Reductase genetic score, known to be directly related to low low-density lipoprotein levels, was not associated with increased mortality. Surprisingly the Proprotein Convertase Subtilisin/Kexin type 9 genetic score, known to be directly related to low low-density lipoprotein levels, was associated with decreased (not increased) mortality.

Conclusions:

Both 3-Hydroxy-3-Methylglutaryl-CoA Reductase and Proprotein Convertase Subtilisin/Kexin type 9 genetic scores should have been associated with increased mortality if low low-density lipoprotein levels contributed causally to sepsis mortality. But this was not the case, and the opposite was observed for the Proprotein Convertase Subtilisin/Kexin type 9 genetic score. This suggests that low-density lipoprotein levels, per se, do not contribute causally to adverse sepsis outcomes. The Proprotein Convertase Subtilisin/Kexin type 9 genetic score finding raises the possibility that increased low-density lipoprotein clearance (the effect of these Proprotein Convertase Subtilisin/Kexin type 9 genotypes) may contribute to improved sepsis outcomes.
Efficacy and Safety of Loading Doses With P2Y12-Receptor Antagonists in Patients Without Dual Antiplatelet Therapy Undergoing Elective Coronary Intervention
Authors: Piqueras-Flores Jesús , Jurado-Román Alfonso , López-Lluva María Thiscal , Sánchez-Pérez Ignacio , Abellán-Huerta José , Lozano-Ruiz Poveda Fernando
Published: November 2018

Background:

European Guidelines on Myocardial Revascularization recommend clopidogrel loading dose added to acetylsalicylic acid in elective percutaneous coronary interventions (PCIs). However, there is few evidence supporting this recommendation and other P2Y12 inhibitors have not been tested in these patients.

Purpose:

To evaluate the effectiveness and safety of different loading doses of clopidogrel and ticagrelor in patients without double antiplatelet therapy and stable coronary artery disease (SCAD) undergoing elective PCI.

Methods:

Retrospective study of 147 consecutive patients with SCAD undergoing elective PCI. Loading P2Y12 inhibitor doses evaluated were: clopidogrel 600 mg, clopidogrel 300 mg, clopidogrel 150 mg, and ticagrelor 180 mg. We analyzed the occurrence of major adverse cardiovascular events and periprocedural myocardial infarction.

Results:

One hundred twenty-five patients were treated with clopidogrel (16 with clopidogrel 150 mg, 7 with clopidogrel 300 mg, and 93 with clopidogrel 600 mg) and 21 with ticagrelor 180 mg at the catheterization laboratory. The ticagrelor group had a significantly lower postprocedural peak of troponin-I (0.7 ± 3.4 vs. 0.3 ± 0.7 ng/mL; P = 0.02). There were no differences between groups in terms of major bleeding and hemoglobin drop after PCI (0.6 ± 0.8 vs. 4 ± 0.6; P = 0.8). The median of follow-up was 17 months (interquartile range 9–32.7). At the end of follow-up, major adverse cardiovascular event rate was not different between groups.

Conclusions:

In patients without dual antiplatelet therapy undergoing elective PCI, the use of ticagrelor showed lower postprocedural myocardial injury without more bleeding complications.
Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment
Authors: TILL SARA R. , AS-SANIE SAWSAN , SCHREPF ANDREW
Published: November 2018

Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic, inflammatory, and neurobiological factors that increase vulnerability to developing both of these conditions. We review treatment strategies for chronic pelvic pain in patients who have comorbid psychological conditions, including both nonpharmacologic and pharmacologic options.
Thirty Years of National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Center Research—An Update
Authors: Dijkers Marcel P. , Marwitz Jennifer H. , Harrison-Felix Cynthia
Published: November 2018

The Traumatic Brain Injury Model Systems Center (TBIMSC) program was established by the National Institute on Disability, Independent Living, and Rehabilitation Research in 1987, with the goal of conducting research to improve the care and outcomes for individuals with moderate-to-severe traumatic brain injury (TBI). This article provides an update on TBIMSC research program activities since 2010 when a similar article was published. It includes (1) discussion of TBIMSC program management and infrastructure; (2) detail on the management, data quality, access, use, and knowledge translation of the TBIMSC National Database, with more than 16 000 participants with follow-up out to 25 years postinjury to date; (3) an overview of the TBIMSC site-specific studies and collaborative module research; (4) highlights of several collaborative initiatives between the TBIMSCs and other federal, advocacy, and research stakeholders; (5) an overview of the vast knowledge translation occurring through the TBIMSC program; and (6) discussion of issues that impact on the data collection methods for and contents of the TBIMSC National Database. On the occasion of the 30th anniversary of the TBIMSC program, this article highlights many of the accomplishments of this well-established, multicenter TBI research consortium.
QUANTITATIVE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES FOR OBJECTIVE CLASSIFICATION AND STAGING OF DIABETIC RETINOPATHY
Authors: Alam Minhaj , Zhang Yue , Lim Jennifer I. , Chan Robison V.P. , Yang Min , Yao Xincheng
Published: November 2018

Purpose:

This study aims to characterize quantitative optical coherence tomography angiography (OCTA) features of nonproliferative diabetic retinopathy (NPDR) and to validate them for computer-aided NPDR staging.

Methods:

One hundred and twenty OCTA images from 60 NPDR (mild, moderate, and severe stages) patients and 40 images from 20 control subjects were used for this study conducted in a tertiary, subspecialty, academic practice. Both eyes were photographed and all the OCTAs were 6 mm × 6 mm macular scans. Six quantitative features, that is, blood vessel tortuosity, blood vascular caliber, vessel perimeter index, blood vessel density, foveal avascular zone area, and foveal avascular zone contour irregularity (FAZ-CI) were derived from each OCTA image. A support vector machine classification model was trained and tested for computer-aided classification of NPDR stages. Sensitivity, specificity, and accuracy were used as performance metrics of computer-aided classification, and receiver operation characteristics curve was plotted to measure the sensitivity–specificity tradeoff of the classification algorithm.

Results:

Among 6 individual OCTA features, blood vessel density shows the best classification accuracies, 93.89% and 90.89% for control versus disease and control versus mild NPDR, respectively. Combined feature classification achieved improved accuracies, 94.41% and 92.96%, respectively. Moreover, the temporal-perifoveal region was the most sensitive region for early detection of DR. For multiclass classification, support vector machine algorithm achieved 84% accuracy.

Conclusion:

Blood vessel density was observed as the most sensitive feature, and temporal-perifoveal region was the most sensitive region for early detection of DR. Quantitative OCTA analysis enabled computer-aided identification and staging of NPDR.
Ocular Toxicity of Mirvetuximab
Authors: Corbelli Eleonora , Miserocchi Elisabetta , Marchese Alessandro , Giuffrè Chiara , Berchicci Luigi , Sacconi Riccardo , Bandello Francesco , Modorati Giulio Maria
Published: November 2018

Purpose:

To report the clinical features and outcomes of corneal toxicity following mirvetuximab soravtansine therapy.

Methods:

Five patients who were treated with mirvetuximab soravtansine were evaluated in our hospital for ocular symptoms during a period of 5 months between December 2017 and April 2018. A complete ophthalmologic examination, including anterior segment infrared reflectance (AS-IR) and anterior segment optical coherence tomography (AS-OCT), was performed.

Results:

All 5 patients were female (average age, 62.4 ± 5.5 years) and being treated for advanced epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer. Both eyes were involved in each case. Patients complained of blurred vision (n = 5), ocular pain (n = 2), tearing (n = 5), foreign-body sensation (n = 4), and photophobia (n = 4). Slit-lamp examination demonstrated fine corneal subepithelial opacities, mainly involving the corneal periphery migrating toward the center. AS-IR revealed the presence of hyporeflective dots on the cornea, suggesting that they were cystic. AS-OCT confirmed the subepithelial location of lesions. In all patients, the cornea cleared, and visual acuity recovered fully with a short course of topical steroids and lubricants.

Conclusions:

Mirvetuximab soravtansine therapy can cause transient corneal toxicity. A short course of topical steroids can reduce the patient symptoms.
Preventing Hepatitis B in US Adults Through Vaccination
Authors: Schaffner William , Nichol Kristin L. , Reingold Arthur L.
Published: November 2018

Chronic hepatitis B virus (HBV) infection causes substantial morbidity, with up to 40% of infected individuals developing cirrhosis, hepatocellular carcinoma, or liver failure. Approximately 25% of individuals with chronic hepatitis B will die prematurely from these complications. Hepatitis B vaccines are safe and more than 90% effective in preventing infection in at-risk adults, yet only approximately 25% of US adults for whom vaccination is recommended by the Centers for Disease Control and Prevention are vaccinated. The rate of new HBV infections dropped substantially in the United States after the introduction and high uptake of hepatitis B vaccines in infants and children, and the burden of disease has shifted primarily to adults. There has been a resurgence of hepatitis B cases in US adults in recent years, with sharp increases in new cases noted in states highly impacted by the opioid epidemic. Improved hepatitis B vaccination coverage rates in US adults can help slow the rate of acute infections and reduce the reservoir of infection in US adults.
Investigation of the Experiences of Mothers Living Through Prenatal Loss Incidents: A Qualitative Study
Authors: AYDIN Ruveyde , KÖRÜKCÜ Öznur , KABUKCUOĞLU Kamile
Published: November 2018

Background:

Fetal death causes women to experience negative feelings after the loss. These lived experiences influence the future pregnancies and maternal health of women negatively.

Purpose:

The aim of this study was to investigate the experiences of women whose pregnancies were terminated because of medical indications.

Methods:

A “design for definitive status study” type of qualitative research design was used. Ten women who were hospitalized between April and July 2017 at the Akdeniz University Clinic of Obstetrics and Gynecology and had subsequently experienced pregnancy loss during their hospitalization were enrolled as participants. Thematic analysis was used to analyze the data.

Results:

The pregnancy loss experiences of participants were investigated under the five main themes of (a) lived experiences before the termination of pregnancy, (b) lived experiences after pregnancy termination, (c) willingness to see the baby after termination, (d) posttermination care requirements, and (e) physical condition of hospital rooms during hospitalization. The participants expressed feelings of hope, fear, and worry over being unsuccessful before fetal death and feelings of loneliness, disappointment, blame, and avoidance after fetal death.

Conclusions/Implications for Practice:

In the aftermath of fetal death, health professionals should use insightful and empathic communication skills to help mothers cope with their loss. In addition, some of the participants wanted to see their babies, and some did not. Thus, individualized care is very important for women who experience pregnancy loss.
Mediating Effects of Social Support on Depression and Suicidal Ideation in Older Korean Adults With Hypertension Who Live Alone
Authors: NAM Eun Jeong , LEE Jong-Eun
Published: November 2018

Background:

Older adults who live alone are less physically and emotionally healthy and report higher levels of depression relative to those who do not live alone. Suicide is the most problematic health issue reported by older adults who live alone. In particular, vulnerable older adults who live alone experience difficulty obtaining self-care and medical services; therefore, early detection of depression is difficult, and there are few opportunities to implement suicide prevention strategies in this population. In addition, social support for depression is an important factor affecting illness and economic vulnerability in older adults who live alone.

Purpose:

This study aimed to examine the relationship between depression and suicidal ideation in vulnerable older Korean adults with hypertension and to explore the mediating effect of social support on this relationship.

Methods:

The study used a cross-sectional design. Vulnerable older adults who were 65 years old or older with hypertension and who received home visit services from a public health center were invited to participate. The participants completed structured questionnaires, including the 15-item Short-Form Geriatric Depression Scale, 12-item Multidimensional Scale of Perceived Social Support, and 19-item Scale for Suicidal Ideation, and provided information regarding their demographic characteristics, health status, and economic status. Descriptive and correlation analyses were performed to examine the correlations among these variables. The three-step regression analysis method proposed by Baron and Kenny was used to examine the mediating effect of social support.

Results:

The mean depression, social support, and suicidal ideation scores of participants were 23.64 (± 2.04), 35.94 (± 15.40), and 7.80 (± 7.73), respectively. In addition, depression was negatively correlated with social support (r = −.27) and positively correlated with suicidal ideation (r = .21), whereas social support was negatively correlated with suicidal ideation (r = −.35). Social support mediated the relationship between depression and suicidal ideation (Z = 2.69).

Conclusions:

Social support was identified as an important variable for older adults with chronic illness who lived alone. Interventions that include social support hold the potential to reduce depression and suicidal ideation in this population.
Shoulder Instability: Anterior, Posterior, Multidirectional, Arthroscopic Versus Open, Bone Block Procedures
Authors: Coyner Katherine J. , Arciero Robert A.
Published: November 2018

This article presents a retrospective comprehensive review of the history of anterior, posterior, and multidirectional shoulder instability and also reviews key concepts such as open versus arthroscopic repair and glenoid and humeral head bone loss and associated treatments. The future of shoulder instability will continue to evolve as research and clinical experience will determine the direction of the future.
Anterior Cruciate Ligament Reconstruction
Authors: Richmond John C.
Published: November 2018

The past 3+ decades have been a period of intense interest in the anterior cruciate ligament. Graft choices, techniques, and fixation devices have all evolved. Our understanding of the anatomy has improved. Our follow-up and criteria for success have also expanded. Over the next several years advanced repair techniques, extra-articular augmentation, and addressing elevated tibial slope will all have to have their indications defined.
Ankle Arthroscopic Surgery
Authors: Shimozono Yoshiharu , Seow Dexter , Kennedy John G. , Stone James W.
Published: November 2018

Ankle arthroscopy is a diagnostic and therapeutic surgical procedure which was first attempted on cadavers by Dr Burman in 1931 and first successfully described in patients by Dr Takagi in 1939. Two general approaches to ankle arthroscopy currently exist: (1) anterior ankle arthroscopy and (2) posterior ankle arthroscopy. The indications for ankle arthroscopy have expanded as increased experience has been obtained treating various pathologic entities and as the surgical results have been reported in the literature. There has been significant progress in ankle arthroscopic surgery over the past decades, notably allowing surgical procedures to be performed with fewer complications and with quicker return to work and play. We anticipate that expanding indications for arthroscopic ankle surgical procedures combined with further development of biomedical devices to enhance these procedures will result in improved patient outcomes in the future.
Meniscus Repair and Replacement
Authors: Kurzweil Peter R. , Cannon W. Dilworth , DeHaven Kenneth E.
Published: November 2018

The importance of preserving the function of the meniscus is seen with renewed interest. There has been an evolution of arthroscopic meniscus repair from inside-out, outside-in, meniscal fixators, to all-inside suturing techniques. Tear patterns once ignored or thought to be irreparable, such as root tears and horizontal cleavage tears, have recently been undergoing repair with promising results. Newer techniques have also recently allowed surgeons to address postmeniscectomy knee pain. Replacing lost tissue with scaffolds or replacing the meniscus with an allograft helps restore function and reduce degenerative changes.
Rotator Cuff Repair: Single Row Repair Versus Double Row Repair and Superior Capsular Reconstruction
Authors: Sheean Andrew J. , Hartzler Robert U. , Burkhart Stephen S.
Published: November 2018

The surgical management of rotator cuff (RC) tears has progressed considerably in recent decades. Arthroscopic procedures now represent the mainstay of contemporary treatment approaches. The success of repair is predicated upon the achievement of a secure, durable repair that promotes tendon-to-bone healing. Both single and double row (DR) suture anchor configurations have been described to achieve stable fixation. Although consensus is lacking with regard to the clinical superiority of one configuration over another, trends in the literature suggest that DR repairs may optimize the likelihood of tendon healing and restoration of shoulder strength. In cases of truly irreparable RC tears, superior capsular reconstruction is a promising alternative to open tendon transfer and arthroplasty procedures. The purposes of this concise review are to: (1) explain our preference for a DR repair configuration in almost all circumstances; and (2) advocate superior capsular reconstruction as a viable treatment tactic for truly irreparable RC tears in the absence of significant glenohumeral arthritis.
A scoping review of nurse practitioner workforce data: Part two of a four-part series on critical topics identified by the 2015 Research Agenda Roundtable
Authors: Barnes Hilary , Novosel Lorraine M.
Published: November 2018

Background and purpose:

There is no single comprehensive data source for conducting nurse practitioner (NP)-focused workforce and outcomes research. The 2015 Research Agenda Roundtable of the Fellows of the American Association of Nurse Practitioners supports the development of a national NP data source. A scoping review was conducted to provide an overview of data being used in NP-focused research and to identify key issues relevant to making progress toward a national NP database.

Methods:

PubMed, CINAHL, and EMBASE were searched for English-language articles published within the past 10 years (2007–2017). Twenty-one articles were included for review and categorized into three themes: 1) NP Workforce Data Collection and Availability; 2) Using Data to Identify NPs; and 3) Minimum Data Sets and Key Variables.

Conclusions:

General consensus among workforce experts suggests that rich sources of NP data exist. However, challenges include a lack of a national data source for studying the NP workforce and outcomes; the inability to identify individual NP providers within existing data; and variations in how different sources of data are collected.

Implications for practice:

Improved NP workforce data collection is vital for workforce planning and forecasting and has implications for outcomes research and NP workforce distribution and employment.
Preparation for Practice in Newly Licensed Registered Nurses
Authors: Shaw Peggy , Abbott Miriam , King Tara Spalla
Published: November 2018

This descriptive study assessed current registered nurse (RN) preceptor perceptions of professional competencies in new nursing graduates. Strengths in caring and compassion were observed by preceptors, in addition to deficiencies in time management and prioritization. Inasmuch as deficiencies observed by RN preceptors may be functions of time and experience, it is recommended that academic nurse educators and residency program educators explore and develop means to improve students’ skills in prioritization and time management.
Qualitative Description of New Graduate Nurses’ Experiences in a Nurse Residency Program
Authors: Fowler Susan B. , Lind Samantha Chuffo , Johnson Pamela R. , Lewis Judy
Published: November 2018

Nurse residents were asked to write a targeted story at the end of the 12-month program. Qualitative content analysis by two reviewers yielded five themes: team and teamwork, gratitude, asking questions, the art of nursing, and change. Findings are supported from previous research and add new information to the body of knowledge about the experience of nurse residents. The nursing professional development practitioner can apply this knowledge in supporting and strengthening residency programs.
Evaluation of a Nurse Residency Program
Authors: Pillai Seema , Manister Nancy N. , Coppolo Mary T. , Ducey Maryanne S. , McManus-Penzero Janet
Published: November 2018

Nurse residency programs are important tools to improve retention of new graduate nurses. The aim of this study was to evaluate the effectiveness of an institutionally developed nurse residency program. Data on 20 cohorts (N = 241) of graduate nurses and best practices for residency programs were examined. Strategies to improve this nurse residency program were identified. Data showed a critical loss of new graduate nurses between Years 1 and 2 of employment.
Evaluating the Impact of Housing Status on Gonorrhea and Chlamydia Screening in an HIV Primary Care Setting
Authors: Clemenzi-Allen Angelo Asa , Hartogensis Wendy , Cohen Stephanie E. , Gandhi Monica , Geng Elvin , Christopoulos Katerina
Published: November 2018

Introduction

Gonorrhea and chlamydia (GC/CT) testing falls below recommended rates for people living with HIV (PLWH) in routine care. Despite evidence that homelessness and unstable housing (HUH) negatively impacts clinical outcomes for PLWH, little is known about GC/CT screening for HUH-PLWH in routine care.

Methods

Using an observational cohort of PLWH establishing care at a large publicly funded HIV clinic in San Francisco between February 2013 and December 2014 and with at least 1 primary care visit (PCV) before February 2016, we assessed GC/CT testing for HUH (staying outdoors, in shelters, in vehicles, or in places not made for habitation in the last year) compared with stably housed patients. We calculated (1) the odds of having GC/CT screening at a PCV using logistic regression with random effects to handle intrasubject correlations and (2) the percent of time enrolled in clinical care in which patients had any GC/CT testing (“time in coverage”) based on 180-day periods and using linear regression modeling.

Results

Of 323 patients, mean age was 43 years, 92% were male, 52% were non-Latino white, and 46% were HUH. Homeless and unstably housed PLWH had 0.66 odds of GC/CT screening at a PCV than did stably housed patients (95% confidence interval, 0.44–0.99; P = 0.043). Time in coverage showed no difference by housing status (regression coefficient, −0.93; 95% confidence interval, −8.02 to 6.16; P = 0.80).

Conclusions

Homeless and unstably housed PLWH had 34% lower odds of GC/CT screening at a PCV, demonstrating a disparity in routine care provision, but similar time in coverage. More research is needed to effectively increase GC/CT screening among HUH-PLWH.
Glypican-3 and Hep Par-1 are Useful Biomarkers in the Cytologic Assessment of Ascites
Authors: Cabibi Daniela , Bisanti Andrea , Lanza Dorotea , Brucculeri Vanessa , Porcasi Rossana , Ingrao Sabrina , Midiri Federico , Picone Dario , Giannone Antonino Giulio
Published: November 2018

Till date, the utility of cytologic assessment of ascites for the identification of hepatocellular carcinoma (HCC) cells is still debated and the usefulness of immunocytochemistry for glypican-3 (GPC3) and Hep Par-1 in this setting has not been reported. Liquid-based cytology of ascitic fluid of 28 cirrhotic patients was performed and the spots obtained were stained with hematoxylin and eosin, papanicolau, and with GPC3 and Hep Par-1 antibodies. GPC3 and Hep Par-1 antibodies stained positively the atypical cells in the ascites of 2 patients with HCC showing an exophytic growth pattern. The specimens of the patients with nonexophytic HCC, other non-HCC cancers, or cirrhosis stained negatively. We hypothesize a relationship with the exophytic growth of the tumor. Thus, GPC3 and Hep Par-1 are useful in the cytologic assessment of peritoneal effusions to distinguish mesothelial cells and neoplastic non-HCC cells from HCC cells, presence of which, however, represent a very rare event. This is the first study in which GPC3 and Hep Par-1 immunostaining has been used in the cytologic assessment of HCC ascites.
Mismatch Repair Protein Expression in Endometrioid Intraepithelial Neoplasia/Atypical Hyperplasia: Should We Screen for Lynch Syndrome in Precancerous Lesions?
Authors: Lucas Elena , Chen Hao , Molberg Kyle , Castrillon Diego H. , Rivera Colon Glorimar , Li Long , Hinson Stacy , Thibodeaux Joel , Lea Jayanthi , Miller David S. , Zheng Wenxin
Published: November 2018

Screening for Lynch syndrome (LS) is routinely performed in patients with endometrial carcinoma. Currently, no screening recommendations exist for LS in precancerous lesions. The study goal was to determine the incidence of abnormal protein expression in endometrioid intraepithelial neoplasia/atypical hyperplasia (EIN/AH). We analyzed mismatch repair (MMR) protein expression by immunohistochemistry in EIN/AH concurrent with MMR-deficient endometrial carcinomas, and in endometrial biopsy/curettage specimens with EIN/AH from an unselected group of patients. Of 63 patients with MMR-deficient endometrial carcinoma, 34 demonstrated loss of MLH1/PMS2 expression; 1 showed loss of PMS2 alone; 12 showed loss of MSH2/MSH6, and 15 had loss of MSH6 alone. Genetic testing identified deleterious mutations in 14 cases (LS). 15 tumors demonstrated MLH1 promoter hypermethylation. Abnormal MMR expression in EIN/AH and adjacent carcinoma was concordant in 100% of LS cases and 71% of MLH1 promoter hypermethylation cases. Of 118 patients from the unselected group with EIN/AH, 4 (3%) cases demonstrated absent expression of one or more MMR proteins. Of these, 2 patients were later confirmed to have deleterious mutations in subsequent specimens with endometrial carcinoma. The prevalence of abnormal MMR expression in EIN/AH adjacent to carcinoma and in the unselected group of patients with EIN/AH is similar to the reported prevalence of LS in endometrial carcinoma. Identifying patients at high risk for LS through abnormal MMR expression in EIN/AH provides the benefit of early surveillance, treatment and timely diagnosis for the patient and affected family members.
Tubulovillous Adenoma of Vagina With Both KRAS and APC Mutations: Case Report
Authors: Shuangshoti Somruetai , Teerapakpinyo Chinachote
Published: November 2018

Adenomatous polyps of the vulva and vagina are extremely rare. We report a case of a 74-yr-old women with a tubulovillous adenoma occurring in the vagina, and a second one occurring later in the vulva. Tumor cells in both lesions were CK7−, CK20+, CDX-2+, and showed intact mismatch-repair proteins. A G13D (c.38G>A, p.Gly13Asp) mutation in the KRAS gene was identified in both masses. As well, a novel frameshift truncating mutation (c.4320delA, p.Pro1441fsTer32) in the APC gene was detected only in the vaginal mass, ruling out the possibility that the vulvar mass was a local recurrence of the vaginal mass. This is the first identification of KRAS and APC gene mutations in adenomatous polyps involving the female lower genital tract.
Altered Functional Connectivity of Amygdala with the Fronto-Limbic-Striatal Circuit in Temporal Lobe Lesion as a Proposed Mechanism for Poststroke Depression
Authors: Zhang Xue-fei , He Xia , Wu Lei , Liu Chu-juan , Wu Wen
Published: November 2018

Objective

Poststroke depression (PSD) is an important complication that affects stroke rehabilitation. Abnormal cortical-subcortical connectivity may be associated with the development of PSD. However, few studies have focused on the emotional network of PSD in the temporal lobe lesions. The aim of is study was to investigate amygdala-cortical functional connectivity (FC) in the temporal lobe in individuals with and without PSD.

Design

Twenty-three patients with PSD and 21 stroke patients without depression were recruited to undergo functional magnetic imaging scanning.

Results

In stroke patients with depression, the left amygdala had increased FC with the bilateral precuneus and right orbital frontal lobe but decreased FC with the right putamen. The right amygdala had increased FC with the right temporal pole, right rectus gyrus, and left orbital frontal lobe but decreased FC with the right primary sensory area (S1). Correlative analyses revealed that the amygdala's FCs with the right orbital frontal lobe, right insular cortex, and right cingulate cortex were correlated with the Hamilton Depression Rating Scale score.

Conclusion

The current study identified mood affected through the fronto-limbic-striatal circuit in PSD. Hyperconnectivity between the amygdala, default mode network, and salience network might be related to depressive symptoms, which may provide novel insight into the underlying neuropathologic mechanisms of PSD in temporal lobe lesions.
Association Between Endothelial Function and Cognitive Performance in Patients With Coronary Artery Disease During Cardiac Rehabilitation
Authors: Saleem Mahwesh , Herrmann Nathan , Dinoff Adam , Mazereeuw Graham , Oh Paul I. , Goldstein Benjamin I. , Kiss Alex , Shammi Prathiba , Lanctôt Krista L.
Published: November 2018

Objective

Subtle cognitive deficits indicating early neural risk are common in the clinical presentation of coronary artery disease (CAD). Although deterioration may be mitigated by exercise, cognitive response to exercise is heterogeneous. Vasculopathy including endothelial dysfunction is a hallmark of CAD and may play an important role in impairing neural adaptation to exercise. This study aimed to assess peripheral measurements of endothelial function as predictors of cognitive performance in CAD participants undertaking cardiac rehabilitation (CR).

Methods

CAD patients (N= 64) undergoing CR were recruited for this prospective observational study. Neuropsychological and endothelial function assessments were performed at baseline and after 3 months of CR. Z-scores for overall cognitive performance and specific cognitive domains (verbal and visuospatial memory, processing speed, and executive function) were calculated. Endothelial function was measured by the reactive hyperemia index (RHI) using peripheral arterial tonometry. Cross-sectional and longitudinal associations between RHI and overall cognition were assessed using linear regressions and mixed models, respectively. Domain-specific associations were also explored.

Results

Although lower RHI was not associated with overall cognition at baseline (b= 0.26,p= .10), an increased RHI was significantly associated with an improvement in overall cognition (b= 0.55,p= .030) over 3 months. Lower RHI was associated with poorer verbal memory (β = 0.28,p= .027) at baseline and an increased RHI over 3 months was associated with an improvement in processing speed (b= 0.42,p= .033).

Conclusions

RHI may be a clinically useful predictor of cognitive change and might provide insight into the etiology of cognitive dysfunction in patients with CAD.
Adaptation and Resilience in Families of Children With Spina Bifida in South Korea
Authors: Choi Eun Kyoung , Van Riper Marcia , Jang Mina , Han Sang Won
Published: November 2018

Purpose

The purpose of this study, which was guided by the Family Resilience Model, was twofold: (1) to assess the risk and protective factors related to adaptation and resilience in families of children with spina bifida (SB) in South Korea and (2) to examine predictors of family adaptation and resilience.

Design

This is a descriptive study using survey methodology.

Methods

Data were collected from 203 parents of children with SB between June 2013 and February 2014 at the SB clinic in South Korea and analyzed using stepwise linear regression.

Findings

The best predictors of family adaptation and resilience in children with SB included one risk factor (parental depression) and four protective factors (parental health, family cohesion, family communication skills, and supportive friends/relatives). These five factors explained 39.7% of the total variance in family functioning (an indicator of family adaptation and resilience; F = 26.43, p < .001).

Conclusion and Clinical Relevance

Findings suggest that nursing interventions designed to strengthen protective factors and reduce risk factors are likely to promote adaptation and resilience in families of children with SB.
Historical Roots of Modern Plastic Surgery
Authors: Chopan Mustafa , Sayadi Lohrasb , Buchanan Patrick J. , Katz Adam J. , Mast Bruce A.
Published: November 2018

Background

Highly cited publications are referred to as citation classics and can signify important contributions to a discipline. Although citation classics in plastic surgery have been identified, none were published before 1960. Citation classics in earlier periods may contain the historical roots or intellectual origins of the field. We set out to identify such scholarly works and analyze their characteristics.

Methods

A novel technique of citation analysis, referred to as reference publication year spectroscopy, was used to analyze the literature. The spectrogram revealed distinct peaks before 1960, which corresponded to 20 citation classics. These 20 references were then analyzed with respect to historical context, topic of interest, anatomical region, originality, and if authors were named for their findings (eponyms).

Results

Twenty distinct citation classics (published from 1851 to 1959) were identified, accounting for 430 literature citations. Salmon’s “Arteres de la Peau” was the most cited reference, followed by Gillies’ “Principles of Plastic Surgery” and Neuber’s “Fat Grafting.” The theme of angiosomes was highly represented. Most citation classics dealt with reconstruction of acquired defects (37%) and primarily focused on the head and neck regions (45%). Thirty-five percent of clinical studies were noted for their originality, and 5 studies earned their authors’ eponymous distinctions.

Conclusion

The roots of modern plastic surgery began in the late 19th century with early efforts to describe cutaneous vasculature. Historical studies that either establish principles or lead to an advancement in our reconstructive methods have the best chance of achieving classical status.