bluuebunny/crossref_metadata_2025 huggingface dataset:
Most Granitoid Rocks are Cumulates: Deductions from Hornblende Compositions and Zircon Saturation
Authors: Barnes Calvin G , Werts Kevin , Memeti Vali , Ardill Katie
Published: February 2020

Cumulate processes in granitic magma systems are thought by some to be negligible and by others to be common and widespread. Because most granitic rocks lack obvious evidence of accumulation, such as modal layering, other means of identifying cumulate rocks and estimating proportions of melt lost must be developed. The approach presented here utilizes major and trace element compositions of hornblende to estimate melt compositions necessary for zircon saturation. It then compares these estimates with bulk-rock compositions to estimate proportions of extracted melt. Data from three arc-related magmatic systems were used (English Peak pluton, Wooley Creek batholith, and Tuolumne Intrusive Complex). In all three systems, magmatic hornblende displays core-to-rim decreases in Zr, Hf, and Zr/Hf. This zoning indicates that zircon must have fractionated during crystallization of hornblende, at temperatures greater than 800 °C. This T estimate is in agreement with Ti-in-zircon thermometry, which yields a maximum T estimate of 855 °C. On the basis of this evidence, concentrations of Zr in melts from which hornblende and zircon crystallized were calculated by (1) applying saturation equations to bulk-rock compositions, (2) applying saturation equations to calculated melt compositions, and (3) using hornblende/melt partition coefficients for Zr. The results indicate that melt was lost during crystallization of the granitic magmas, conservatively at least as much as 40 %. These results are in agreement with published estimates of melt loss from other plutonic systems and suggest that bulk-rock compositions of many granitic rocks reflect crystal accumulation and are therefore inappropriate for use in thermodynamic calculations and in direct comparison of potentially consanguineous volcanic and plutonic suites.
Reducing the Toxicity of Radiotherapy for Pancreatic Cancer With Magnetic Resonance-guided Radiotherapy
Authors: Tchelebi Leila T , Zaorsky Nicholas G , Rosenberg Jennifer C , Sharma Navesh K , Tuanquin Leonard C , Mackley Heath B , Ellis Rodney J
Published: February 2020

Pancreatic cancer is a highly fatal malignancy for which surgery is currently considered to be the only curative treatment. However, less than a quarter of patients have disease amenable to definitive surgical resection. Local treatment with radiation therapy is a promising alternative to surgery for those patients with unresectable disease. However, conventional radiation techniques with computed tomography (CT)-guided therapy have yielded disappointing results due to the inability to deliver ablative doses of ionizing radiation, while sparing the radiosensitive adjacent organs at risk. Magnetic resonance-guided radiotherapy (MRgRT) has emerged as an alternative to CT-guided radiation treatment which allows for the delivery of higher doses of radiation with low toxicity to surrounding structures. Further study into the use of MRgRT and dose escalation for locally advanced unresectable pancreatic cancer is needed.
Characterization and Fungicide Sensitivity of Colletotrichum Species Causing Strawberry Anthracnose in Eastern China
Authors: Zhang Liqing , Song Lili , Xu Xiangming , Zou Xiaohua , Duan Ke , Gao Qinghua
Published: February 2020

Strawberry anthracnose caused by Colletotrichum spp. is one of the most serious diseases in the strawberry fields of China. In total, 196 isolates of Colletotrichum were obtained from leaves, stolons, and crowns of strawberry plants with anthracnose symptoms in eastern China and were characterized based on morphology, internal transcribed spacer (ITS), and β-tubulin (TUB2) gene sequences. All 196 isolates were identified as the Colletotrichum gloeosporioides species complex. In total, 62 strains were further identified at the species level by phylogenetic analyses of multilocus sequences of ITS, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), actin (ACT), Apn2-Mat1-2 intergenic spacer and partial mating type (ApMat), calmodulin (CAL), and TUB2. Three species from the C. gloeosporioides species complex were identified: Colletotrichum siamense, C. fructicola, and C. aenigma. Isolates of C. siamense were tolerant to high temperatures, with a significantly larger colony diameter than the other two species when grown above 36°C. The inoculation of strawberry plants confirmed the pathogenicity of all three species. C. siamense isolates resulted in the highest disease severity. The in vitro sensitivities of C. siamense and C. fructicola isolates to azoxystrobin and three demethylation-inhibitor (DMI) fungicides (difenoconazole, tebuconazole, and prochloraz) were determined. Both species were sensitive to DMI fungicides but not to azoxystrobin. C. siamense isolates were more sensitive to prochloraz, while C. fructicola isolates were more sensitive to difenoconazole and tebuconazole. The present study provides valuable information for the effective management of strawberry anthracnose.
Genome Sequence Resource for Pathogen Bipolaris sorokiniana Shoemaker GN1 Causing Spot Blotch of Barley (Hordeum vulgare L.)
Authors: Meng Yaxiong , Wang Juncheng , Bai Bin , Wang Le , Yao Lirong , Ma Zengke , Si Erjing , Li Baochun , Ma Xiaole , Shang Xunwu , Wang Huajun
Published: February 2020

Spot blotch, caused by fungal pathogen Bipolaris sorokiniana Shoemaker, is one of the most frequent diseases affecting barley-growing regions worldwide. In this study, we reported the genome sequence of the highly virulent B. sorokiniana strain GN1 using the Illumina HiSeq 4000 platform. In total, 57 million 150-nucleotide paired-end clean reads were obtained and assembled into 96 scaffolds with an estimated genome size of 34.33 Mb. Furthermore, we identified genes that may be associated with strain-specific virulence and performed phylogenetic analysis of GN1 with five other Bipolaris spp. These results for GN1 will provide important information in understanding its molecular underpinning of pathogenicity and help identify novel sources of genetic resistance for improving disease resistance in barley.
Reenvisioning Advising Models: Meeting the Needs of Prelicensure Nursing Students
Authors: Morton Jennifer L. , Kramlich Debra , Simpson Nancy
Published: February 2020

Effective academic advising is a dynamic process that is linked to student success. In 2015, a private institution in northern New England began the process of reenvisioning academic advisement as a quality improvement goal for program evaluation. A three-tiered model was used that encompassed targeted academic advising during the early foundational period (core coursework), academic advising during intensive theory and clinical coursework, and postgraduation advising targeting NCLEX-RN® support and mentoring. The goal of this advising model is to develop a relationship with students in forming a plan that leads to a self-fulfilling academic journey and life.
Personalized medicine for asthma in tropical regions
Authors: Caraballo Luis , Acevedo Nathalie , Zakzuk Josefina
Published: February 2020

Purpose of review

Precision medicine could help to improve diagnosis and treatment of asthma; however, in the tropics there are special conditions to be considered for applying this strategy. In this review, we analyze recent advances of precision allergology in tropical regions, highlighting its limitations and needs in high-admixed populations living under environments with high exposure to house dust mites and helminth infections.

Recent findings

Advances have been made regarding the genetic characterization of the great diversity of populations living in the tropics. Genes involved in shared biological pathways between immune responses to nematodes and the allergic responses suggested new mechanisms of predisposition. Genome wide association studies of asthma are progressively focusing on some highly replicated genes such as those in chromosome 17q31-13, which have been also replicated in African ancestry populations. Some diagnostic difficulties, because of the endemicity of helminth infections, are now more evident in the context of phenotype definition.

The clinical impact of the advances in precision medicine for asthma in the tropics is still limited and mainly related to component resolved diagnosis. More basic and clinical research is needed to identify genetic, epigenetic, or other biologic markers that allow and accurate definition of phenotypes and endotypes of this heterogeneous disease. This will substantially improve the selection of personalized treatments.
Rapid Transition From Methadone to Buprenorphine Utilizing a Micro-dosing Protocol in the Outpatient Veteran Affairs Setting
Authors: De Aquino Joao P. , Fairgrieve Christopher , Klaire Sukhpreet , Garcia-Vassallo Gabriela
Published: February 2020

Objectives:

Alternative transition protocols from methadone to buprenorphine in the treatment of opioid use disorder (OUD) are needed to reduce the risk of precipitated withdrawal and opioid use during induction.

Methods:

Case report (n = 1).

Results:

One patient with OUD underwent a rapid microinduction outpatient protocol that did not cause precipitated withdrawal or require preceding taper before cessation of methadone. The induction was carried out safely in the outpatient setting.

Conclusions:

This report provides a patient-centered approach demonstrating feasibility and cost-effectiveness of rapid transition to buprenorphine in the US outpatient psychiatry setting. Barriers to adherence to opioid agonist therapy may be reduced using this protocol.
Daily Cannabis Use During Pregnancy and Postpartum in a State With Legalized Recreational Cannabis
Authors: Barbosa-Leiker Celestina , Burduli Ekaterina , Smith Crystal Lederhos , Brooks Olivia , Orr Michael , Gartstein Maria
Published: February 2020

Objective:

To identify perceptions of risks and benefits of cannabis use during pregnancy and postpartum from the patient perspective.

Methods:

Pregnant and postpartum (up to 3 months) women residing in a state that legalized the sale of recreational cannabis in 2012 were interviewed to determine their perceptions of risks and benefits of cannabis use during pregnancy and postpartum. Qualitative description methodology was used to identify common themes in the data. Nineteen (n = 14 pregnant; n = 5 post-partum) women who used cannabis daily while pregnant were interviewed about perceptions of risks and benefits of cannabis use during pregnancy and postpartum.

Results:

Five themes, describing the participants’ cannabis use while pregnant and postpartum, emerged from the data. These themes include (1) continued use for health management, (2) ongoing evaluative process, (3) mixed messages, (4) wanting more information, and (5) legal considerations. All 5 of these themes contributed to the overarching theme of Taking Care of Mom and Baby, which encompasses the mother's need and struggle to care for her own health and wellness, as well as that of her unborn baby.

Conclusions:

In a state with legalized recreational cannabis, pregnant and postpartum women reported continuing daily cannabis use during pregnancy to take care of themselves and their baby. It is crucial for healthcare providers to follow national guidelines and explain risks of cannabis use during pregnancy and postpartum, while also managing expectations based on patient history. A harm reduction approach to decrease cannabis use is vital to help pregnant women who are using cannabis for health management to continuously evaluate their use during pregnancy and postpartum.
Physician Communication in Injectable Opioid Agonist Treatment: Collecting Patient Ratings With the Communication Assessment Tool
Authors: Palis Heather , Marchand Kirsten , Beaumont Scott , Guh Daphne , Harrison Scott , MacDonald Scott , Brissette Suzanne , Marsh David C. , Schechter Martin T. , Oviedo-Joekes Eugenia
Published: February 2020

Objective:

Patient ratings of physician communication in the setting of daily injectable opioid agonist treatment are reported. Associations between communication items and demographic, health, drug use, and treatment characteristics are explored.

Methods:

Participants (n = 121) were patients receiving treatment for opioid use disorder with hydromorphone (an opioid analgesic) or diacetylmorphine (medical grade heroin). Ratings of physician communication were collected using the 14-item Communication Assessment Tool. Items were dichotomized and associations were explored using univariate and multivariable logistic regression models for each of the 14 items.

Results:

Ratings of physician communication were lower than reported in other populations. In nearly all of the 14 multivariable models, participants with more physical health problems and with lower scores for treatment drug liking had lower odds of rating physician communication as excellent.

Conclusions:

In physician interactions with patients with opioid use disorder, there is a critical need to address comorbid physical health problems and account for patient medication preferences.

Practice Implications:

Findings reinforce the role physicians can play in communicating with patients about their comorbid conditions and about medication preferences. In the patient-physician interaction efforts to meet patients’ evolving treatment needs and preferences can be made by offering patients access to all available evidence-based treatments.
Hemodynamic Monitoring in Patients With Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis
Authors: Simonassi Francesca , Ball Lorenzo , Badenes Rafael , Millone Marco , Citerio Giuseppe , Zona Gianluigi , Pelosi Paolo , Robba Chiara
Published: February 2020

Aneurysmal subarachnoid hemorrhage (aSAH) often causes cardiopulmonary dysfunction. Therapeutic strategies can be guided by standard (invasive arterial/central venous pressure measurements, fluid balance assessment), and/or advanced (pulse index continuous cardiac output, pulse dye densitometry, pulmonary artery catheterization) hemodynamic monitoring. We conducted a systematic review and meta-analysis of the literature to determine whether standard compared with advanced hemodynamic monitoring can improve patient management and clinical outcomes after aSAH. A literature search was performed for articles published between January 1, 2000 and January 1, 2019. Studies involving aSAH patients admitted to the intensive care unit and subjected to any type of hemodynamic monitoring were included. A total of 14 studies were selected for the qualitative synthesis and 3 randomized controlled trials, comparing standard versus advanced hemodynamic monitoring, for meta-analysis. The incidence of delayed cerebral ischemia was lower in the advanced compared with standard hemodynamic monitoring group (relative risk [RR]=0.71, 95% confidence interval [CI]=0.52-0.99; P=0.044), but there were no differences in neurological outcome (RR=0.83, 95% CI=0.64-1.06; P=0.14), pulmonary edema onset (RR=0.44, 95% CI=0.05-3.92; P=0.46), or fluid intake (mean difference=−169 mL; 95% CI=−1463 to 1126 mL; P=0.8) between the 2 groups. In summary, this systematic review and meta-analysis found only low-quality evidence to support the use of advanced hemodynamic monitoring in selected aSAH patients. Because of the small number and low quality of studies available for inclusion in the review, further studies are required to investigate the impact of standard and advanced hemodynamic monitoring–guided management on aSAH outcomes.
Dietary Supplement Use and Its Micronutrient Contribution During Pregnancy and Lactation in the United States
Authors: Jun Shinyoung , Gahche Jaime J. , Potischman Nancy , Dwyer Johanna T. , Guenther Patricia M. , Sauder Katherine A. , Bailey Regan L.
Published: February 2020

OBJECTIVE:

To estimate the prevalence of use and the micronutrient contribution of dietary supplements among pregnant, lactating, and nonpregnant and nonlactating women in the United States.

METHODS:

Cross-sectional data from 1,314 pregnant, 297 lactating, and 8,096 nonpregnant and nonlactating women (aged 20–44 years) in the 1999–2014 National Health and Nutrition Examination Survey were combined to produce statistically reliable, nationally representative estimates. Information about dietary supplements used in the past 30 days was collected through an interviewer-administered questionnaire and in-home inventory. The prevalence of nutrient-specific supplement use, mean daily nutrient intakes from supplements among users, and motivations for supplement use were assessed. Differences by age, income, and trimester within pregnant women were also tested.

RESULTS:

Seventy-seven percent of pregnant women and 70% of lactating women used one or more dietary supplements, whereas 45% of nonpregnant and nonlactating women used supplements. In particular, 64% of pregnant and 54% of lactating women used prenatal supplements. Mean intakes of thiamin, riboflavin, niacin, folic acid, vitamins B6, B12, and C, iron, and zinc from supplements alone were at or above their respective recommended dietary allowances (RDAs) among pregnant and lactating supplement users. About half of pregnant and 40% of lactating women took supplements based on the recommendation of a health care provider. Among pregnant women, those in their first trimester, aged 20–34 years, or in a lower-income family were less likely to use supplements compared with their counterparts.

CONCLUSION:

The majority of pregnant and lactating women used dietary supplements, which contributed many nutrients in doses above the RDAs. Although inadequate Intakes of folate and iron are of concern among pregnant women who are not using supplements, supplement users often consumed high doses, suggesting a potential need of health care providers to discuss dietary supplement use and the recommended doses of nutrients during pregnancy and lactation.
Effect of Delayed Cord Clamping on Umbilical Blood Gas Values in Term Newborns
Authors: Nudelman Matthew J. R. , Belogolovsky Esther , Jegatheesan Priya , Govindaswami Balaji , Song Dongli
Published: February 2020

OBJECTIVE:

To compare the effect of delayed cord clamping on cord blood gas values in vaginally delivered, healthy, term singletons.

DATA SOURCE:

We used MEDLINE, CINAHL, CENTRAL, EMBASE, and ClinicalTrials.gov databases.

METHODS OF STUDY SELECTION:

Eligible studies included randomized controlled trials (RCTs) comparing cord blood gas values obtained from early compared with delayed cord clamping groups and observational studies using serial cord blood gas from the same umbilical cord. We described the difference in means of cord blood gas parameters and comparative descriptive statistics when a difference in means was not available. We used a domain-based risk bias tool to extract methodologic details and assess potential risk of bias.

TABULATION, INTEGRATION, AND RESULTS:

This review included two RCTs and three observational studies. These studies included a total of 234 newborns with early cord clamping and 218 newborns with delayed cord clamping. The observational studies showed that 45–90 seconds delayed cord clamping was associated with mean decreases in umbilical arterial pH (0.02–0.03), HCO3 (0.3–0.8 mmol/L) and increases in base deficit (0.3–1.3 mmol/L) compared with early cord clamping. One observational study showed that delayed cord clamping was associated with decreases in umbilical venous pH (0.01) and HCO3 (0.2 mmol/L) and increase in venous base deficit (0.1–0.3 mmol/L) compared with early cord clamping. These changes were not observed in the two RCTs.

CONCLUSION:

Delayed cord clamping up to 120 seconds has either no effect or only a small effect on cord blood acid–base balance; overall, the magnitude of these changes is not clinically significant in vaginally delivered, healthy, term singletons.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42019135779.
Umbilical Cord Abnormalities and Stillbirth
Authors: Hammad Ibrahim A. , Blue Nathan R. , Allshouse Amanda A. , Silver Robert M. , Gibbins Karen J. , Page Jessica M. , Goldenberg Robert L. , Reddy Uma M. , Saade George R. , Dudley Donald J. , Thorsten Vanessa R. , Conway Deborah L. , Pinar Halit , Pysher Theodore J. ,   the NICHD Stillbirth Collaborative Research Network Group
Published: February 2020

OBJECTIVE:

Umbilical cord abnormalities are commonly cited as a cause of stillbirth, but details regarding these stillbirths are rare. Our objective was to characterize stillbirths associated with umbilical cord abnormalities using rigorous criteria and to examine associated risk factors.

METHODS:

The Stillbirth Collaborative Research Network conducted a case-control study of stillbirth and live births from 2006 to 2008. We analyzed stillbirths that underwent complete fetal and placental evaluations and cause of death analysis using the INCODE (Initial Causes of Fetal Death) classification system. Umbilical cord abnormality was defined as cord entrapment (defined as nuchal, body, shoulder cord accompanied by evidence of cord occlusion on pathologic examination); knots, torsions, or strictures with thrombi, or other obstruction by pathologic examination; cord prolapse; vasa previa; and compromised fetal microcirculation, which is defined as a histopathologic finding that represents objective evidence of vascular obstruction and can be used to indirectly confirm umbilical cord abnormalities when suspected as a cause for stillbirth. We compared demographic and clinical factors between women with stillbirths associated with umbilical cord abnormalities and those associated with other causes, as well as with live births. Secondarily, we analyzed the subset of pregnancies with a low umbilical cord index.

RESULTS:

Of 496 stillbirths with complete cause of death analysis by INCODE, 94 (19%, 95% CI 16–23%) were associated with umbilical cord abnormality. Forty-five (48%) had compromised fetal microcirculation, 27 (29%) had cord entrapment, 26 (27%) knots, torsions, or stricture, and five (5%) had cord prolapse. No cases of vasa previa occurred. With few exceptions, maternal characteristics were similar between umbilical cord abnormality stillbirths and non–umbilical cord abnormality stillbirths and between umbilical cord abnormality stillbirths and live births, including among a subanalysis of those with hypo-coiled umbilical cords.

CONCLUSION:

Umbilical cord abnormalities are an important risk factor for stillbirth, accounting for 19% of cases, even when using rigorous criteria. Few specific maternal and clinical characteristics were associated with risk.
Risk Factors Associated With Cesarean Delivery After Induction of Labor in Women With Class III Obesity
Authors: Paidas Teefey Christina , Reforma Liberty , Koelper Nathanael C. , Sammel Mary D. , Srinivas Sindhu K. , Levine Lisa D. , Durnwald Celeste P.
Published: February 2020

OBJECTIVE:

To assess the risk factors associated with cesarean delivery in women with class III obesity (body mass index [BMI, calculated as weight in kilograms divided by height in meters squared] 40 or higher) who are undergoing induction of labor.

METHODS:

This was a retrospective cohort of obese women with a BMI of 40 or higher and singleton pregnancy of 34 weeks of gestation or longer who underwent induction of labor at two large teaching institutions from January 2013 to December 2015. The primary outcome was cesarean delivery. Secondary outcomes included maternal and neonatal composite morbidity. We then assessed the applicability of using a previously developed calculator to predict the risk of cesarean delivery. The area under the receiver operating characteristic (ROC) curve was used as a measure of the ability of the calculator to discriminate between women who underwent cesarean compared with vaginal delivery.

RESULTS:

There were 485 women with class III obesity who underwent induction during the study period. Of the 428 women who met inclusion criteria, 81.8% had a BMI of 40–50, 14.5% had a BMI of 50–60, and 3.7% had a BMI higher than 60. The overall cesarean delivery rate was 49.1% (46% with BMI 40–50, 63% with BMI 50–60, and 69% with BMI higher than 60, P=.012). Of the 428 women studied, 77.6% were black and 55% were nulliparous. Nulliparity, height, initial cervical dilation, and modified Bishop score were associated with a higher rate of cesarean delivery in multivariable models. Maternal and neonatal composite morbidity was higher in obese women who underwent cesarean delivery, compared with those who delivered vaginally. The performance of a previously developed induction calculator applied to this cohort had an area under the ROC curve of 75% (95% CI 0.70–0.79).

CONCLUSIONS:

In women with class III obesity who underwent labor induction, the cesarean delivery rate approaches 50%. Nulliparity, height, and unfavorable cervical examination were the most significant risk factors for cesarean delivery. This information can be used to augment counseling for the obese patient who is undergoing induction.
Ethiopian and American Collaboration
Authors: Negussie Dereje , Bekele Delayhu , Curran Diana , Ogburn Tony , Peterson Herbert , Clem Fiona , Chescheir Nancy
Published: February 2020

From 2015 to 2018, the Ethiopian Society of Obstetricians & Gynecologists (ESOG), the American College of Obstetricians and Gynecologists, the Ethiopian Federal Ministry of Health, and the Center for International Reproductive Health Training at the University of Michigan collaborated to define and execute the goals of ESOG to enhance education, research, publishing, and clinical care in Ethiopia. We outline the processes used to define and execute these goals, accomplishments toward achieving them, and key lessons learned.
Fassier-Duval Rod Failure: Is It Related to Positioning in the Distal Epiphysis?
Authors: Holmes Kaley , Gralla Jane , Brazell Christopher , Carry Patrick , Tong Suhong , Miller Nancy H. , Georgopoulos Gaia
Published: February 2020

Background:

The relationship between Fassier-Duval (FD) rod placement and rod failure rates has not previously been quantified.

Methods:

Retrospective review was conducted on patients with osteogenesis imperfecta treated with FD rods between 2005 and 2017. Age at first surgery, sex, Sillence type of osteogenesis imperfecta, bisphosphonate treatment, location of rod (side of body and specific bone), and dates of surgeries, radiographs, and rod failures were collected. C-arm images determined rod fixation within the distal epiphysis at the time of surgery. C-arm variables included rod deviation (percent deviation from the midline of the distal epiphysis) and anatomical direction of deviation (anterior/posterior and medial/lateral). X-ray images were examined for rod failure, which was defined as bending, pulling out of the physis, protrusion out of the bone, and/or failure to telescope. Cox proportional hazards regression models were used to compare failure rates with location of placement within the distal epiphysis allowing for clustering of the data by side (left or right) and bone (femur or tibia).

Results:

The cohort was 13 patients (11 female individuals and 2 male individuals) with a total of 66 rods and 75 surgeries. Mean time from the first surgery to the last follow-up visit was 8.9 years (SD=5 y). There was a 7% increase in hazard of failure per 1-mm increase in antero-posterior (AP) deviation [hazard ratio (HR), 1.07; 95% confidence interval (CI), 1.01-1.14; P=0.029)]. Similarly, there was a 9% increase in hazard of failure for every 1-mm increase in lateral deviation (HR, 1.09; 95% CI, 1.01-1.18; P=0.019). A 12% increase in hazard of failure per 10% increase in deviation from the midline for both AP and lateral radiograph views was also found, although this was only statistically significant for lateral deviation on the AP radiograph view (HR, 1.12; 95% CI, 1.01-1.25; P=0.030).

Conclusions:

FD rod placement within the distal epiphysis has significant impact on increasing rod survival.

Level of Evidence:

Level III—therapeutic study.
Injection Drug Use in Patients With Spinal Epidural Abscess
Authors: Toppo Alexander J. , Rogerson Ashley , Oh David H.W. , Tybor David J. , Wurcel Alysse G. , Salzler Matthew J.
Published: February 2020

Study Design.

Retrospective review of the Healthcare Cost and Utilization Project National Inpatient Sample, 2000 to 2013.

Objective.

To determine the proportion of spinal epidural abscess (SEA) cases that were related to injection drug use (IDU) and to compare length of stay, leaving against medical advice, paralysis, cauda equina syndrome, radiculitis, and in-hospital mortality between SEA cases with and without IDU.

Summary of Background Data.

The US opioid epidemic impacts all aspects of healthcare, including spinal surgeons. Although injection drug use (IDU) is a risk factor for spinal epidural abscess (SEA), IDU among SEA patients and its effect on clinical outcomes is not well understood.

Methods.

Cases aged 15 to 64 with principal diagnosis of SEA were classified as IDU-related (IDU-SEA) or non-IDU-related (non-IDU-SEA) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for illicit drug use and hepatitis C. We determined the proportion of SEA patients with IDU and compared length of stay, leaving against medical advice, paralysis, cauda equina syndrome, radiculitis, and in-hospital mortality between IDU-SEA and non-IDU-SEA patients.

Results.

From 2000 to 2013, there were 20,425 admissions with a principal diagnosis of SEA (95% confidence interval (CI), 19,281–21,568); 19.1% were associated with IDU (95% CI, 17.7%–20.5%). The proportion of white IDU-SEA cases increased by 2.4 percentage points annually (95% CI, 1.4–3.4). After adjusting for age, sex, and race, IDU-SEA patients stayed a mean of 6.7 more days in the hospital (95% CI, 5.1–8.2) and were 4.8 times more likely to leave against medical advice (95% CI, 2.9–8.0). Mean hospital charges for IDU-SEA patients were $31,603 higher (95% CI: $20,721–$42,485). Patients with IDU-SEA were less likely to have cauda equina syndrome (adjusted odds ratio, 0.48, 95% CI, 0.26–0.87).

Conclusion.

IDU-SEA patients stay in the hospital longer and more often leave against medical advice. Providers and hospitals may benefit from exploring how to better facilitate completion of inpatient treatment and achieve superior outcomes.

Level of Evidence: 3
The Role of Radiotherapy for Chordoma Patients Managed With Surgery
Authors: Dial Brian L. , Kerr David L. , Lazarides Alexander L. , Catanzano Anthony A. , Green Cindy L. , Risoli Thomas , Blazer Dan G. , Goodwin Rory C. , Brigman Brian E. , Eward William C. , Larrier Nicole A. , Kirsch David G. , Mendoza-Lattes Sergio A.
Published: February 2020

Study Design.

Retrospective review.

Objective.

To determine if adjuvant radiation therapy (RT) improves overall survival (OS) following surgical resection of chordomas.

Summary of Background Data.

The role of RT for the treatment of chordomas remains incompletely described. Previous studies have not found adjuvant RT to improve OS, but these studies did not group patients based on surgical margin status or radiation dose or modality. We used the National Cancer Database to investigate the role of RT in chordomas following surgical resection.

Methods.

Patients were stratified based on surgical margin status (positive vs. negative). Utilizing the Kaplan–Meier method, OS was compared between treatment modalities (surgical resection alone, therapeutic RT alone, and surgical resection plus therapeutic RT). OS was subsequently compared between patients treated with palliative dose (<40 Gy), low dose (40–65 Gy), and high dose (>65 Gy) RT. Similarly, OS was compared between advanced RT modalities including proton beam therapy (PBT) and intensity-modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS), and external beam radiation therapy (EBRT). A multivariable model was used to determine adjusted variables predictive of mortality.

Results.

One thousand four hundred seventy eight chordoma patients were identified; skull base (n = 567), sacral (n = 551), and mobile spine (n = 360). Surgical resection and therapeutic adjuvant RT improved 5-year survival in patients with positive surgical margins (82% vs. 71%, P = 0.03). No clear survival benefit was observed with the addition of adjuvant RT in patients with negative surgical margins. High dose RT was associated with improved OS compared with palliative and low dose RT (P < 0.001). Advanced RT techniques and SRS were associated with improved OS compared with EBRT. In the multivariate analysis high dose advanced RT (>65 Gy) was superior to EBRT.

Conclusion.

Patients with positive surgical margins benefit from adjuvant RT. Optimal OS is associated with adjuvant RT administered with advanced techniques and cumulative dose more than 65 Gy.

Level of Evidence: 4
Reoperation for Late Neurological Deterioration After Laminoplasty in Individuals With Degenerative Cervical Myelopathy
Authors: Nakashima Hiroaki , Kanemura Tokumi , Satake Kotaro , Ito Kenyu , Ouchida Jun , Morita Daigo , Ando Kei , Kobayashi Kazuyoshi , Ishiguro Naoki , Imagama Shiro
Published: February 2020

Study Design.

Retrospective cohort study.

Objective.

The objective of this study was to elucidate the rate and causes of reoperation for late neurological deterioration after cervical laminoplasty by comparing cases of cervical spondylotic myelopathy (CSM) with those of ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data.

Although the long-term surgical outcomes of cervical laminoplasty in patients with CSM or OPLL are satisfactory, reoperation is sometimes required for late neurological deterioration after laminoplasty. However, limited information is available about long-term follow-up in such cases.

Methods.

This retrospective cohort study included 623 patients who underwent cervical laminoplasty for cervical myelopathy (average follow-up duration, 6.1 [range, 2–15] years). The rate of reoperations for late neurological deterioration (>6 mo after the initial surgery) was investigated.

Results.

Primary diagnoses were CSM and OPLL in 522 (83.8%) and 101 (16.2%) patients, respectively. During the follow-up period, 10 (1.6%) patients required reoperation: 7 (1.3%) in the CSM group and 3 (3.0%) in the OPLL group. No significant difference was found between the CSM and OPLL groups regarding patients requiring reoperation (P = 0.26). The mean elapsed time between primary surgery and reoperation was 4.7 ± 3.2 and 10.0 ± 5.7 years in the CSM and OPLL groups, respectively. The predicted risk percentages of reoperation at 10 years after primary surgery were 2.9% and 1.0% in the CSM and OPLL group, respectively. The causes of reoperation for CSM were C5 palsy in five, severe radiculopathy in one, and restenosis due to instability after laminoplasty in one case; the cause of reoperation for OPLL was enlargement of ossification in all three cases.

Conclusion.

Although the clinical outcomes of laminoplasty were favorable in most patients, reoperation for late neurological deterioration was required in approximately 1.0% to 3.0% of CSM and OPLL cases within 10 years after laminoplasty.

Level of Evidence: 4
Anticancer activity of a 1,4-dihydropyridine in DMBA-induced mouse skin tumor model
Authors: Manna Debashri , Akhtar Shabnam , Maiti Pragati , Mondal Samiran , Kumar Mandal Tapan , Ghosh Rita
Published: February 2020

Antitumor potential of a 1,4-dihydropyridine derivative (DHP-8) has been successfully studied previously in a number of cancer cell lines including the human melanoma cells, A375. In order to validate its anticancer activity, DMBA induced tumor in Swiss Albino mice was considered for this study. DMBA causes skin carcinoma in murine systems and is an important in vivo model for evaluating the efficacy of any new chemical entity against skin cancer. Topical administration of DHP-8 at the dose rate of 33.3 and 50.0 mg/kg body weight showed a significant reduction in tumor parameters. It also prevented the progression and differentiation of squamous cell carcinoma, as evidenced from histopathological studies. Immunohistochemical analysis for the expression of Ki67 indicated that it also reduced cancer cell proliferation. Additionally, it induced apoptosis in the tumor cells by activation of Caspase3. Our results indicated that DHP-8 efficiently attenuated DMBA induced tumor progression and it could be a potent therapeutic agent for skin cancer treatment.
Association between neutropenia and response to ramucirumab and paclitaxel in patients with metastatic gastric cancer
Authors: Roviello Giandomenico , Conca Raffaele , D’Angelo Alberto , Multari Andrea Giovanni , Paganini Giovanni , Chiriacò Giorgio , Petrioli Roberto , Corona Silvia Paola , Rosellini Pietro , Aieta Michele
Published: February 2020

The aim of this study was to evaluate if the occurrence of neutropenia is correlated with response to ramucirumab plus paclitaxel for metastatic gastric cancer. This is a retrospective study of patients treated with ramucirumab plus paclitaxel. Fifty-three patients were evaluated. Among these, 10 patients (26.5%) developed grade ≥3 neutropenia. Patients with grade ≥3 neutropenia reported a progression-free survival of 6.6 months (95% confidence interval 3.3–8.4) and overall survival of 11 months (95% confidence interval 5.9–13.1) vs. 4.4 months (95% confidence interval 3.9–5.2) and 8.7 months (95% confidence interval 7.8–10.1) respectively in patients’ group with lower grade events. Our analysis seems to suggest that the occurrence of neutropenia predicts response to treatment with ramucirumab and paclitaxel.
Tanshinone I regulates autophagic signaling via the activation of AMP-activated protein kinase in cancer cells
Authors: Zheng Lihua , Zhang Ying , Liu Guijian , Cheng Shi , Zhang Ge , An Cheng , Sun Shipeng , Wang Jian , Pang Bo , Li Shanhu
Published: February 2020

Tanshinone I, one of the components of Salvia miltiorrhiza Bunge, exhibits anti-tumor ability and induces autophagy. But the mechanisms are not fully understood. This study aims to investigate whether AMP-activated protein kinase dependent pathway is involved in the autophagic signaling regulation and its relationship with tumor suppression. Breast cancer cells (MDA-MB-231, MCF-7) and hepatocellular carcinoma cells (HepG2) were treated with Tanshinone I or vehicle. Acridine orange dyeing and transmission electron microscopy were employed to evaluate autophagic cells. MTT and Cell Counting Kit-8 assays were used to detect the effect of Tanshinone I combined with autophagy inhibitors on cell proliferation. Western blot was used to detect the expression levels of Beclin1 and LC3-I/II, as well as the phosphorylation of AMPKα and ULK1. Our results showed that Tanshinone I suppressed proliferation of HepG2, MDA-MB-231 and MCF-7 cancer cell lines. LC3-II and P62 were induced by Tanshinone I in all three cancer cell lines. But autophagic flux analysis showed that Tanshinone I treatment induced autophagy only in MDA-MB-231, which was also proved by transmission electron microscopy. Tanshinone I upregulated the phosphorylation of AMPKα and its downstream ULK1. AMP-activated protein kinase inhibitor compound C attenuated Beclin 1 and LC3-II expression induced by Tanshinone I in HepG2. In MDA-MB-231, compound C surprisingly induced LC3-II upregulation which is independent of AMPKα activation. Under this circumstance, treatment of Tanshinone I combined with compound C significantly inhibited MDA-MB-231 proliferation, compared with Tanshinone I treatment alone. This study demonstrates that Tanshinone I could induce cancer cell death and regulate autophagy signaling in breast cancer and hepatic carcinoma cells. Activation of AMPKα was found to be involved in autophagic signaling regulation by Tanshinone I.
Full-dose cisplatin chemotherapy combined with hemodialysis in a patient with impaired renal function and a mediastinal germ cell tumor
Authors: Jager Nynke G.L. , Sari Vicdan , Westermann Anneke M. , Bijleveld Yuma A. , Bijlsma Joost A.
Published: February 2020

Cisplatin is the first choice treatment in mediastinal germ cell tumors. However, concerns regarding increased toxicity of cisplatin hamper its administration in patients with impaired renal function. We describe a 42-year-old man with chronic kidney disease stage 4 who was diagnosed with a mediastinal germ cell tumor and metastases in lung and brain. Treatment with cisplatin-etoposide was considered essential for a chance of cure. In order to administer the full cisplatin dose, 4-hour hemodialysis sessions were performed after each cisplatin infusion. During treatment cycle 3, 4 and 5, total and unbound plasma platinum concentrations were measured. Trough concentrations and half-life were at the higher end of the range of those observed in patients with adequate renal function who received the same dose of cisplatin. Hemodialysis aided platinum clearance, although our patient was also able to clear some platinum by his own renal function. With this full dose treatment, our patient obtained a favorable tumor response, with a strong decrease of beta-human chorionic gonadotropin and tumor size. The side effects experienced by our patient were serious, although not worse than what could be expected with this type of treatment. His renal function remained stable during the treatment period.
Complete Recovery of Immune Checkpoint Inhibitor–induced Colitis by Diverting Loop Ileostomy
Authors: Horisberger Karoline , Portenkirchner Carmen , Rickenbacher Andreas , Biedermann Luc , Gubler Christoph , Turina Matthias
Published: February 2020

Checkpoint inhibitor–induced side effects such as diarrhea and colitis occur in up to 30% of patients. We present a case of recurrent episodes of checkpoint inhibitor–induced colitis and subsequent Fournier gangrene that resolved after ileostomy formation. Once the Fournier gangrene and colitis had resolved, the ileostomy was reversed. However, within only 4 days, another serious flare-up of colitis occurred, necessitating emergent re-formation of the ileostomy. Expertise in the management of side effects of immune checkpoint inhibitor therapy is currently limited. Although most side effects are mild to moderate and transient, a minority of patients suffer from life-threatening complications, such as colitis. The creation of an ileostomy might be a valid treatment option in severe or recurrent colitis due to immune checkpoint inhibitor therapy. Intestinal diversion surgery may be useful if conservative treatment has failed, similar to other forms of immune-mediated intestinal inflammation.
A comparative study of three concentrations of intravenous nalbuphine combined with hydromorphone for post-cesarean delivery analgesia
Authors: Huang Chun-Yun , Li Shu-Xi , Yang Mei-Juan , Xu Li-Li , Chen Xin-Zhong
Published: February 2020

Background:

Nalbuphine has been suggested to be used for post-cesarean section (CS) intravenous analgesia. However, ideal concentration of nalbuphine for such analgesia remains unclear. The present study was conducted to explore an ideal concentration of nalbuphine for post-CS intravenous analgesia by evaluating the analgesic effects and side-effects of three different concentrations of nalbuphine combined with hydromorphone for post-CS intravenous analgesia in healthy parturients.

Methods:

One-hundred-and-fourteen parturients undergoing elective CS were randomly allocated to one of three groups (38 subjects per group) according to an Excel-generated random number sheet to receive hydromorphone 0.05 mg/mL + nalbuphine 0.5 mg/mL (group LN), hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL (group MN), and hydromorphone 0.05 mg/mL + nalbuphine 0.9 mg/mL (group HN) using patient-controlled analgesia (PCA) pump. Visual analog scale (VAS) for pain, PCA bolus demands, cumulative PCA dose, satisfaction score, Ramsay score, and side-effects such as urinary retention were recorded.

Results:

The number of PCA bolus demands and cumulative PCA dose during the first 48 h after CS were significantly higher in group LN (21 ± 16 bolus, 129 ± 25 mL) than those in group MN (15 ± 10 bolus, 120 ± 16 mL) (both P < 0.05) and group HN (13 ± 9 bolus, 117 ± 13 mL) (both P < 0.01), but no difference was found between group HN and group MN (both P > 0.05). VAS scores were significantly lower in group HN than those in group MN and group LN for uterine cramping pain at rest and after breast-feeding within 12 h after CS (all P < 0.01) and VAS scores were significantly higher in group LN than those in group MN and group HN when oxytocin was intravenously infused within 3 days after CS (all P < 0.05), whereas VAS scores were not statistically different among groups for incisional pain (all P > 0.05). Ramsay sedation scale score in group HN was significantly higher than that in group MN at 8 and 12 h after CS (all P < 0.01) and group LN at 4, 8, 12, 24 h after CS (all P < 0.05).

Conclusions:

Hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL for intravenous PCA could effectively improve the incisional pain and uterine cramping pain management and improve comfort in patients after CS.

Trial registration number:

ChiCTR1800015014, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.
Squamous Cell Carcinoma of the Hand: A Retrospective Study in Immunosuppressed and Immunocompetent Individuals
Authors: Mull Jamie L. , Phelan Patrick S. , Mull Aaron B. , Russell Aaron J. , Hurst Eva A. , Council M. Laurin
Published: February 2020

BACKGROUND

Cutaneous squamous cell carcinoma (SCC) of the hand presents a treatment challenge because of the anatomical complexity of this location. Immunosuppressed patients are disproportionately affected by cutaneous SCC. Existing data on SCC of the hand are primarily presented in the orthopedic literature, and may thus be affected by referral bias.

OBJECTIVE

Characterization of epidemiology and treatment outcomes for hand versus nonhand cutaneous SCC in immunosuppressed versus immunocompetent patients, across all clinical departments.

MATERIALS AND METHODS

Single-institution retrospective cohort study of cutaneous SCC evaluated over 3 years and hand SCC over an additional 5 years.

RESULTS

A cohort of 522 hand SCC cases (1,746 total SCC) was ascertained among 1,064 patients, of whom 175 were immunosuppressed. Occurrence on the hand was more common for SCC arising in immunosuppressed versus immunocompetent patients (38% vs 24% of cases respectively). Hand SCC cases demonstrated balanced laterality and comparable spectra of differentiation regardless of immunosuppression. No cases of hand SCC metastasis were observed over greater than 2 years' mean follow-up, and digital amputation was only required in approximately 1% of hand SCCs.

CONCLUSION

In our cohort, assessment of hand SCC across all clinical departments suggests more favorable prognosis than reflected in the previous literature.
A review of the intriguing interaction between testosterone and neurocognitive development in males with 47,XXY
Authors: Samango-Sprouse Carole A. , Yu Christine , Porter Grace F. , Tipton Elizabeth S. , Lasutschinkow Patricia C. , Gropman Andrea L.
Published: February 2020

Purpose of review

Although 47,XXY (Klinefelter syndrome) was first discovered more than 50 years ago, there have been limited comprehensive studies on this disorder. The present review explains the study of neurodevelopmental dysfunction and the impact of testosterone replacement at specific junctions in the life of males with 47,XXY. The intricate relationship between testosterone, neurodevelopment, health, and well being warrants an in-depth investigation in order to achieve optimal outcomes.

Recent findings

Current literature suggests that the implementation of biological treatment has a positive impact on numerous areas of neurodevelopment. Further research is needed to determine ideal dosage, timing, and frequency of biological treatment for efficacy and safety of the child with 47,XXY.

As noninvasive prenatal screening has detected increasing numbers of fetuses with 47,XXY, parents may benefit from both prenatal and postnatal counseling, including the latest innovative biological treatment, that may further optimize the child's outcome, especially when coupled with targeted early intervention services.