bluuebunny/crossref_metadata_2025 huggingface dataset:
Geometric Torsion in Adolescent Idiopathic Scoliosis
Authors: Shen Jesse , Kadoury Samuel , Labelle Hubert , Roy-Beaudry Marjolaine , Aubin Carl-Éric , Parent Stefan
Published: August 2016

Study Design.

Consecutive case series.

Objective.

To study geometric torsion in thoracic adolescent idiopathic scoliosis (AIS) to propose it as a numerical three-dimensional (3D) parameter that quantifies the scoliosis deformity.

Summary of Background Data.

AIS is a 3D deformity of the spine. The most widely accepted and used classification systems, however, still rely on two-dimensional aspects of x-rays. Yet, a 3D classification of AIS remains elusive because there is no widely accepted 3D parameter in the clinical practice.

Methods.

Analysis of 141 patients with Lenke type-1 deformity recruited in our institution. The Lenke classification was identified by two observers and 3D reconstructions were obtained using biplanar radiographs. Geometric torsion measuring the twisting effect of the spine was computed using a novel technique by approximating local arc lengths at the neutral vertebra in the thoracolumbar segment. An inter- and intragroup statistical analysis was performed to evaluate the torsion index, and how it relates to other 3D indices.

Results.

A statistically significant increase in torsion was observed between Lenke 1A (1.15 mm−1) and Lenke 1C (2.10 mm−1) subgroups. No differences were found between the Lenke 1B (1.75 mm−1) subgroup with either of the other two subgroups. An automatic classification based on torsion indices identified two groups: one with high torsion values (3.02 mm−1) and one with low torsion values (0.82 mm−1). Statistically significant differences were found between the main thoracic planes of maximum curvature (PMC) orientation of the high-torsion group (73.72°) and the low-torsion group (79.85°). Statistically significant differences were also found for the thoracolumbar/lumbar PMC orientation between the high-torsion group (56.41°) and the low-torsion group (49.25°).

Conclusion.

These results suggest that a numerical method of describing scoliosis in 3D is within reach. They also suggest the existence of two subgroups of 3D deformations based on torsion values (high and low) with links to PMC orientation.

Level of Evidence: 4
Rectus Capitis Posterior Minor
Authors: Venne Gabriel , Rasquinha Brian J. , Kunz Manuela , Ellis Randy E.
Published: August 2016

Study Design.

Serial histological investigation was performed on 10 cadaveric specimens and biomechanical tests were performed on five specimens, both focused on the tissue connexion between the rectus capitis posterior minor (RCPMi) and the spinal dura.

Objective.

This study had two components: to clarify the microscopic structure of the tissue link between RCPMi and the dura mater, and to evaluate the mechanical role of this tissue complex.

Summary of Background Data.

Dissection-based and imaging-based reports have suggested a connective tissue link between the RCPMi and the dura mater at the posterior-atlanto-occipital (PAO) level. Existence of this link, and properties, remain unclear.

Methods.

Histological investigation: RCPMi muscles, their bony attachments, PAO space, and adjacent spinal dura mater were resected from 10 cadavers. Tissues were subdivided into medial and lateral parts. Serial histological sections were prepared to cover maximum surface area; Masson trichrome stain was used to evaluate the tissue connection. Biomechanical investigation: individualized RCPMi muscles from five cadavers were detached from their origin. Each muscle was loaded incrementally up to 2 kg, with the cervical spine hyperextended. Using a structured light scanner, the dura mater was scanned for each loaded state. Comparison between unloaded and each loaded scanned surface quantified the displacement of the dura mater.

Results.

Histological investigation confirmed the existence of a connective tissue link between the RCPMi and the dura mater. The biomechanical testing suggests that this tissue link complex can reduce the bulging of the dura mater into the spinal canal, caused during hyperextension, by 53.4% ± 6.9% under RCPMi loading.

Conclusion.

This histological investigation clarified the structure of the tissue link between the RCPMi and the dura mater. The biomechanical testing indicated a potential mechanical function of the RCPMi in regards to the spinal dura mater, which may include a stabilizing role of the dura mater during neck extension.

Level of Evidence: N/A
Anterior Cervical Discectomy and Fusion Provides Better Surgical Outcomes Than Posterior Laminoplasty in Elderly Patients With C3-4 Level Myelopathy
Authors: Tamai Koji , Terai Hidetomi , Suzuki Akinobu , Toyoda Hiromitsu , Hoshino Masatoshi , Takahashi Shinji , Hayashi Kazunori , Ohyama Shoichiro , Nakamura Hiroaki
Published: August 2016

Study Design.

Retrospective analyses of prospectively collected data regarding 180 patients with cervical spondylotic myelopathy (CSM).

Objective.

To detect the characteristics of C3-4 level CSM in elderly patients (C3-4CSM) (main analysis) and to validate the postoperative outcomes of anterior cervical discectomy and fusion (ACDF) and of laminoplasty (LAMP) (subgroup analysis).

Summary of Background Data.

It remains unclear which surgical technique offers the best outcomes for CSM.

Methods.

The main analysis included 180 patients with CSM, divided into two groups (C3-4CSM group, n = 46; conventional CSM group, n = 134) according to the findings of the preoperative physical examination and magnetic resonance imaging. The subgroup analysis included 46 patients with C3-4CSM, divided into two groups (ACDF group, n = 21; LAMP group, n = 25) according to surgical technique. Preoperative demographics and postoperative outcomes were compared.

Results.

The age at surgery was higher, disease duration was shorter, and preoperative Japanese Orthopaedic Association (JOA) score was lower in the C3-4CSM group than in the conventional CSM group. Although the C3-4 range of motion was significantly higher, that of other levels was significantly lower in the C3-4CSM group. The anteroposterior diameter for levels C3-C7 was significantly larger in the C3-4CSM group. In the subgroup analysis using the repeated-measures analysis of variance, the postoperative JOA scores, and visual analog scale of neck pain were significantly better in the ACDF group.

Conclusion.

Higher age, shorter disease duration, and worse JOA scores appear to be characteristic of C3-4CSM. In the management of C3-4CSM, ACDF provided better surgical outcomes than did LAMP; hypermobility at the C3-4 level, a radiological characteristic of C3-4CSM, may be one of key factors affecting surgical outcome. The chance to diagnose C3-4CSM is increasing with the increasing healthy life expectancy. To enable effective resolution of symptoms, C3-4CSM must be distinguished from conventional CSM.

Level of Evidence: 4
Interpositional Arthroplasty Technique for Hallux Rigidus Using Amniotic Membrane and Regenerative Tissue Matrix
Authors: Garras David N. , Holton Jacob P.
Published: August 2016

Hallux rigidus is a painful osteoarthritic condition of the first metatarsophalangeal joint. It is the most prevalent arthritic condition of the foot, affecting up to 1 in 40 adults over 50 years of age. Mild cases of hallux rigidus are frequently treated with cheilectomy, whereas severe cases are often treated with arthrodesis. Interposition arthroplasty is a joint-sparing alternative to fusion that has been used effectively in moderate to severe cases of hallux rigidus. This paper discusses a novel modification of interpositional arthroplasty technique using amniotic membrane graft and regenerative tissue matrix to successfully treat patients who have failed cheilectomy.

Levels of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.
Depressive symptoms across the menopause transition: findings from a large population-based cohort study
Authors: Hickey Martha , Schoenaker Danielle A.J.M. , Joffe Hadine , Mishra Gita D.
Published: August 2016

Objective:

The aim of the study was to describe the trajectories of depressive symptoms in a large population-based cohort of midaged women, and to examine the associations of current and changing reproductive stage with depressive symptoms over time.

Methods:

Prospective, population-based cohort study of 13,715 women aged 45 to 50 years followed up for over 15 years (Australian Longitudinal Study on Women's Health). Nearly 6,000 women provided complete data for this study. Menopause status was determined from questionnaires about hysterectomy, oophorectomy, hormone therapy, and menstrual patterns. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression scale (CESD-10).

Results:

Latent class analysis indicated four distinct profiles of CESD-10 scores over 15 years: stable low (80.0%), increasing (9.0%), decreasing (8.5%), and stable high (2.5%). Those with “increasing” depressive symptoms were more likely to have had bilateral salpingo-oophorectomy or be perimenopausal at baseline compared with women in the “stable low” group. Depressive symptoms were higher in perimenopausal women, (higher CESD-10 score of 0.19, 95% CI 0.02, 0.31), after hysterectomy alone (0.53, 95% CI 0.31, 0.74), bilateral salpingo-oophorectomy with/without hysterectomy (0.85, 95% CI 0.58, 1.12), hormone therapy users (0.19, 95% CI 0.01, 0.36), and after starting or stopping hormone therapy compared with postmenopausal women (adjusted for sociodemographic factors, vasomotor symptoms, health behaviors, and history of depression diagnosis or treatment).

Conclusions:

Depressive symptoms follow distinct trajectories across the menopause transition. Most women have stable symptoms, but around 9% have increasing symptoms and a similar proportion (8.5%) decreasing symptoms. Increasing depressive symptoms were independent of vasomotor symptoms but were associated with oophorectomy and stopping or starting hormone therapy. A large number of women were excluded due to missing data, and thus the results should be interpreted with caution.
UNUSUAL CASE OF STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS
Authors: Dolz-Marco Rosa , Kato Kenneth , Freund K. Bailey , Yannuzzi Lawrence A.
Published: August 2016

Purpose:

To report a case of unilateral stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) in a young male showing structural changes induced by a Valsalva maneuver.

Methods:

Case report of a 26-year-old oboist with SNIFR, including multimodal imaging. Eye-tracked spectral-domain optical coherence tomography (SD-OCT) was used to compare the retinal architecture at rest and during a Valsalva maneuver.

Results:

Spectral-domain optical coherence tomography showed macular and peripapillary retinoschisis with no signs of pathologic myopia, optic pit, or vitreoretinal traction. A full-field electroretinogram showed supranormal responses in the eye studied. Magnetic resonance imaging of the brain showed no abnormalities. Eye-tracked SD-OCT scans showed an increase in retinal thickness reaching 28 microns superior to the disc during an induced Valsalva maneuver.

Conclusion:

Stellate nonhereditary idiopathic foveomacular retinoschisis is a diagnosis made when other known causes of retinoschisis have been excluded. In this patient with unilateral SNIFR, an increase in retinal thickness during a Valsalva maneuver was demonstrated. Further study would be needed to determine the mechanism producing this change and to assess its potential influence on visual prognosis.
The Wills Eye Glaucoma App: Interest of Patients and Their Caregivers in a Smartphone-based and Tablet-based Glaucoma Application
Authors: Waisbourd Michael , Dhami Hermandeep , Zhou Chen , Hsieh Michael , Abichandani Pramod , Pro Michael J. , Moster Marlene R. , Katz L. Jay , Hark Lisa A. , Myers Jonathan S.
Published: August 2016

Purpose:

To evaluate the interest of glaucoma patients and their caregivers in a smartphone-based and tablet-based glaucoma application (App), developed by the Wills Eye Glaucoma Research Center in collaboration with Drexel University.

Materials and Methods:

Cross-sectional survey of patients with glaucoma and their caregivers. Main outcome measures are answers to survey questions regarding how receptive participants are to using the Glaucoma App.

Results:

Fifty subjects completed the survey. The mean age (SD) was 59.5 (±17.3) years. A total of 88.6% of the participants lived in a household with access to a smartphone or tablet. The majority (72.3%) of participants would consider downloading the Glaucoma App, and younger participants (<65 y) were more likely to do so compared with their older (≥65 y) counterparts, P=0.025. Participants were more likely to download the App if it was free of charge, compared with a version that costs $3, P=0.018. Although only about one third (37.8%) of participants used eye drop reminders, nearly 3 of 4 (72.9%) participants were receptive to using the automated reminder feature of the Glaucoma App.

Conclusions:

Glaucoma patients and their caregivers were very interested in using a Glaucoma App; however, many were not willing to spend $3 for an App they seem to value. The free Wills Eye Glaucoma App currently available on the Apple store, includes educational videos, eye drop and appointment reminders, medical and ocular data storage, visual field tutorial, and intraocular pressure tracker. These features aim to increase patients’ level of knowledge about glaucoma and improve their adherence to medication and follow-up appointment recommendations.
Acute Primary Angle Closure in the Fellow Eye as a Complication of Facedown Position After Vitrectomy Surgery
Authors: Lin Zhong , Wu Ronghan , Moonasar Nived , Zhou Yehui
Published: August 2016

Purpose:

To report a case of acute primary angle closure that developed in the fellow eye rapidly after facedown position after vitrectomy surgery.

Patients and Methods:

A 66-year-old female developed acute primary angle closure in the fellow eye approximately 1.5 hours after facedown position after vitrectomy surgery for macular hole.

Results:

The intraocular pressure was controlled after treatment that included halting the facedown position, intravenous mannitol injection, and topical pilocarpine instillation. Facedown position was continued after laser peripheral iridotomy was performed. The intraocular pressure was controlled within normal range even after pilocarpine was withdrawn.

Conclusions:

Although rare, the potential risk of acute-angle closure should be explicitly explained to patients being considered for facedown position after vitrectomy. Prophylactic intervention, such as laser peripheral iridotomy, could be considered for anatomically predisposed eyes.
Patterns of Damage in Young Myopic Glaucomatous-appearing Patients With Different Optic Disc Tilt Direction
Authors: Lee Jong Eun , Lee Jiyun , Lee Jin Young , Kook Michael S.
Published: August 2016

Purpose of the Study:

The purpose of the study was to compare patterns of damage in young myopic glaucomatous-appearing patients with horizontal disc tilt (HDT) to a control group of patients with vertical disc tilt (VDT).

Patients and Methods:

We consecutively enrolled 104 eyes of 104 young, myopic, glaucomatous-appearing patients without or with early visual field (VF) defects. The eyes were divided into those with HDT or VDT. The clinical characteristics of the peripapillary retinal nerve fiber layer (pRNFL) and VF damage were compared between groups after matching for age, refractive error, and neural rim area using spectral-domain optical coherence tomography and standard automated perimetry 24-2 VF testing. Multivariate logistic regression analysis was performed to determine the risk factors associated with more advanced VF damage (mean deviation <−6 dB) at initial presentation.

Results:

The asymmetric loss of pRNFL thickness between hemispheres was significantly greater in the HDT group (P=0.002). Myopic eyes with HDT were more likely to have peripheral VF loss than those with VDT (P<0.05). HDT was an independent risk factor for more advanced VF loss at initial presentation (P=0.011).

Conclusions:

The disc tilt direction may be related to asymmetrical pRNFL loss and the location and gravity of VF loss at initial presentation in young myopic glaucomatous-appearing patients. These findings are clinically important for initial detection and planning the follow-up strategy in myopic glaucomatous-appearing eyes with different disc tilt directions.
Evaluation of a Trabecular Micro-Bypass Stent in Pseudophakic Patients With Open-Angle Glaucoma
Authors: Ferguson Tanner J. , Berdahl John P. , Schweitzer Justin A. , Sudhagoni Ramu
Published: August 2016

Purpose of the Study:

The purpose of the study was to evaluate the safety and efficacy of the iStent Trabecular Micro-Bypass stent in pseudophakic patients with open-angle glaucoma.

Methods:

Retrospective, consecutive case series from October 2012 to May 2015 with no exclusion criteria. The series comprised 42 pseudophakic eyes with open-angle glaucoma that were implanted with 1 iStent. Data were collected preoperatively, and postoperative data were collected at 1 day, 1 week, 1, 3 and 6 months, 1 year, 18 months and 2 years. Data included intraocular pressure (IOP), number of glaucoma medications, the incidence of postoperative IOP pressure spikes ≥15 mm Hg at any timepoint, and the need for additional surgery.

Results:

The mean preoperative IOP was 20.26±6.00 mm Hg. At 1 year postoperatively, the mean IOP was 16.34±3.78 mm Hg (P<0.01). At 2 years postoperatively, the mean IOP was 13.62±4.55 (P<0.01). The mean number of glaucoma medications was 1.95±1.01 preoperative and 1.69±1.28 (P>0.05) at 1 year postoperatively. Postoperatively, 3 eyes (7%) experienced an IOP increase of 15 mm Hg above their baseline IOP that responded to topical therapy. In total, 96% of patients with an IOP≥19 mm Hg achieved a reduction in IOP at their last collected follow-up.

Conclusions:

The insertion of the iStent Trabecular Micro-Bypass stent effectively lowers IOP in pseudophakic patients with open-angle glaucoma. Although medication use was not significantly reduced postoperatively at 1 year, 80% of patients either experienced a reduction or no change in medication use. The safety profile appears favorable with a low rate of IOP spikes and only 1 patient requiring additional surgery.
Increased Cell Adhesion Molecules, PECAM-1, ICAM-3, or VCAM-1, Predict Increased Risk for Flare in Patients With Quiescent Inflammatory Bowel Disease
Authors: Gu Phillip , Theiss Arianne , Han Jie , Feagins Linda A.
Published: August 2016

Goals and Background:

Predicting the risk of flare-ups for patients with inflammatory bowel disease (IBD) is difficult. Alterations in gut endothelial regulation of mucosal immune homeostasis might be early events leading to flares in IBD. Cell adhesion molecules (CAMs), in particular, are important in maintaining endothelial integrity and regulating the migration of leukocytes into the gut.

Study:

We evaluated the mRNA expression of various tight junction proteins, with an emphasis on CAMs, in 40 patients with IBD in clinical remission. Patients were retrospectively assessed at 6, 12, and 24 months after baseline colonoscopy, and at the end of all available follow-up (maximum 65 mo), for flare events to determine whether baseline mRNA expression was associated with subsequent flares.

Results:

At all follow-up points, the baseline expression of platelet endothelial cell adhesion molecule-1 (PECAM-1), ICAM-3, and VCAM-1 was significantly higher in patients who flared than in those who did not (2.4-fold elevation, P=0.012 for PECAM-1; 1.9-fold increased, P=0.03 for ICAM-3; and 1.4-fold increased, P=0.02 for VCAM-1). PECAM-1 and ICAM-3 expression was significantly increased in patients who flared as early as 6 months after baseline colonoscopy. In contrast, there were no significant differences between patients with and without flares in baseline expression of other CAMs (ESAM, ICAM-1, ICAM-2, E-selectin, P-selectin, and MadCAM1).

Conclusions:

Increased expression of PECAM-1, ICAM-3, and VCAM-1 in colonic biopsies from patients with IBD in clinical remission is associated with subsequent flares. This suggests that increases in the expression of these proteins may be early events that lead to flares in patients with IBD.
Multiple biopsy passes and the risk of complications of percutaneous liver biopsy
Authors: Chi Heng , Hansen Bettina E. , Tang Wing Yin , Schouten Jeoffrey N.L. , Sprengers Dave , Taimr Pavel , Janssen Harry L.A. , de Knegt Robert J.
Published: August 2016

Background and aim

To minimize the sample variability of liver biopsy, the tissue length should be at least 25 mm. Consequently, more than one biopsy pass is needed with cutting biopsy needles. We aimed to investigate the risk factors of biopsy-related complication, including the number of biopsy passes.

Methods

All consecutive liver biopsies performed between 2005 and 2014 were included. Biopsies were ultrasound assisted and performed with cutting biopsy needles. A complication was an event where the patient visited a healthcare provider because of biopsy-related complaints. Complications followed by hospitalization 2 or more days or intervention were considered severe.

Results

In total, 1806 liver biopsies were analyzed. Overall, 102 (5.6%) complications were observed, of which 31 (1.7%) were severe. One (0.06%) patient died. Common complications were pain (n=75/102; 74%) and bleeding (n=34/102; 33%). Two biopsy passes were not associated with an increased risk of complications compared with one biopsy pass [odds ratio (OR): 1.59; 95% confidence interval (CI): 0.83–3.04; P=0.16], whereas three or more biopsy passes increased this risk compared with one (OR: 2.97; 95% CI: 1.38–6.42; P=0.005) or two biopsy passes (OR: 1.87; 95% CI: 1.10–3.19; P=0.021). The risk of severe complications was not influenced by the number of biopsy passes (P>0.24). Hepatic malignancy (OR: 3.21; 95% CI: 1.18–8.73; P=0.022) and international normalized ratio 1.4 or more (OR: 7.03; 95% CI: 2.74–18.08; P<0.001) were risk factors of severe complications.

Conclusion

Severe complication rate and mortality were low. Performing multiple biopsy passes was not associated with severe complications, whereas hepatic malignancy or elevated international normalized ratio were associated with an increased risk.
The utility and yield of endoscopic ultrasonography for suspected choledocholithiasis in common gastroenterology practice
Authors: Quispel Rutger , van Driel Lydi M.W.J. , Veldt Bart J. , van Haard Paul M.M. , Bruno Marco J.
Published: August 2016

Background and study aim

Endoscopic ultrasonography (EUS) is an established diagnostic modality for diagnosing common bile duct (CBD) stones. Its use has led to a reduction in the number of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed for suspected choledocholithiasis. We aimed to explore the role of EUS in detecting CBD stones and/or sludge in common gastroenterology practice.

Patients and methods

We reviewed case records of 268 consecutive patients who underwent (EUS) procedures performed to confirm or rule out the presence of CBD stones and/or sludge between November 2006 and January 2011 in the Reinier de Graaf Hospital, Delft, The Netherlands, which is a nonacademic community hospital.

Results

On the basis of EUS findings, 169 of 268 (63%) patients did not undergo ERCP and were therefore not exposed to its risk of complications. Patients with positive findings on EUS (n=99) all underwent ERCP and endoscopic sphincterotomy. Only 57 of 99 (58%) had positive findings at ERCP. The main contributing factors to this finding seem to be time interval between EUS and ERCP and the type of CBD content (i.e. sludge, one CBD stone or more than one CBD stone) described.

Conclusion

In our common gastroenterology practice, EUS plays an important role in selecting patients suspected to have CBD stones or sludge for ERCP. Much is to be learned about the probability of spontaneous passage of CBD stones and sludge into the duodenum.
Optical Coherence Tomography and Biometry in High Myopia with Tilted Disc
Authors: Moghadas Sharif Nasrin , Shoeibi Nasser , Ehsaei Asieh , Mallen Edward A. H.
Published: August 2016

Purpose

The purpose of this study was to compare retinal thickness and biometric parameters between highly myopic eyes with and without tilted optic discs.

Methods

A total of 60 eyes from 60 highly myopic individuals (defined as a mean spherical equivalent refraction of −6.00 D or greater and axial length ≥26 mm) underwent detailed ophthalmic examination. Twenty-one eyes (13 females and 8 males; mean age: 29 ± 7 years) with tilted optic discs were recruited and compared with 39 eyes (23 females and 16 males; mean age: 28 ± 6 years) of control subjects without tilted optic discs using spectral domain optical coherence tomography (OCT) and the Lenstar biometer. Disc ovality was assessed using the ratio of minimum to maximum disc diameter (index of tilt). A ratio of ≤0.80 was considered as a tilted optic disc.

Results

There were no significant differences in biometric parameters between two groups. However, myopia in the tilted disc group was significantly greater compared to the non-tilted group (−8.82 ± 1.58 D vs. −7.84 ± 1.22 D, p = 0.01). Comparison of OCT sectoral macular nerve fiber layer measurements between groups showed significant differences in inner ring thicknesses for the nasal (p = 0.01), inferior (p < 0.001), and temporal (p = 0.04) quadrants. A significant difference was also seen in outer ring macular nerve fiber layer thickness for the temporal quadrant (p = 0.03). No significant differences were demonstrated in optic disc peripapillary retinal nerve fiber layer (RNFL) thickness between the two groups.

Conclusions

Mean spherical equivalent refractive error is strongly correlated with optic disc tilt; however, other biometric factors are independent of tilt. Structural examination of the eye using OCT can be employed to differentiate between eyes with tilted optic discs and those with normal discs. Peripapillary RNFL appears to be unaffected by tilted discs.
High Expression of Vimentin is Associated With Progression and a Poor Outcome in Glioblastoma
Authors: Zhao Jiaxin , Zhang Liqiu , Dong Xingli , Liu Lu , Huo Linman , Chen Huirong
Published: August 2016

Glioblastoma multiforme (GBM) has a high recurrence and mortality rate. Because of a poor understanding of the mechanism for this disease, treatment regimens have remained limited. Vimentin, one of the major cytoskeletal proteins, is associated with cellular structure. However, the function of vimentin in GBM is still undefined. In the present study, we investigated the expression level of vimentin in 179 GBM tissues using immunohistochemistry. We found that the vimentin expression level was associated with the time to progression (P=0.029). A Kaplan-Meier analysis revealed that patients with high vimentin expression had a significantly shorter overall survival (P=0.0002) and progression-free survival (P=0.0001) compared with those with low expression. Furthermore, in vitro experiments showed that withaferin-A, a chemical inhibitor of vimentin, could inhibit GBM cell migration and invasion activity when its concentrations were <0.5 μM, and higher concentrations of withaferin-A could decrease the viability of U251and U87 cells significantly. In conclusion, our results indicated that vimentin may play an important role in the progression of GBM.
The Evaluation of Angiogenesis Markers in Hepatocellular Carcinoma and Precursor Lesions in Liver Explants From a Single Institution
Authors: Teixeira André C. , Brasil Ivelise R.C. , Torres Alba F.C. , Tavora Fabio
Published: August 2016

Hepatocellular carcinoma (HCC) is a global health problem associated with chronic liver disease. Precursor lesions are described, and the correct diagnosis of liver nodules is paramount when considering liver transplantation. We evaluated the immunohistochemical expression of vascular endothelial growth factor (VEGF) and angiopoietin-2 in HCC and precursors lesion in a single institution series of whole liver explants between 2013 and 2015, evaluating morphologic and clinical variables. The study comprised 67 patients (32.8% female) and 107 nodules. The mean age of the patients was 52.7 years (29 to 70 y). There were no significant epidemiologic differences among malignant lesions, dysplastic nodules, and regenerative nodules. Angiopoietin-2 expression was significantly more expressed in carcinoma when compared with regenerative lesions (P<0.0001). A statistically significant relationship was noted between the expression of VEGF in hepatocytes and Ang-2 expression in the small vasculature (P=0.006). VEGF expression also correlated significantly with the number of nonpaired arteries (P=0.03), although it was not useful in separating benign from malignant cases. We identified a sensitivity of 54% and a specificity of 96% using angiopoietin-2, and a sensitivity of 68.7% and a specificity of 31.2% when using VEGF for the diagnosis of HCC. There was no significant correlation between the immunohistochemical parameters and the clinical staging, the number of gross lesions, and the histologic grade in cases of HCC. Angiopoietin-2 may be a candidate biomarker in assessing liver nodules in transplant patients, and may assist in the diagnosis of difficult lesions and in small biopsies pretransplant.
Proximal CD13 Versus Distal GATA-3 Expression in Renal Neoplasia According to WHO 2016 Classification
Authors: Brunelli Matteo , Erdini Francesco , Cima Luca , Eccher Albino , Fioravanzo Adele , Gobbo Stefano , Segala Diego , Ghimenton Claudio , Mazzoleni Guido , Munari Enrico , Carella Rodolfo , Martignoni Guido
Published: August 2016

Little is known about the aminopeptidase CD13 in renal neoplasia according to the new 2016 World Health Organization renal tumor classification. We selected 175 cases, including 79 clear cell, 31 papillary, 24 chromophobe, 8 clear cell papillary renal cell carcinomas (RCCs), 21 oncoytomas, and 12 microphthalmia transcription factor family translocation RCCs: 4 t(6;11)/transcription factor EB (TFEB), 7 t(Xp11) with 2 cystic variants and 1 t(X;17). GATA binding protein 3 (GATA-3) was inserted as control. Expression of proximal antigen CD13 was observed in 63/79 (80%) clear cell, 25/31 (81%) papillary, 3/8 (37%) clear cell papillary, 1/4 (25%) t(6;11)/TFEB, 2/7 (28%) cystic t(Xp11), and in 1/1 t(X;17) RCCs. All chromophobe RCC (0/24) and all oncocytomas (0/21) resulted negative. CD10 was seen in 76/79 (96%) clear cell, 15/31 (48%) papillary, 10/24 (42%) chromophobe, 1/8 (12%) clear cell papillary RCCs, 4/21 (19%) oncocytomas, 1/4 (25%) t(6;11)/TFEB, 2/7 (29%) cystic t(Xp11), and in 1/1 t(X;17) RCCs. GATA-3 was positive in 3/7 (42%) clear cell papillary RCCs and negative in all remaining RCCs, except a single chromophobe RCC and a single oncocytoma. We concluded that: (1) CD13 and GATA-3 immunostains may serve as a diagnostic aid in differentiating subtypes of RCC; (2) CD13 is always absent in chromophobe RCC and oncocytomas, whereas CD10 can be immunoexpressed in both; (3) CD13 should be included in a panel of antibodies to distinguish “proximal renal tumors” from “distal renal tumors” and between clear cell RCC versus microphthalmia transcription factor family translocations RCCs; and (4) when present, GATA-3 is specific for clear cell papillary RCC.
A Review of Cellular and Acellular Matrix Products: Indications, Techniques, and Outcomes
Authors: Hughes Olivia B. , Rakosi Adele , Macquhae Flor , Herskovitz Ingrid , Fox Joshua D. , Kirsner Robert S.
Published: August 2016

Background:

Wound healing is a dynamic process whereby cells, growth factors (GFs), and the extracellular matrix (ECM) interact to restore the architecture of damaged tissue. Chronic wounds can be difficult to treat due to the increased presence of inflammatory cells that degrade the ECM, GF, and cells necessary for wound healing to occur. Cellular and acellular matrix products can be used in the management of a variety of chronic wounds including venous, diabetic, and pressure ulcers and other conditions such as burns, epidermolysis bullosa, pyoderma gangrenosum, and surgical wounds. These matrices provide cells, GF, and other key elements that act as a scaffold and promote reepithelialization and revascularization of the wound bed.

Methods:

This article focuses on cellular and acellular matrix products that have been well-studied clinically with positive results in randomized clinical trials and widely available matrices for chronic nonhealing wounds. We present trial results as well as their indications, techniques, and outcomes.

Results:

There are a variety of matrix products available on the market. Some of these products are used to treat chronic wounds, for example, diabetic foot ulcers, venous leg ulcers, pyoderma gangrenosum, and pressure ulcers. In this review, we found that wounds of different etiologies have been treated with a variety of matrices, with successful outcomes compared with standard wound care.

Conclusions:

Both cellular and acellular matrix products are useful in the management of a variety of chronic wounds. These matrices provide cells, GF, and other key elements that promote reepithelialization and revascularization of the wound bed while preventing degradation of the ECM. The treatment of chronic wounds with matrix products in combination with standard wound care has been proven to aid in wound healing when added to standard of care.
Prevention of Pressure Ulcers in the Acute Care Setting: New Innovations and Technologies
Authors: Tran Jacquelynn P. , McLaughlin Jillian M. , Li Ramon T. , Phillips Linda G.
Published: August 2016

Background:

Pressure ulcers (PUs) challenge many in the healthcare field requiring costly and complex care. PUs result from prolonged ischemia and subsequent soft-tissue injury caused by unrelieved pressure over a bony prominence. Proper risk assessment and implementation of prevention strategies for PUs are crucial to providing comprehensive care while reducing healthcare costs. The emphasis has led to the expansion of research in PU prevention technologies in the recent years. The aim of this review is to present an evidence-based summary of some of the new innovations in PU prevention.

Methods:

A literature search was performed. Articles were included if the article discussed the cost, prevalence, assessment, diagnosis, and/or prevention of PUs. The literature search was limited to 2013 to 2016.

Results:

A total of 1393 potential studies were identified using the search criteria. Three hundred fifty-three articles were reviewed and when possible, preference for inclusion was given to those studies with a higher level of evidence or those discussing novel ideas/innovations.

Conclusion:

The summary of topics explored includes the following: the use of risk assessment scales as an adjunct in risk identification, the benefit of alternative support surfaces to aid in prevention as compared with standard hospital mattresses, effective repositioning strategies, silicone prophylactic dressing for shear reduction, microclimate control, nutritional considerations, use of electrical stimulation for spinal cord injury patients, and the importance of patient participation.
The Role of Dermal Matrices in Treating Inflammatory and Diabetic Wounds
Authors: Climov Mihail , Bayer Lauren R. , Moscoso Andrea V. , Matsumine Hajime , Orgill Dennis P.
Published: August 2016

Background:

Dermal matrices are used to improve healing in both acute and chronic wounds including diabetic and lower extremity wounds, burns, trauma, and surgical reconstruction. The use of dermal matrices for the closure of inflammatory ulcerations is less frequent but growing. Currently available products include decellularized dermis and semisynthetic matrices.

Methods:

A review of the published literature was performed to identify reports that use acellular dermal matrices in diabetic and inflammatory wounds. Studies were evaluated for quality and outcomes, and a level of evidence was assigned according to the American Society of Plastic Surgeons’ Rating Levels of Evidence. Case studies from the authors’ experience are also presented.

Results:

Seventeen primary studies evaluating the use of dermal matrices in diabetic ulcers were identified with 2 based on level I data. There are no prospective clinical trial reports of their use in atypical or inflammatory wounds, but there are several case studies.

Conclusions:

Treatment of diabetic and inflammatory wounds may include both medical and surgical modalities. The use of dermal matrices can be a useful adjunct, but their optimal use will require future clinical studies.
Update on the Role of Infection and Biofilms in Wound Healing: Pathophysiology and Treatment
Authors: Gompelman Michelle , van Asten Suzanne A. V. , Peters Edgar J. G.
Published: August 2016

Background:

Chronic wounds, and among these infected diabetic foot ulcers, are a worldwide problem. The poor treatment outcomes result in high healthcare costs, amputations, a decreased quality of life, and an increased mortality. These outcomes are influenced by several factors, including biofilm formation. A biofilm consists of pathogenic bacteria that are encased in an exopolysaccharide layer and communicate through secretion of signaling molecules. Bacteria that live in a biofilm are refractory to host responses and treatment.

Methods:

We performed a nonsystematic review of the currently published to-date medical biofilm literature. The review summarizes the evidence of biofilm in chronic wounds, the role of biofilm in wound healing, detection of biofilm, and available antibiofilm treatments. Articles containing basic science and clinical research, as well as systematic reviews, are described and evaluated. The articles have variable levels of evidence. All articles have been peer reviewed and meet the standards of evidence-based medicine.

Results:

Both animal and human studies have identified biofilm in chronic wounds and have suggested that healing might be influenced by its presence. A promising development in biofilm detection is rapid molecular diagnostics combined with direct microscopy. This technique, rather than classic culture, might support individualized treatment in the near future. A wide range of treatments for chronic wounds also influence biofilm formation. Several agents that specifically target biofilm are currently being researched.

Conclusions:

Biofilm formation has a substantial role in chronic wounds. Several diagnostic and therapeutic methods against biofilm are currently being developed.
Advanced Technologies to Improve Wound Healing: Electrical Stimulation, Vibration Therapy, and Ultrasound—What Is the Evidence?
Authors: Ennis William J. , Lee Claudia , Gellada Karen , Corbiere Thomas F. , Koh Timothy J.
Published: August 2016

Background:

Cellular energy is required for the healing cascade to occur. A combination of cells, cytokines, chemokines, tissue perfusion, an extracellular matrix, and local forces are also required to allow for human tissue repair to proceed. Although there are many examples of treatment options, energy-based therapies are the least understood, appreciated, and employed by practicing wound care physicians. The recent growth of tissue engineering has encouraged researchers to employ both electrical stimulation and therapeutic ultrasound (US) to stimulate cells, induce migration, and modify tissue constructs.

Methods:

The authors have reviewed the literature on electrical stimulation, US, and vibrational therapy and are providing an update to a prior 2007 publication on this topic. The hope was to provide a broad exposure to these treatments but not to create a comprehensive review. A table of evidence was generated from the recent literature to help guide treatment decisions for the clinician.

Results:

In the current literature, there is much debate over which treatment modality, dosage levels, and timing are optimal. There are numerous in-vitro-based publications that describe mechanism of action and several clinical articles that describe effectiveness of electrical stimulation and US, but few well-controlled and/or randomized trials. The absence of level one evidence has hindered the adoption of these techniques throughout the years. Three energy-based treatment options, electrical stimulation, vibration, and US, will be reviewed along with possible clinical applications

Conclusions:

Although most trials are underpowered with inconsistent treatment settings, physical therapy modality use is increasing in the clinical community. Recent guidelines reference the use of these treatments with increasing evidence level recommendations. At the present time, electrical stimulation carries the greatest level of evidence for clinical use.
Lymphedema: Surgical and Medical Therapy
Authors: Chang David W. , Masia Jaume , Garza Ramon , Skoracki Roman , Neligan Peter C.
Published: August 2016

Background:

Secondary lymphedema is a dreaded complication that sometimes occurs after treatment of malignancies. Management of lymphedema has historically focused on conservative measures, including physical therapy and compression garments. More recently, surgery has been used for the treatment of secondary lymphedema.

Methods:

This article represents the experience and treatment approaches of 5 surgeons experienced in lymphatic surgery and includes a literature review in support of the techniques and algorithms presented.

Results:

This review provides the reader with current thoughts and practices by experienced clinicians who routinely treat lymphedema patients.

Conclusion:

The medical and surgical treatments of lymphedema are safe and effective techniques to improve symptoms and improve quality of life in properly selected patients.
The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of Recurrence
Authors: Bus Sicco A.
Published: August 2016

Background:

An increased plantar pressure is a causative factor in the development of plantar foot ulcers in people with diabetes mellitus, and ulcers are a precursor of lower extremity amputation.

Methods:

In this article, the evidence is reviewed that relieving areas of increased plantar pressure (ie, offloading) can heal plantar foot ulcers and prevent their recurrence.

Results:

Noninfected, nonischemic neuropathic plantar forefoot ulcers should heal in 6 to 8 weeks with adequate offloading. Recent meta-analyses and systematic reviews show that nonremovable knee-high devices are most effective. This is probably because they eliminate the problem of nonadherence with the use of a removable device. Studies show a large discrepancy between evidence-based recommendations on offloading and what is used in clinical practice. Many clinics continue to use methods that are less effective or have not been proven to be effective, while ignoring evidence-based methods. Strategies are proposed to address this issue, notably the adoption and implementation of recent international guidelines by professional societies and a stronger focus of clinicians on expedited healing. For the prevention of plantar foot ulcer recurrence in high-risk patients, 2 recent trials have shown that the incidence of recurrence can be significantly reduced with custom-made footwear that has a demonstrated pressure-relieving effect through guidance by plantar pressure measurements, under the condition that the footwear is worn.

Conclusion:

This review helps to inform clinicians about effective offloading treatment for healing plantar foot ulcers and preventing their recurrence.
The Role of Telemedicine in Wound Care: A Review and Analysis of a Database of 5,795 Patients from a Mobile Wound-Healing Center in Languedoc-Roussillon, France
Authors: Sood Aditya , Granick Mark S. , Trial Chloé , Lano Julie , Palmier Sylvie , Ribal Evelyne , Téot Luc
Published: August 2016

Background:

Telemedicine in wound care is an evolving method of information technology and telecommunication designed to provide health care at a distance. Given the visual nature of wound care, telemedicine has many potential applications within this field. The authors will review the current status of wound care and telemedicine.

Methods:

A comprehensive literature review of articles published on telemedicine in wound care was performed. Articles were selected for their relevance to wound healing and then reviewed for their discussion on the potential applications, benefits, and limitations to telemedicine in wound care. The CICAT network data were reviewed including 5,794 patients between January 2005 and October 2015. Clinical efficacy and medicoeconomic results were analyzed.

Results:

Current literature suggests a myriad of potential benefits of telemedicine in wound care, often citing increased access to professional expertise in remote and rural settings, as well as cost savings. The CICAT wound network in France analyzed wounds, which were principally pressure ulcers (44%), leg ulcers (24%), and diabetic foot ulcers (8%). Results demonstrated 75% of wounds improved or healed, a 72% reduction in the number of hospitalizations, and 56% reduction in ambulance transfers to wound healing centers.

Conclusions:

There is an increasing demand for assistance from professionals not specialized in wound healing, facing complex wounds. The goal is to enable the spread of expertise beyond major medical centers. Several limitations and barriers to the application of telemedicine in all settings are evident, including over diagnosis, dependence on a functional telecommunication system, and various legal aspects. The CICAT network in France provides an example of a how telemedicine may be of benefit in wound care, although it is important to note that in other countries, such as the United States, legal constraints and credentialing concerns may make telemedicine extremely complicated.
Temporal Dynamics of Health and Well-Being: A Crowdsourcing Approach to Momentary Assessments and Automated Generation of Personalized Feedback
Authors: van der Krieke Lian , Blaauw Frank J. , Emerencia Ando C. , Schenk Hendrika M. , Slaets Joris P.J. , Bos Elisabeth H. , de Jonge Peter , Jeronimus Bertus F.
Published: August 2016

Objective

Recent developments in research and mobile health enable a quantitative idiographic approach in health research. The present study investigates the potential of an electronic diary crowdsourcing study in the Netherlands for (1) large-scale automated self-assessment for individual-based health promotion and (2) enabling research at both the between-persons and within-persons level. To illustrate the latter, we examined between-persons and within-persons associations between somatic symptoms and quality of life.

Methods

A website provided the general Dutch population access to a 30-day (3 times a day) diary study assessing 43 items related to health and well-being, which gave participants personalized feedback. Associations between somatic symptoms and quality of life were examined with a linear mixed model.

Results

A total of 629 participants completed 28,430 assessments, with a mean (SD) of 45 (32) assessments per participant. Most participants (n = 517 [82%]) were women and 531 (84%) had high education. Almost 40% of the participants (n = 247) completed enough assessments (t = 68) to generate personalized feedback including temporal dynamics between well-being, health behavior, and emotions. Substantial between-person variability was found in the within-person association between somatic symptoms and quality of life.

Conclusions

We successfully built an application for automated diary assessments and personalized feedback. The application was used by a sample of mainly highly educated women, which suggests that the potential of our intensive diary assessment method for large-scale health promotion is limited. However, a rich data set was collected that allows for group-level and idiographic analyses that can shed light on etiological processes and may contribute to the development of empirical-based health promotion solutions.