bluuebunny/crossref_metadata_2025 huggingface dataset:
Benefits and Limitations of Indocyanine Green Fluorescent Image-Guided Surgery for Spinal Intramedullary Tumors
Authors: Takami Toshihiro , Naito Kentaro , Yamagata Toru , Shimokawa Nobuyuki , Ohata Kenji
Published: May 2017

BACKGROUND

Intraoperative image guidance using near-infrared indocyanine green videoangiography (ICG-VA) has been used to provide real-time angiographic images during vascular or brain tumor surgery, and it is also being used for spine surgery.

OBJECTIVE

To further investigate the benefits and limitations of ICG-VA image-guided surgery for spinal intramedullary tumors through retrospective study.

METHODS

ICG-VA was used in 48 cases that were treated surgically over the past 5 yr. The pathological diagnoses of the tumors included astrocytic tumor, ependymal tumor, cavernous malformation, and hemangioblastoma.

RESULTS

Localization of normal spinal arteries and veins on the dorsal surface of the spinal cord helped the surgeons determine the length or point of myelotomy. Well-demarcated tumor stain was recognized in limited cases of anaplastic or highly vascularized tumors, whereas the location of cavernous malformation was recognized as an avascular area on the dorsal surface of the spinal cord. Feeding arteries and tumor stain were well differentiated from draining veins in dorsal hemangioblastomas, but not in intramedullary deep-seated or ventral tumors. The preservation of small perforating branches of the anterior spinal artery after successful resection of the tumor could be well visualized.

CONCLUSION

ICG-VA can provide real-time information about vascular flow dynamics during the surgery of spinal intramedullary tumors, and it may help surgeons localize the normal circulation of the spinal cord, as well as the feeding arteries and draining veins, especially in highly vascular tumors. However, the benefits of intraoperative ICG-VA might be limited for intramedullary deep-seated or ventral tumors.
sEEG is a Safe Procedure for a Comprehensive Anatomic Exploration of the Insula: A Retrospective Study of 108 Procedures Representing 254 Transopercular Insular Electrodes
Authors: Salado Anne Laure , Koessler Laurent , De Mijolla Gabriel , Schmitt Emmanuelle , Vignal Jean-Pierre , Civit Thierry , Tyvaert Louise , Jonas Jacques , Maillard Louis Georges , Colnat-Coulbois Sophie
Published: May 2017

BACKGROUND

The exploration of the insula in pre-surgical evaluation of epilepsy is considered to be associated with a high vascular risk resulting in an incomplete exploration of the insular cortex.

OBJECTIVE

To report a retrospective observational study of insular exploration using stereoelectroencephalography (sEEG) with transopercular and parasagittal oblique intracerebral electrodes from January 2008 to January 2016. The first purpose of this study was to evaluate the surgical risks of insular cortex sEEG exploration. The second purpose was to define the ability of placing intracerebral contacts in the whole insular cortex.

METHODS

Ninety-nine patients underwent 108 magnetic resonance imaging (MRI)-guided stereotactic implantations of intracerebral electrodes in the context of preoperative assessment of drug-resistant epilepsy, including at least 1 electrode placed in the insular cortex. On postoperative computed tomography images co-registered with MRI, followed by MRI segmentation and application of a transformation matrix, intracerebral contact coordinates of the insular electrodes’ contacts were anatomically localized in the Talairach space. Finally, dispersion and clustering analysis was performed.

RESULTS

There was no morbidity, in particular hemorrhagic complications, or mortality related to insular electrodes. Statistical comparison of intracerebral contact positions demonstrated that whole insula exploration is possible on the left and right sides. In addition, the clustering analysis showed the homogeneous distribution of the electrodes within the insular cortex.

CONCLUSION

In the presurgical evaluation of drug-resistant epilepsy, the insular cortex can be explored safely and comprehensively using transopercular sEEG electrodes. Parasagittal oblique trajectories may also be associated to achieve an optimal exploration.
Spinal Cord Suspension Using Dentate Ligament Hitch Stitches: A Novel Technique for the Repair of Ventral Spinal Cord Herniation
Authors: Lui Jonathan , Sayal Parag , Choi David
Published: May 2017

BACKGROUND

Idiopathic spinal cord herniation is usually repaired by releasing the spinal cord and inserting a dural patch to close the herniated segment of dura. However, reherniation is a potential limitation of this standard technique.

OBJECTIVE

To describe early results of a novel technique that utilizes the dentate ligament to hitch the spinal cord and prevent reherniation.

METHODS

Two patients underwent dural hernia repair and the dentate hitch technique was performed.

RESULTS

Restored lower limb power and mobility, and satisfactory reduction of spinal cord herniation on magnetic resonance imaging in 2 patients at 6- and 24-mo follow-ups, respectively.

CONCLUSION

The dentate hitch technique can achieve repair of spinal cord herniation, with satisfactory postoperative results and minimizes the risk of reherniation.
Pharmacists’ Role in Opioid Safety: A Focus Group Investigation
Authors: Hartung Daniel M , Hall Jennifer , Haverly Sarah N , Cameron David , Alley Lindsey , Hildebran Christi , O’Kane Nicole , Cohen Deborah
Published: May 2017

Objective

The pharmacist’s role and responsibilities in addressing the opioid epidemic have yet to be clearly defined, particularly from the patient’s point of view. This qualitative study explores the pharmacist’s role in promoting opioid safety from the perspective of pharmacists and patients.

Design

Focus groups.

Setting

Patient groups were held in person, and pharmacist groups were held online.

Subjects

Oregon pharmacists (N = 19, Mage = 39.0 years, range = 26–57 years, 58% female) and patients (N = 18, Mage = 60.1 years, range = 30–77 years, 71% female) with current experience dispensing or receiving opioid medications.

Methods

Pharmacists were asked about the challenges and opportunities for opioid safety monitoring and prescription dispensing. Patients were asked about their experiences accessing care, medications, and safety information. Focus group data were analyzed by a multidisciplinary team using an immersion-crystallization approach.

Results

Pharmacists and patients agreed that pharmacists are responsible for medication safety. Pharmacists expressed discomfort filling potentially high-risk opioid prescriptions and noted barriers such as lack of clinical information and discomfort policing high-risk prescribing. Patients were concerned about pharmacists potentially overstepping their professional responsibilities by interfering with prescribers’ clinical decisions.

Conclusions

Feedback from both pharmacists and patient participants suggests that there is uncertainty in the degree to which pharmacists can and should confront the prescription opioid epidemic directly. Ambiguities in the pharmacist’s role may be best clarified through structured training promoting enhanced between-party communication.
Incidence and Timing of Thromboembolic Events in Patients With Ovarian Cancer Undergoing Neoadjuvant Chemotherapy
Authors: Greco Patricia S. , Bazzi Ali A. , McLean Karen , Reynolds R. Kevin , Spencer Ryan J. , Johnston Carolyn M. , Liu J. Rebecca , Uppal Shitanshu
Published: May 2017

OBJECTIVE:

To identify the incidence and timing of venous thromboembolism as well as any associated risk factors in patients with ovarian, fallopian tube, or primary peritoneal cancer undergoing neoadjuvant chemotherapy.

METHODS:

We conducted a retrospective cohort study of patients diagnosed with ovarian, fallopian tube, and primary peritoneal cancer and receiving neoadjuvant chemotherapy from January 2009 to May 2014 at a single academic institution. The timing and number of venous thromboembolic events for the entire cohort were categorized as follows: presenting symptom, during neoadjuvant chemotherapy treatment, after debulking surgery, and during adjuvant chemotherapy.

RESULTS:

Of the 125 total patients with ovarian cancer undergoing neoadjuvant chemotherapy, 13 of 125 patients (10.4%, 95% confidence interval [CI] 6.1–17.2%) had a venous thromboembolism as a presenting symptom and were excluded from further analysis. Of the 112 total patients at risk, 30 (26.8%, 95% CI 19.3–35.9%) experienced a venous thromboembolism. Based on the phase of care, 13 (11.6%, 95% CI 6.8–19.1%) experienced a venous thromboembolism during neoadjuvant chemotherapy, six (5.4%, 95% CI 2.4–11.5%) developed a postoperative venous thromboembolism, and 11 (9.9%, 95% CI 5.5–17%) developed a venous thromboembolism during adjuvant chemotherapy. Two of the four patients with clear cell histology developed a venous thromboembolism in this cohort.

CONCLUSION:

Overall new diagnosis of venous thromboembolism was associated with one fourth of the patients undergoing neoadjuvant chemotherapy for ovarian cancer with nearly half of these diagnosed during chemotherapy cycles before interval debulking surgery. Efforts to reduce venous thromboembolism so far have largely focused on the postoperative period. Additional attention to venous thromboembolic prophylaxis during chemotherapy (neoadjuvant and adjuvant) in this patient population is warranted in an effort to decrease the rates of venous thromboembolism.
Universal Cervical Length Screening and Antenatal Corticosteroid Timing
Authors: Sahasrabudhe Nicole , Igel Catherine , Echevarria Ghislaine C. , Dar Pe'er , Wolfe Diana , Bernstein Peter S. , Angert Robert , Dayal Ashlesha , Gallagher Patience , Rosner Mara
Published: May 2017

OBJECTIVE:

To evaluate the relationship between universal transvaginal screening for short cervical length in the second trimester and the timing of antenatal corticosteroids.

METHODS:

We performed a retrospective cohort study of patients with nonanomalous singleton gestations and spontaneous preterm birth between 24 and 34 weeks of gestation after the initiation of a universal transvaginal cervical length screening program between October 2012 and August 2015. Our primary outcome was antenatal corticosteroid administration to a delivery interval of fewer than 7 days. Secondary outcomes were delivery 24 hours to 7 days after the initial steroid injection, steroid administration to delivery interval, neonatal survival, neonatal intensive care unit length of stay, and respiratory distress syndrome. Multivariable logistic regression was used to estimate the association between antenatal corticosteroid timing and the diagnosis of a short cervix adjusted for potential confounders.

RESULTS:

Among 266 eligible patients, 69 with a short cervical length and 197 without a short cervical length were identified. There were no statistically significant differences in baseline characteristics between the groups. During the study period, 64 of 69 (92.8%) of patients with a short cervix and 176 of 197 (89.3%) without a short cervix received at least one steroid injection before delivery (P=.411). Steroids were given within 7 days of delivery in 33 of 69 (47.8) patients with a short cervix compared with 126 of 197 (64%) patients in the no short cervix group (P=.015; adjusted odds ratio 0.51, 95% confidence interval 0.29–0.9). Median interval between steroid administration and delivery was 8 days in patients diagnosed with a short cervix compared with 3 days for those without a short cervical length (P<.001).

CONCLUSION:

Patients identified as having a short cervical length by universal transvaginal ultrasound screening were at greater risk of delivering more than 7 days after the initiation of corticosteroids for fetal lung maturation compared with women without a short cervical length.
Nonpresenting Dichorionic Twins and Placental Vascular Malperfusion
Authors: Weiner Eran , Kahn Michael , Giltvedt Kristine , Kibel Mia , Sherman Christopher , Kingdom John , Barrett Jon , Melamed Nir
Published: May 2017

OBJECTIVE:

To explore the hypothesis that selective placental pathology affecting the nonpresenting twin is a significant contributory factor mediating the smaller size at birth of nonpresenting dichorionic twins.

METHODS:

We conducted a retrospective cohort study of all dichorionic twin deliveries in a single tertiary center between 2002 and 2015 where by departmental policy, all placentas from multifetal gestations are routinely sent for pathologic examination. Maternal charts, neonatal charts, and pathology reports were reviewed. Placental abnormalities were classified into lesions associated with maternal vascular malperfusion, fetal vascular malperfusion, placental hemorrhage, and chronic villitis. Comparison of neonatal outcomes and placental abnormalities was made between all nonpresenting and all presenting twins as well as within twin pairs.

RESULTS:

A total of 1,322 women with dichorionic twins were studied. Nonpresenting twins were smaller at birth compared with the presenting cotwin starting at 32 weeks of gestation (birth weight [±standard deviation] 2,224±666 g compared with 2,278±675 g, P=.036). Nonpresenting twins had smaller placentas (361±108 g compared with 492±129 g, P<.001) as early as 24 weeks of gestation. Nonpresenting twins had higher odds for any placental abnormality (adjusted odds ratio [OR] 1.91, 95% confidence interval [95% CI] 1.63–2.23), small placenta (adjusted OR 4.69, 95% CI 3.75–5.88), and maternal vascular malperfusion (OR 2.75, 95% CI 2.32–3.27) compared with their presenting cotwins. In nonpresenting twins, the presence of maternal vascular malperfusion pathology was associated with lower birth weight compared with their presenting cotwin during the third trimester.

CONCLUSION:

The lower birth weight of nonpresenting fetuses in dichorionic twin pregnancies is correlated with a higher rate of placental maternal vascular malperfusion pathology.
Pregnancy Outcomes After Fertility Preservation in Transgender Men
Authors: Maxwell Susan , Noyes Nicole , Keefe David , Berkeley Alan S. , Goldman Kara N.
Published: May 2017

BACKGROUND:

Transgender individuals, individuals whose gender identity does not align with their sex assigned at birth, undergoing gender-affirming hormonal or surgical therapies may experience loss of fertility. Assisted reproductive technologies have expanded family-building options for transgender men who were assigned female at birth.

CASES:

Three transgender men underwent oocyte cryopreservation before gender-affirming hormonal therapy. One patient underwent fertility preservation as an adolescent. Two adult patients had children using their cryopreserved oocytes, with the pregnancies carried by their sexually intimate partners.

CONCLUSION:

Transgender men with cryopreserved gametes can build families in a way that affirms their gender identity. Obstetrician–gynecologists should be familiar with the fertility needs of transgender patients so appropriate discussions and referrals can be made.
Association Between Planned Cesarean Delivery and Neonatal Mortality and Morbidity in Twin Pregnancies
Authors: Schmitz Thomas , Prunet Caroline , Azria Elie , Bohec Caroline , Bongain André , Chabanier Pierre , D'Ercole Claude , Deruelle Philippe , De Tayrac Renaud , Dreyfus Michel , Dupont Corinne , Gondry Jean , Graesslin Olivier , Kayem Gilles , Langer Bruno , Marpeau Loïc , Morel Olivier , Parant Olivier , Perrotin Franck , Pierre Fabrice , Poulain Patrice , Riethmuller Didier , Rozenberg Patrick , Rudigoz René-Charles , Sagot Paul , Sénat Marie-Victoire , Sentilhes Loïc , Vayssière Christophe , Venditelli Françoise , Verspyck Eric , Winer Norbert , Lecomte-Raclet Laurence , Ancel Pierre-Yves , Goffinet François ,   for the JUmeaux MODe d'Accouchement (JUMODA) Study Group and the Groupe de Recherche en Obstétrique et Gynécologie (GROG)
Published: May 2017

OBJECTIVE:

To evaluate the association between the planned mode of delivery and neonatal mortality and morbidity in an unselected population of women with twin pregnancies.

METHODS:

The JUmeaux MODe d'Accouchement (JUMODA) study was a national prospective population-based cohort study. All women with twin pregnancies and their neonates born at or after 32 weeks of gestation with a cephalic first twin were recruited in 176 maternity units in France from February 2014 to March 2015. The primary outcome was a composite of intrapartum mortality and neonatal mortality and morbidity. Comparisons were performed according to the planned mode of delivery, planned cesarean or planned vaginal delivery. The primary analysis to control for potential indication bias used propensity score matching. Subgroup analyses were conducted, one according to gestational age at delivery and one after exclusion of high-risk pregnancies.

RESULTS:

Among 5,915 women enrolled in the study, 1,454 (24.6%) had planned cesarean and 4,461 (75.4%) planned vaginal deliveries, of whom 3,583 (80.3%) delivered both twins vaginally. In the overall population, composite neonatal mortality and morbidity was increased in the planned cesarean compared with the planned vaginal delivery group (5.2% compared with 2.2%; odds ratio [OR] 2.38, 95% confidence interval [CI] 1.86–3.05). After matching, neonates born after planned cesarean compared with planned vaginal delivery had higher composite neonatal mortality and morbidity rates (5.3% compared with 3.0%; OR 1.85, 95% confidence interval 1.29–2.67). Differences in composite mortality and morbidity rates applied to neonates born before but not after 37 weeks of gestation. Multivariate and subgroup analyses after exclusion of high-risk pregnancies found similar trends.

CONCLUSION:

Planned vaginal delivery for twin pregnancies with a cephalic first twin at or after 32 weeks of gestation was associated with low composite neonatal mortality and morbidity. Moreover, planned cesarean compared with planned vaginal delivery before 37 weeks of gestation might be associated with increased composite neonatal mortality and morbidity.
Cumulative Incidence of a Subsequent Surgery After Stress Urinary Incontinence and Pelvic Organ Prolapse Procedure
Authors: Wu Jennifer M. , Dieter Alexis A. , Pate Virginia , Jonsson Funk Michele
Published: May 2017

OBJECTIVE:

To assess the 5-year risk and timing of repeat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) procedures.

METHODS:

We conducted a retrospective cohort study using a nationwide database, the 2007–2014 MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases (Truven Health Analytics), which contain deidentified health care claims data from approximately 150 employer-based insurance plans across the United States. We included women aged 18–84 years and used Current Procedural Terminology codes to identify surgeries for SUI and POP. We identified index procedures for SUI or POP after at least 3 years of continuous enrollment without a prior procedure. We defined three groups of women based on the index procedure: 1) SUI surgery only; 2) POP surgery only; and 3) Both SUI+POP surgery. We assessed the occurrence of a subsequent SUI or POP procedure over time for women younger than 65 years and 65 years or older with a median follow-up time of 2 years (interquartile range 1–4).

RESULTS:

We identified a total of 138,003 index procedures: SUI only n=48,196, POP only n=49,120, and both SUI+POP n=40,687. The overall cumulative incidence of a subsequent SUI or POP surgery within 5 years after any index procedure was 7.8% (95% confidence interval [CI] 7.6–8.1) for women younger than 65 years and 9.9% (95% CI 9.4–10.4) for women 65 years or older. The cumulative incidence was lower if the initial surgery was SUI only and higher if an initial POP procedure was performed, whether POP only or SUI+POP.

CONCLUSIONS:

The 5-year risk of undergoing a repeat SUI or POP surgery was less than 10% with higher risks for women 65 years or older and for those who underwent an initial POP surgery.
Effects of Exercise on Mild-to-Moderate Depressive Symptoms in the Postpartum Period
Authors: McCurdy Ashley P. , Boulé Normand G. , Sivak Allison , Davenport Margie H.
Published: May 2017

OBJECTIVE:

To examine the influence of exercise on depressive symptoms and the prevalence of depression in the postpartum period.

DATA SOURCES:

A structured search of MEDLINE, EMBASE, CINAHL, Sport Discus, Ovid's All EBM Reviews, and ClinicalTrials.gov databases was performed with dates from the beginning of the databases until June 16, 2016. The search combined keywords and MeSH-like terms including, but not limited to, “exercise,” “postpartum,” “depression,” and “randomized controlled trial.”

METHODS OF STUDY SELECTION:

Randomized controlled trials comparing postpartum exercise (structured, planned, repetitive physical activity) with the standard care for which outcomes assessing depressive symptoms or depressive episodes (as defined by trial authors) were assessed. Trials were identified as prevention trials (women from the general postpartum population) or treatment trials (women were classified as having depression by the trial authors). Effect sizes with 95% confidence intervals (CIs) were calculated using Hedges' g method and standardized mean differences in postintervention depression outcomes were pooled using a random-effects model.

TABULATION, INTEGRATION, AND RESULTS:

Across all 16 trials (1,327 women), the pooled standardized mean difference was −0.34 (95% CI −0.50 to −0.19, I2=37%), suggesting a small effect of exercise among all postpartum women on depressive symptoms. Among the 10 treatment trials, a moderate effect size of exercise on depressive symptoms was found (standardized mean difference−0.48, 95% CI −0.73 to −0.22, I2=42%). In six prevention trials, a small effect (standardized mean difference−0.22, 95% CI −0.36 to −0.08, I2=2%) was found. In women with depression preintervention, exercise increased the odds of resolving depression postintervention by 54% (odds ratio 0.46, Mantel-Haenszel method, 95% CI 0.25–0.84, I2=0%). The trials included in this meta-analysis were small and some had methodologic limitations.

CONCLUSION:

Light-to-moderate intensity aerobic exercise improves mild-to-moderate depressive symptoms and increases the likelihood that mild-to-moderate depression will resolve.
Breastfeeding and Endometrial Cancer Risk
Authors: Jordan Susan J. , Na Renhua , Johnatty Sharon E. , Wise Lauren A. , Adami Hans Olov , Brinton Louise A. , Chen Chu , Cook Linda S. , Dal Maso Luigino , De Vivo Immaculata , Freudenheim Jo L. , Friedenreich Christine M. , La Vecchia Carlo , McCann Susan E. , Moysich Kirsten B. , Lu Lingeng , Olson Sara H. , Palmer Julie R. , Petruzella Stacey , Pike Malcolm C. , Rebbeck Timothy R. , Ricceri Fulvio , Risch Harvey A. , Sacerdote Carlotta , Setiawan Veronica Wendy , Sponholtz Todd R. , Shu Xiao Ou , Spurdle Amanda B. , Weiderpass Elisabete , Wentzensen Nicolas , Yang Hannah P. , Yu Herbert , Webb Penelope M.
Published: May 2017

OBJECTIVE:

To investigate the association between breastfeeding and endometrial cancer risk using pooled data from 17 studies participating in the Epidemiology of Endometrial Cancer Consortium.

METHODS:

We conducted a meta-analysis with individual-level data from three cohort and 14 case–control studies. Study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the association between breastfeeding and risk of endometrial cancer using multivariable logistic regression and pooled using random-effects meta-analysis. We investigated between-study heterogeneity withI 2and Q statistics and metaregression.

RESULTS:

After excluding nulliparous women, the analyses included 8,981 women with endometrial cancer and 17,241 women in a control group. Ever breastfeeding was associated with an 11% reduction in risk of endometrial cancer (pooled OR 0.89, 95% CI 0.81–0.98). Longer average duration of breastfeeding per child was associated with lower risk of endometrial cancer, although there appeared to be some leveling of this effect beyond 6–9 months. The association with ever breastfeeding was not explained by greater parity and did not vary notably by body mass index or histologic subtype (grouped as endometrioid and mucinous compared with serous and clear cell).

CONCLUSION:

Our findings suggest that reducing endometrial cancer risk can be added to the list of maternal benefits associated with breastfeeding. Ongoing promotion, support, and facilitation of this safe and beneficial behavior might therefore contribute to the prevention of this increasingly common cancer.
Trends in Mode of Hysterectomy After the U.S. Food and Drug Administration Power Morcellation Advisory
Authors: Ottarsdottir Helga , Cohen Sarah L. , Cox Mary , Vitonis Allison , Einarsson Jon I.
Published: May 2017

OBJECTIVE:

To evaluate the trends in mode of surgery for benign hysterectomy after the 2014 U.S. Food and Drug Administration (FDA) morcellation guidelines.

METHODS:

This is a retrospective review of all patients who underwent a hysterectomy for benign indications, specifically for leiomyomas, at Brigham and Women's Hospital from 2013 to 2015. The rates of abdominal, vaginal, laparoscopic, and robotic-assisted laparoscopic hysterectomy as well as the perioperative outcomes were compared over the study period. Analysis was performed using multivariable linear, multinomial, and logistic regression. Regression models were adjusted for potential confounders.

RESULTS:

From 2013 to 2015, 1,530 patients underwent a hysterectomy for benign indications and 639 patients underwent the procedure for the indication of uterine leiomyomas; there was a decrease in the number of hysterectomy cases in the later years. Focusing on the patients with leiomyomas alone, there was a 40–60% decreased odds of a minimally invasive procedure in 2014 or 2015 compared with 2013 [adjusted odds ratio (OR) 0.53 (0.29–0.97) in 2014 and adjusted OR 0.40 (0.22–0.74) in 2015, P=.003]. A 24% decrease in the supracervical approach to hysterectomy was also noted. Despite these trends, the majority of cases in each year were still performed in a minimally invasive fashion. The factor most strongly associated with undergoing a minimally invasive hysterectomy was having a fellowship-trained surgeon perform the procedure [adjusted OR 6.80 (3.65–12.7), P<.001]. There was no significant difference between the year of surgery and occurrence of intraoperative complications or reoperation.

CONCLUSION:

Although key perioperative outcomes remained similar, the overall rate of minimally invasive surgery declined at our institution after the FDA's recommendations. With changing practice patterns and vigilance surrounding power morcellation, gynecologic surgeons may still offer patients minimally invasive procedures with all of the accompanying advantages.
Adult Posttraumatic Reconstruction Using a Magnetic Internal Lengthening Nail
Authors: Rozbruch S. Robert
Published: May 2017

A new generation of internal lengthening nail is now available that has reliable remote-controlled mechanisms. This allows accurate and well-controlled distraction rate and rhythm, and early clinical results have been very positive. In this article, 2 posttraumatic cases are presented that illustrate deformity correction and lengthening using the internal lengthening nail. Surgical planning and adjuvant techniques of fixator-assisted nailing and the use of blocking screws are discussed.
The Evolution of Remote-Controlled Intramedullary Lengthening and Compression Nails
Authors: Green Stuart A.
Published: May 2017

The operative elongation of limbs has long been a goal of orthopaedic surgeons. Indeed, the very first external skeletal fixators, although designed for stabilization of displaced fractures, were also used to overcome the posttrauma shortening that so commonly accompanies fracture deformities.
Prospective Evaluation of Posttraumatic Stress Disorder and Depression in Orthopaedic Injury Patients With and Without Concomitant Traumatic Brain Injury
Authors: Roden-Foreman Kenleigh , Solis Jaicus , Jones Alan , Bennett Monica , Roden-Foreman Jacob W. , Rainey Evan E. , Foreman Michael L. , Warren Ann Marie
Published: May 2017

Objectives:

Psychological morbidities after injury [eg, posttraumatic stress disorder (PTSD) and depression] are increasingly recognized as a significant determinant of overall outcome. Traumatic brain injury (TBI) negatively impacts outcomes of patients with orthopaedic injury, but the association of concurrent TBI, orthopaedic injury, and symptoms of PTSD and depression has not been examined. This study's objective was to examine symptoms of PTSD and depression in patients with orthopaedic trauma with and without TBI.

Design:

Longitudinal prospective cohort study.

Setting:

Urban Level I Trauma Center in the Southwest United States.

Patients/Participants:

Orthopaedic trauma patients older than 18 years admitted for ≥24 hours.

Main Outcome Measurements:

Questionnaires examining demographics, injury-related variables, PTSD, and depression were administered during hospitalization and 3, 6, and 12 months later. Orthopaedic injury and TBI were determined based on ICD-9 codes. Generalized linear models determined whether PTSD and depression at follow-up were associated with TBI.

Results:

Of the total sample (N = 214), 44 (21%) sustained a TBI. Those with TBI had higher rates of PTSD symptoms, 12 months postinjury (P = 0.04). The TBI group also had higher rates of depressive symptoms, 6 months postinjury (P = 0.038).

Conclusions:

Having a TBI in addition to orthopaedic injury was associated with significantly higher rates of PTSD at 12 months and depression at 6 months postinjury. This suggests that sustaining a TBI in addition to orthopaedic injury places patients at a higher risk for negative psychological outcomes. The findings of this study may help clinicians to identify patients who are in need for psychological screening and could potentially benefit from intervention.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Adult desmoid tumors: biology, management and ongoing trials
Authors: Penel Nicolas , Chibon Frédéric , Salas Sébastien
Published: May 2017

Purpose of review

To summarize the current knowledge about the biology and clinical management of adult desmoid tumors.

Recent findings

In the past decade, we have learned that desmoid tumors are driven by alterations of the Wnt/APC/β-catenin pathway, sporadic desmoid tumors are associated with somatic mutations ofCTNNB1, and germline mutations of APC and somatic mutations ofCTNNB1are probably mutually exclusive. One-third of desmoid tumors are misdiagnosed; a second pathological opinion is therefore of major importance for desmoid tumor. Surgery is no longer regarded as the cornerstone of desmoid tumors; several retrospective studies have demonstrated the safety of a ‘wait and see’ policy in sporadic abdominal wall desmoid tumor. Desmoid tumors is no longer regarded as an absolute contraindication for pregnancy. At least two new investigational drugs targeting the Wnt/APC/β-catenin pathway are currently being developed.

The management of desmoid tumors requires multidisciplinary expertise by an experienced team. We must fully understand the physiopathology of the disease (factors influencing the natural history of the disease) and learn how to avoid desmoid tumors occurrence in patients with APC germline mutations, identify reliable prognostic/predictive factors and better assess the efficacy of systemic treatment.
MUC1, MUC5AC, and MUC6 polymorphisms, Helicobacter pylori infection, and gastric cancer: a systematic review and meta-analysis
Authors: Giraldi Luca , Michelazzo Maria B. , Arzani Dario , Persiani Roberto , Pastorino Roberta , Boccia Stefania
Published: May 2017

The risk of Helicobacter pylori (HP) infection, as well as gastric cancer (GC), in association with genetic polymorphisms of gene encoding for mucins, has been investigated with contradictory results. We carried out this systematic review and meta-analysis to summarize the relationship between MUC1, MUC5AC, and MUC6 polymorphisms and HP infection, as well as GC risk. We searched MEDLINE, ISI Web of Science, Scopus bibliographic databases and the HuGE Navigator database. Odds ratios (ORs) and 95% confidence interval (CI) were calculated to assess the association between the genetic polymorphisms, and HP/GC risk. A random-effect model was used to calculate the pooled ORs, overall and by ethnicity. Twenty-one studies were included, of which five on HP and 18 on GC, of which two were in common. The meta-analysis of 10 studies on the MUC1 rs4072037 polymorphism and GC risk reported an OR of 0.66 (95% CI: 0.57–0.78) for the dominant model (AG/GG vs. AA). When stratifying for ethnicity, an OR of 0.73 (95% CI: 0.62–0.86) was reported for the Asian population and an OR of 0.48 (95% CI: 0.38–0.61) was reported for the White population. Our study confirms the protective effect of MUC1 rs4072037 polymorphism on the risk of GC under the dominant model. Further studies reporting information on HP status in cases and controls would be required to evaluate whether the protective effect of MUC1 protein might be attributable to a protective effect towards the HP infection, or through different mechanisms.
Cyclic AMP-Epac signaling pathway contributes to repression of PUMA transcription in melanoma cells
Authors: Lakhter Alexander J. , Naidu Samisubbu R.
Published: May 2017

The universal second messenger cAMP regulates numerous cellular processes. Although the cAMP-signaling pathway leads to induction of gene transcription, it remains unknown whether this pathway contributes toward suppression of transcription. Here, we show that blockade of cAMP signaling using MDL12330A led to an increase in PUMA transcript levels, but not p21 in melanoma cells. cAMP downstream component Epac activation was essential for suppression of PUMA transcription as an Epac agonist reversed the effects of MDL12330A. These results suggest that transcriptional repression is one of the functions of the cAMP-Epac signaling pathway.
Pharmacology of Thiopurine Therapy in Inflammatory Bowel Disease and Complete Blood Cell Count Outcomes: A 5-Year Database Study
Authors: Meijer Berrie , Wilhelm Abraham J. , Mulder Chris J. J. , Bouma Gerd , van Bodegraven Adriaan A. , de Boer Nanne K. H.
Published: May 2017

Background:

Thiopurines are the prerequisite for immunomodulation in inflammatory bowel disease (IBD) therapy. When administered in high (oncological) dose, thiopurine metabolites act as purine antagonists, causing DNA-strand breakage and myelotoxicity. In lower IBD dosages, the mode of action is primarily restricted to anti-inflammatory effects. Then, myelosuppression and hepatotoxicity are the most common adverse events of thiopurines. The aim of this study was to assess the effect of thiopurine metabolites on hematologic and hepatic parameters and to determine which patient characteristics are related to generation of thiopurine metabolites.

Methods:

The authors scrutinized the therapeutic drug monitoring database of the VU University medical center and subsequently merged this database with the Clinical Laboratory database of our hospital covering the same time period (2010–2015).

Results:

The authors included 940 laboratory findings of 424 unique patients in this study. Concentrations of 6-thioguanine nucleotides (6-TGN) correlated negatively with red blood cell count, white blood cell count, and neutrophil count in both azathioprine (AZA) and mercaptopurine users. There was a positive correlation with mean corpuscular volume. In patients using 6-thioguanine, 6-TGN concentrations correlated positively with white blood cell count. Furthermore, there was an inverse correlation between patient's age and 6-TGN concentrations in patients using AZA or 6-thioguanine, and we observed an inverse correlation between body mass index and 6-TGN concentrations in patients using AZA or mercaptopurine. No relations were observed with liver test abnormalities.

Conclusions:

Thiopurine derivative therapy influenced bone marrow production and the size of red blood cells. Age and body mass index were important pharmacokinetic factors in the generation of 6-TGN.
Outcomes for Ab Interno Bleb Revision With a Novel Translimbal Sclerostomy Spatula
Authors: Grover Davinder S. , Fellman Ronald L.
Published: May 2017

Purpose:

To report outcomes for a novel ab interno bleb revision technique and spatula.

Patients and Methods:

This is a retrospective chart review.

Results:

A total of 21 eyes of 21 patients underwent ab interno bleb revision with the Grover-Fellman biplanar sclerostomy spatula. Mitomycin C was given at least 1 week preoperation. The mean age of the patients and blebs were 67 and 6.75 years, respectively. The mean follow-up is 10.6 months (range: 3 to 17 mo). Mean preoperative intraocular pressure (IOP) (SD) was 21.9 (9.1) mm Hg on 3.7 (1.2) glaucoma medications. At 12 months follow-up, the mean IOP was 12.1 mm Hg on 0.86 medications. Four eyes failed due to uncontrolled IOP needing a tube shunt. One eye failed due to uncontrolled IOP but was lost to follow-up before a tube shunt could be performed. All failures occurred within 3 months. Two eyes had an IOP of <5 mm Hg after 1 month with no evidence of hypotony maculopathy. These cases resolved after 3 months without surgical intervention. All successful cases had blebs that were low, diffuse, and posterior.

Conclusions:

After a failed filtration surgery, a low-diffuse bleb was reestablished by pretreating with subconjunctival mitomycin C followed by ab interno bleb revision with the Grover-Fellman biplanar sclerostomy spatula, decreasing further more invasive glaucoma procedures.
Experiences of Older Adult Trauma Patients Discharged Home From a Level I Trauma Center
Authors: Rodrigue Nathalie , Laizner Andréa Maria , Tze Nancy , Sewitch Maida
Published: May 2017

The number of patients 65 years and older has been rising steadily every year at our Level I trauma center. Our clinical experience demonstrated that once discharged, some of these patients were not managing well. Postdischarge portrait is difficult to ascertain because this information is not captured in the trauma registry database. The purpose of this study was to describe the experiences of hospitalized trauma patients 65 years and older who are discharged home. A descriptive cross-sectional study of hospitalized trauma patients was conducted 1 month postdischarge using PREPARED Patient and 36-item Short Form Health Survey questionnaires. Data were analyzed with SPSS and NVivo. A convenience sample of 33 participants was recruited from four surgical inpatient trauma units of an urban, downtown hospital in Eastern Canada. Participants scored below 50% on most categories related to discharge preparedness and reported not having received enough information about their medication, available community resources, and permitted activities. They had worries about managing at home and 40% experienced unexpected problems. Participants reported feeling confident (80%) to be discharged home mostly because of support or previous experience with illness and 53% felt very prepared to return home. Health status scores were lowest for the domain “role limitation due to physical health” at 16% and highest around 70% for “emotional well-being” and “general health.” Patients did not receive enough information; some experienced unexpected problems once home but having support and previous experience with illness seems to help participants be confident with discharge home. There is room for improvement on specific aspects of discharge planning and preparedness.
The Lived Experience of Suffering of Males After Blunt Trauma: A Phenomenological Study
Authors: Filhour Louis D.
Published: May 2017

Using a phenomenological design, the researcher explored the question of what is the experience of suffering as voiced by male patients 7–12 months after hospitalization for blunt trauma. Seventeen male volunteers were interviewed and asked questions about how they suffered, what made their suffering more or less bearable, and how they were transformed through their suffering. Participants experienced changes in patterns resulting in a perception of suffering. Participants reported mostly experiencing physical, emotional, and social forms of suffering, whereas fewer experienced economic and spiritual suffering. Experiences of suffering resulted from the threat to their normal state or sense of wholeness because of their injuries. Intrinsic and extrinsic factors were identified, making the participants' suffering more or less bearable as they regained their lost state of normal. Positive attitude and motivation were significant intrinsic factors, whereas quality supportive care was the most significant extrinsic factor. Poor quality care was a significant negative extrinsic factor resulting in experiences of increased suffering. Through their experiences of suffering, the participants were transformed, amending their previous state of normal. Knowledge gained through this phenomenological study may be useful to nurses in guiding their care to alleviate patients' suffering and help them find meaning.
Obesity/Bariatric Surgery and Crohn’s Disease
Authors: Korelitz Burton I. , Sonpal Niket , Schneider Judy , Swaminath Arun , Felder Joseph , Roslin Mitchell , Aronoff Jeffrey
Published: May 2017

Background:

Crohn’s disease (CD) following bariatric surgery has been previously described. It is not clear whether the clinical entity is due to rapid metabolism of fat, change in the bacterial milieu of the bowel, the loss of defense mechanisms of the stomach, or even a coincidence.

Objectives:

To present observations which might serve to sort out these various etiologies.

Design:

We present 5 cases of colitis, ileocolitis or enteritis, some with fistula formation, with clinical onset following bariatric surgery and add these to the 7 cases previously identified as CD reported elsewhere. We provide the clinical features of these 12 cases to reconcile with causative mechanisms.

Limitations:

It remains possible that the onset of CD (or other inflammatory bowel disease) precedes the bariatric surgery which then accelerates the clinical manifestations described. Furthermore, without controls the association could remain a coincidence.

Conclusions:

We review the evidence for release of proinflammatory cells and cytokines contained in fat following the bariatric surgery, and also consider the roles that the surgical resection of stomach and shortening of the bowel may also bring about this syndrome. The earlier onset is more likely due to surgical loss of defenses of the stomach and the later onset to a metabolic alteration of the presurgical obesity, involving fat metabolism, and/or the microbiome. The role of characteristic creeping fat of CD is also addressed.
Systematic Review
Authors: Gibson Philippa S. , Lang Sarah , Dhawan Anil , Fitzpatrick Emer , Blumfield Michelle L. , Truby Helen , Hart Kathryn H. , Moore J. Bernadette
Published: May 2017

Objectives:

The aim of the study was to evaluate efficacy of nutrition and physical activity interventions in the clinical management of paediatric nonalcoholic fatty liver disease. The prevalence of paediatric nonalcoholic fatty liver disease continues to rise alongside childhood obesity. Weight loss through lifestyle modification is currently first‐line treatment, although supplementation of specific dietary components may be beneficial.

Methods:

Medline, CINAHL, EMBASE, Scopus, and Cochrane Libraries were systematically searched to identify randomized controlled trials assessing nutritional and physical activity interventions. Primary outcome measures were changes to liver biomarkers assessed by imaging, histology, or serum liver function tests. Study quality was evaluated using the American Dietetic Association Quality Criteria Checklist.

Results:

Fifteen articles met eligibility criteria investigating nutritional supplementation (vitamin E [n = 6], probiotics [n = 2], omega‐3 fatty acids [n = 5]), dietary modification (low glycaemic load [n = 1] and reducing fructose intake [n = 1]). No randomized controlled trials examining physical activity interventions were identified. Vitamin E was ineffective at improving alanine transaminase levels, whereas omega‐3 fatty acids decreased hepatic fat content. Probiotics gave mixed results, whereas reduced fructose consumption did not improve primary outcome measures. A low glycaemic load diet and a low‐fat diet appeared equally effective in decreasing hepatic fat content and transaminases. Most studies were deemed neutral as assessed by the American Dietetic Association Quality Criteria Checklist.

Conclusions:

The limited evidence base inhibits the prescription of specific dietary and/or lifestyle strategies for clinical practice. General healthy eating and physical activity guidelines, promoting weight loss, should remain first‐line treatment until high‐quality evidence emerges that support specific interventions that offer additional clinical benefit.
Differentiation Between Crohn Disease and Intestinal Tuberculosis in Children
Authors: Singh Sumit K. , Srivastava Anshu , Kumari Niraj , Poddar Ujjal , Yachha Surender K. , Pandey Chandra M.
Published: May 2017

Objectives:

The aim of the study was to evaluate clinical, endoscopic, radiologic, and histopathological features helpful in differentiating Crohn disease (CD) from intestinal tuberculosis (ITB) in children.

Methods:

Patients diagnosed to have CD or ITB based on standard recommended criteria were enrolled. Children with inflammatory bowel disease unclassified or suspected ITB or CD with incomplete work‐up or lost to follow‐up were excluded. The clinical and laboratory (radiology, endoscopy, and histology) details of children were analyzed.

Results:

Twenty cases of ITB (14 [3–17] years) and 23 of CD (11 [1–17] years) were enrolled. Presentation with chronic diarrhea (82% vs 40%; P = 0.006) and blood in stool (74% vs 10%; P = 0.001) favored CD, whereas subacute intestinal obstruction (20% vs 0%; P = 0.04) and ascites (30% vs 0%; P = 0.005) favored ITB. Presence of deep ulcers (61% vs 30%; P = 0.04), longitudinal ulcers (48% vs 15%; P = 0.02), involvement of multiple colonic segments (70% vs 35%; P = 0.02), left‐sided colon (87% vs 40%; P = 0.003), extraintestinal manifestations (21.7% vs 0%; P = 0.02), and higher platelet count (3.9 vs 2.6 × 105/mm3; P = 0.02) favored CD. Isolated ileocecal involvement (40% vs 8.7%; P = 0.03) was a feature of ITB. TB bacilli were demonstrated in 40% ITB cases (colon‐6, ascites‐1, abdominal lymph node‐1). On multivariate analysis, presence of blood in stool (odds ratio: 37.5 [confidence interval: 3.85–365.72], P = 0.002) and left‐sided colonic involvement (odds ratio: 16.2 [confidence interval: 1.63–161.98], P = 0.02) were independent predictors of CD.

Conclusions:

Microbiologic confirmation of tuberculosis is possible in 40% ITB cases. Presence of blood in stool and left‐sided colonic involvement are the most important features favoring CD.