bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Surgical Technique in Total Knee Arthroplasty for Varus Osteoarthritic Knee on the Rotational Alignment of Femoral Component: Gap Balancing Technique versus Measured Resection Technique
Authors: Kim Chang-Wan , Lee Chang-Rack , Gwak Heui-Chul , Kim Jung-Han , Kwon Yong-Uk , Kim Doo-Yeol
Published: January 2019

Few studies have compared the accuracy of femoral component rotation in the measured resection technique according to the preoperative computed tomography (CT) and gap balancing technique. The aim of this study was to evaluate whether there is a difference in accuracy and outlier incidence of femoral component rotation between gap balancing and measured resection techniques with or without preoperative CT and to evaluate the difference in patellofemoral alignment on simple radiographs and clinical outcomes. In this retrospective study, we evaluated femoral component rotation angle on the clinical and surgical transepicondylar axis (FCRA-cTEA and FCRA-sTEA, respectively), patellar tilt angle, lateral patellar displacement, and patient-reported outcomes in the gap balancing technique (Group 1) and in the measured resection technique without (Group 2) and with (Group 3) preoperative CT. A total of 163 total knee arthoplasty (TKA) replacements were included in this study. Average FCRA-cTEA was −3.4 ± 2.6, −2.8 ± 2.1, and −1.8 ± 2.3 degrees in groups 1 to 3, respectively (p = 0.002). Average FCRA-sTEA was −0.2 ± 2.7, 0.5 ± 2.4, and 1.5 ± 2.1 degrees, respectively (p = 0.001). In an outlier analysis that evaluated femoral component rotation using cTEA as reference, no significant difference was observed between the three groups (40.8, 37.3, and 23.7%, respectively, p = 0.133). When sTEA was used as a reference, groups 1 and 3 showed an outlier incidence of 8.2 and 8.5%, respectively, whereas this incidence was as high as 23.5% in group 2 (p = 0.030). No statistically significant group difference in patellofemoral alignment and patient-reported outcome was observed. In the measured resection technique with preoperative CT, the femoral component was externally rotated approximately 1 degree more than in the gap balancing or measured resection technique without preoperative CT. However, the difference in FCRA among the three techniques was not linked to the difference in patellofemoral alignment or patient-reported outcomes.
Genomic Analysis of Posterior Fossa Meningioma Demonstrates Frequent AKT1 E17K Mutations in Foramen Magnum Meningiomas
Authors: Williams Sally R. , Juratli Tareq A. , Castro Brandyn A. , Lazaro Tyler T. , Gill Corey M. , Nayyar Naema , Strickland Matthew R. , Babinski Melanie , Johnstone Sarah E. , Frosch Matthew P. , Silverman Ian M. , Ely Heather A. , Kaplan Alexander B. , D'Andrea Megan R. , Bihun Ivanna V. , Hoang Kaitlin , Batchelor Emily , Christiansen Jason , Cahill Daniel P. , Barker Frederick G. , Brastianos Priscilla K.
Published: January 2019

Objective Posterior fossa meningiomas are surgically challenging tumors that are associated with high morbidity and mortality. We sought to investigate the anatomical distribution of clinically actionable mutations in posterior fossa meningioma to facilitate identifying patients amenable for systemic targeted therapy trials.

Methods Targeted sequencing of clinically targetable AKT1, SMO, and PIK3CA mutations was performed in 61 posterior fossa meningioma using Illumina NextSeq 500 to a target depth of >500 × . Samples were further interrogated for 53 cancer-relevant RNA fusions by the Archer FusionPlex panel to detect gene rearrangements.

Results AKT1 (E17K) mutations were detected in five cases (8.2%), four in the foramen magnum and one in the cerebellopontine angle. In contrast, none of the posterior fossa tumors harbored an SMO (L412F) or a PIK3CA (E545K) mutation. Notably, the majority of foramen magnum meningiomas (4/7, 57%) harbored an AKT1 mutation. In addition, common clinically targetable gene fusions were not detected in any of the cases.

Conclusion A large subset of foramen magnum meningiomas harbor AKT1 E17K mutations and are therefore potentially amenable to targeted medical therapy. Genotyping of foramen magnum meningiomas may enable more therapeutic alternatives and guide their treatment decision process.
Adverse Maternal Outcomes Associated with Uterine Extensions at the Time of Cesarean Delivery
Authors: Patel Soha S. , Koelper Nathanael C. , Srinivas Sindhu K. , Sammel Mary D. , Levine Lisa D.
Published: January 2019

Objective We sought to compare adverse maternal outcomes between women with and without a uterine extension at the time of cesarean.

Study Design We conducted a retrospective cohort study of women with and without a uterine extension during a primary low transverse cesarean of a full-term singleton gestation. The primary outcomes were (1) estimated blood loss (EBL) and (2) composite maternal morbidity (defined as ≥ 1 of the following: blood transfusion, endometritis, or readmission). Pearson's chi-square or Fisher's exact test was used to compare categorical data; Student's t-test or Mann–Whitney's U-tests was used for continuous data. Linear and logistic regressions were used to adjust for confounding factors.

Results There were 252 women included (126 with extension and 126 without an extension). Women with extensions had a higher EBL (1,038 vs. 832 mL, p < 0.001) and higher rate of the composite maternal morbidity (19.1 vs. 5.6%, p = 0.001). Additionally, women with extensions had an increased risk of postpartum hemorrhage ≥ 1 L (53.2 vs. 23.8%, p < 0.001) and 1.5 L (12.7 vs. 0%, p < 0.001) and were associated with prolonged length of hospital stay (29 vs. 17%, p = 0.04).

Conclusion Uterine extensions are associated with adverse maternal outcomes including higher EBL and increase in maternal morbidity.
Impact of Previous Sternotomy on Outcome after Left Ventricular Assist Device Implantation
Authors: Zhigalov Konstantin , Szczechowicz Marcin , Mashhour Ahmed , Mkalaluh Sabreen , Isaev Maxim , Kadyraliev Bakitbek , Easo Jerry , Ennker Juergen , Eichstaedt Harald , Weymann Alexander
Published: January 2019

Background The main purpose of this article is to investigate the impact of previous sternotomy (PS) on the outcome of three different left ventricular assist devices (LVAD).

Methods Between June 2007 and February 2018, a total of 121 patients received HeartMate II (60.3%), HeartWare (12.4%), or HeartMate III (27.3%), with or without previous sternotomy (PS and non-PS groups, respectively). Propensity matching resulted in 44 patient pairs. The primary end point was overall survival at 30 days, 1 year, 2, and 5 years, postoperatively. Secondary end points were adverse events.

Results The overall cumulative survival rates for the two study groups were significantly different (77, 63, 54, and 38% for non-PS group vs 64, 39, 27, and 24% for PS group, p = 0.036). In the PS group, there was a higher need for intraoperative implantation of short-term right ventricular assist device (22.7 vs 6.8%, p = 0.034) and a higher incidence of hepatic dysfunction (20.5 vs 4.5%, p = 0.025) and acute kidney dysfunction (40.9 vs 20.5%, p = 0.032).

Conclusion PS is a reliable predictor of mortality and morbidity after LVAD implantation.
Daily Functioning and Quality of Life in Patients with Sjögren–Larsson Syndrome
Authors: de Groot Imelda , van Gerven Marjo , Willemsen Michèl , Staps Pippa
Published: January 2019

Aim Sjögren–Larsson syndrome (SLS) is an autosomal recessively inherited neurometabolic disease caused by an enzyme defect in lipid metabolism. Patients suffer from intellectual disability, bilateral spastic paresis, ichthyosis, visual impairment, and photophobia. Knowledge about the meaning of having SLS in daily life is lacking.

Methods Sixteen parents or caregivers of patients with SLS were asked to fill out online questionnaires about daily functioning, quality of life, feeding and swallowing problems, skin treatment, female hormonal status, and greatest problems.

Results Questionnaires were filled out by parents or caregivers of six children and 10 adult patients, age range 11 to 58 years. The median quality of life score was 73 (range: 26–100). Most often reported problems were itchy skin, reduced mobility, and dependency. Feeding and swallowing problems were reported in 75% of the patients. Mood problems were rarely mentioned.

Discussion Despite the large disruptions of daily functioning, patients with SLS are according to their parents generally content with their quality of life and participation. There was a broad range in reported problems. We found it very useful to systematically ask parents about their children's feelings and needs, to better understand the meaning of living with a complex disorder like SLS.
Kinetic and Angiogenic Activity of Circulating Endothelial Colony Forming Cells in Patients with Infantile Haemangioma Receiving Propranolol
Authors: Campanelli Rita , Codazzi Alessia , Poletto Valentina , Abbà Carlotta , Catarsi Paolo , Fois Gabriela , Avanzini Maria , Brazzelli Valeria , Tzialla Chryssoula , De Silvestri Annalisa , Tinelli Carmine , Licari Amelia , Berra-Romani Roberto , Zuccolo Estella , Moccia Francesco , Mannarino Savina , Rosti Vittorio , Massa Margherita
Published: January 2019

Endothelial progenitor cells (EPCs) have been suggested to contribute to the neovascularization of infantile haemangioma (IH). There is strong evidence of the efficacy of propranolol in the treatment of IH, possibly by inhibiting both vasculogenesis and angiogenesis in the tumour. We evaluate the frequency of circulating endothelial colony forming cells (ECFCs), as the best EPC surrogate, in patients with IH at diagnosis and while receiving propranolol by an ex vivo 12-month longitudinal study. Biological aspects of the ECFCs, such as their in vitro angiogenic potential, membrane CXCR4 expression and Ca2+ signalling, were investigated. Circulating ECFCs were isolated by in vitro culture and expanded for 2 to 3 passages in 23 patients with IH (median age: 5.5 months, range: 5.5 weeks–11 months) before and 3, 6, 9 and 12 months after receiving propranolol. Twenty-four healthy subjects comparable for age were also assessed (CTRLs). Untreated patients with IH had a circulating ECFC frequency lower (p = 0.001) than CTRLs; nevertheless, in in vitro starving conditions, ECFCs showed enhanced capacity to form tube-like structures than those of CTRLs. Patients with IH following the therapy with propranolol had a significantly increased (p = 0.022) circulating ECFC frequency, that showed a diminished tube-like formation capacity in vitro, and an altered constitutive store-operated Ca2+ entry. ECFCs play a role in IH pathogenesis; the response to propranolol therapy is associated with their increased frequency in the peripheral blood and a reduction of their vasculogenic activity.
Role of Betahistine in the Management of Vertigo
Authors: Biswas Anirban , Dutta Nilotpal
Published: January 2019

Though betahistine is the most commonly prescribed drug for vertigo, there are a lot of controversies on its efficacy as well as its proclaimed mechanism of action. There are authentic studies that have shown it to be no different from a placebo in Ménière’s disease. It is often promoted as a vestibular stimulant, but scientific evidence suggests that it is a vestibular suppressant. It is also not very clear whether it is an H3-receptor antagonist as most promotional literature shows it to be, or whether it is an inverse agonist of the H3 receptors. Owing to insufficient data on its efficacy in Ménière’s disease, betahistine is not approved by the U.S. Food and Drug Administration (FDA). The much-advertised role of betahistine in augmenting histaminergic transmission and thereby inducing arousal, though beneficial is some ways in the restoration of balance after peripheral vestibulopathy, is yet not without systemic problems, and the pros and cons of histaminergic stimulation in the brain need to be assessed more by clinical studies in humans before imbibing it in clinical practice. The effect of increasing blood flow to the cochlea and the vestibular labyrinth and “rebalancing the vestibular nuclei” (as claimed in some literature) and whether they are actually beneficial to the patient with vertigo in the therapeutic doses are very controversial issues. The mechanism of action of betahistine in vertigo in general and in Ménière’s disease in particular is very confusing, and there are too many conjectural and hypothetical, if not controversial issues involved that call for close scrutiny. Everything taken together, betahistine appears to be an unduly hyped-up drug and clinicians need to review the scientific literature available and be convinced about its efficacy and mechanism of action before using it in clinical practice. This review article puts forth some controversial issues and reviews the relevant scientific literature for clinicians to analyze and then take the final call on its clinical use.
Fibrodysplasia Ossificans Progressiva – FOP
Authors: Morhart R. , Semler O. , Seefried L.
Published: January 2019

Bei der Fibrodysplasia ossificans progressiva (FOP) besteht aufgrund einer aktivierenden Mutation im Gen für den Activin A Rezeptor Typ 1 (ACVR1 / ALK2), eine Prädisposition zu heterotoper Knochenbildung in Weichgeweben, insbesondere der Muskulatur. Die Prävalenz der Erkrankung wird in einer Größenordnung von 1 pro 1–2 Mio. angegeben. Klinisch kommt es intrauterin zu Fehlbildungen, z. B. zu einem bds. Hallux valgus, der bei der überwiegenden Mehrheit der Patienten bereits bei Geburt besteht. Postnatal kommt es meist in den ersten Lebensjahren beginnend im Schulter-/ Nackenbereich episodenartig bereits nach kleineren Verletzungen zu schmerzhaften Weichteilreaktionen, sogenannten flareups die nachfolgend im Sinne einer enchondralen Ossifikation verknöchern. Die Akkumulation dieser irreversiblen Verknöcherungen im Weichgewebe bedingt eine zunehmende Einschränkung der Beweglichkeit bis hin zur kompletten Einsteifung des Körpers. Letztlich kommt es durch die fortschreitende Rigidität des Thorax zu einer respiratorischen Insuffizienz und kardialer Dekompensation.

Therapeutisch steht im Vordergrund die Vermeidung von Traumata als Auslöser für die Entstehung extraossären Knochengewebes, insbesondere auch der Verzicht auf unnötige iatrogene Schädigungen durch Operationen, Biopsien und intramuskuläre Injektionen. Supportiv sind eine adäquate Hilfsmittelversorgung, psychologische Unterstützung und eine analgetische Versorgung erforderlich. Im Falle eines Traumas werden kurzfristig hochdosiert Glucocorticoide empfohlen, um das Risiko und Ausmaß der flare-ups und nachfolgender Verknöcherungen zu reduzieren. Ergänzend können NSAR hilfreich sein. Derzeit werden unterschiedliche neue Therapieansätze entwickelt. Am weitesten fortgeschritten ist dabei der Retinolsäure Rezeptor Gamma (RARg) Agonist Palovarotene, der durch Interferenz mit der ALK2 vermittelten Signalkaskade einen zentralen Punkt im Pathomechanismus der Erkrankung adressiert.
Meniscus Injuries in the Military Athlete
Authors: Zhou Liang , Haley Chad , Donohue Michael
Published: January 2019

Meniscal injuries in the young, active patient are often challenging injuries for the orthopaedic surgeon whose goal is to provide pain-free return to play/military duty and preserve maximal meniscal integrity. In the U.S. military, the incidence rate of meniscal tears is almost 10 times higher than that of the civilian population; although, the rates of reoperation following meniscal repair are fairly similar. The decision to pursue meniscal debridement versus repair is multifactorial depending on tear characteristics, concomitant injury, patient characteristics, and goals. Meniscal allograft transplantation remains reserved as a salvage procedure but with limited goals for potential to return to complete unrestricted military duties. The purpose of this article is to review treatment principles for the military athlete with meniscal pathology.
Perioperative Endocarditis Management in a Patient with Homozygous Sickle Cell Disease
Authors: Gozdzik Malgorzata , Mariotti Sergio , Genoni Michele , Zientara Alicja
Published: January 2019

Background Homozygous sickle cell disease (SCD) compounded with bacterial endocarditis makes open-heart surgery a multidisciplinary challenge.

Case description A 45-year-old African male patient with homozygous SCD presented with right heart decompensation, tricuspid regurgitation, and endocarditis of the aortic valve. Blood coulters were positive for coagulase-negative staphylococci. An emergent double valve replacement was successfully performed involving a multidisciplinary team.

Conclusion Homozygous SCD is associated with an increased risk of preoperative vaso-occlusive complications. Surgery with cardiopulmonary bypass can be performed, if hypothermia, hypoxia, acidosis, or low-flows are being avoided. Due to the lack of data, the adequate approach is still intuitive and requires standardization.
Ruptured Deep Femoral Artery Aneurysm Confused with an Incarcerated Inguinal Hernia: a Case of an Elderly Patient
Authors: Hamasaki Takafumi , Ota Rikako , Matsuoka Yuki , Kodama Wataru , Fukino Syunsuke , Nishimura Kengo
Published: January 2019

Deep femoral artery (DFA) aneurysms are rare. DFA is protected by the adductor canal, which may delay the diagnosis. Then, its early diagnosis may be difficult and it is possible to be misdiagnosis with incarcerated inguinal hernia, which occurs more often in elderly people. We report a very rare case of a treatment of an advanced elderly patient with an isolated ruptured DFA aneurysm that was preoperatively confused with an incarcerated inguinal hernia.

A 97-year-old man was admitted to a neighboring hospital due to a painful mass of the right groin after transient consciousness loss and the patient was diagnosed with right incarcerated inguinal hernia by a nonenhanced computed tomography (CT). Although he was observed for 3 days, he suddenly lost consciousness again with a decrease in blood pressure. Thus, he was referred to our hospital due to the painful pulsatile inguinal mass after resuscitation from shock. As we diagnosed a ruptured DFA aneurysm by an enhanced CT, we emergently performed an excision of the aneurysm with revascularization of the right DFA. The postoperative course was uneventful without ischemic change of the lower leg.
Technology Access, Technical Assistance, and Disparities in Inpatient Portal Use
Authors: Grossman Lisa , Masterson Creber Ruth , Ancker Jessica , Ryan Beatriz , Polubriaginof Fernanda , Qian Min , Alarcon Irma , Restaino Susan , Bakken Suzanne , Hripcsak George , Vawdrey David
Published: January 2019

Background Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use.

Objective To examine predictors of frequent versus infrequent portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance.

Materials and Methods This subgroup analysis includes 146 intervention-arm participants from a pragmatic randomized controlled trial of an inpatient portal. The participants received free access to an iPad and inpatient portal while hospitalized on medical and surgical cardiac units, together with hands-on help using them. We used logistic regression to identify characteristics predictive of frequent use.

Results More technology experience (adjusted odds ratio [OR] = 5.39, p = 0.049), less severe illness (adjusted OR = 2.07, p = 0.077), and private insurance (adjusted OR = 2.25, p = 0.043) predicted frequent use, with a predictive performance (area under the curve) of 65.6%. No significant differences in age, gender, race, ethnicity, level of education, employment status, or patient activation existed between the frequent and infrequent users in bivariate analyses. Significantly more frequent users noticed medical errors during their hospital stay.

Discussion and Conclusion Portal use was not associated with several sociodemographic characteristics previously found to limit use in the inpatient setting. However, limited technology experience and high illness severity were still barriers to frequent use. Future work should explore additional strategies, such as enrolling health care proxies and improving usability, to reduce potential disparities in portal use.
The New York State Safe Motherhood Initiative: Early Impact of Obstetric Hemorrhage Bundle Implementation
Authors: Goffman Dena , Ananth Cande V. , Fleischer Adiel , D'Alton Mary , Lavery Jessica A. , Smiley Richard , Zielinski Kristin , Chazotte Cynthia ,   for the Safe Motherhood Initiative Obstetric Hemorrhage Work Group
Published: January 2019

Objective To determine the effects of the Safe Motherhood Initiative's (SMI) obstetric hemorrhage bundle in New York State (NYS).

Study Design In 2013, the SMI convened interprofessional workgroups on hemorrhage, venous thromboembolism, and hypertension tasked with developing evidence-based care bundles. Participating hospitals submitted data measured before, during, and after implementation of the hemorrhage bundle: maternal mortality, intensive care unit (ICU) admission, cardiovascular collapse, hysterectomy, and transfusion of ≥4 units of red blood cells (RBCs). Data were analyzed for trends stratified by implementation status.

Results Of the 123 maternity hospitals in NYS, 117 participated, of which 113 submitted data. Of 250,719 births, transfusion of ≥4 units RBCs (1.8 per 1,000) and ICU admissions (1.1 per 1,000) were the most common morbidities. Four hemorrhage-related maternal deaths (1.6 per 100,000) and 10 cases of cardiovascular collapse requiring cardiopulmonary resuscitation (4.0 per 100,000) occurred. Hemorrhage morbidity did not change over the five quarters studied. Risks were similar across hospital level of care and implementation status.

Conclusion Statewide implementation of bundles is feasible with resources critical to success. The low hemorrhage-related maternal death rate makes changes in mortality risk difficult to detect over short time intervals. Long-term and timely data collection with individual expert case review will be required.
Esophageal Blood Flow May Not Be Directly Influenced by Anastomotic Tension: An Exploratory Laser Doppler Study in Swine
Authors: Oetzmann von Sochaczewski Christina , Heimann Axel , Linder Andreas , Kempski Oliver , Muensterer Oliver J.
Published: January 2019

Background Anastomotic tension has been linked to leakage and stenosis in esophageal surgery in both adults and children. We aimed to determine the effects of esophageal topography, operative technique, and anastomotic tension on esophageal blood flow.

Materials and Methods We divided and reanastomosed the esophagi at the carinal level with increasing levels of anastomotic tension in piglets (n = 10) and sham controls (n = 4). We examined esophageal blood flow pre- and postoperatively using laser Doppler flowmetry at the anastomosis and two predetermined proximal and distal points. Blood flow in relation to distance from the anastomosis was examined by multivariate linear regression.

Results Thoracotomy alone did not influence perfusion at the carinal level in shams (Δ = 3.13 laser Doppler units, 95% confidence interval: −3.4 to 9.7, p = 0.2686). We constructed a (F[5,134] = 6.34, p < 0.0001) multinomial regression model based on distance to the anastomotic site and pre-/postoperative measurements (adjusted R
2 = 0.1624). Tissue blood flow was higher distant to the carina, but lower postoperatively and not influenced by the tension resulting from the extent of resection (F[1, 8] = 1.134, p = 0.318).

Conclusion Esophageal blood flow is higher at greater distances to the carinal level and hampered by esophageal division and reanastomosis. The extent of resection has less influence than previously assumed. Therefore, leakage and stenosis after esophageal anastomosis may not solely be caused by insufficient anastomotic blood flow.
Characteristics and Outcomes in Patients with Venous Thromboembolism Taking Concomitant Anti-Platelet Agents and Anticoagulants in the AMPLIFY Trial
Authors: Cohen Alexander , Agnelli Giancarlo , Buller Harry , Gallus Alexander , Raskob Gary , Sanders Paul , Thompson John , Weitz Jeffrey
Published: January 2019

The double-blind, randomized, AMPLIFY trial compared 6 months' treatment with apixaban (10 mg twice daily for 7 days and 5 mg twice daily thereafter) versus conventional treatment (subcutaneous enoxaparin [1 mg/kg twice daily for ≥ 5 days] overlapped and followed by warfarin [international normalized ratio = 2.0–3.0]) in patients with acute venous thromboembolism (VTE). This post hoc analysis of AMPLIFY compared outcomes among those taking or not taking concomitant anti-platelet therapy. The primary efficacy outcome was recurrent VTE or VTE-related death; the principal safety outcome was major bleeding. Of 5,365 (apixaban, n = 2,676; enoxaparin/warfarin, n = 2,689) randomized patients, 813 (apixaban, n = 402 [15%]; enoxaparin/warfarin, n = 411 [15%]) took concomitant anti-platelet therapy, of which 92% consisted of low-dose aspirin. Rates of VTE or VTE-related death were similar whether or not anti-platelet agents were taken (apixaban: 3.6 and 2.0%; enoxaparin/warfarin: 3.0 and 2.6%; anti-platelet use: relative risk [RR], 1.23; 95% confidence interval [CI], 0.58–2.62; no anti-platelet use: RR, 0.77; 95% CI, 0.52–1.13); interaction p-value = 0.299. Major bleeding rates were threefold higher in those taking versus those not taking anti-platelet agents (apixaban: 1.2 and 0.4%; enoxaparin/warfarin: 4.1 and 1.4%; anti-platelet use: RR, 0.30; 95% CI, 0.11–0.81; no anti-platelet use: RR, 0.31; 95% CI, 0.15–0.63); interaction p-value = 0.924. Concomitant anti-platelet therapy produced a proportionally similar increase in major bleeding in patients randomized to apixaban or conventional therapy, but there were fewer major bleeds with apixaban. Therefore, the overall safety of apixaban over conventional therapy was maintained in patients receiving anti-platelet therapy. Clinicaltrials.gov: NCT00643201.
Novel Murine Model of Immune Thrombocytopaenia through Immunized CD41 Knockout Mice
Authors: Li Xin , Wang Shu-wen , Feng Qi , Hou Yu , Lu Nan , Ma Chun-hong , Gao Cheng-jiang , Hou Ming , Peng Jun
Published: January 2019

Immune thrombocytopaenia (ITP) is the most common autoimmune bleeding disorder, where platelets are destroyed by auto-antibodies and/or cell-mediated mechanisms. To understand the pathogenesis of ITP and explore novel therapeutics, three types of animal models have been used: passive ITP, secondary ITP and platelet-induced ITP. However, the first two are not ideal for chronic ITP pathophysiology where both T cell and B cell play important roles in platelet destruction. The most efficient model to mimic chronic ITP is developed by Chow et al through transferring splenocytes from platelet-immune CD61-knockout (KO) mice into mice with severe combined immunodeficiency (SCID). However, placental defects are evident in 25% of CD61-KO females and post-natal haemorrhage does occur, reducing the survival rate of embryos and pups. Compared with CD61-KO mice, CD41-KO ones do not present such problems. In our study, we employ CD41-KO mice as another source of immunized spleen cells. We evaluated our model with existing standards. Transferred SCID mice presented typical features of ITP, such as reduced platelet counts in the peripheral blood, increased anti-platelet antibody levels in the serum and reduced mature megakaryocytes in the bone marrow. What is more, lymphocyte-depletion experiments showed the role of CD8+ T cells in mature megakaryocyte decrease and thrombocytopaenia. And we confirmed the antibody-mediated platelet destruction by phagocytosis in the spleen. Our study develops another efficient murine ITP model through immunized CD41-KO mice.
Bleeding After Free Flap-Based Breast Reconstruction: A NSQIP Analysis
Authors: Orr Jonah Parker , Shammas Ronnie Labib , Thomas Analise B. , Truong Tracy , Cho Eugenia H. , Kuchibhatla Maragatha , Hollenbeck Scott Thomas
Published: January 2019

Background Despite limited oncologic benefit for women without an increased risk for breast cancer, the rates of contralateral prophylactic mastectomy (CPM) have increased. Patients undergoing CPM are more likely to undergo bilateral and immediate breast reconstruction. This study assessed the relationship between the timing and laterality of free flap-based breast reconstruction and the risk of postoperative bleeding complications.

Methods Women undergoing postmastectomy free-flap based breast reconstruction from 2010 to 2015 were identified using the National Surgical Quality Improvement Program (NSQIP) dataset. Patients were categorized according to reconstructive laterality and timing. Modified Poisson regression was used to assess the risk of postoperative bleeding and complications across reconstructive procedures.

Results Of the 4,133 patients undergoing free flap-based breast reconstruction, 12% (n = 494) experienced postoperative bleeding complications. Bilateral immediate reconstruction was associated with the highest incidence of bleeding (16.6%, n = 188), followed by bilateral delayed (12.8%, n = 58), unilateral immediate (10%, n = 142), and unilateral delayed reconstruction (9.4%, n = 106). Among patients undergoing immediate reconstruction, bilateral, rather than unilateral, reconstruction was associated with a significantly elevated risk of bleeding complications (RR [rate ratio]  = 1.58; 95% CI [confidence interval] =1.19, 2.10; p = 0.0002). Furthermore, immediate bilateral reconstruction was associated with a significantly higher rate of return to the operating room (RR =1.39; 95% CI =1.06, 1.82; adjusted p = 0.009) when compared with a unilateral procedure.

Conclusion Patients undergoing immediate bilateral free flap-based breast reconstruction may be at an increased risk for experiencing acute postoperative bleeding complications and a return to the operating room. Patients undergoing CPM and considering immediate reconstruction should be counseled regarding the increased morbidity of a bilateral reconstructive procedure.
Inklusion chronisch kranker Kinder und Jugendlicher in den Schulsport
Authors: Merker J. , Henner N. , Hartmann M.
Published: January 2019

Chronische Erkrankungen verursachen im Kindesalter bisweilen erhebliche Auswirkungen auf die Funktionalität und körperliche Aktivität. Die Inklusion in den Schulsport ist von hoher Bedeutung und in den meisten Fällen möglich. Ein vollständiges Sportverbot sollte daher die Ausnahme bleiben. Wichtig sind vielmehr die Beratung des Patienten und der Eltern durch den Arzt hinsichtlich der sportlichen Aktivität trotz chronischer Erkrankung sowie die Empfehlung für den Sportlehrer in Form einer Sportbescheinigung mit einer möglichst genauen Beschreibung der Einschränkungen und der Fähigkeiten. Wenn möglich, sollten dabei zu vermeidende und zu fördernde sportliche Funktionen beschrieben werden. Hierbei muss der Datenschutz Berücksichtigung finden. Eine Zusammenarbeit von Sportlehrer, Patient, Eltern und Arzt ermöglicht die optimale Abstimmung auf die individuellen Voraussetzungen des Patienten. Der Sportlehrer kann dazu auf pädagogische und didaktische Modelle, wie beispielsweise das Zusammenspiel von Informationsanforderungen und Druckbedingungen für koordinative Anforderungen, zurückgreifen. Grundsätzlich sind alternative Notengebungen möglich und sollten genutzt werden. Unter Berücksichtigung dieser Punkte kann die Inklusion des chronisch kranken Schülers in den Sportunterricht erfolgreich gelingen.
Sport und chronische Entzündung
Authors: Milatz F. , Wolfarth B.
Published: January 2019

Gesellschaftliche Veränderungen und eine zunehmend medienorientierte Welt haben sich in den letzten Dekaden negativ auf das Bewegungsverhalten Heranwachsender ausgewirkt. Die Folgen eines unterdrückten „natürlichen Bewegungsdrangs” äußern sich in einer Verschlechterung der motorischen Leistungsfähigkeit, einer Zunahme von Haltungsschäden sowie psychomotorischen Störungen. Kinder mit chronischen Erkrankungen haben dasselbe Bedürfnis wie gesunde Kinder, körperlich aktiv zu sein. Eine ungerechtfertigte Einschränkung von Bewegung, Spiel und Sport ist bei chronisch kranken Heranwachsenden kontraindiziert. Die Möglichkeit, diese ausüben zu können, dient auch als Gradmesser für ihre Lebensqualität und Gesundheit. Im Rahmen kindlich rheumatischer Erkrankungen, wie der juvenilen idiopathischen Arthritis (JIA), gilt ein bewegungsreicher Alltag als feste therapeutische Säule. Der aktuelle wissenschaftliche Datenbestand unterstreicht die Bedeutung regelmäßiger Sportaktivität zur Verbesserung der gesundheitsbezogenen Lebensqualität sowie Reduktion der Krankheitslast.
Endokrinologische Korrelate der Borderline-Persönlichkeitsstörung
Authors: Kröner J. , Schaitz C. , Maier A. , Connemann B. , Sosic-Vasic Z.
Published: January 2019

Die Borderline-Persönlichkeitsstörung (BPS) ist eine schwerwiegende und im psychiatrischen sowie psychotherapeutischen Kontext die am häufigsten vorkommende Persönlichkeitsstörung. Sie zeichnet sich durch ein Muster von Instabilität im zwischenmenschlichen Kontakt und im Selbstbild sowie eine gesteigerte Impulsivität aus. Annahmen besagen, dass Personen mit einer BPS sehr stark auf emotionale Stimuli reagieren und Schwierigkeiten haben, ihre physiologischen Reaktionen zu kontrollieren. Die Übersichtsarbeit durchleutete die Datenbank PubMed systematisch auf Artikel zum Thema „Kortisol“ oder „Hpa“ und „psychosozialer Stress“ oder „interpersoneller Stress“ und „Borderline“. Hierbei konnten von 135 Artikeln 8 identifiziert werden, die den Suchkriterien entsprachen. Nach Evaluation der Studien können die Hypothesen bezüglich interpersoneller Stressoren teilweise bestätigt werden. Hierbei erlebten Personen mit BPS im Vergleich zu gesunden Kontrollprobanden eine erhöhte physiologische Stressreaktion, gemessen am Kortisol im Speichel, auf einen interpersonellen Konflikt. In Studien zu sozial-evaluativen Stressoren reagierten BPS-Probanden jedoch im Gegensatz zu diesen Ergebnissen auf Stress mit einer Hyporeagibilität des physiologischen und endokrinologischen Stresssystems. In Bezug auf ein Fazit bleiben die Befunde uneindeutig, was den geringen Stichprobengrößen, teilweise fehlenden Mediatorsowie Moderatorvariablen, unterschiedlichen Einschlusskriterien und Messzeitpunkten, aber auch der einseitigen Geschlechterverteilung geschuldet sein könnte.
Psychiatrische Türöffnung
Authors: Mühleck M. , Meyer D. , Elmiger A. , Leyhe T. , Reiter-Theil S.
Published: January 2019

Zur Unterstützung der Türöffnung einer ehemals geschlossenen psychiatrischen Station wurde begleitend eine Serie von Ethikkonsultationen durchgeführt. Aus der Ethikserie wurden Ansätze zur Verbesserung und Vereinfachung der Prozesse auch für andere Institutionen mit bevorstehender Türöffnung herausgearbeitet. Ziel ist, dem Auftreten ethischer Probleme während und nach einem Türöffnungsprozess vorzubeugen.
Neutrophil isolation from feline blood using discontinuous Percoll dilutions
Authors: Cakmak Ayse , Yildiz Kader , Sursal Neslihan
Published: January 2019

Objective: Some studies have performed in vitro neutrophil isolation from feline blood. The major limiting factor for these studies is the small volume of blood that can be collected without development of potentially life-threatening complications. In the present study we attempted neutrophil isolation from feline venous blood samples using discontinuous Percoll gradients. Material and methods: Blood was collected from the cephalic vein of clinically healthy adult cats. The blood samples were layered on Percoll dilutions (72 %, 63 %, 54 % and 45 %). After centrifugation, the feline polymorphonuclear leukocytes (PMN) accumulated as a band between 72–63 % Percoll dilutions. The total cell count was calculated using light microscopy counts. The percentage of the neutrophils was determined microscopically after staining with Diff-Quik stain. Neutrophil viability was evaluated with a 0.01 % Trypan blue assay. The activation was determined based on intact cell morphology in the isolated neutrophils. Results: The mean PMN number was 22 x 105 per ml (minimum – maximum: 20–26 x 105/ml). Neutrophil homogeneity was > 95 % in the cell suspensions. The viability of isolated neutrophils was > 98 %. The technique did not result in neutrophil activation. Conclusion and clinical relevance: Discontinuous Percoll gradients (72 %, 63 %, 54 % and 45 %) can be used to isolate neutrophils from blood samples of cats. The technique was simple to perform and neutrophil activation was minimal.
Postpartal klinisch manifeste alveoläre Echinokokkose bei einer Hündin
Authors: Gawda Natalia , Joekel Deborah
Published: January 2019

Die Entwicklung des Fuchsbandwurms Echinococcus multilocularis findet typischerweise im Fuchs (Endwirt) und in Wühlmäusen (Zwischenwirte) statt. Hunde können ebenfalls als Endwirte fungieren und selten ist der Hund Fehlwirt mit einer manifestierten alveolären Echinokokkose (AE) hauptsächlich in der Leber. Dieser Fallbericht beschreibt eine klinisch manifeste AE bei einer 3-jährigen Hündin, die 5 Wochen post partum mit Inappetenz und Apathie vorgestellt wurde. Radiologisch waren weichteildichte, teilweise mineralisierte Umfangsvermehrungen zu befunden, die sich sonographisch als kavernös und flüssigkeitsgefüllt darstellten. Intra operationem zeigte sich eine multifokal generalisierte zystische Veränderung der Leber mit Metastasierung in das Omentum. Aufgrund der hochgradigen Veränderungen wurde die Hündin euthanasiert. Histopathologisch ließen sich neben der für E. multilocularis typischen Laminarschicht vereinzelnd Protoskolizes-Anschnitte darstellen. Die spezifische PCR zum Nachweis von E. multilocularis ergab einen positiven Befund. Nach bestem Wissen der Autorinnen ist bislang kein Fallbericht einer postpartal klinisch manifesten AE beim Hund beschrieben. Die Trächtigkeit könnte den progressiven Verlauf der Erkrankung begünstigt haben.
Waning Time of Maternally Derived Anti-Hepatitis A and Anti-Varicella Zoster Virus Antibodies
Authors: Duyan Camurdan Aysu , Beyazova Ufuk , Bozdayı Gulendam , Civil Fusun , Altay Kocak Aylin , Guzelkucuk Zeliha
Published: January 2019

Objective The objective of this study was to investigate the persistence of maternally derived antibodies to hepatitis A (anti-HAV) and varicella zoster (anti-VZV) viruses to determine the optimal time of vaccination of infants.

Materials and Methods This study was conducted between 2011 and 2012 at the Gazi University Hospital. Blood samples were collected from healthy infants' cord blood and at 12th, 18th, and 24th months of age. Anti-HAV and anti-VZV immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies were measured by enzyme-linked immunosorbent assay kit in blood samples.

Results A total of 546 infants and children were included in the study; all had blood samples taken at four time points (at birth [cord blood], and at 12, 18, and 24 months). Anti-HAV IgG seropositivity rates in these samples were 77.3, 29.6, 14.8, and 17.7%, respectively (p < 0.05). Corresponding anti-VZV IgG seropositivity rates were 83.3, 21.5, 29.5, and 33.8%, respectively (p < 0.05).

Conclusion Anti-HAV and anti-VZV seropositivity rates were lowest at 18 and 12 months, respectively. We suggest that if VZV and hepatitis A vaccines were included in the national vaccination program after the age of 1 year, there should be little interference from passively acquired maternal antibodies.
Restoration of Constitutional Alignment in TKA with a Novel Osteotomy Technique
Authors: Wang Zhibing , Cheng Xingwang , Zhang Yuan , Zhang Xia , Zhou Yue
Published: January 2019

Many studies have shown that restoration of the preoperative constitutional varus may lead to a normal knee status in total knee arthroplasty (TKA). It is also known that coronal femoral lateral bowing contributes to constitutional varus of the femoral shaft, and bilateral femoral lateral bowing (BFLB) can decelerate medial knee osteoarthritis progression. In this sense, the BFLB should be reserved in TKA. To date, no study has yet reported the technique to reserve BFLB in TKA. Our study showed that the proximal and distal femur had no significant geometric difference between patients with varus knees and BFLB (> 5°) and volunteers with healthy knees and straight femoral shaft. So, the virtual center of femoral head fell on the distal femoral mechanical axis (DMA) after accurate correction of the bowing, indicating that the DMA should be the femoral original constitutional mechanical axis (CA). Subsequently, the distal femoral osteotomy was performed perpendicular to DMA in TKA, and the postoperative angle formed by DMA and tibial mechanical axis (TMA) was measured to assess whether CA was restored successfully. In this study, the gap balance was achieved without medial collateral ligaments release, and the patient's CA was successfully restored (range of DMA–TMA angle 178.2°–179.9°). This study provides a novel technique to restore preoperative CA in patients with varus knees and BFLB. It is found that the distal femur should be cut perpendicular to DMA, so the lower limb alignment and soft tissue strains can be restored to the preoperative state, and the knees would be stable and in a natural status after TKA.
Sepsis Biomarkers
Authors: Wong Hector
Published: January 2019

Sepsis-related biomarkers have a variety of potential applications. The most well-known application is to differentiate patients with signs of systemic inflammation caused by infection, from those with systemic inflammation due to a non-infectious cause. This application is important for timely and judicious prescription of antibiotics. Apart from diagnostic applications, biomarkers can also be used to identify patients with sepsis who are at risk for poor outcome and to subgroup patients with sepsis based on biological commonalities. The latter two applications embody the concepts of prognostic and predictive enrichment, which are fundamental to precision medicine. This review will elaborate on these concepts, provide relevant examples, and discuss important considerations in the process of biomarkers discovery and development.
Vitamin D Deficiency: A Treatable but Often Forgotten Cause of Motor Delay in Infants
Authors: Kakkar Shruti , Sahni Suhalika Singla , Kumar Ruchika , Goraya Jatinder Singh
Published: January 2019

Vitamin D deficiency is an under-recognized cause of motor delays in infants and young children. Retrospective chart review identified 17 infants, 11 boys and 6 girls, aged between 7 and 27 months with motor delays attributable to vitamin D deficiency. Diagnosis of vitamin D deficiency was made on the basis of clinical, radiological, and biochemical findings. Presenting symptoms were delay in motor milestones in 14 and hypocalcemic seizures in 3. On physical examination, clinical signs of rickets were present in all. Neurological examination displayed hypotonia with retained tendon reflexes. Thirteen and ten infants, respectively, underwent radiographical and biochemical investigations, and all had abnormalities consistent with rickets. All infants were treated with 6,00,000 IU of vitamin D. Four infants were lost to follow-up. Rapid recovery of motor development was observed in remaining 13 infants. Vitamin D deficiency should be considered in the differential diagnosis of motor delays in infants and young children.
Hearing Preservation in Vestibular Schwannoma Surgery
Authors: Saliba Joe , Friedman Rick , Cueva Roberto
Published: January 2019

Modern imaging techniques allow early detection of small vestibular schwannomas (VSs) with minimal or no hearing impairment. While controversy surrounds the management of these tumors, given their benign nature and unpredictable natural history, microsurgical excision is the only modality that offers the opportunity to cure the tumor and preserve hearing. Hearing preservation in VS surgery may be accomplished via the middle fossa or retrosigmoid approaches. Appropriate patient selection and surgical approach is critical in achieving the best hearing outcomes. This article highlights the preoperative assessment, patient selection and prognostic factors, intraoperative monitoring of hearing, and surgical approaches to optimize hearing preservation during VS removal.
Die Neuvermessung der Onkologie
Authors: Bubenzer Rainer
Published: January 2019

Der großartige Roman von Daniel Kehlmann über die „Vermessung der Welt” inspirierte die Veranstalter des vierten interdisziplinären Symposiums „Innovations in Oncology” zu dem vielversprechenden Veranstaltungstitel „Die Neuvermessung der Onkologie”. So wie der Roman eine Gratwanderung zwischen Lächerlichkeit und Größe bzw. Scheitern und Erfolg beschreibt, zeigte die Berliner Veranstaltung, dass sich die onkologische Forschung in Deutschland anstrengen muss, mit dem internationalen Fortschritt Schritt zu halten. Nicht ganz einfach mit der beschränkten finanzieller Ausstattung. Dennoch gilt es, da waren sich alle Referenten einig, diese Entwicklungen – von denen einige in Berlin thematisiert wurden – im Interesse der Patienten so rasch wie möglich in die Praxis zu übertragen.
Endoskopische Darmkrebs-Früherkennung immer unbeliebter
Authors: Grübler Dr. Beate
Published: January 2019

Die Auswertung von über zwei Millionen in den Jahren 2014 bis 2017 vorgenommenen Koloskopien hat ergeben, dass lediglich 19 % als präventive Maßnahme abgerechnet wurden, weitere 16 % als diagnostische Maßnahme und die übrigen 65 % in kurativer Intention. Die Daten wurden aus einem Pool von über einer Million Versicherten der Techniker Krankenkasse generiert. 80 % der Abrechnungsdaten entfallen auf den ambulanten Bereich.
Helicobacter pylori-assoziiertes Magenkarzinom
Authors: Kretzschmar Dr. Alexander
Published: January 2019

Eine chronische Infektion der Magenschleimhaut durch das Bakterium Helicobacter pylori (HP) ist ein Risikofaktor für die Entwicklung eines Magenkarzinoms. In der The-rapieforschung wird DLC1 (Deleted in liver cancer-1) als potenzieller Prognosemarker zur Früherkennung der Erkrankung und zielgerichteter Behandlungen beim fortgeschrittenen Magenkarzinom intensiv erforscht. Eine neue Studie zeigt, dass der Ver-lust der DLC1-Expression ein frühes molekulares Ereignis in der Transformation von normalem zu neoplastischem Gewebe in der Magenschleimhaut ist. Dies unterstützt die Bedeutung von DLC1 als potenziellem künftigem Biomarker oder Zielstruktur in der Krebsprävention.
Kolorektales Karzinom
Authors: Krome Dr. Susanne
Published: January 2019

Ein 48-jähriger Mann stellt sich mit rechtsseitigen abdominellen Schmerzen vor. Die Koloskopie ergibt einen zökalen Tumor, der histologisch einem undifferenzierten Adenokarzinom entspricht. Die Mutter war 48-jährig an einem gynäkologischen und der Großvater mütterlicherseits an einem kolorektalen Karzinom erkrankt. Prof. Frank Sinicrope von der Mayo-Klinik in Rochester/USA, stellt das aktuelle Management bei Patienten mit einem Lynch-Syndrom vor.
Neuroendokrine Tumoren und Lebermetastasen
Authors: Krome Dr. Susanne
Published: January 2019

Die Inzidenz neuroendokriner Tumoren (NET) nimmt stetig zu. Die heterogene Krankheitsgruppe erfordert eine differenzierte Untersuchungsplanung und adaptierte Behandlungsentscheidungen. Sowohl diagnostisch als auch therapeutisch stehen neue Verfahren und Substanzen zur Verfügung. Foster et al. von der Stanford University School of Medicine, Stanford/USA, stellen in ihrem Review einen Algorithmus vor und konzentrieren sich dabei auf Patienten mit NET und Lebermetastasen.
Fortgeschrittenes Harnblasenkarzinom
Authors: Krome Dr. Susanne
Published: January 2019

Leitlinien verschiedener Fachgesellschaften, darunter der European Association of Urology (EAU), empfehlen bei muskelinvasiven Harnblasenkarzinomen vor der Zystektomie eine neoadjuvante Chemotherapie (NAC). Trotz der hohen Evidenz für einen Überlebensvorteil erfolgt sie wegen assoziierter Nebenwirkungen nicht immer. Eine aktuelle Studie belegt die Effektivität der NAC und vergleicht die Ergebnisse verschiedener neoadjuvanter Protokolle.