bluuebunny/crossref_metadata_2025 huggingface dataset:
Third-nearest WZ Sge-Type dwarf nova candidate ASASSN-14dx classified on the basis of Gaia Data Release 2
Authors: Isogai Keisuke , Kato Taichi , Imada Akira , Ohshima Tomohito , Kojiguchi Naoto , Ohnishi Ryuhei , Hambsch Franz-Josef , Monard Berto , Kiyota Seiichiro , Nishimura Hideo , Nogami Daisaku
Published: November 2018

ASASSN-14dx showed an extraordinary outburst whose features are a small outburst amplitude (∼2.3 mag) and long duration (>4 yr). Because we found a long observational gap of 123 d before the outburst detection, we propose that the main outburst plateau was missed and that this outburst is just a “fading tail” often seen after the WZ Sge-type super-outbursts. In order to distinguish between WZ Sge and SU UMa-type dwarf novae (DNe), we investigated Gaia Data Release 2 (DR2) statistically. We applied a logistic regression model and succeeded in classifying by using absolute Gaia magnitudes MG and Gaia colors GBP–GRP. Our new classifier also suggests that ASASSN-14dx is the best candidate of a WZ Sge-type DN. We estimated distances from the Earth of known WZ Sge stars by using Gaia DR2 parallaxes. The result indicates that ASASSN-14dx is the third-nearest WZ Sge star (next to WZ Sge and V455 And), and hence the object can show the third-brightest WZ Sge-type super-outburst whose maximum is V = 8–9 mag.
The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity
Authors: Neal J.M. , Barrington M.J. , Fettiplace M.R. , Gitman M. , Memtsoudis S.G. , Mörwald E.E. , Rubin D.S. , Weinberg G.
Published: November 2018

(Reg Anesth Pain Med. 2018;43:113–123)

Local anesthetic systemic toxicity (LAST) is a rare, adverse event that can occur when local anesthetics are administered despite advances in technique. Patients can experience mild prodromal symptoms to serious events such as seizure, cardiac arrest, and/or death. It is important that all professionals administering local anesthetics be educated and prepared for LAST. This article uses emerging research to update the 2010 advisory from the American Society of Regional Anesthesia and Pain Medicine. This practice advisory provides recommendations from recently published articles.
Delayed Versus Early Umbilical Cord Clamping for Preterm Infants: A Systematic Review and Meta-Analysis
Authors: Fogarty M. , Osborn D.A. , Askie L. , Seidler A.L. , Hunter K. , Lui K. , Simes J. , Tarnow-Mordi W.
Published: November 2018

(Am J Obstet Gynecol. 2018;218(1):1–18)

Delayed umbilical cord clamping may benefit preterm infants by increasing the volume of blood transferred to the neonate as well as allowing time for physiological transition, which may result in improved outcomes. The effects of delayed cord clamping are still unclear and an updated systematic review was needed. This systematic review included randomized controlled trials (RCTs) though July 31, 2017 in order to evaluate the effects of delayed clamping without cord milking compared to early clamping in reducing mortality in preterm infants.
Food and Drug Administration Warning on Anesthesia and Brain Development: Implications for Obstetric and Fetal Surgery
Authors: Olutoye O.A. , Baker B.W. , Belfort M.A. , Olutoye O.O.
Published: November 2018

(Am J Obstet Gynecol. 2018;218(1):98–102)

The United States Food and Drug Administration has warned against the use of general anesthetics and sedation medications for >3 hours in pregnant women in the third trimester and children younger than 3 years old. The anesthetics agents listed included midazolam, propofol, and inhalational anesthetics (isoflurane, sevoflurane, and desflurane). They claim these agents may affect the development of children’s brains.
Diagnostic Accuracy of Ultrasound in Detecting the Severity of Abnormally Invasive Placentation: A Systematic Review and Meta-Analysis
Authors: Pagani G. , Cali G. , Acharya G. , Trisch I.T. , Palacios-Jaraquemada J. , Familiari A. , Buca D. , Manzoli L. , Flacco M.E. , Fanfani F. , Liberati M. , Scambia G. , D’antonio F.
Published: November 2018

(Acta Obstet Gynecol Scand. 2018;97:25–37)

Abnormally invasive placentation (AIP) includes several conditions characterized by abnormal adherence and invasion of the placenta at its implantation site. Prenatal diagnosis of AIP and its preplanned management can reduce the maternal complications associated with this condition, including severe hemorrhage, the need for blood transfusion, and peripartum hysterectomy. The frequency and severity of complications from AIP is related to the degree of placental invasion. Prenatal ultrasound has been found to be relatively effective in detecting AIP, especially in those patients at increased risk, such as women with previous cesarean delivery and current placenta previa. However, its accuracy in detecting the severity of AIP is unclear. The purpose of this systematic review and meta-analysis was to elucidate the diagnostic accuracy of ultrasound in recognizing the severity of AIP.
Within Country Inequalities in Cesarean Section Rates: Observational Study of 72 Low and Middle Income Countries
Authors: Boatin A.A. , Schlotheuber A. , Betran A.P. , Moller A.B. , Barros A.J.D. , Boerma T. , Torloni M.R. , Victora C.G. , Hosseinpoor A.R.
Published: November 2018

(BMJ. 2018;360:k55)

It remains unclear what the ideal cesarean section rate should be. Very low rates may be indicative of a lack of access when needed, leading to high rates of maternal and newborn morbidity and mortality. In contrast, high cesarean section rates suggest a bias for cesarean delivery without medical indication, increasing the risk of surgical complications, hemorrhage, and infection, Studies have shown that inequalities in cesarean section rates exist both between countries and within countries. The highest rates of cesarean delivery are generally observed among the wealthiest regions, and low rates are prevalent among the most disadvantaged areas. These inequalities have been shown to remain even as a country’s overall cesarean section rate has risen. The purpose of this observational study was to provide an update about economic inequalities in cesarean section rates within a large number of countries from various regions as well as the change in inequality over time.
Association Between Loss of Hospital-based Obstetric Services and Birth Outcomes in Rural Counties in the United States
Authors: Kozhimannil K.B. , Hung P. , Henning-Smith C. , Casey M.M. , Prasad S.
Published: November 2018

(JAMA. 2018;319(12):1239–1247)

Between 2004 and 2014, hospital-based obstetric services have decreased from 55% to 46% in rural counties in the United States. Prior studies have shown that women and children in remote rural areas have delayed prenatal care initiation and higher rates of pregnancy hospitalizations, low birth weight, preterm births, and infant mortality. This retrospective cohort study examined whether the loss of rural obstetric services was associated with changes in location of childbirth or outcomes of care.
Anesthesia for Cesarean Delivery: A Cross-sectional Survey of Provincial, District, and Mission Hospitals in Zimbabwe
Authors: Lonnée H.A. , Madzimbamuto F. , Erlandsen O.R.M. , Vassenden A. , Chikumba E. , Dimba R. , Myhre A.K. , Ray S.
Published: November 2018

(Anesth Analg. 2018;126:2056–2064)

In low- and middle-income countries like Zimbabwe, cesarean delivery (CD) is the most common surgical procedure, and as such, can indicate overall surgical activity in a health care system. Recent studies have shown the highest risk of anesthesia-related maternal death occurring in sub-Saharan Africa. Using a questionnaire, the authors of the present study assessed the type of anesthesia used for CD, level of training of anesthesia providers, and availability of resources in provincial, district, and mission hospitals in Zimbabwe.
Offspring Birthweight by Gestational Age and Parental Cardiovascular Mortality: A Population-based Cohort Study
Authors: Morken N.H. , Halland F. , DeRoo L.A. , Wilcox A.J. , Skjærvena R.
Published: November 2018

(BJOG. 2018;125:336–341)

Worldwide, cardiovascular disease is the leading cause of death in women. Risk of cardiovascular disease may be identified by a woman’s physiological response to pregnancy. There is an established association between offspring low birthweight and parental cardiovascular disease and death. This study used linked data from 42 years of population-based registries to estimate the risk of parental cardiovascular disease mortality by offspring birthweight and gestational age.
Associations of Neighborhood-level Racial Residential Segregation With Adverse Pregnancy Outcomes
Authors: Salow A.D. , Pool L.R. , Grobman W.A. , Kershaw K.N.
Published: November 2018

(Am J Obstet Gynecol. 2018;218:351.e1–351.e7)

Environmental factors, including racial residential segregation, may contribute to a higher risk of experiencing adverse pregnancy outcomes such as preterm birth (PTB). This study utilized electronic medical records to examine the associations of segregation among non-Hispanic Black women with overall PTB, spontaneous PTB, medically indicated PTB, and small-for-gestational-age birth.
Platelet Counts During Pregnancy
Authors: Reese J.A. , Peck J.D. , Deschamps D.R. , McIntosh J.J. , Knudtson E.J. , Terrell D.R. , Vesely S.K. , George J.N.
Published: November 2018

(N Engl J Med. 2018;379:32–43)

In the present study, the authors evaluated platelet counts in women (15 to 44 y of age) who delivered at the Oklahoma University Medical Center between 2011 and 2014. Their objectives were to (1) evaluate the potential severity of gestational thrombocytopenia (<150,000 platelets/mm3 at the time of delivery) in uncomplicated pregnancies and risk for recurrence, (2) determine whether there was a relationship between identified pregnancy complications and platelet counts, and (3) ascertain associations between preexisting disorders and thrombocytopenia and any impact on pregnancy course.
Cost-effectiveness Analysis of Intraoperative Cell Salvage for Obstetric Hemorrhage
Authors: Lim G. , Melnyk V. , Facco F.L. , Waters J.H. , Smith K.J.
Published: November 2018

(Anesthesiology. 2018;128(2):328–337)

Intraoperative cell salvage is recommended for blood conservation in cases of anticipated extreme blood loss, and reduces the need for allogeneic blood transfusion after cesarean delivery. There is a need for cost-effectiveness analysis of cell salvage in patients undergoing cesarean delivery to inform guidelines on obstetric blood management. Prior cost-effectiveness analysis demonstrated cost-savings in cases of massive transfusion or high risk of transfusion. This study aimed to use a societal perspective to analyze the cost-effectiveness of intraoperative cell salvage during cesarean delivery.
Atraumatic Versus Conventional Lumbar Puncture Needles: A Systematic Review and Meta-Analysis
Authors: Nath S. , Koziarz A. , Badhiwala J.H. , Alhazzani W. , Jaeschke R. , Sharma S. , Banfield L. , Shoamanesh A. , Singh S. , Nassiri F. , Oczkowski W. , Belley-Côté E. , Truant R. , Reddy K. , Meade M.O. , Farrokhyar F. , Bala M.M. , Alshamsi F. , Krag M. , Etxeandia-Ikobaltzeta I. , Kunz R. , Nishida O. , Matouk C. , Selim M. , Rhodes A. , Hawryluk G. , Almenawer S.A.
Published: November 2018

(Lancet. 2018;391:1197–204)

Among patients who undergo lumbar puncture, up to 35% return to the hospital with a postdural puncture headache, which is caused by continuing leakage of the cerebrospinal fluid (CSF) from the dural defect created by the spinal needle. Conventional needles are most frequently used in clinical practice by nonanesthesiologists and have a sharp slanted tip designed to cut through the dura with a distal opening for injection of drugs or collection of CSF. As these needles cut through tissues, they cause irregular lacerations that can increase the potential for CSF leakage. In contrast, atraumatic needles are blunt with a closed pencil point tip and a side port for drug injection or CSF collection. They separate and dilate dural fibers rather than cutting through the fibers; thus they have been postulated to reduce the incidence of postdural puncture headache because they limit the leakage of CSF after lumbar puncture. Although atraumatic needles are now commonly used by anesthesiologists for spinal anesthesia, they are infrequently used by other clinicians as they seem unaware of their existence. This systematic review and meta-analysis of randomized controlled trials was performed to compare atraumatic and conventional lumbar puncture needles.
The Evolving Dilemma of Factor XI in Pregnancy: Suggestions for Management
Authors: Shander A. , Friedman T. , Palleschi G. , Shore-Lesserson L.
Published: November 2018

(Anesth Analg. 2018;126:2032–2037)

Factor XI (FXI) deficiency or hemophilia C is an autosomal inherited multigenic bleeding disorder that can cause clinically significant hypocoagulability and bleeding, the severity of which does not correlate to the measured level of FXI. In this case study and discussion, the authors presented a 36-year-old pregnant patient of Ashkenazi Jewish descent with FXI deficiency, who had no history of excessive bleeding in multiple prior pregnancies. Before entering the authors’ practice, the patient had 4 previous uncomplicated vaginal deliveries, and denied any history of heavy menses or periods of heavy bleeding. In 2008 and 2012, the patient had 2 successful vaginal deliveries with no transfusions or noted postdelivery complications, with an estimated blood loss ranging from 250 to <300 mL. For her seventh pregnancy, a routine hematology evaluation advised that the patient “should be monitored. for excess bleeding peripartum.and given fresh frozen plasma (FFP) if needed.” Laboratory evaluation revealed an FXI level at 3% and an elevated activated partial thromboplastin time (aPTT) of 54.2 seconds. She prophylactically received 2 units of FFP, with a measured aPTT of 45 seconds after infusion, and the underwent a vaginal delivery of a healthy infant with an estimated blood loss of <250 mL. The patient was discharged from the hospital on postpartum day 1 with no complications.
Continuous Epidural Infusion Versus Programmed Intermittent Epidural Bolus for Labor Analgesia: A Prospective, Controlled, Before-and-After Cohort Study of Labor Outcomes
Authors: Bullingham A. , Liang S. , Edmonds E. , Mathur S. , Sharma S.
Published: November 2018

(Br J Anaesth. 2018;121:432–437)

Recent studies have shown that programmed intermittent epidural bolus (PIEB) may be more effective at achieving lower rates of motor block, shortened second stage of labor, improved patient satisfaction outcomes, and lower total local anesthetic dose for labor pain than standard techniques like continuous epidural infusion (CEI) or patient-controlled epidural analgesia (PCEA). Therefore, the authors of this prospective, controlled, before-and-after cohort study evaluated the effectiveness of PIEB+PCEA versus CEI for labor analgesia in a tertiary referral hospital in Sydney, New South Wales, Australia.
Prophylactic Norepinephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery
Authors: Ngan Kee W.D. , Lee S.W.Y. , Ng F.F. , Khaw K.S.
Published: November 2018

(Anesth Analg. 2018;126:1989–1994)

Norepinephrine has been recently described as a possible alternative to phenylephrine for maintaining blood pressure during spinal anesthesia for cesarean delivery. However, its administration via manually titrated infusions in obstetric patients has not been previously described. The authors of the present study evaluated the efficacy of a titrated, manually controlled variable-rate infusion of norepinephrine for maintaining blood pressure and preventing hypotension in patients receiving spinal anesthesia for elective cesarean delivery.
Impact of Recommended Changes in Labor Management for Prevention of the Primary Cesarean Delivery
Authors: Thuillier C. , Roy S. , Peyronnet V. , Quibel T. , Nlandu A. , Rozenberg P.
Published: November 2018

(Am J Obstet Gynecol. 2018;218(3):341.e1–341.e9)

The significant increase in cesarean delivery (CD) rates is a cause of concern due to the potential negative consequences for maternal and infant health. Indications for CD are often overused and the CD rates vary among institutions, according to the population, management, and local practices. Therefore, in 2014, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) jointly published an Obstetric Care Consensus for safe prevention of the primary CD. This consensus established new guidelines for management and definitions for arrest of labor (AoL) and failed induction. The objective of this study was to assess whether adoption of the new consensus recommendations contributed to a safe decrease in the primary CD rate.
Treatment Patterns and Clinical Outcomes in Neonates Diagnosed With Respiratory Distress Syndrome in a Low-income Country: A Report From Bangladesh
Authors: Hubbard R.M. , Choudhury K.M. , Lim G.
Published: November 2018

(Anesth Analg. 2018;126:1684–1686)

Advances in neonatal critical care, such as surfactant replacement therapy (SRT), have led to significant reductions in neonatal mortality in the United States. However, respiratory distress syndrome (RDS)-related mortality rates remain high, particularly in areas with low resource availability, for example low-income countries. The authors of the present study described practice patterns and treatment modalities in RDS neonates in resource-limited settings and identified potential predictors of mortality.
Delineating the Association Between Mode of Delivery and Postpartum Depression Symptoms: A Longitudinal Study
Authors: Eckerdal P. , Georgakis M.K. , Kollia N. , Wikström A.K. , Högberg U. , Skalkidou A.
Published: November 2018

(Acta Obstet Gynecol Scand. 2018;97:301–311)

Postpartum depression (PPD) affects around 10% to 20% of parturients. The main risk factors for PPD include presence of antepartum depression, history of psychiatric illness, low self-esteem, stressful life events, and the lack of social support. Research has also been performed investigating associations between factors such as mode of delivery, discrepancy between desired delivery mode and actual mode, and negative delivery experience and the development of PPD. Studies investigating mode of delivery and PPD have produced conflicting results. The aim of this longitudinal study was to unravel the association between mode of delivery and the risk of PPD, taking into account potential mediators and confounders, such as sociodemographic factors, psychiatric history, fear of delivery, delivery experience, and postpartum physical symptoms and complications.
Hydralazine Versus Nifedipine For Acute Hypertensive Emergency In Pregnancy: A Randomized Controlled Trial
Authors: Sharma C. , Soni A. , Gupta A. , Verma A. , Verma S.
Published: November 2018

(Am J Obstet Gynecol. 2017;217:687.e1–687.e6)

Hypertensive disorders of pregnancy can contribute to maternal and fetal mortality and morbidity. Timely antihypertensive therapy is recommended to lower severe hypertension in preeclamptic women during pregnancy. Intravenous hydralazine, intravenous labetalol, and oral nifedipine are commonly used to control the blood pressure (BP) in such women, but there is a paucity of evidence regarding the best option for the acute control of BP in the setting of severe sustained hypertension. This double-blind, randomized, controlled trial was conducted to determine the efficacy of 2 commonly used agents—intravenous hydralazine and oral nifedipine—for controlling acute severe hypertension in pregnant women with preeclampsia.
III. REGIONAL ANESTHESIA Using Activity Trackers to Quantify Postpartum Ambulation: A Prospective Observational Study of Ambulation After Regional Anesthesia and Analgesia Interventions
Authors: Ma J. , Martin R. , Chan B. , Gofeld M. , Geary M.P. , Laffey J.G. , Abdallah F.W.
Published: November 2018

(Anesthesiology. 2018;128:598–608)

Early ambulation can improve outcomes in surgical patients and is an important component of enhanced recovery. However, there is a lack of evidence on the ideal approach for evaluating early ambulation. Real-time quantification of ambulation is important, as most tools used to collect activity information are influenced by recall bias. This prospective observational study explored the feasibility of the use of activity fitness trackers in objectively quantifying ambulation, hypothesizing that in the 24 hours after delivery, vaginal delivery patients would have greater ambulation than cesarean delivery patients.
Clonidine Effect on Pain After Cesarean Delivery: A Randomized Controlled Trial of Different Routes of Administration
Authors: Fernandes H.S. , Bliacheriene F. , Vago T.M. , Corregliano G.T. , Torres M.L. , Francisco R.P. , Ashmawi H.A.
Published: November 2018

(Anesth Analg. 2018;127:165–170)

Systemic clonidine [oral or intravenous (IV)] has been administered preoperatively for attenuation of perioperative hemodynamic instability and for reducing anesthetic and postoperative analgesic needs. However, IV clonidine has not been evaluated as an adjuvant during cesarean delivery. In the present study, the authors evaluated and compared the effectiveness of standard spinal anesthesia, standard spinal anesthesia combined with intrathecal clonidine, and standard spinal anesthesia combined with IV clonidine.
Trends in Self-reported and Biochemically Tested Marijuana Use Among Pregnant Females in California From 2009 to 2016
Authors: Young-Wolff K.C. , Tucker L.Y. , Alexeeff S. , Armstrong M.A. , Conway A. , Weisner C. , Goler N.
Published: November 2018

(JAMA. 2017;318(24):2490–2491)

Self-reported marijuana use in adult pregnant women in the United States increased from 2.4% to 3.9% between 2002 and 2014. The scope of marijuana use in pregnant women is left unclear due to social bias in self-reporting and underreporting. This study used data from the years 2009-2016 from a large California health care system using self-reporting and urine toxicology screening.
Technique for partial transphyseal anterior cruciate ligament reconstruction in skeletally immature athletes: preliminary results
Authors: Bettin Clayton C. , Throckmorton Thomas W. , Miller Robert H. , Azar Frederick M.
Published: November 2018

Background:

A number of safe and successful surgical techniques to avoid physeal injury about the knee have been described, but their reported outcomes have not equaled success rates of procedures in skeletally mature patients. The purpose of this study was to determine the outcomes of an arthroscopic-assisted ACL reconstruction using a quadruple-looped hamstring graft with a synthetic graft extender and a physeal-sparing technique for partial transphyseal ACL reconstruction in skeletally immature patients.

Methods:

Medical record review identified skeletally immature patients who had this procedure and a minimum 6-month follow-up. A quadrupled-looped hamstring autograft and a synthetic graft extender allowed the optimal portion of the graft to be placed intra-articular and maintain sufficient length for proximal and distal fixation. Repeat physical examination included KT-1000 measurement, scanogram, and completion of a Lysholm knee scale and International Knee Documentation Committee (IKDC) evaluation.

Results:

Seventeen male patients 7.7 to 14.9 yr who fit the inclusion criteria were identified. All had open tibial and femoral physes at the time of ACL reconstruction. Average follow-up was 2 yr. At latest follow-up, all patients had stable Lachman tests and were able to return to sporting activities at their previous levels. Average limb-length discrepancy was 2.2 mm, with an average angular difference of 1.7 degrees, neither of which was statistically or clinically significant. Average Lysholm score was 91.5, and the average IKDC score was 92.7.

Conclusions:

This technique can restore motion and stability after ACL injury in skeletally immature patients while minimizing the risk of growth disturbance that might result in length or angular deformities.

Level of Evidence:

IV.
Retrograde Stainless Steel Flexible Nails Have Superior Resistance to Bending in Distal Third Femoral Shaft Fractures
Authors: Hubbard Elizabeth W. , Thompson Rachel M. , Jo Chan-Hee , Pierce William A. , Riccio Anthony I. , Wimberly Robert L.
Published: November 2018

Background:

It has been shown that retrograde titanium flexible intramedullary nails (Ti FIN) provide superior resistance to bending compared to antegrade Ti FIN in distal femur fractures. The purpose of this study was to compare resistance to torsional and bending forces of stainless steel (SS) FIN, with or without a locking screw, and Ti FIN in distal third femoral shaft fractures. We hypothesize that locked retrograde SS FIN will demonstrate greater resistance to both bending and torsional forces.

Methods:

Thirty adolescent synthetic femur models were used to simulate transverse distal femoral fractures at either 60 mm or 90 mm proximal to the distal femoral physis. The femurs were instrumented with antegrade Ti FIN, antegrade SS FIN, retrograde Ti FIN, retrograde SS FIN, or retrograde locked SS FIN. Three models for each construct at both osteotomy levels were tested. Models were analyzed to determine maximum resistance to bending and torsion.

Results:

In fractures 60 mm from the physis, retrograde SS FIN demonstrated statistically superior resistance to bending when compared with both antegrade and retrograde Ti FIN (P=0.001 and 0.008, respectively) and antegrade SS FIN (P=0.0001). Locked SS constructs showed a trend towards greater resistance to bending forces when compared with unlocked constructs (P>0.05). No significant difference was seen in resistance to bending when fractures were 90 mm proximal to the distal femoral physis between the five groups. No significant differences were observed in resistance to torsion in either the proximal or distal fracture models, regardless of construct type.

Conclusions:

Retrograde SS FIN confer significantly greater resistance to bending forces for fractures 60 mm proximal to the distal femoral physis compared with Ti FIN or antegrade entry SS FIN. In fractures 90 mm from the physis, no differences were noted in our model. Our results support the use of retrograde SS nails in the pediatric patient with distal femoral shaft fractures.

Level of Evidence:

Level II—comparative biomechanical study.
Grading of Complications After Cervical Deformity-corrective Surgery
Authors: Bortz Cole A. , Passias Peter G. , Segreto Frank A. , Horn Samantha R. , Lafage Renaud , Smith Justin S. , Line Breton G. , Mundis Gregory M. , Kelly Michael P. , Park Paul , Sciubba Daniel M. , Hamilton D. Kojo , Gum Jeffrey L. , Burton Douglas C. , Hart Robert A. , Schwab Frank J. , Bess Shay , Shaffrey Christopher , Klineberg Eric O.
Published: November 2018

Study Design:

This is a retrospective review of prospective multicenter cervical deformity (CD) database.

Objective:

Assess the impact of complication type and Clavien complication (Cc) grade on clinical outcomes of surgical CD patients

Background:

Validated for general surgery, the Clavien-Dindo complication classification system allows for broad comparison of postoperative complications; however, the applicability of this system is unclear in CD-specific populations.

Methods:

Surgical CD patients above 18 years with baseline and postoperative clinical data were included. Primary outcomes were complication type (renal, infection, cardiac, pulmonary, gastrointestinal, neurological, musculoskeletal, implant-related, radiographic, operative, wound) and Cc grade (I, II, III, IV, V). Secondary outcomes were estimated blood loss (EBL), length of stay (LOS), reoperation, and health-related quality of life (HRQL) score. The univariate analysis assessed the impact of complication type and Cc grade on improvement markers and 1-year postoperative HRQL outcomes.

Results:

In total, 153 patients (61±10 y, 61% female) underwent surgery for CD (8.1±4.6 levels fused; surgical approach included 48% posterior, 18% anterior, 34% combined). Overall, 63% of patients suffered at least 1 complication. Complication breakdown by type: renal (2.0%), infection (5.2%), cardiac (7.2%), pulmonary (3.9%), gastrointestinal (2.0%), neurological (26.1%), musculoskeletal (0.0%), implant-related (3.9%), radiographic (16.3%), operative (7.8%), and wound (5.2%). Of complication types, only operative complications were associated with increased EBL (P=0.004), whereas renal, cardiac, pulmonary, gastrointestinal, neurological, radiographic, and wound infections were associated with increased LOS (P<0.050). Patients were also assessed by Cc grade: I (28%), II (14.3%), III (16.3%), IV (6.5%), and V (0.7%). Grades I and V were associated with increased EBL (both P<0.050); Cc grade V was the only complication not associated with increased LOS (P=0.610). Increasing complication severity was correlated with increased risk of reoperation (r=0.512; P<0.001), but not inferior 1-year HRQL outcomes (all P>0.05).

Conclusions:

Increasing complication severity, assessed by the Clavien-Dindo classification system, was not associated with increased EBL, inpatient LOS, or inferior 1-year postoperative HRQL outcomes. Only operative complications were associated with increased EBL. These results suggest a need for modification of the Clavien system to increase applicability and utility in CD-specific populations.
Sacral Dysmorphism and its Implication on the Size of the Sacroiliac Joint Surface
Authors: Weigelt Lizzy , Laux Christoph J. , Slankamenac Ksenija , Ngyuen Thi D.L. , Osterhoff Georg , Werner Clément M.L.
Published: November 2018

Study Design:

This is a retrospective data analysis.

Objective:

The aim of this study was to analyze the prevalence of sacral dysmorphism and its correlation to the size of the sacroiliac joint (SIJ) surface based on computed tomography (CT) scans.

Summary of Background Data:

Sacroiliac screw fixation is a widely accepted technique for stabilization of posterior pelvic ring injuries. Safe sacral screw placement may be impaired by sacral dysmorphism. The prevalence and impact of sacral dysmorphism on the size of the SIJ surface is unknown.

Materials and Methods:

In total, 269 CT scans were evaluated for the presence of the 5 signs of sacral dysmorphism (mammillary bodies, tongue-in-groove, residual upper sacral disk space, colinearity, and dysmorphic sacral neural foramina). The size of the SIJ surface was calculated by measuring the sacral joint line of the SIJ on each axial CT slice. Logistic regression analyses were conducted to reveal sex-related or age-related differences and correlations between the presence of the dysmorphic signs and the size of the SIJ surface.

Results:

Prevalence rates of the dysmorphic signs ranged from 5% (colinearity) to 70% (residual sacral disk space). Only 15% did not show any sign of sacral dysmorphism. The average size of the SIJ surface was 7.36 cm2; it was significantly larger in male (8.46 cm2) than in female (6.11 cm2) patients (P<0.001). The presence of tongue-in-groove morphology was associated with a significantly larger SIJ surface (P<0.001), the presence of a residual upper sacral disk space with a significantly smaller joint surface (P=0.006).

Conclusions:

The prevalence of sacral dysmorphism is remarkably high in a normal population and it is questionable if the respective signs should be called dysmorphic after all. The possibility of a smaller joint surface in female patients and patients with a residual upper sacral disk space should be considered in the planning of iliosacral screw placement.
A Minimally Invasive, Dual-incision (Medial and Lateral) Approach: An Alternative Technique for Reduction and Fixation of Intra-Articular Calcaneus Fractures
Authors: Neary Kaitlin C. , Daws Snow B. , Dunaway Linda J. , Kaiser Cody , Lundeen Gregory A.
Published: November 2018

Calcaneus fractures are severe injuries that historically have been associated with poor outcomes and debilitating consequences. To maximize functional outcome, the literature in favor of operative management encourages anatomic reduction and alignment of displaced, intra-articular calcaneus fractures, while minimizing risk to soft tissues. Because of the increased risk of soft tissue complications with extensile approaches, minimally invasive techniques have continued to gain popularity. The current technique aims to describe a minimally invasive approach to calcaneus fractures through a dual-incision, lateral (sinus tarsi) and medial, approach. This approach facilitates anatomic reduction of the calcaneal tubercle to restore calcaneal tuberosity height and length, thus facilitating anatomic reduction of the posterior facet and realignment of the anterior calcaneus while minimizing risk of soft tissue complications. The authors’ results support this technique and we recommend it as a safe and effective method for open reduction and internal fixation of displaced, intra-articular calcaneal fractures.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Risk Factors for 1-Year Mortality and Hospital Utilization Patterns in Critical Care Survivors: A Retrospective, Observational, Population-Based Data Linkage Study*
Authors: Szakmany Tamas , Walters Angharad M. , Pugh Richard , Battle Ceri , Berridge Damon M. , Lyons Ronan A.
Published: November 2018

Objectives:

Clear understanding of the long-term consequences of critical care survivorship is essential. We investigated the care process and individual factors associated with long-term mortality among ICU survivors and explored hospital use in this group.

Design:

Population-based data linkage study using the Secure Anonymised Information Linkage databank.

Setting:

All ICUs between 2006 and 2013 in Wales, United Kingdom.

Patients:

We identified 40,631 patients discharged alive from Welsh adult ICUs.

Interventions:

None.

Measurements and Main results:

Primary outcome was 365-day survival. The secondary outcomes were 30- and 90-day survival and hospital utilization in the 365 days following ICU discharge. Kaplan-Meier curves were plotted to compare survival rates. Cox proportional hazards regression models were used to determine risk factors of mortality. Seven-thousand eight-hundred eighty-three patients (19.4%) died during the 1-year follow-up period. In the multivariable Cox regression analysis, advanced age and comorbidities were significant determinants of long-term mortality. Expedited discharge due to ICU bed shortage was associated with higher risk. The rate of hospitalization in the year prior to the critical care admission was 28 hospitalized days/1,000 d; post critical care was 88 hospitalized days/1,000 d for those who were still alive; and 57 hospitalized days/1,000 d and 412 hospitalized days/1,000 d for those who died by the end of the study, respectively.

Conclusions:

One in five ICU survivors die within 1 year, with advanced age and comorbidity being significant predictors of outcome, leading to high resource use. Care process factors indicating high system stress were associated with increased risk. More detailed understanding is needed on the effects of the potentially modifiable factors to optimize service delivery and improve long-term outcomes of the critically ill.
Integration of protein interaction and gene co-expression information for identification of melanoma candidate genes
Authors: Wu Kejia , Wang Wen , Ye Yaqi , Huang Junhong , Zhou Yinghui , Zhang Yue , Zhang Xuewenjun , Wu Wenyu
Published: November 2018

Cutaneous melanoma is an aggressive form of skin cancer that causes death worldwide. Although much has been learned about the molecular basis of melanoma genesis and progression, there is also increasing appreciation for the continuing discovery of melanoma genes to improve the genetic understanding of this malignancy. In the present study, melanoma candidate genes were identified by analysis of the common network from cancer type-specific RNA-Seq co-expression data and protein–protein interaction profiles. Then, an integrated network containing the known melanoma-related genes represented as seed genes and the putative genes represented as linker genes was generated using the subnetwork extraction algorithm. According to the network topology property of the putative genes, we selected seven key genes (CREB1, XPO1, SP3, TNFRSF1B, CD40LG, UBR1, and ZNF484) as candidate genes of melanoma. Subsequent analysis showed that six of these genes are melanoma-associated genes and one (ZNF484) is a cancer-associated gene on the basis of the existing literature. A signature comprising these seven key genes was developed and an overall survival analysis of 461 cutaneous melanoma cases was carried out. This seven-gene signature can accurately determine the risk profile for cutaneous melanoma tumors (log-rank P=3.27E−05) and be validated on an independent clinical cohort (log-rank P=0.028). The presented seven genes might serve as candidates for studying the molecular mechanisms and help improve the prognostic risk assessment, which have clinical implications for melanoma patients.
TRAF2 and FKBP51 as possible markers for identification of suitable melanoma tumors for tumor necrosis factor-α inhibition
Authors: Romano Simona , D’Arrigo Paolo , Tufano Martina , Staibano Stefania , Rea Anna , Merolla Francesco , Ilardi Gennaro , Petrella Antonello , Romano Maria F.
Published: November 2018

Tumor necrosis factor-α (TNF-α) is a pleiotropic cytokine, whose role in melanoma is controversial. Although high-dose TNF-α is approved for the treatment of patients with in transit-metastatic melanoma confined to the limb, diverse preclinical models of melanoma have shown that TNF-α can induce cell invasion. Biomarkers that can differentiate between the dual role of TNF-α are needed. TRAF2 is critical to TNF receptor-induced activation of nuclear factor-κB (NF-κB), allowing shifting from death to survival-signaling cascades. The large immunophilin FKBP51 acts as a scaffold and catalyst in the IκB kinase complex assembly and activation. Here, using microscopy and an electrophoretic mobility-shift assay, we provide further evidence in support of the essential role of FKBP51 in sustaining the TNF-α NF-κB signaling in melanoma. Through the cross-linking reaction with the chemical linker disuccinimidyl glutarate, we show that a direct interaction occurs between FKBP51 and TRAF2 in melanoma cells. Immunohistochemistry of tumor samples from 24 patients with cutaneous melanomas showed a correlation between the expressions of the two proteins. Given the association of FKBP51 and TRAF2 with TNF-α-induced NF-κB signaling and their correlation in tumor samples, we propose that the two proteins can be exploited as useful markers for the identification of those melanoma tumors that can benefit from TNF-α inhibition. Future studies will address this hypothesis.
MGMT Testing in Glioblastomas
Authors: Philteos Justine , Karmur Brij S. , Mansouri Alireza
Published: November 2018

Gliomas, that do not respond to alkylating agent chemotherapy, can be made more sensitive to chemotherapy through promotor mediated epigenetic silencing of the MGMT gene. MGMT is one of the important markers in glioblastomas as it not only predicts response to therapy but may also be used as an independent prognostic marker. As such, MGMT is gaining increasing traction in diagnosis, prognostication, and therapeutic decision-making for these highly malignant gliomas. Although, MGMT promotor methylation status is becoming more commonly used in neuro-oncology; this test remains imperfect. Because of its increasing use in clinical practice and research, it is integral that we are aware of its pitfalls and complications. Currently, there are many ways to detect a patient’s MGMT promotor methylation status, including: quantitative PCR, methylation-specific PCR, pyrosequencing, real time PCR with high resolution melt, and the infinitum methylation EPIC beadChip. The technical aspects, shortcomings, and optimal approach to interpreting the results of each method will be discussed. Furthermore, given that none of these methods have been prospectively validated, the challenge of equivocal cases will be discussed, and technical and logistic strategies for overcoming these challenges will be proposed. Finally, the difficulty in validating these methods, establishing standardized practice, and considerations of the cost of these competing methods will be explored.
Acetabular Labral Tears Are Common in Asymptomatic Contralateral Hips With Femoroacetabular Impingement
Authors: Vahedi Hamed , Aalirezaie Arash , Azboy Ibrahim , Daryoush Tanine , Shahi Alisina , Parvizi Javad
Published: November 2018

Background

The number of patients undergoing hip arthroscopy for labral tears has increased, but labral tears are sometimes seen in asymptomatic patients with femoroacetabular impingement (FAI). The frequency of this finding, however, has not been well characterized nor is the proportion of patients with previously asymptomatic labral tears who may later become symptomatic.

Questions/purposes

The purpose of this study was to determine (1) the prevalence of labral tears and other intraarticular pathology in the asymptomatic contralateral hip of patients undergoing surgery for symptomatic FAI; (2) the likelihood that the asymptomatic hip had become symptomatic at latest followup; and (3) any association between MRI findings and age, sex, and body mass index (BMI) in both symptomatic and asymptomatic sides.

Methods

This study included patients who were diagnosed with unilateral symptomatic FAI between 2013 and 2015 and who had an available MRI of both hips. The study included 100 patients (47 females, 53 males) with a mean age of 33 years (range, 17-57 years). Patients with a symptomatic contralateral hip (n = 56) or an unsuitable MRI for review based on both reviewers’ consensus (n = 344) were excluded. The MRI of both hips was independently evaluated by two orthopaedic surgeons and interobserver reliability tested. The interobserver reliability for the two surgeons’ MRI ratings was almost perfect (κ ≥ 0.85). The presence of a labral tear, an acetabular chondral lesion, subchondral acetabular cysts, and fibrocystic changes in the femoral head-neck junction was documented for both hips. At latest followup, asymptomatic hips were investigated for any symptomatic labral tears or surgical procedures resulting from FAI.

Results

A labral tear was recorded in 97 (97%) and 96 (96%) of symptomatic hips, respectively, for each surgeon’s evaluation. A labral tear was also detected in 41 (41%) and 43 (43%) of asymptomatic hips. In addition, an acetabular chondral lesion was detected in 32 (32%) and 35 (35%) of the symptomatic hips and 15 (15%) and 17 (17%) of the asymptomatic hips. At latest followup, nine of the patients were diagnosed with symptomatic labral tears in the contralateral asymptomatic hip and were treated. None of the radiologic parameters examined demonstrated an association with patient age, sex, or BMI in either symptomatic or asymptomatic hips.

Conclusions

Labral tears and acetabular chondral lesions are common in the asymptomatic contralateral hip of patients undergoing surgery for FAI. The incidence of a symptomatic labral tear in these asymptomatic hips was 9% during 2 years of followup. We suggest that the decision to perform chondral or labral surgery in patients with FAI should be made with caution considering the relatively high prevalence of labral tears in asymptomatic hips and the low chance of development of symptoms.

Level of Evidence

Level IV, case-series study.
General Cognitive Ability as an Early Indicator of Problem Behavior Among Toddlers in Foster Care
Authors: Olson Anneke E. , Kim Hyoun K. , Bruce Jacqueline , Fisher Philip A.
Published: November 2018

Objective:

Children who have experienced maltreatment and subsequent placement in foster care are at increased risk of problem behavior. Increased knowledge of the development of problem behavior in this population, particularly during toddlerhood, can greatly inform preventive intervention efforts. This study examined variability in problem behavior among toddlers entering new foster care placements and identified related child and parenting characteristics.

Methods:

Ninety-one toddlers in foster care (mean = 2.26 years) and their caregivers completed an initial assessment and were reassessed 6 months later. A child's general cognitive ability was assessed via performance on a standardized developmental measure, and child problem behavior, parenting stress, frequency of family routines, and harsh discipline were assessed via caregiver report.

Results:

Upon entering a new foster care placement and 6 months after placement, respectively, 38% and 25% of the toddlers were within the borderline clinical or clinical range in terms of problem behavior when assessed using the Child Behavior Checklist. There was not a significant difference in problem behavior over this 6-month period, suggesting that problem behavior was quite stable among the toddlers as a group. However, general cognitive ability was a significant predictor of individual differences in change in problem behavior, with toddlers with lower general cognitive ability displaying increased problem behavior over this period.

Conclusion:

An increased number of toddlers in foster care displayed clinically significant levels of problem behavior, further demonstrating that these children are an extremely high-risk group. The association between general cognitive ability and change in problem behavior highlights the importance of early developmental screenings, which may help identify children at greatest risk of problem behavior and most in need of preventive intervention efforts.