bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Initiating Cardiac Rehabilitation After Myocardial Infarction on Subsequent Hospitalization in Older Adults
Authors: Bush Montika , Kucharska-Newton Anna , Simpson Ross J. , Fang Gang , Stürmer Til , Brookhart M. Alan
Published: October 2019

Purpose:

Outpatient cardiac rehabilitation (CR) participation after myocardial infarction (MI) reduces all-cause mortality; however, less is known about effects of CR on post-MI hospitalization. The study objective was to investigate effects of CR on hospitalization following acute MI among older adults.

Methods:

Medicare beneficiaries aged 65 to 88 yr hospitalized in 2008 with acute MI, who survived at least 60 d post-discharge, had a revascularization procedure during index hospitalization, and did not have an MI in previous year were eligible for this study. CR initiation was assessed in the 60 d post-discharge. Competing risk survival analysis was used to estimate the proportion of discharged beneficiaries hospitalized between the end of 60-d exposure window and December 31, 2009, treating death as a competing event.

Results:

The mean ± SD age of 32 851 Medicare beneficiaries meeting study criteria was 75 ± 6.0 yr, approximately half were male (52%), and the majority were white (88%). In this study, 21% of beneficiaries initiated CR within the exposure window. At 1 yr post-discharge, CR initiators had a lower risk of recurrent MI (4.2% [95% CI, 3.5-5.1]), cardiovascular (15.7% [95% CI, 14.3-17.2]), and all-cause (30.4% [95% CI, 28.8-32.1]) hospitalization than noninitiators (5.2% [95% CI, 5.0-5.5]; 18.0% [95% CI, 17.6-18.4]; and 33.2% [95% CI, 32.5-33.8], respectively). There was no difference in fracture risk (negative control outcome).

Conclusions:

This study provides evidence that CR can reduce the 1-yr risk of cardiovascular and all-cause hospital admissions in Medicare aged MI survivors.
Characterization of Dyspnea in Veteran Lung Cancer Survivors Following Curative-Intent Therapy
Authors: Ha Duc , Ries Andrew L.
Published: October 2019

Purpose:

Dyspnea is highly prevalent in lung cancer survivors following curative-intent therapy. We aimed to identify clinical predictors or determinants of dyspnea and characterize its relationship with functional exercise capacity (EC).

Methods:

In an analysis of data from a cross-sectional study of lung cancer survivors at the VA San Diego Healthcare System who completed curative-intent therapy for stage I-IIIA disease ≥1 mo previously, we tested a thorough list of comorbidities, lung function, and lung cancer characteristics. We assessed dyspnea using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Lung Cancer Module 13 (LC13) and functional EC using the 6-minute walk. We replicated results with the University of California San Diego Shortness of Breath Questionnaire.

Results:

In 75 participants at a median of 12 mo since treatment completion, the mean ± SD LC13-Dyspnea score was 35.3 ± 26.2; 60% had abnormally high dyspnea. In multivariable linear regression analyses, significant clinical predictors or determinants of dyspnea were (β [95% CI]) psychiatric illness (−20.8 [−32.4 to −9.09]), heart failure with reduced ejection fraction (−15.5 [−28.0 to −2.97]), and forced expiratory volume in the first second of expiration (−0.28 [−0.49 to −0.06]). Dyspnea was an independent predictor of functional EC (−1.54 [−2.43 to −0.64]). These results were similar with the University of California San Diego Shortness of Breath Questionnaire.

Conclusion:

We identified clinical predictors or determinants of dyspnea that have pathophysiological bases. Dyspnea was independently associated with functional EC. These results have implications in efforts to reduce dyspnea and improve exercise behavior and functional EC in lung cancer survivors following curative-intent therapy.
Is Asymmetric Hearing Loss a Risk Factor for Vestibular Dysfunction? Lesson From Big Data Analysis Based on the Korean National Health and Nutrition Survey
Authors: Suh Michelle Jee Young , Yi Hee Jun , Kim Hyun Jung , Kim Sung Huhn
Published: October 2019

Objective:

The purpose of this study was to investigate whether asymmetric hearing loss affects vestibular function.

Study Design:

Retrospective cross-sectional study.

Patients:

Data from the 2010 Korean National Health and Nutrition Survey for adults aged 40 years or more were used.

Interventions:

The modified Romberg test and pure-tone audiometry were performed. Data were analyzed using a complex sample χ
2 test of independence and complex sample logistic regression analysis.

Main Outcome Measures:

Vestibular dysfunction and hearing thresholds.

Results:

The overall prevalence of vestibular dysfunction was 3.3% (95% confidence interval [CI], 2.5–4.3%). In adults more than 40 years of age, multivariate linear regression analyses showed that the odds ratio (OR) of vestibular dysfunction was 3.067 times higher than the reference for a 30-dB difference in hearing thresholds between both ears (CI, 1.481–6.351; p = 0.007) after adjusting for factors associated with vestibular dysfunction. Among these individuals, the risk of equilibrium disturbance was higher in the presence of low-frequency asymmetric hearing loss (OR, 2.148; CI, 1.216–3.793; p = 0.009); on the other hand, high-frequency asymmetry did not lead to a higher risk.

Conclusions:

As low-frequency asymmetric hearing thresholds tend to coexist with vestibular dysfunction in adults, those with asymmetric hearing loss should be closely monitored.
Red meat consumption, risk of incidence of cardiovascular disease and cardiovascular mortality, and the dose–response effect
Authors: Medeiros Gidyenne Christine Bandeira Silva de , Azevedo Kesley Pablo Morais de , Mesquita Gabriella Xavier Barbalho , Lima Severina Carla Vieira Cunha , Silva David Franciole de Oliveira , Pimenta Isac Davidson Santiago Fernandes , Gonçalves Ana Katherine da Silveira , Lyra Clélia de Oliveira , Piuvezam Grasiela
Published: October 2019

Background:

Red and (particularly) processed meats are high in cholesterol and saturated and solid fatty acids. Their consumption is considered one of the risk factors for metabolic disorders. Numerous studies demonstrated a possible association between red meat consumption and cardiovascular disease (CVD). In this protocol, we propose a systematic review of the literature to examine the associations of red meat consumption with CVD incidence and mortality, and explore the potential dose–response relationship.

Methods:

We will search MEDLINE/PubMed, Scopus, SciELO, LILACS, ScienceDirect, Web of Science, Cochrane (CENTRAL), WHOLIS, PAHO, and Embase. We will include prospective epidemiological studies (longitudinal cohort). Risk of bias will be assessed using the Newcastle-Ottawa scale (NOS). Four independent researchers will conduct all evaluations. Disagreements will be referred to a fifth reviewer. We will summarize our findings using a narrative approach and tables to describe the characteristics of the included studies. The heterogeneity between trial results will be evaluated using a standard chi-squared test with P < .05. We will conduct the study in accordance with the guideline of the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols (PRISMA-P).

Results:

This review will evaluate the association between red meat consumption and incidence of CVD and mortality (primary outcome measures). The secondary outcome measure will include the dose–response effect.

Conclusion:

The findings of this systematic review will summarize the latest evidence of the association between red meat consumption and incidence of CVD and mortality and the dose–response effect through a systematic review and meta-analysis.

Registration:

PROSPERO CRD42019100914.
Can atherosclerosis be cured?
Authors: Wilkins John T. , Gidding Samuel S. , Robinson Jennifer G.
Published: October 2019

Purpose of review

Determine if evidence supports interventions to prevent development of atherosclerosis and atherosclerotic cardiovascular disease (ASCVD) events and death.

Recent findings

An extensive body of evidence supports the fundamental causal role of apolipoprotein B lipoproteins in the development of atherosclerosis. Recent epidemiologic studies have shown that LDL-cholesterol (LDL-C) and non-HDL-cholesterol levels in early adults are associated with accelerated subclinical atherosclerosis and an excess of atherosclerotic cardiovascular events later in life. Animal and human data have shown that intensive LDL-C lowering can regress earlier stages of atherosclerosis.

The next research priority is evaluating the impact of lowering LDL-C earlier in life to regress early atherosclerosis, followed by trials to demonstrate this approach will eradicate later-life ASCVD events and death. This approach of curing atherosclerosis will likely be the most effective strategy for reducing the huge global burden of atherosclerosis.
Otitis media: what is new?
Authors: Shirai Nanako , Preciado Diego
Published: October 2019

Purpose of review

To review the latest literature on otitis media diagnosis, guidelines, treatment, and pathophysiology.

Recent findings

Although otitis media remains one of the most common reasons for outpatient visits, antibiotic prescriptions, and surgery in the United States, little progress has been made in terms of developing novel treatments for the prevention and resolution of this condition, indicating the urgent need to continue investigations into the pathophysiology of this disorder. The recent past has seen the publication of new guidelines for the management of both acute otitis media, chronic otitis media and tympanostomy tube placement. Exciting technologies are being investigated into novel means to improve the diagnosis of otitis media, reviewed herein. Advancements in mucosal immunology and genetics have offered clues as to the underlying pathophysiology influencing otitis media propensity. Future research into modifying these pathophysiologic underpinnings, potentially through the usage of transtympanic drug delivery systems, should greatly influence the management of this condition.

Research into novel methods for otitis media pathophysiology, diagnosis and treatment has seen great strides in the recent past. Avenues towards markedly altering the evaluation and management of the condition are likely to be adopted into clinical practice over the coming years.
Impact of extracellular vesicles on innate immunity
Authors: Chen Zhizhao , Larregina Adriana T. , Morelli Adrian E.
Published: October 2019

Purpose of review

Extracellular vesicles released by prokaryote or eukaryote cells are emerging as mechanisms of cell-to-cell communication, by either physically interacting with the surface of target cells or transferring proteins/peptides, lipids, carbohydrates, and nuclei acids to acceptor cells. Accumulating evidence indicates that extracellular vesicles, among other functions, regulate innate and adaptive immune responses. We revisit here the effects that extracellular vesicles of various origins have on innate immunity.

Recent findings

Extracellular vesicles comprise a heterogeneous group of vesicles with different biogenesis, composition and biological properties, which include exosomes, microvesicles, apoptotic cell-derived extracellular vesicles, and other extracellular vesicles still not well characterized. Extracellular vesicles released by pathogens, leukocytes, nonhematopoietic cells, tumor cells, and likely allografts, can either stimulate or suppress innate immunity via multiple mechanisms. These include transfer to target leukocytes of pro-inflammatory or anti-inflammatory mediators, membrane receptors, enzymes, mRNAs, and noncoding RNAs; and interaction of extracellular vesicles with the complement and coagulation systems. As a result, extracellular vesicles affect differentiation, polarization, activation, tissue recruitment, cytokine and chemokine production, cytolytic and phagocytic function, and antigen transfer ability, of different types of innate immune cells.

The field of intercellular communication via extracellular vesicles is a rapid evolving area and the effects of pathogen-derived and host-derived extracellular vesicles on innate immunity in particular, have received increasing attention during the past decade. Future studies will be necessary to assess the full potential of the crosstalk between extracellular vesicles and the innate immune system and its use for therapeutic applications to treat chronic inflammation-based diseases and cancer growth and dissemination, among the growing list of disorders in which the innate immune system plays a critical role.
Innate immunity in ischemia-reperfusion injury and graft rejection
Authors: Nakamura Kojiro , Kageyama Shoichi , Kupiec-Weglinski Jerzy W.
Published: October 2019

Purpose of review

Although organ transplantation has become the standard life-saving strategy for patients with end-stage organ failure and those with malignancies, effective and safe therapeutic strategies to combat allograft loss remain to be established. With the emerging evidence suggesting the critical role of innate immunity in the mechanism of allograft injury, we summarize the latest understanding of macrophage-neutrophil cross-communication and discuss therapeutic prospects of their targeting in transplant recipients.

Recent findings

Macrophages and neutrophils contribute to the pathogenesis of early peritransplant ischemia-reperfusion injury and subsequent allograft rejection immune cascade, primarily by exacerbating inflammatory response and tissue damage. Noteworthy, recent advances enabled to elucidate multifaceted functions of innate immune cells, which are not only deleterious but may also prove graft-protective. Indeed, the efficacy of macrophage polarizing regimens or macrophage-targeted migration have been recognized to create graft-protective local environment. Moreover, novel molecular mechanisms in the neutrophil function have been identified, such as neutrophil extracellular traps, tissue-repairing capability, crosstalk with macrophages and T cells as well as reverse migration into the circulation.

As efficient strategies to manage allograft rejection and improve transplant outcomes are lacking, newly discovered, and therapeutically attractive innate immune cell functions warrant comprehensive preclinical and clinical attention.
Magnetic Resonance Imaging Findings of All-Trans Retinoic Acid–induced Pseudotumor Cerebri in a Child With Acute Promyelocytic Leukemia
Authors: Shirai Ryota , Tomizawa Daisuke , Okamoto Reiko , Matsumoto Kimikazu , Miyazaki Osamu
Published: October 2019

Pseudotumor cerebri (PTC), also known as idiopathic or benign intracranial hypertension, is characterized by elevated intracranial pressure without any evidence of organic central nervous system disorders. PTC is a rare but well-known adverse event associated with all-trans retinoic acid (ATRA) treatment. Persistent blindness in about 10% of affected patients is caused by PTC; therefore, prompt and accurate diagnosis is required. Recently, magnetic resonance imaging (MRI) findings, including empty sella, flattening of the posterior aspect of the globe, and distention of the perioptic subarachnoid space, have been found to be of high diagnostic value in PTC, but there apparently have been no reports about MRI findings in ATRA-induced PTC. We report here an 11-year-old boy with acute promyelocytic leukemia who developed ATRA-induced PTC during leukemia treatment. MRI findings beneficial for the diagnosis of PTC were observed.
Hematopoietic Stem Cell Transplantation in Congenital Dyserythropetic Anemia Type II: A Case Report and Review of the Literature
Authors: Uygun Vedat , Russo Roberta , Karasu Gülsün , Daloğlu Hayriye , Iolascon Achille , Yeşilipek Akif
Published: October 2019

Currently, there is no guideline for the treatment of patients with congenital dyserythropoietic anemia (CDA) type II. One approach is to follow-up patients with transfusions, on the basis of individually determined target hemoglobin levels, and iron chelation according to the thalassemia guidelines. In some transfusion-dependent CDA II patients, splenectomy reduces the number of transfusions; however, the only known curative option for CDA II patients is hematopoietic stem cell transplantation (HSCT). Only a few published case reports of allogeneic HSCT in CDA II patients are available. Here, we review the literature and add our data of a CDA II patient who developed transfusion dependence and was cured with HSCT.
Prostate Carcinoma Grade and Length But Not Cribriform Architecture at Positive Surgical Margins Are Predictive for Biochemical Recurrence After Radical Prostatectomy
Authors: Hollemans Eva , Verhoef Esther I. , Bangma Chris H. , Rietbergen John , Helleman Jozien , Roobol Monique J. , van Leenders Geert J.L.H.
Published: October 2019

Postoperative biochemical recurrence occurs in up to 40% of prostate carcinoma patients treated with radical prostatectomy. Primary tumor grade and cribriform architecture are important parameters for clinical outcome; however, their relevance at positive surgical margins has not been completely elucidated yet. We reviewed 835 radical prostatectomy specimens and recorded pT-stage, surgical margin status, Grade Group, and cribriform architecture of the primary tumor and at positive surgical margins. Clinicopathologic parameters and biochemical recurrence-free survival (BCRFS) were used as endpoints. Positive surgical margins were present in 284 (34%) patients, with a median cumulative length of 5.0 mm. In 46%, the Grade Group at the margin was equal to the primary tumor grade, while being lower in 42% and higher in 12%. In multivariable analysis, Grade Group at the margin outperformed the Grade Group of the primary tumor in predicting BCRFS. Among primary Grade Group 2 patients, 56% had Grade Group 1 disease at the margin. Multivariable analysis identified cumulative length, Grade Group at the margin, and lymph node metastasis as independent predictors for BCRFS, while percentage Gleason pattern 4, tertiary Gleason pattern 5 of the primary tumor, and cribriform architecture at the margin were not. In conclusion, the Grade Group at the positive surgical margin was dissimilar to the primary tumor grade in 54% and better predicted BCRFS than the primary tumor grade. Cumulative length and tumor grade at the margin were independent predictors for BCRFS, whereas cribriform architecture at the margin was not.
Multiple Splenic Infarcts Complicating Plasmodium vivax Malaria
Authors: Tripathi Neha , Saha Abhijeet , Kaur Manpreet
Published: October 2019

Splenic infarct is a rare complication in Plasmodium vivax malaria. We report a case of splenic infarction with acute kidney injury in a case of P. vivax malaria in a 13-year-old male child who presented to the emergency department with severe pain in the left hypochondrium. The patient was managed with intravenous artesunate and oral primaquine. Pain in left hypochondrium in children with P. vivax malaria due to splenic infarction needs to be evaluated for any surgical emergency like rupture or abscess. A review of literature of the unusual but serious complication is presented along with the case report.
Breast Cancer Population Screening Program Results in Early Detection and Reduced Treatment and Health Care Costs for Medicaid
Authors: Homan Sherri G. , Yun Shumei , Bouras Adam , Schmaltz Chester , Gwanfogbe Philomina , Lucht Jill
Published: October 2019

Context:

The National Breast and Cervical Cancer Early Detection Program has increased access to screening services for low-income females since 1991; however, evaluation information from states implementing the program is sparse. This study evaluates the impact of the Missouri program, Show Me Healthy Women (SMHW), on early detection and treatment cost.

Objective:

To estimate breast cancer treatment and health care services costs by stage at diagnosis among Missouri's Medicaid beneficiaries and assess the SMHW program impact.

Design:

Analyzed Missouri Medicaid claims linked with Missouri Cancer Registry data for cases diagnosed 2008-2012 (N = 1388) to obtain unadjusted and incremental costs of female breast cancer treatment and follow-up care at 6, 12, and 24 months following diagnosis. Noncancer controls (N = 3840) were matched on age, race, and disability to determine usual health care cost. Regression analyses estimated the impact of stage at diagnosis on expenditures and incremental cost. Show Me Healthy Women participants were compared with other breast cancer patients on stage at diagnosis. A comparison of SMHW participants to themselves had they not been enrolled in the program was analyzed to determine cost savings.

Results:

Expenditures increased by stage at diagnosis from in situ to distant with unadjusted cost at 24 months ranging from $50 245 for in situ cancers to $152 431 for distant cancers. Incremental costs increased by stage at diagnosis from 6 months at $7346, $11 859, $21 501, and $20 235 for in situ, localized, regional, and distant breast cancers, respectively, to $9728, $17 056, $38 840, and $44 409 at 24 months. A significantly higher proportion of SMHW participants were diagnosed at an early stage resulting in lower unadjusted expenditures and cost savings.

Conclusions:

Although breast cancer treatment costs increased by stage at diagnosis, the population screening program's significant impact on early diagnosis resulted in important cost savings over time for Medicaid.
US State-Level Preemption Legislation, 2017-2018: Implications for Public Health Policy and Practice
Authors: Wetter Sarah , Rutkow Lainie
Published: October 2019

Objectives:

We sought to systematically identify US state-level proposed legislation focused on preemption and introduced over a 2-year period. We analyzed each bill's objectives and intended impacts on local public health policy making and practice.

Design/Setting:

Using standardized search terms, we used the LexisNexis State Capital database to identify state-level bills relating to preemption that were introduced between January 1, 2017, and December 31, 2018. Information was abstracted from relevant bills via an electronic data collection form. Abstracted information was analyzed using descriptive statistics to identify preemption-related patterns and trends.

Results:

One hundred thirty-four bills were included in our analysis. The bills were introduced in 35 states and 28 received sufficient votes to pass into law. The majority of the 134 bills (89%), and all of the bills that passed into law (100%), removed or restricted local authority to regulate. Of the bills that became law, the most common topic areas in which local regulatory authority was restricted were firearms (14%), business and professions (11%), and employment (11%).

Conclusions:

Lawmakers at the state level are introducing and passing legislation that preempts local regulatory authority on a variety of public health topics. To preserve local control, local leaders should anticipate the introduction of state preemption legislation, engage with public health stakeholders, and work to counter bills that would restrict local authority.
Diabetes Self-Care and Clinical Care Among Adults With Low Health Literacy
Authors: Rafferty Ann P. , Winterbauer Nancy L. , Luo Huabin , Bell Ronny A. , Little N. Ruth Gaskins
Published: October 2019

Objective:

Low health literacy has been associated with unfavorable health outcomes. We examined diabetes self- and clinical care measures among adults with diabetes by 3 dimensions of health literacy.

Design/Setting:

Questions about health literacy were available for optional use in the 2016 Behavioral Risk Factor Surveillance System. We analyzed 2016 Behavioral Risk Factor Surveillance System data from 4 states and the District of Columbia that had included both the Health Literacy and Diabetes optional modules.

Participants:

Respondents who participated in the 2016 Behavioral Risk Factor Surveillance System in Alabama, Louisiana, Mississippi, Virginia, and Washington, District of Columbia, and completed both modules (n = 4397).

Main Outcome Measures:

Health literacy was measured by level of difficulty (easy, difficult) with 3 health literacy tasks: getting health advice or information, understanding health information delivered orally by health professionals, and understanding written health information. Diabetes care measures included physical activity, self-monitoring blood glucose, self-checking feet, hemoglobin A1c testing, professional foot examination, flu vaccination, professional eye examination, dental visits, and diabetes self-management education.

Results:

Among those with self-reported diabetes, 5.9% found it difficult to get health advice or information, 10.7% found it difficult to understand information health professionals told them, and 12.0% found it difficult to understand written health information. Those who found it difficult to get health advice or information had 44% to 56% lower adjusted odds of A1c testing, professional foot examinations, and dental visits; those who found it difficult to understand written health information had lower odds of self-monitoring glucose and self-checking feet. Difficulty understanding both oral and written health information was associated with never having taken a diabetes self-management class.

Conclusions:

Our results suggest that problems with health literacy may be a barrier to good disease management among adults with diabetes and that health care providers should be attentive to the needs of patients with low health literacy, especially for diabetes-specific specialty care.
Experiences and Knowledge of US Department of Veterans Affairs Clinical Services, Research, and Education: Results From a National Survey of Veterans
Authors: Tsai Jack , Mehta Kandarp , Hunt-Johnson Nora , Pietrzak Robert H.
Published: October 2019

Objective:

This study examined (1) sociodemographic, health, and psychosocial characteristics associated with using the Department of Veterans Affairs (VA) health care system as a primary health care provider; (2) veterans' experience and knowledge of VA clinical services, research, and education; and (3) veteran characteristics associated with VA experience and knowledge.

Design:

A nationally representative survey was conducted in 2018; eligibility criteria for participation were adults aged 18 years or older, currently living in the United States, and having served on active duty in the US military.

Setting:

The survey was conducted online using large national survey panels.

Participants:

A sample of 1002 veterans across 49 states participated.

Main Outcome Measures:

The survey assessed experience and knowledge of majority of VA clinical services, research, and education.

Results:

One-quarter of the total sample reported that the VA was their primary health care provider. Among veterans who had ever used VA health care, the majority (68%) reported overall high satisfaction with VA health care but also agreed with “privatizing parts of the VA” (70%). The majority (51%-73%) of veterans reported knowledge of major VA clinical services, with the exception of comprehensive management for chronic pain (24%) and treatment of opioid use disorders (31%). One-quarter to one-half also reported knowledge of several VA research and education centers. Less than 10% of veterans reported having ever used a VA mobile app.

Conclusions:

The US veterans generally reported positive experiences and good knowledge of VA services and resources. Greater awareness of available VA services for chronic pain and opioid use disorders, as well as VA mobile apps, may help promote more comprehensive care in this population.
One-Year Outcomes of Intraarticular Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis: Case Review of 99 Joints
Authors: Haas Elisabeth M. , Eisele Angelika , Arnoldi Andreas , Paolini Marco , Ehrl Denis , Volkmer Elias , Giunta Riccardo E.
Published: October 2019

Background:

This study aims to present a new therapeutic option for the treatment of thumb carpometacarpal joint osteoarthritis. Knowing that autologous fat may be beneficial for osteoarthritis through antiinflammatory and chondroprotective effects, the authors transplanted autologous adipose fat into the thumb carpometacarpal joint with the objective of postponing definite resection arthroplasty surgery.

Methods:

In this pilot study, the authors performed surgery on 99 joints. The study population consisted of patients with symptomatic and radiologically confirmed osteoarthritis of the thumb carpometacarpal joint. After harvesting abdominal adipose tissue, 1 to 2 ml of fat without physical or enzymatic manipulation were transplanted into the thumb carpometacarpal joint. Surgical outcome was quantified by use of the Michigan Hand Outcomes Questionnaire in addition to strength and pain measurements during a 12-month follow-up consultation. We conducted Friedman’s analysis of variance to gauge the differences over time regarding Michigan Hand Outcomes Questionnaire and pain under stress.

Results:

From 2 weeks on, there was pain relief, both under stress and at rest. Friedman’s analysis of variance revealed a significant change in pain under stress [chi-square (5) = 68.52; p < 0.001]. Postoperative Michigan Hand Outcomes Questionnaire Scores improved significantly over 12 months [chi-square (5) = 90.56; p < 0.001].

Conclusion:

The authors’ preliminary findings suggest that intraarticular autologous fat transplantation is a promising alternative treatment of carpometacarpal joint osteoarthritis of the thumb.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Free Fibula Flap for Restoration of Spinal Stability after Oncologic Vertebrectomy Is Predictive of Bony Union
Authors: Mericli Alexander F. , Boukovalas Stefanos , Rhines Laurence D. , Adelman David M. , Hanasono Matthew M. , Chang Edward I.
Published: October 2019

Background:

Nonvascular bone grafts larger than 4 cm have a 50 percent nonunion rate in spine surgery. Vascular bone flaps are one potential solution; however, their utility in spine surgery has not been fully elucidated. The authors hypothesized that the addition of a free fibula flap after oncologic vertebrectomy would safely potentiate bone union.

Methods:

The authors performed a retrospective analysis, including all patients who underwent oncologic vertebrectomy for a primary bone tumor at their institution from 2002 to 2017. Patients were divided into two groups: those who underwent spinal reconstruction with nonvascularized bone graft and an alloplastic cage (control) and those whose reconstruction was augmented with a free fibula flap.

Results:

Forty patients were included (free fibula flap, n = 16; control, n = 24). Adjuvant therapies and medical comorbidities were similar between the two groups. Chordoma was the most common abnormality in both groups. The median number of vertebrae resected in the free fibula flap group was two, compared to one in the cage group (p = 0.08). Despite the smaller mean resection size, there were significantly more nonunions (41.7 percent versus 6.3 percent; p = 0.02), instrumentation complications (33.3 percent versus 6.3 percent; p = 0.04), and neurologic complications (25 percent versus 0 percent; p = 0.03) in the control group. Multivariate logistic regression revealed a control reconstruction significantly predictive of nonunion (OR, 57.04; 95 percent CI, 1.17 to 2773; p = 0.04). Free fibula flap patients demonstrated evidence of bony union at a mean of 4.8 months versus 22.4 months in the control group (p < 0.001).

Conclusions:

Free fibula flap surgery in spinal reconstruction after oncologic vertebrectomy is safe and effective. Free fibula flap surgery is independently protective against nonunion and is associated with more rapid union compared with the control.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Unilateral Cleft Lip Nasal Deformity: Three-Dimensional Analysis of the Primary Deformity and Longitudinal Changes following Primary Correction of the Nasal Foundation
Authors: Tse Raymond W. , Knight Robert , Oestreich Makinna , Rosser Mica , Mercan Ezgi
Published: October 2019

Background:

Objective assessment of the unilateral cleft lip nasal deformity and the longitudinal changes with treatment is critical for optimizing cleft care.

Methods:

Consecutive patients undergoing cleft lip repair and foundation-based rhinoplasty were included (n = 102). Three-dimensional images preoperatively, postoperatively, and at 5 years of age were assessed and compared to age-matched controls. Images were normalized to standard horizontal, craniocaudal, and anteroposterior axes.

Results:

Cleft subalare was similar in position relative to controls but was 1.6 mm retrodisplaced. Subnasale was deviated 4.6 mm lateral to midline and had the greatest displacement of any landmark. Noncleft subalare was displaced 2.3 mm laterally. Regression analysis with deviation of subnasale from the midline as a dependent variable revealed progressive lateral displacement of noncleft subalare, narrowing of noncleft nostril, and intercanthal widening. Surgery corrected nasal base displacements along all axes, resulting in landmark positions similar to controls. Symmetry of nasal base correction persisted at 5-year follow-up, with no recurrent cleft alar base retrusion, regardless of initial cleft type.

Conclusions:

Unilateral cleft lip nasal deformity may be “driven” by displacement of the anterior nasal spine and caudal septum. The cleft alar base is normal in position but retruded, whereas the noncleft alar base is displaced laterally. Changes with surgery involve anterior movement of the cleft alar base but also include medial movement of the noncleft alar base and columella. Symmetry of correction, including alar base retrusion, was stable over time and did not rely on alveolar bone grafting.
Posterior Tibial Artery Flap with an Adipofascial Extension: Clinical Application in Head and Neck Reconstruction with Detailed Insight into Septocutaneous Perforators and Donor-Site Morbidity
Authors: Mashrah Mubarak Ahmed , Mai Lianxi , Wan Quan , Huang Zhiquan , Wang Jianguang , Lin Zhaoyu , Fan Song , Pan Chaobin
Published: October 2019

Background:

The general aim of this study is to describe a new modification to the posterior tibial artery flap and its clinical application in head and neck reconstruction and to investigate the distribution of septocutaneous perforators of the posterior tibial artery. The specific aim of this study is to evaluate the effectiveness of this new modification to the posterior tibial artery flap and describe the flap survival rate and donor-site morbidity.

Methods:

From November of 2017 to August of 2018, 85 consecutive patients underwent posterior tibial artery flap reconstruction of the head and neck region after tumor extirpation. All posterior tibial artery flaps were harvested with a long adipofascial extension, and donor-site defects were closed with a triangular full-thickness skin graft harvested adjacent to the flap. Special consideration was given to the harvesting technique, distribution of the posterior tibial artery septocutaneous perforators, flap outcomes, and associated donor-site morbidity.

Results:

Flap survival was 100 percent. The number of septocutaneous perforators varied from one to five per leg, with a mean of 2.61 ± 1.15, and the septocutaneous perforators were mostly clustered in the middle and distal thirds of the medial surface of the leg. The prevalence of the presence of one, two, three, four, and five septocutaneous perforators per leg was 7, 33, 27, 19, and 14 percent, respectively. Total and partial skin graft loss at the donor site was reported in two and six patients, respectively, who were managed conservatively. There was no statistically significant difference when comparing the preoperative and postoperative range of ankle movements (p > 0.05).

Conclusion:

This new modification to the posterior tibial artery flap allows for the incorporation of more septocutaneous perforators into the flap, omits the need for a second donor site to close the donor-site defect, and provides sufficient tissue to fill the dead space after tumor resection and neck dissection.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
The Effect of Probiotic Supplementation on Depressive Symptoms and Quality of Life in Patients After Myocardial Infarction: Results of a Preliminary Double-Blind Clinical Trial
Authors: Moludi Jalal , Alizadeh Mohammad , Mohammadzad Mir Hossein Seyed , Davari Mina
Published: October 2019

Objective

Evidence indicates that probiotic supplements may improve or prevent depression. Little is known about the effects of probiotic supplementation on symptoms of depression and quality of life (QOL) in patients with myocardial infarction (MI).

Methods

This randomized, double-blind, and placebo-controlled clinical trial was performed in 44 patients with a recent diagnosis of MI who underwent percutaneous coronary intervention. Patients were randomly assigned to receive either capsules containing 1.6 × 109 colony-forming units of Lactobacillus rhamnosus capsules with their lunch (the active intervention group) or capsules that contained maltodextrin (the placebo control group) for 12 weeks. The Beck Depression Inventory, QOL, and biomarkers of oxidative stress (serum total antioxidant capacity), and malondialdehyde), and high-sensitivity C-reactive protein (hs-CRP) as inflammation marker were assessed. These measures were obtained at baseline and at 12 weeks’ follow-up.

Results

The total Beck Depression Inventory score decreased significantly in patients who received probiotic supplements compared with the placebo group (−5.57 [6.1] versus −0.51 [2.8], p = .045). Improvements in the mean QOL score were also stronger in the probiotic versus the placebo group (23.6 [39.1] versus 0.44 [42.6], p = .023). In addition, increases in total antioxidant capacity (93.7 [88.4] versus 27.54 [64.7] mmol/l, p = .009) and decreases in malondialdehyde (−40.7 [63.73] versus −4.2 [67.6] nmol/ml, p = .033) and high-sensitivity C-reactive protein (−1.74 [0.70] versus 0.67 [1.27] mg/l, p = .040) levels were stronger in patients receiving probiotic supplementation than the placebo group.

Conclusion

These data provide preliminary evidence that probiotic supplementation in patients with percutaneous coronary intervention post-MI has beneficial effects on depressive symptoms and markers of oxidative stress and inflammation. Multicenter studies with larger sample sizes are needed to replicate these findings and identify patient subgroups with the most benefit from probiotic supplementation.

Trial Registration:
www.irct.ir identifier: IRCT20121028011288N15.
The Longitudinal Association of Reduced Vagal Tone With Burnout
Authors: Wekenborg Magdalena K. , Hill LaBarron K. , Thayer Julian F. , Penz Marlene , Wittling Ralf Arne , Kirschbaum Clemens
Published: October 2019

Objective

Previous research indicates a link between burnout symptoms and reduced vagally mediated heart rate variability (HRV); however, the directionality of this relationship is still largely unknown. The objective of the present study was to examine the longitudinal relationship between HRV and burnout symptoms for 1 year, with a special focus on the emotional exhaustion (EE) burnout subdimension, which remains inadequately distinguished from overlapping with depressive symptoms.

Methods

Here we present HRV and behavioral data from 167 individuals (mean [SD] age = 43.43 [11.78] years; 30.5% male) who attended two biomarker samplings (T1 and T2) of the Dresden Burnout Study approximately 12 months apart.

Results

In hierarchical linear regression analyses, T1 HRV significantly inversely predicted T2 overall burnout symptoms (β = −.16; p = .03) and EE (β = −.23; p = .02), adjusting for age, sex, body mass index, adverse health behaviors, and depressive symptoms. Importantly, only high EE at T1 (β = −.22; p = .04), and not the T1 Maslach Burnout Inventor total score, predicted reductions in HRV from T1 to T2.

Conclusions

We report for the first time longitudinal evidence that HRV is associated with changes in burnout symptoms, independently of depressive symptoms. Results suggest vagal dysfunction being predictive and specific for burnout symptoms, making HRV a promising starting point for the explanation of biophysiological mechanisms underlying burnout symptoms and cardiovascular diseases. The finding of only EE at T1 being predictive for changes in HRV underscores the importance of exhaustion for modulations in autonomic regulation.
Candida auris: what have we learned so far?
Authors: Corsi-Vasquez Gabriela , Ostrosky-Zeichner Luis
Published: October 2019

Purpose of review

The increasing prevalence of fungal infections due to Candida species has been well described in critically ill patient populations, but in recent years a new species, Candida auris has received attention from the medical community worldwide. We aim to summarize the current knowledge related to C. auris, as new identification techniques, novel antifungal agents and more experience with outbreak management have been published in the past few years.

Recent findings

C. auris has been described in several countries, arising independently in separate clades. Its resistance to multiple antifungals and persistent colonization of patients and medical surfaces have become a therapeutic and infection control challenge. Recent elucidation of some of the molecular mechanisms related to pathogenicity and studies of in-vitro efficacy of novel antifungal agents can better guide therapy.

As C. auris continues to cause outbreaks worldwide, newer, and more efficient identification techniques, novel antifungals, and more knowledge in effective infection control techniques will allow better clinical outcomes in the management and control of invasive fungal disease.
Dedicated Spiral Breast Computed Tomography With a Single Photon-Counting Detector
Authors: Berger Nicole , Marcon Magda , Frauenfelder Thomas , Boss Andreas
Published: October 2019

Objectives

The aim of this study was to describe our initial clinical experiences using a dedicated spiral breast computed tomography (B-CT) with a single photon-counting detector.

Materials and Methods

This retrospective study was approved by the institutional review board. Examinations of 300 consecutive women undergoing B-CT were evaluated on reason of assignment for B-CT instead of mammography, detection rate of breast cancer, and quality criteria of data acquisition. Further evaluated performance indicators were the number of additional ultrasounds examinations due to unclear findings or dense breast tissue and reliability of the technical data acquisition.

Results

Five hundred ninety-one B-CT acquisitions in 300 women were performed. The main reason for preference of B-CT over mammography was the lack of breast compression (254 of 300, 84.7%), which was desired due to personal reasons or mastodynia, whereas 10 patients (0.3%) had implants hampering mammography. One hundred two possible lesions were detected in B-CT including 4 cases of breast cancer (1.3% of all patients). Additional ultrasound was performed in 226 patients (102 due to detected lesions and 124 due to dense breast tissue). Three malignant lesions were only detected in an additional ultrasound (1% of all patients). As a quality criterion, the pectoralis muscle was included in 341 of 591 examinations, but complete assessment of breast tissue was only possible in 149, respectively 140 examinations. No movement artifacts were noted. In 99% of all women, the examination could be realized.

Conclusions

The dedicated B-CT provides high-quality images. It can be used as alternative particularly in those patients not otherwise willing to perform mammography because of the breast compression.
Optimizing Surveillance and Re-intervention Strategy Following Elective Endovascular Repair of Abdominal Aortic Aneurysms
Authors: Kim Lois G. , Sweeting Michael J. , Epstein David , Venermo Maarit , Rohlffs Fiona E. V. , Greenhalgh Roger M.
Published: October 2019

Background:

EVAR for abdominal aortic aneurysm has an initial survival advantage over OR, but more frequent complications increase costs and long-term aneurysm-related mortality. Randomized controlled trials of EVAR versus OR have shown EVAR is not cost-effective over a patient's lifetime. However, in the EVAR-1 trial, postoperative surveillance may have been sub-optimal, as the importance of sac growth as a predictor of graft failure was overlooked.

Methods:

Real-world data informed a discrete event simulation model of postoperative outcomes following EVAR. Outcomes observed EVAR-1 were compared with those from 5 alternative postoperative surveillance and re-intervention strategies. Key events, quality-adjusted life years and costs were predicted. The impact of using complication and rupture rates from more recent devices, imaging and re-intervention methods was also explored.

Results:

Compared with observed EVAR-1 outcomes, modeling full adherence to the EVAR-1 scan protocol reduced abdominal aortic aneurysm (AAA) deaths by 3% and increased elective re-interventions by 44%. European Society re-intervention guidelines provided the most clinically effective strategy, with an 8% reduction in AAA deaths, but a 52% increase in elective re-interventions. The cheapest and most cost-effective strategy used lifetime annual ultrasound in primary care with confirmatory computed tomography if necessary, and reduced AAA-related deaths by 5%. Using contemporary rates for complications and rupture did not alter these conclusions.

Conclusions:

All alternative strategies improved clinical benefits compared with the EVAR-1 trial. Further work is needed regarding the cost and accuracy of primary care ultrasound, and the potential impact of these strategies in the comparison with OR.