bluuebunny/crossref_metadata_2025 huggingface dataset:
The finances of a liver transplant program
Authors: Cook Makenzie , Zavala Edward
Published: January 2019

Purpose of review

The current review provides an overarching examination of liver transplant finances and factors contributing to cost of care.

Recent findings

Transplant hospitals must seek to optimize areas of revenue and cut costs as the cost of transplantation continues to rise and public policies strain reimbursement.

Transplantation remains a complicated multipayor system that requires focused attention and care. With rising costs and increased focus on quality in the healthcare market, it is integral that both the clinical and business teams work together to strive for optimization of costs and revenue.
The parallel paradigm between intestinal transplant inflammation and inflammatory bowel disease
Authors: Belyayev Leonid , Loh Katrina , Fishbein Thomas M. , Kroemer Alexander
Published: January 2019

Purpose of review

A significant shift in our understanding of the molecular and cellular basis for inflammatory bowel disease (IBD) mirrors research that has been ongoing in intestinal transplantation. The blurring of lines between these two disease states creates an avenue into potential therapeutic interventions which take advantage of these molecular similarities.

Recent findings

Traditional knowledge of T-cell involvement in IBD has expanded to highlight the role of T helper 17 (Th17) cells as key effector cells. A similar role has been demonstrated in cellular rejection of intestinal allografts. Genetic polymorphism related to the propagation and function of Th17 cells has been found to confer significant risk of developing autoimmune conditions. Interleukin-23, a cytokine identified as crucial to the expansion of Th17 cells, has become a validated molecular target in psoriatic arthritis and IBD, and could become a target for intestinal transplant therapies.

Intestinal transplant rejection and IBD share a similar phenotype, especially as it relates to key effector cells and gene polymorphisms. Improvements in our understanding of the immune-pathogenesis of IBD, as well as molecular targeting exploiting that knowledge, provide a potential route to improve outcomes for intestinal transplant patients.
Statin Use and Risk of Pancreatic Cancer
Authors: Zhang Yun , Liang Mingming , Sun Chenyu , Qu Guangbo , Shi Tingting , Min Min , Wu Yile , Sun Yehuan
Published: January 2019

Objective

The aim of this study was to explore the relationship between statin use and the risk of pancreatic cancer.

Methods

Electronic databases were searched to identify relevant studies published until January 2018. The pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated with random-effects model. Subgroup analyses and sensitivity analysis were also conducted. Cochran Q test and I
2 statistic were used to evaluate the heterogeneity.

Results

Twenty-six studies were included that contained more than 3 million participants and 170,000 pancreatic cancer patients. The overall result demonstrated a significant decrease in pancreatic cancer risk with statin use (RR, 0.84; 95% CI, 0.73–0.97; P = 0.000; I
2 = 84.4%). In subgroup analyses, nonsignificant association was detected between long-term statin use and the risk of pancreatic cancer (RR, 0.98; 95% CI, 0.86–1.11; P = 0.718; I
2 = 0.0%). Meanwhile, there was nonsignificant association between the use of lipophilic statins and the risk of pancreatic cancer (RR, 0.98; 95% CI, 0.84–1.15; P = 0.853; I
2 = 27.2%). No publication bias was found in this meta-analysis.

Conclusions

The overall result of this meta-analysis supports the hypothesis that statins have a protective effect on pancreatic cancer. Furthermore, high-quality randomized clinical trials and cohort studies are needed to confirm these findings.
Temporal Trends in Incidence and Outcomes of Acute Pancreatitis in Hospitalized Patients in the United States From 2002 to 2013
Authors: Brindise Elizabeth , Elkhatib Imad , Kuruvilla Aneesh , Silva Rogelio
Published: January 2019

Objectives

We sought to examine temporal trends in incidence and outcomes of acute pancreatitis (AP) in hospitalized adult patients in the United States.

Methods

Subjects were obtained from the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample database using International Classification of Diseases, Ninth Revision, Clinical Modification codes for the years 2002–2013. Incidence of AP, all-cause mortality, cost, and duration of hospitalization were assessed.

Results

We identified 4,791,802 cases of AP. A significant increase in the incidence of AP was observed from 9.48 cases per 1000 hospitalizations in 2002 to 12.19 per 1000 hospitalizations in 2013 (P < 0.001). In-hospital mortality decreased from 2.99 cases per 100 cases in 2002 to 2.04 cases per 100 cases in 2013 (P < 0.001). Mean length of stay decreased from 6.99 (standard deviation [SD], 9.37) days in 2002 to 5.74 (SD, 7.94) days in 2013 (P < 0.001). Cost of hospitalization increased from $27,827 (SD, $54,556) in 2002 to $49,772 (SD, $106,205) in 2013 (P < 0.001).

Conclusions

Hospital admissions for AP in adults increased significantly in the United States from 2002 to 2013. In-hospital all-cause mortality and mean length of stay significantly decreased. In contrast, total cost of hospitalization rose.
Sinistral Portal Hypertension in Acute Pancreatitis
Authors: Xie Chao Lian , Wu Chang Qiang , Chen Yong , Chen Tian Wu , Xue Hua Dan , Jin Zheng Yu , Zhang Xiao Ming
Published: January 2019

Objective

The aim of the study was to study the prevalence and characteristics of sinistral portal hypertension (SPH) in acute pancreatitis (AP) and its correlation with the severity of AP.

Methods

Retrospectively studied 633 patients with AP admitted to our institution and underwent magnetic resonance imaging (MRI). Diagnosis of SPH was based on clinical manifestations, laboratory tests, and MRI. The venous system and pancreatitis were evaluated on T1 weighted imaging, T2 weighted imaging, and dynamic-enhancement MRI. Data on patients' demographics, etiology, organ failure, MR severity index, and clinical outcomes were all collected.

Results

The SPH was detected in 21 patients (3.3%, 21/633). There was no statistical difference in organ failure between patients with SPH and without SPH (P > 0.05). The prevalence of SPH in males and females was 5.1% (17/336) versus 1.3% (4/297) (χ2 = 6.775, P = 0.009), in edematous and necrotizing AP was 0.4% (2/510) versus 15.5% (19/123) (χ2 = 65.413, P = 0.000), and in mild, moderate, and severe AP, based on MR severity index, were 0.6% (2/334) versus 2.9% (8/276) versus 47.8% (11/23) (χ2 = 55.977, P = 0.000), respectively.

Conclusions

The SPH rarely occurs in AP, and its risk is higher in males. Its presence is strongly associated with the local conditions of pancreatitis.
Assessing Organizational Supports for Evidence-Based Decision Making in Local Public Health Departments in the United States: Development and Psychometric Properties of a New Measure
Authors: Mazzucca Stephanie , Parks Renee G. , Tabak Rachel G. , Allen Peg , Dobbins Maureen , Stamatakis Katherine A. , Brownson Ross C.
Published: January 2019

Context:

Fostering evidence-based decision making (EBDM) within local public health departments and among local health department (LHD) practitioners is crucial for the successful translation of research into public health practice to prevent and control chronic disease.

Objective:

The purpose of this study was to identify organizational supports for EBDM within LHDs and determine psychometric properties of a measure of organizational supports for EBDM in LHDs.

Design:

Cross-sectional, observation study.

Setting:

Local public health departments in the United States.

Participants:

Local health department practitioners (N = 376) across the United States participated in the study.

Main Outcome Measures:

Local health department practitioners completed a survey containing 27 items about organizational supports for EBDM. Most items were adapted from previously developed surveys, and input from researchers and practitioners guided survey development. Confirmatory factor analysis was used to test and refine the psychometric properties of the measure.

Results:

The final solution included 6 factors of 22 items: awareness of EBDM (3 items), capacity for EBDM (7 items), resources availability (3 items), evaluation capacity (3 items), EBDM climate cultivation (3 items), and partnerships to support EBDM (3 items). This factor solution achieved acceptable fit (eg, Comparative Fit Index = 0.965). Logistic regression models showed positive relationships between the 6 factors and the number of evidence-based interventions delivered.

Conclusions:

This study identified important organizational supports for EBDM within LHDs. Results of this study can be used to understand and enhance organizational processes and structures to support EBDM to improve LHD performance and population health. Strong measures are important for understanding how LHDs support EBDM, evaluating interventions to improve LHD capacity, and to guide programmatic and policy efforts within LHDs.
Novel Agents in Multiple Myeloma
Authors: Szalat Raphaël , Munshi Nikhil C.
Published: January 2019

The therapeutic landscape of multiple myeloma (MM) has dramatically changed in the last 15 years with the advent of immunomodulatory drugs and proteasome inhibitors. However, majority of MM patients relapse, and new therapies are needed. Various agents with diverse mechanisms of action and distinct targets, including cellular therapies, monoclonal antibodies, and small molecules, are currently under investigation. In this review, we report novel drugs recently approved or under advanced investigation that will likely be incorporated in the future as new standard for MM treatment, focusing on their mechanisms of action, cellular targets, and stage of development.
Cost-Effectiveness Analysis of Virtual Surgical Planning in Mandibular Reconstruction
Authors: Fatima Aaisha , Hackman Trevor G. , Wood Jeyhan S.
Published: January 2019

Background:

Because of the complex nature of osteocutaneous free flap mandibular reconstruction, modern technologies such as virtual surgical planning have become popularized to refine the procedure. Compared with usual care, virtual surgical planning has been suggested to reduce operative time and improve accuracy of outcomes. The aim of this study was to examine the cost-effectiveness of virtual surgical planning versus usual care in mandibular reconstruction.

Methods:

A decision-analytic model was constructed to comparatively understand cost-effectiveness of virtual surgical planning and usual care treatments based on additional costs of virtual surgical planning, and costs attributed to probabilities of postoperative complications. Model structure was informed through qualitative clinical interviews from the University of North Carolina, and supported through University of North Carolina clinical data and literature. Costs and complication probabilities were estimated from the literature. Sensitivity analyses of all uncertain model parameters were performed, and distributional parameters were selected based on best practices.

Results:

Results of base-case analysis indicated that virtual surgical planning was more costly by a difference of $7099 per person and did not reduce the risk of complications or flap loss. Virtual surgical planning cases had an increased incidence of flap loss by 0.6 percent and an increased incidence of mandibular infection by 6.5 percent.

Conclusions:

Virtual surgical planning has upfront expenses that do not necessarily translate into downstream reduction in complications or improved outcomes. Clinical decision-makers would benefit from future research to identify thresholds whereby virtual surgical planning may result in more cost-savings for particular types of patients.
Management of High-Output Chyle Leak after Harvesting of Vascularized Supraclavicular Lymph Nodes
Authors: Teven Chad M. , Hunter Cedric L. , Chang David W.
Published: January 2019

Vascularized lymph node transfer is a physiologic microsurgical technique used for the treatment of lymphedema. As vascularized lymph node transfer is becoming more common, it is essential that one is aware of all potential complications associated with vascularized lymph node transfer and know how to avoid and manage them when they do occur. The authors recently encountered a complication after supraclavicular vascularized lymph node transfer that has not been previously reported. A patient developed a recalcitrant high-output (>500 ml/day) chyle leak in the neck donor site after supraclavicular vascularized lymph node transfer harvest. In this article, the authors share their experience with massive chyle leak and review the management strategies of how to effectively avoid and treat this potentially dangerous complication. This review of a previously unreported complication of supraclavicular vascularized lymph node transfer is timely and important, as this procedure is increasingly being offered to patients, and surgeons performing these procedures should be familiar with effectively managing this potentially dangerous complication.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
A Virtual Surgical Planning Algorithm for Delayed Maxillomandibular Reconstruction
Authors: Stranix John T. , Stern Carrie S. , Rensberger Michael , Ganly Ian , Boyle Jay O. , Allen Robert J. , Disa Joseph J. , Mehrara Babak J. , Garfein Evan S. , Matros Evan
Published: January 2019

Background:

The absence of a tumor specimen from which to obtain measurements at the time of delayed maxillomandibular reconstruction introduces degrees of uncertainty, creating the need for substantial intraoperative guesswork by the surgeon. Using the virtual surgical planning environment, the size and shape of missing bony elements is determined, effectively “recreating the defect” in advance of the surgery. Three virtual surgical planning techniques assist the reconstructive surgeon: patient-specific modeling, mirroring the normal contralateral side, and scaled normative data. To facilitate delayed reconstruction a hierarchical algorithm using virtual surgical planning techniques was developed.

Methods:

Delayed maxillomandibular virtual surgical planning reconstructions were identified from 2009 to 2016. Demographics, modeling techniques, and surgical characteristics were analyzed.

Results:

Sixteen reconstructions were performed for osteoradionecrosis with displacement (50.0 percent) or oncologic defects (37.5 percent). Most patients had prior surgery (81.3 percent) and preoperative radiation therapy (81.3 percent); four had failed prior reconstructions. The following delayed virtual surgical planning techniques were used: patient-specific modeling based on previous imaging (43.8 percent), mirroring normal contralateral anatomy (37.5 percent), and scaled normative data (18.8 percent). Normative and mirrored reconstructions were designed to restore normal anatomy; however, most patient-specific virtual surgical planning designs (71.4 percent) required nonanatomical reconstructions to accommodate soft-tissue limitations and to avoid the need for a second flap. One partial flap loss required a second free flap, and one total flap failure occurred. Hardware exposure was the most common minor complication, followed by infection, dehiscence, and sinus tract formation.

Conclusions:

Virtual surgical planning has inherent advantages in delayed reconstruction when compared to traditional flap shaping techniques. An algorithmic approach based on available imaging and remaining native anatomy enables accurate reconstructive planning followed by flap transfer without the need for intraoperative guesswork.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Symmetric Philtral Column Repair for Unilateral Cleft Lip
Authors: Madaree Anil
Published: January 2019

Background:

When treating a patient with a unilateral cleft lip, the goal is to try and achieve a result that is the least perceivable at conversational distance. The result should be a balanced and symmetric lip with scars that are hidden or are placed in natural anatomical lines. Several methods have been described to repair the lip. The most popular repairs at present are the rotation-advancement or its modifications and the various versions of the straight-line repair.

Methods:

In the author’s unit, a method has evolved entitled the symmetric philtral column repair. In this method, the author attempts to achieve a philtral column that mirrors the philtral column on the normal side, producing a balanced appearing lip. This method has been used for the past 14 years in over 500 patients.

Results:

The results have been satisfying, with a lip revision rate of 6 percent.

Conclusions:

The symmetric philtral column repair of a unilateral cleft lip is an effective and safe repair. The repair is easy to understand and produces results that minimize the stigmata of a cleft lip deformity.
Long-Term Functional Upper-Extremity Outcomes in Adults with Apert Syndrome
Authors: Taghinia Amir H. , Yorlets Rachel R. , Doyle Michael , Labow Brian I. , Upton Joseph
Published: January 2019

Background:

The goal of this study was to determine upper-extremity function and health-related quality of life in a cohort of adults with Apert syndrome.

Methods:

Twenty-two adults with Apert syndrome completed the Disabilities of the Arm, Shoulder, and Hand survey; the 36-Item Short-Form Health Survey; and a semistructured interview. One surgeon administered the Jebsen Hand Function Test and measured sensation, joint motion, and strength.

Results:

Median Disabilities of the Arm, Shoulder, and Hand score was 16.9, which indicated slightly greater disability than the population norm of 10.1. Median 36-Item Short-Form Health Survey scores were 54.5 for mental health and 57.0 for physical health—both more favorable than population norms. Total Jebsen Hand Function Test scores for dominant hand were 69.2 seconds for men and 64.7 seconds for women versus 37.8 seconds for population norms of both sexes. More complex syndactyly resulted in worse metacarpophalangeal joint motion but no significant difference in Disabilities of the Arm, Shoulder, and Hand; 36-Item Short-Form Health Survey; or other functional results. There was no difference in self-reported outcomes between patients with four (n = 8) versus five digits (n = 14) in each hand.

Conclusions:

In this cohort of adults with Apert syndrome, self-reported assessment of disability was more favorable than measured functional data would suggest. Despite significant functional deficits, the participants in this study had adapted remarkably well.
Patient Attitudes Toward Telemedicine-Delivered Cardiac Rehabilitation
Authors: Grover David B. , Alexander Jeffrey L.
Published: January 2019

Background

Telemedicine-delivered cardiac rehabilitation (telemedicine-CR) provides an alternative pathway for patients who are unable to participate in conventional CR. Little is known regarding the relationships among potential participants’ perceptions of barriers to CR participation, interest in telemedicine-CR, and self-efficacy beliefs toward the use of telemedicine. The purpose of this study was to identify if associations exist between these variables.

Methods

A quantitative, correlational survey study was conducted using the Cardiac Rehabilitation Barriers Scale and a survey examining interest in and self-efficacy for telemedicine technologies. Eighty-three patients were invited to participate.

Results

Twenty surveys (24%) were returned. Significant correlations were identified between interest in telemedicine-CR and self-efficacy beliefs for the use of live video links, r
s(14) = .510, p = .044, and the Cardiac Rehabilitation Barriers Scale Comorbidity subscale, r
s(18) = −.469, p = .037.

Conclusions

Higher self-efficacy for the use of video chat and fewer perceived comorbidity barriers were associated with greater interest in telemedicine-CR.
Using Volume-Based Tube Feeding to Increase Nutrient Delivery in Patients on a Rehabilitation Unit
Authors: Kinikin JaNae , Phillipp Rita , Altamirano Christine
Published: January 2019

Purpose

The purpose of this study was to determine whether volume-based tube feeding (VBTF) increased nutrient delivery to patients in a rehabilitation unit.

Design

A cohort study with a prospective group and a historical control group was used as the study design.

Methods

The intervention was VBTF, a change from the standard hourly rate-based enteral nutrition. Data were collected on 70 rehabilitation patients. Data on the control group (n = 35) were collected through retrospective chart review of rate-based tube-fed patients. Data on the VBTF intervention group (n = 35) were collected prospectively after implementation of VBTF in the inpatient medical rehabilitation unit at University of Utah Health.

Findings

The results showed patients in the VBTF group received 82% of their prescribed feed whereas rate-based patients received 70%.

Clinical Relevance

VBTF appears to increase the amount of nutrition inpatient medical rehabilitation patients receive, which may help with the intensive therapy sessions these patients must undergo.
Quadruple Perforator Flaps for Primary Closure of Large Myelomeningoceles
Authors: Rankin Timothy M. , Wormer Blair A. , Tokin Christopher , Kaoutzanis Christodoulos , Al Kassis Salam , Wellons John C. , Braun Stephane
Published: January 2019

Introduction

Myelomeningocele is the most common open neural tube defect. A quadruple rotation-VY advancement flap (butterfly flap) was recently reported for closure of large myelomeningocele defects; however, no series has been reproduced to evaluate this technique. The objective of this study was to describe our experience with this technique.

Materials and Methods

We reviewed all infants born with large myelomeningocele defects who underwent butterfly flap closure over a 2-year period. Demographics, defect size, operative details, and complications were used to generate descriptive statistics.

Results

From June 2015 to January 2018, 7 infants met inclusion criteria. Mean defect width was 52% ± 0.11 of the back, representing 21% ± 0.09 of the total back area. Only 1 child had central breakdown. All patients had some peripheral skin dehiscence that occurred on postoperative day 12 ± 7, and these were treated with outpatient wound care. Four patients returned to the operating room for dehiscence electively. There were no incidences of total flap loss. There were no cases of meningitis or myelomeningocele dehiscence. All patients had successful closure of their myelomeningocele without the use of skin grafts.

Conclusions

The butterfly flap is able to close large myelomeningocele defects and has the potential to improve contour. There are minor wound-healing complications, but in the rare event of central dehiscence, quadruple rotation-VY advancement flaps can be re-advanced. In all cases, a large myelomeningocele was successfully reconstructed with robust full-thickness flaps, and there was no need for skin grafting of donor sites.
Cosmetically Challenging Congenital Melanocytic Nevi
Authors: Fahradyan Artur , Wolfswinkel Erik M. , Tsuha Michaela , Reinisch John F. , Magee William , Hammoudeh Jeffrey A. , Urata Mark M. , Howell Lori K.
Published: January 2019

Background

Congenital melanocytic nevi (CMN) have a 1% to 5% lifetime risk for malignant transformation, with 50% of transformations occurring before the age of 5 years.

The aim of this study is to assess the risk of melanoma development in pediatric patients with facial CMN involving the eyebrows, eyelid margins, and nasal alae where a margin of CMN was not excised to preserve these structures.

Methods

A retrospective chart review of all pediatric patients with CMN from 1986 to 2014 was performed to review demographic information, diagnosis, and number of surgeries. Patients' clinical photographs were evaluated for residual nevi after completion of the treatment.

Results

More than 950 medical charts of patients with CMN of the face area were reviewed. We identified 32 patients (13; 41% male) that met the study criteria with pathology-confirmed diagnosis of facial CMN with an average age of 4.4 years (3.3 months–15.8 years) at the time of initial surgery. The CMNs were classified into small (1; 3%), medium (14; 44%), large (14; 44%), and giant (3; 9%) based on their projected adult sizes. No patients developed melanoma within the small residual lesions left over the eyebrows and eyelids and inside nostrils at an average follow-up time of 5.6 (1.0–14.4) years and average age of 9.6 (1.8–19.2) years at the time of last follow-up.

Conclusions

Although a lifelong risk of malignant transformation of the residual CMN cannot be concluded, our results found no transformation in follow-up visits at an average age beyond the highest risk of melanoma development in childhood. We feel that leaving residual lesions on the face in areas of important anatomic structures for better cosmetic outcome is an acceptable risk.
“No-Touch” Enhancement Significantly Reduces the Risk of Infection-Related Failure in Immediate Breast Reconstruction
Authors: Wilson Henry B.
Published: January 2019

Purpose

Infection rates in prosthetic breast reconstruction after mastectomy vary widely, ranging from 1% to 35%, with meta-analyses reporting average infection rates of greater than 5%. This infection rate of greater than 5% is unfortunate for one of today's most commonly performed plastic surgical procedures. In an attempt to reduce infectious events, the author developed a “no-touch” protocol for performing breast reconstruction with tissue expanders and acellular dermis (ADM). This approach utilizes a transparent barrier drape and self-retaining retractor system patterned after similar orthopedic and urologic techniques that have proven to significantly reduce infection of implanted prostheses. Our preliminary results published in 2015 showed a significant improvement in infection rates. With this study, we assess the impact of the no-touch technique on a much larger number of patients.

Methods

Institutional review board approval was granted for a retrospective study of patients who underwent immediate breast reconstruction with tissue expanders and ADM from 2010 to 2017 by the author. Reconstructions prior to the institution of a no-touch protocol in 2014 were compared with those after the enhancement was instituted. A minimum of 60 days' follow-up was used to assess surgical complications. Demographic and outcome data were analyzed.

Results

Immediate breast reconstruction with tissue expanders and ADM was performed on 133 patients (217 breasts) from 2010 to 2017. Sixty-nine patients (113 breasts) underwent reconstruction from 2010 to 2014 utilizing the traditional technique, and 64 patients (104 breasts) underwent reconstruction from 2014 to 2017 using the new no-touch enhancement applied by the author. Patients in both groups had similar demographics and comorbidity profiles. The only other technique variable besides the addition of no-touch was the trend toward the use of larger sizes of ADM in the later group (164 vs 108 cm2). The rate of infection-related reconstructive failure dropped from 11.5% (13/113) to 1.9% (2/104) (P = 0.0054) after institution of the no-touch protocol.

Conclusions

Institution of a specific no-touch protocol to immediate breast reconstruction with tissue expanders and ADM lowered the risk of reconstructive failure due to infection 6-fold—11.5% to 1.9%. Comparative studies from other surgeons are encouraged.
A Study to Evaluate Change in Ventricular Volume Obtained by Cranial Distraction for Craniosynostosis
Authors: Hashmi Asra , Davis Greta , Zaldana Michelle , Vinocur Daniel , Cahill Gabrielle L. , Brandel Michael G. , Lance Samuel , Meltzer Hal S. , Gosman Amanda A.
Published: January 2019

Background

The aims of the current analysis were to study the change in ventricular volume (VV) obtained with cranial distraction in patients with craniosynostosis and compare it with the change in total intracranial volume (ICV) and brain volume.

Methods

After institutional review board approval, a retrospective review was performed on patients undergoing cranial distraction over a 5-year period. GE Healthcare AdW 4.3 volume assessment software was utilized to calculate preoperative and postdistraction ICV, VV, and whole-brain volume. Data were also collected on patient demographics, age at the time of distraction, time spent in distraction and consolidation, and length of stay. t Tests were used for comparison.

Results

Twenty-three patients met our inclusion criteria. Forty-eight percent of patients (n = 11) had right-sided cranial distraction, 30% (n = 7) had bilateral distraction, and 22% of patients (n = 5) had left-sided distraction. At the preoperative stage, mean head circumference was 42.5 ± 4.7 cm, mean ICV was 810.1 ± 27 cm3, mean non-VV (NVV) was 796.2 ± 268 cm3, and mean VV was 13.9 ± 9 cm3. After a mean of 27.4 mm of distraction, occurring over a mean of 26 days and consolidation period of 149 days, a second computed tomography scan was obtained. Mean postdistraction head circumference was 49.1 ± 3.9 cm, mean ICV was 1074.1 ± 203 cm3, mean NVV was 1053.5 ± 197 cm3, and VV was 20.6 ± 14 cm3. Mean % increase in ICV at this stage was 47.4%; mean % NVV increase was 48.5% as opposed to 60.3% increase in VV.

Conclusions

Cranial distraction is known to effectively increase ICV. Our study suggests that the effect of this volumetric increase is much more pronounced on the VV compared with the brain volume. Further studies are underway to investigate whether this short-term marked increase in VV is sustained over a long-term period.
Long-term Follow-up of Intracapsular Schwannoma Excision
Authors: Niepel Albert Laurenz , Steinkellner Lara , Sokullu Fuat , Hellekes Dirk , Kömürcü Fercan
Published: January 2019

Introduction

The current criterion-standard treatment for schwannomas is intracapsular excision. This study was designed as a long-term follow-up to investigate postoperative symptoms, nervous impairment, and recurrence rate.

Methods

We performed a long-term follow-up of 18 subjects who underwent intracapsular schwannoma excision. We evaluated preoperative versus postoperative 2-point discrimination (2-PD) in the affected dermatome, pain (visual analog scale [VAS] from 0–10), Hoffmann-Tinel sign, and thermoreceptor response. For reasons of comparison, all examinations were done on both the healthy and affected extremity.

Results

Last postoperative follow-up was done on average after approximately 50.4 months. Comparison between preoperative and postoperative sensibility testing (2-PD) in the affected dermatome showed a significant improvement of 22.7% after surgery (5-mm 2-PD; P = 0.02). Compared with the healthy nonoperated extremity preoperatively, subjects showed a significant sensory deficit of 40.9% (9-mm 2-PD; P < 0.000). Postoperatively, 12 of 18 subjects still showed a deficit in 2-PD. However, deficiency was decreased to 23.5% (mean, 4-mm 2-PD; P = 0.003). Through intracapsular schwannoma excision, subjects could drastically improve their pain (from VAS 6.7 to VAS 4.0).

During our examination, we clinically suspected recurrence in 3 subjects, which were sent to magnetic resonance imaging to rule out or confirm a recurrent tumor.

Discussion

Many subjects reported ongoing pain and sensory deficits after intracapsular excision of schwannomas. Symptoms right after surgery may be due to iatrogenic nerve injury or residual deficits from compression damage of the tumor mass. As schwannomas are usually growing at a slow rate, early symptoms after a symptom-free period might possibly indicate scarring of soft tissue, which may cause signs of recurrent neurological deficits or pain. Patients with a late onset of symptoms are at the highest risk of having a true recurrence of schwannoma. None of the 3 suspected subjects showed radiological evidence for a recurrent schwannoma, but rather scarring and soft tissue adhesions to the nerve, which could explain the clinical findings.

Intracapsular removal of schwannomas is relatively easy to perform, does not cause any additional damage to the nerve in most cases, and is therefore an excellent method for treatment of symptomatic schwannoma patients.
N-Acetylcysteine Ameliorates Gentamicin-Induced Nephrotoxicity by Enhancing Autophagy and Reducing Oxidative Damage in Miniature Pigs
Authors: Cui Jing , Tang Li , Hong Quan , Lin Shupeng , Sun Xuefeng , Cai Guangyan , Bai Xue-Yuan , Chen Xiangmei
Published: January 2019

The clinical use of gentamicin over prolonged periods is limited because of dose and time-dependent nephrotoxicity, in which intracellular oxidative stress and heightened inflammation have been implicated. Macroautophagy/autophagy is an essential and highly conserved self-digestion pathway that plays important roles in the maintenance of cellular function and viability under stress. The aim of this study was to determine changes in autophagy in response to the antioxidant N-acetylcysteine (NAC), via its effects on oxidative stress, inflammation, apoptosis, and renal function, following treatment with gentamicin in mini pigs. Adult mini pigs were divided into isotonic saline solution, gentamicin, and gentamicin plus NAC combination treatment groups. Gentamicin-induced histopathological changes, including inflammatory cell infiltration and tubular necrosis, were attenuated by NAC. NAC ameliorated the gentamicin-induced decreases in the levels of autophagy-related proteins, such as LC3 (microtubule-associated protein 1 light chain 3), PINK1 (phosphatase and tensin homologue deleted on chromosome10-induced kinase 1), phospho-parkin, AMBRA1 (activatingmolecule in Beclin 1-regulated autophagy), p62/SQSTM1 (sequestosome protein 1), and polyubiquitinated protein aggregates. NAC also caused a significant reduction in oxidative damage markers, including 4-hydroxy-2-nonenal, protein carbonyls, γ-H2AX (gamma histone variant H2AX), and 8-hydroxy-2′-deoxyguanosine, in gentamicin-treated animals. These data show that the protective effects of NAC might be related, at least in part, to a reduced inflammatory response, as observed in animals treated with both gentamicin and NAC. These results suggest that autophagy could be a new therapeutic target for preventing gentamicin-induced kidney injury, and that NAC might ameliorate gentamicin-induced nephrotoxicity by autophagy.
Cost-effectiveness Evaluation of Laparoscopic Versus Robotic Minimally Invasive Colectomy
Authors: Simianu Vlad V. , Gaertner Wolfgang B. , Kuntz Karen , Kwaan Mary R. , Lowry Ann C. , Madoff Robert D. , Jensen Christine C.
Published: January 2019

Objective:

Evaluate the cost-effectiveness of open, laparoscopic, and robotic colectomy.

Background:

The use of robotic-assisted colon surgery is increasing. Robotic technology is more expensive and whether a robotically assisted approach is cost-effective remains to be determined.

Methods:

A decision-analytic model was constructed to evaluate the 1-year costs and quality-adjusted time between robotic, laparoscopic, and open colectomy. Model inputs were derived from available literature for costs, quality of life (QOL), and outcomes. Results are presented as incremental cost-effectiveness ratios (ICERs), defined as incremental costs per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were performed to test the effect of clinically reasonable variations in the inputs on our results.

Results:

Open colectomy cost more and achieved lower QOL than robotic and laparoscopic approaches. From the societal perspective, robotic colectomy costs $745 more per case than laparoscopy, resulting in an ICER of $2,322,715/QALY because of minimal differences in QOL. From the healthcare sector perspective, robotics cost $1339 more per case with an ICER of $4,174,849/QALY. In both models, laparoscopic colectomy was more frequently cost-effective across a wide range of willingness-to-pay thresholds. Sensitivity analyses suggest robotic colectomy becomes cost-effective at $100,000/QALY if robotic disposable instrument costs decrease below $1341 per case, robotic operating room time falls below 172 minutes, or robotic hernia rate is less than 5%.

Conclusions:

Laparoscopic and robotic colectomy are more cost-effective than open resection. Robotics can surpass laparoscopy in cost-effectiveness by achieving certain thresholds in QOL, instrument costs, and postoperative outcomes. With increased use of robotic technology in colorectal surgery, there is a burden to demonstrate these benefits.
Effects of Telmisartan and Candesartan on the Metabolism of Lipids and Glucose in Kidney Transplant Patients: A Prospective, Randomized Crossover Study
Authors: Miura Yoshifumi , Noguchi Hiroshi , Okabe Yasuhiro , Masutani Kosuke , Tokunaga Shoji , Nakamura Masafumi
Published: January 2019

Background

The risk of cardiovascular events remains after kidney transplantation (KT). Abnormal glucose metabolism and hyperlipidemia contribute partly to this risk. Among angiotensin II type-1 receptor blockers, telmisartan alone has been shown to ameliorate these effects on glucose and lipid metabolism (GLM). We investigated the effects of telmisartan on GLM in KT patients.

Methods

This trial had a crossover design. Forty-six KT patients with well-controlled hypertension under angiotensin II type-1 receptor blockers were randomized into telmisartan and candesartan groups. After a 12-week treatment, crossover was initiated, and additional 12-week treatment was administered without a washout period. We examined the laboratory parameters of GLM, blood pressure and graft function before and after each treatment period.

Results

Forty patients completed the scheduled treatment regimen. Serum levels of triglyceride were significantly lower (114.3 ± 50.8 mg/dL vs 136.5 ± 66.8 mg/dL; P = 0.019), and the estimated glomerular filtration rate was significantly higher (50.4 ± 15.1 mL/min per 1.73 m2 vs 48.5 ± 12.5 mL/min per 1.73 m2; P = 0.038) after telmisartan treatment than after candesartan treatment. There were no significant differences between the 2 treatment groups with regard to the other parameters studied (including serum adiponectin levels and parameters of glucose metabolism).

Conclusions

These data suggest that telmisartan can improve serum triglyceride levels and graft function for KT patients better than candesartan.
Are high-frequency oscillations better biomarkers of the epileptogenic zone than spikes?
Authors: Roehri Nicolas , Bartolomei Fabrice
Published: January 2019

Purpose of review

Precise localization of the epileptogenic zone is imperative for the success of resective surgery of drug-resistant epileptic patients. To decrease the number of surgical failures, clinical research has been focusing on finding new biomarkers. For the past decades, high-frequency oscillations (HFOs, 80–500 Hz) have ousted interictal spikes – the classical interictal marker – from the research spotlight. Many studies have claimed that HFOs were more linked to epileptogenicity than spikes. This present review aims at refining this statement in light of recent studies.

Recent findings

Analysis based on single-patient characteristics has not been able to determine which of HFOs or spikes were better marker of epileptogenic tissues. Physiological HFOs are one of the main obstacles to translate HFOs to clinical practice as separating them from pathological HFOs remains a challenge. Fast ripples (a subgroup of HFOs, 250–500 Hz) which are mostly pathological are not found in all epileptogenic tissues.

Quantified measures of HFOs and spikes give complementary results, but many barriers still persist in applying them in clinical routine. The current way of testing HFO and spike detectors and their performance in delineating the epileptogenic zone is debatable and still lacks practicality. Solutions to handle physiological HFOs have been proposed but are still at a preliminary stage.
Assessing the anterior visual pathway in optic neuritis: recent experimental and clinical aspects
Authors: Dietrich Michael , Aktas Orhan , Hartung Hans-Peter , Albrecht Philipp
Published: January 2019

Purpose of review

Multiple sclerosis (MS) and related autoimmune disorders of the central nervous system such as neuromyelitis optica spectrum disorders (NMOSD) are characterized by chronic disability resulting from autoimmune neuroinflammation, with demyelination, astrocyte damage, impaired axonal transmission and neuroaxonal loss. Novel therapeutics stopping or reversing the progression of disability are still urgently warranted. This review addresses research on optic neuritis in preclinical experimental models and their translation to clinical trials.

Recent findings

Optic neuritis can be used as paradigm for an MS relapse which can serve to evaluate the efficacy of novel therapeutics in clinical trials with a reasonable duration and cohort size. The advantage is the linear structure of the visual pathway allowing the assessment of visual function and retinal structure as highly sensitive outcome parameters. Experimental autoimmune encephalomyelitis is an inducible, inflammatory and demyelinating central nervous system disease extensively used as animal model of MS. Optic neuritis is part of the clinicopathological manifestations in a number of experimental autoimmune encephalomyelitis models. These have gained increasing interest for studies evaluating neuroprotective and/or remyelinating substances as longitudinal, visual and retinal readouts have become available.

Translation of preclinical experiments, evaluating neuroprotective or remyelinating therapeutics to clinical studies is challenging. In-vivo readouts like optical coherence tomography, offers the possibility to transfer experimental study designs to clinical optic neuritis trials.
Birds with high lifetime reproductive success experience increased telomere loss
Authors: Sudyka Joanna , Arct Aneta , Drobniak Szymon M. , Gustafsson Lars , Cichoń Mariusz
Published: January 2019

Lifetime reproductive success (LRS) is what counts in terms of evolution, but investments in reproduction entail costs for an organism. The idea that telomere dynamics may be shaped in response to such costs is already established; however, we still lack information on whether this relation translates to overall fitness. Here, we quantified LRS (number of fledged young) and longitudinal telomere dynamics of small passerine birds—the blue tits (
Cyanistes caeruleus
). We found that individual telomere erosion rate was positively associated with lifetime fledgling number. Birds with more fledged young experienced increased telomere attrition. We show that telomere attrition rate, but not telomere length, is related to individual fitness and suggest that telomere dynamics may underlie reproductive costs experienced by animals as a consequence of prioritizing their lifetime fitness. This is the first study, to our knowledge, to provide evidence that more pronounced telomere erosion is associated with higher fitness gain.
HDPE/UHMWPE hybrid nanocomposites with surface functionalized graphene oxide towards improved strength and cytocompatibility
Authors: Bhusari Shardul Atul , Sharma Vidushi , Bose Suryasarathi , Basu Bikramjit
Published: January 2019

High-density polyethylene (HDPE)-based and ultra-high molecular weight polyethylene (UHMWPE)-based composites with carbonaceous reinforcements are being widely investigated for biomedical applications. The enhancement of material properties critically depends on the nature, amount and compatibility of the reinforcement with the polymeric matrix. To this end, this study demonstrates the efficacy of a ‘dual’ hybrid approach of incorporating modified inorganic nanofiller into an optimized polyethylene blend. In particular, a unique synthesis strategy was adopted to design a covalently bonded maleated polyethylene (mPE) grafted modified graphene oxide (mGO) hybrid nanocomposite. In this scheme, polyethyleneimine (PEI) was initially attached onto GO to synthesize amine functionalized GO (GO–PEI). This is followed by mPE grafting, resulting in mGO. Melt-extrusion together with injection moulding of a polymer mix (60% HDPE–40% UHMWPE) with different proportions (less than or equal to 3 wt%) of surface functionalized GO was conducted to develop nanocomposites of different sizes and shapes. When compared with unreinforced PE blend, the nanocomposites with 1 wt% mGO exhibited an increase in ultimate tensile strength by 120% (up to 65 MPa) and elastic modulus by 40% (up to 908 MPa). The uniform dispersion of modified GO nanofillers, confirmed using X-ray micro-computed tomography and transmission electron microscopy, facilitated effective interfacial adhesion and compatibility with the hybrid polymer matrix. The variation in mechanical properties with GO/mGO addition to PE blend was critically discussed in reference to the structural modification of GO, crystallinity and nature of dispersion of fillers. Importantly, the nanocomposites support the attachment and proliferation of C2C12 murine myoblast cells over 3 days in culture in a statistically insignificant manner with respect to polymer blends without any nanofiller. Taken together, the experimental results suggest that HDPE/UHMWPE/mGO is a promising biomaterial for bone tissue engineering applications.
A model of the oscillatory mechanical forces in the conventional outflow pathway
Authors: Sherwood Joseph M. , Stamer W. Daniel , Overby Darryl R.
Published: January 2019

Intraocular pressure is regulated by mechanosensitive cells within the conventional outflow pathway, the primary route of aqueous humour drainage from the eye. However, the characteristics of the forces acting on those cells are poorly understood. We develop a model that describes flow through the conventional outflow pathway, including the trabecular meshwork (TM) and Schlemm’s canal (SC). Accounting for the ocular pulse, we estimate the time-varying shear stress on SC endothelium and strain on the TM. We consider a range of outflow resistances spanning normotensive to hypertensive conditions. Over this range, the SC shear stress increases significantly and becomes highly oscillatory. TM strain also increases, but with negligible oscillations. Interestingly, TM strain responds more to changes in outflow resistance around physiological values, while SC shear stress responds more to elevated levels of resistance. A modest increase in TM stiffness, as observed in glaucoma, suppresses TM strain and practically eliminates the influence of outflow resistance on SC shear stress. As SC and TM cells respond to mechanical stimulation by secreting factors that modulate outflow resistance, our model provides insight regarding the potential role of SC shear and TM strain as mechanosensory cues for homeostatic regulation of outflow resistance and hence intraocular pressure.