bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended Nicotine Patch Treatment Among Smokers With and Without Comorbid Psychopathology
Authors: Carroll Allison J , Mathew Amanda R , Leone Frank T , Wileyto E Paul , Miele Andrew , Schnoll Robert A , Hitsman Brian
Published: September 2018

Introduction

Individuals with psychiatric conditions smoke at higher rates than the general population and may need more intensive treatment to quit. We examined whether or not extended treatment with nicotine patch, combined with behavior counseling, would disproportionally benefit smokers with versus without a lifetime psychiatric condition.

Methods

We conducted a secondary analysis of data from an effectiveness trial of treatment with 12 counseling sessions (48 weeks) and 21-mg nicotine patch (8, 24, or 52 weeks) among 525 adult daily smokers. A structured clinical interview assessed past and current psychiatric disorders (major depression, generalized anxiety disorder, alcohol abuse and/or dependence, and substance abuse and/or dependence), as described in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Abstinence was bioverified at week 52. Logistic regression evaluated the effect of the psychiatric status × treatment duration interaction on abstinence at week 52, covarying for sociodemographics, baseline psychological symptoms, and treatment adherence.

Results

At baseline, 115 (21.9%) participants were diagnosed with one or more psychiatric conditions. The psychiatric status × treatment duration interaction was significant for week 52 abstinence (p = .027). Abstinence rates between smokers with versus without a psychiatric condition in the 24-week treatment arm (9.3% vs. 31.5% abstinent) significantly differed from the 8-week treatment arm (18.8% vs. 22.3%), p = .017. Abstinence rates for smokers with (22.5%) versus without a psychiatric condition (19.7%) in the 52-week treatment arm did not differ from those in the 8-week arm.

Conclusions

Targeted smoking cessation treatment, rather than extending treatment duration, may be especially warranted to optimize treatment for smokers with comorbid mood, anxiety, and substance use disorders.

Implications

Individuals with psychiatric conditions smoke at higher rates and have greater difficulty quitting compared to those in the general population, but little is known about how to best optimize treatment for this high tobacco burden population. The present study found that cessation response to extended duration treatment with the transdermal nicotine patch did not differ for smokers with versus without comorbid anxiety, mood, and substance use disorders in a large-scale clinical effectiveness trial. Development of targeted behavioral treatments may be required to optimize abstinence outcomes for this high-risk population, rather than simply extending the duration of pharmacotherapy treatments.
Improved Cosmetic Outcome With Bilateral Paraspinal Muscle Flap Closure Following Cervical Laminectomy and Fusion
Authors: Weinstein Gila R , Komlos Daniel , Haranhalli Neil , Houten John K
Published: September 2018

BACKGROUND

Poor cosmetic results following cervical laminectomy and fusion (CLF) are rarely considered in assessing surgical complications. Atrophy from muscle denervation and posterior bone loss may result in a sunken appearance; relative tension may lead to wide, unsightly scars. Paraspinal muscle flaps are routinely employed by plastic surgeons for closure of wound infection and dehiscence.

OBJECTIVE

To assess clinical and cosmetic results of CLF with/without a paraspinal muscle flap closure technique.

METHODS

A retrospectively collected cohort analysis was undertaken for a 12-yr period in CLF patients. During the study period, a paraspinal muscle flap closure technique was adopted. Wounds were inspected for scar width and depth using a scale devised to categorize the posterior neck contour. Minimum follow-up was 12 mo.

RESULTS

Of 159 patients, 94 wounds were evaluated of which 34 had muscle flap closure. There were no differences in age, sex, body mass index, mJOA scores, diabetes status, or number of spinal levels treated. Mean follow-up was 18.6 (12-48) and 49.8 (12-130) mo in the muscle flap and conventional closure groups respectively; contour scores were 1.20 vs 2.65 (P < .00001) and scar width was 2.8 vs 4.9 mm (P < .0001). No patient had a wound complication in the muscle flap group and 4 (7%) in the conventional closure group.

CONCLUSION

Paraspinal muscle flap closure of CLF improved cosmetic appearance in terms of wound contour and scar width. Further investigation is needed to determine any effect upon wound infection and dehiscence rates.
Use of Tubular Retractor for Resection of Colloid Cysts: Single Surgeon Experience and Review of the Literature
Authors: Eichberg Daniel G , Buttrick Simon S , Sharaf Jake M , Snelling Brian M , Shah Ashish H , Ivan Michael E , Komotar Ricardo J
Published: September 2018

BACKGROUND

Colloid cysts are challenging lesions to access. Various surgical approaches are utilized which all require brain retraction, creating focal pressure, local trauma, and potentially surgical morbidity. Recently, tubular retractors have been developed that reduce retraction pressure by distributing it radially. Such retractors may be beneficial in colloid cyst resection.

OBJECTIVE

To retrospectively review a single neurosurgeon's case series, as well as the literature, to determine the efficacy and safety profile of transtubular colloid cyst resections. We also aim to describe our operative technique for this approach.

METHODS

We conducted a retrospective review of colloid cyst resections using either ViewSite Brain Access System (Vycor Medical, Boca Raton, Florida) or BrainPath (NICO, Indianapolis, Indiana) tubular retractors performed by a single neurosurgeon from 2015 to 2017 (n = 10). A literature review was performed to find all published cases of transtubular colloid cyst resections.

RESULTS

Gross total resection was achieved in all patients. Early neurologic deficit rate was 10% (n = 1), and permanent neurologic deficit rate was 0%. There were no postoperative seizures or venous injuries. Average hospital stay was 2.0 d. There was no evidence of recurrence at average follow-up length of 13.6 mo. A literature review demonstrated nine studies (n = 77) with an overall complication rate of 7.8%.

CONCLUSION

Tubular retractors offer an attractive surgical corridor for colloid cyst resections, avoiding much of the morbidity of interhemispheric approaches, while minimizing damage to normal cortex. There were no permanent complications in our series of ten cases, and a literature review found a similarly benign safety profile.
Convenience store visitors recall cigarette advertisements even if they do not purchase cigarettes
Authors: Hwang Ji-eun , Cho Sung-il , Yang Yu-seon , Lee Joung-eun , Lee Seon-young , Oh Yu-mi
Published: September 2018

Background

This study examined the extent to which visitors to convenience stores remember the cigarette advertisements they encounter in these stores and investigated the relationships between how advertisements are recalled and attitudes toward them.

Methods

Exit surveys of 1007 visitors to three convenience stores located in Seoul, Korea, were conducted between 25 November 2015 and 7 December 2015.

Results

Of the respondents, 23.4% (n = 236) freely recalled the cigarette advertisement in the store just visited. However, the percentage of participants who correctly recalled the advertisement increased to 55.2% (n = 556) after we presented them with a card showing options for the advertisement (i.e. a cued recall task). Regardless of sex or purchasing cigarettes, free recall performance was significantly associated with age, number of weekly visits to the convenience store and current smoking status. In addition, free recall increased with having a positive attitude toward cigarette advertisements.

Conclusions

Repeated visits to convenience stores may continue to expose individuals to cigarettes and their advertisements; such exposure may subconsciously affect recall of the advertisements and maintenance of a positive attitude toward cigarette advertisements. Therefore, to denormalize smoking in society, cigarette advertising and displays at points of sale including convenience stores, should be banned.
A Market-Based Funding Liquidity Measure
Authors: Chen Zhuo , Lu Andrea
Published: September 2018

We construct a traded funding liquidity measure from stock returns. Guided by a model, we extract the measure as the return spread between two beta-neutral portfolios constructed using stocks with high and low margins, to control for their sensitivity to the aggregate funding shocks. Our measure of funding liquidity is correlated with other funding liquidity proxies. It delivers a positive risk premium that cannot be explained by existing risk factors. A model augmented by our funding liquidity measure has superior pricing performance for various portfolios. Despite evident comovement, this measure contains additional information that is not subsumed by market liquidity.

Received March 29, 2017; accepted August 8, 2018 by Editor Wayne Ferson.
Behavior change is not one size fits all: psychosocial phenotypes of childhood obesity prevention intervention participants
Authors: Burgermaster Marissa , Contento Isobel , Koch Pamela , Mamykina Lena
Published: September 2018

Variability in individuals’ responses to interventions may contribute to small average treatment effects of childhood obesity prevention interventions. But, neither the causes of this individual variability nor the mechanism by which it influences behavior are clear. We used qualitative methods to characterize variability in students’ responses to participating in a childhood obesity prevention intervention and psychosocial characteristics related to the behavior change process. We interviewed 18 students participating in a school-based curriculum and policy behavior change intervention. Descriptive coding, summary, and case-ordered descriptive meta-matrices were used to group participants by their psychosocial responses to the intervention and associated behavior changes. Four psychosocial phenotypes of responses emerged: (a) Activated—successful behavior-changers with strong internal supports; (b) Inspired—motivated, but not fully successful behavior-changers with some internal supports, whose taste preferences and food environment overwhelmed their motivation; (c) Reinforced—already practiced target behaviors, were motivated, and had strong family support; and (d) Indifferent—uninterested in behavior change and only did target behaviors if family insisted. Our findings contribute to the field of behavioral medicine by suggesting the presence of specific subgroups of participants who respond differently to behavior change interventions and salient psychosocial characteristics that differentiate among these phenotypes. Future research should examine the utility of prospectively identifying psychosocial phenotypes for improving the tailoring of nutrition behavior change interventions.
Down-Regulation of p23 in Normal Lung Epithelial Cells Reduces Toxicities From Exposure to Benzo[a]pyrene and Cigarette Smoke Condensate via an Aryl Hydrocarbon Receptor-Dependent Mechanism
Authors: Chen Jinyun , Yakkundi Poonam , Chan William K
Published: September 2018

The aryl hydrocarbon receptor (AHR) is a ligand-activated signaling molecule which controls tumor growth and metastasis, T cell differentiation, and liver development. Expression levels of this receptor protein is sensitive to the cellular p23 protein levels in immortalized cancer cell lines. As little as 30% reduction of the p23 cellular content can suppress the AHR function. Here we reported that down-regulation of the p23 protein content in normal, untransformed human bronchial/tracheal epithelial cells to 48% of its content also suppresses the AHR protein levels to 54% of its content. This p23-mediated suppression of AHR is responsible for the suppression of (1) the ligand-dependent induction of the cyp1a1 gene transcription; (2) the benzo[a]pyrene- or cigarette smoke condensate-induced CYP1A1 enzyme activity, and (3) the benzo[a]pyrene and cigarette smoke condensate-mediated production of reactive oxygen species. Reduction of the p23 content does not alter expression of oxidative stress genes and production of PGE2. Down regulation of p23 suppresses the AHR protein levels in two other untransformed cell types, namely human breast MCF-10A and mouse immune regulatory Tr1 cells. Collectively, down-regulation of p23 suppresses the AHR protein levels in normal and untransformed cells and can in principle protect our lung epithelial cells from AHR-dependent oxidative damage caused by exposure to agents from environment and cigarette smoking.
Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients
Authors: Muramatsu Takahiro , Isono Shiroh , Ishikawa Teruhiko , Nozaki-Taguchi Natsuko , Okazaki Junko , Kitamura Yuji , Murakami Noriko , Sato Yasunori
Published: September 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Complete recovery from rocuronium-induced muscle paralysis with sugammadex is reported to be delayed in elderly patients. The authors tested a hypothesis that recovery from deep neuromuscular block with low-dose sugammadex is slower (primary hypothesis) and incidence of recurarization is higher (secondary hypothesis) in elderly patients than in nonelderly patients.

Methods

In anesthetized elderly (n = 20; 76.9 ± 5.0 yr of age) and nonelderly patients (n = 20; 53.7 ± 12.8 yr of age) under deep paralysis with rocuronium, change of train-of-four ratio per minute (primary outcome variable) was measured with an acceleromyograph neuromuscular monitor during spontaneous recovery from rocuronium-induced muscle paralysis (0.6 mg/kg) and after infusion of low-dose sugammadex (50 µg · kg-1 · min-1). Recurarization was defined as the negative change of train-of-four ratio.

Results

Spontaneous train-of-four ratio recovery rate was significantly slower in the elderly group (median [25th percentile, 75th percentile]: 1.89 [1.22, 2.90] %/min) than in the nonelderly group (3.45 [1.96, 4.25] %/min, P = 0.024). Train-of-four ratio change rate in response to low-dose sugammadex was significantly slower in elderly (0.55 [–0.29, 1.54] %/min) than in the nonelderly group (1.68 [0.73, 3.13] %/min, P = 0.024). Incidence of recurarization was significantly higher in the elderly group than in the nonelderly group (35% vs. 5%, P = 0.044). Multiple linear regression analyses indicate that slower spontaneous train-of-four ratio recovery rate and impaired renal function are two major contributing factors that decrease train-of-four ratio change rate in response to low-dose sugammadex.

Conclusions

Elderly patients are at greater risk for recurarization and residual muscle paralysis when low-dose sugammadex is administered.
Brain Dynamics and Temporal Summation of Pain Predicts Neuropathic Pain Relief from Ketamine Infusion
Authors: Bosma Rachael L. , Cheng Joshua C. , Rogachov Anton , Kim Junseok A. , Hemington Kasey S. , Osborne Natalie R. , Venkat Raghavan Lakshmikumar , Bhatia Anuj , Davis Karen D.
Published: September 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Ketamine is an N-methyl-d-aspartate receptor antagonist that reduces temporal summation of pain and modulates antinociception. Ketamine infusions can produce significant relief of neuropathic pain, but the treatment is resource intensive and can be associated with adverse effects. Thus, it is crucial to select patients who might benefit from this treatment. The authors tested the hypothesis that patients with enhanced temporal summation of pain and the capacity to modulate pain via the descending antinociceptive brain pathway are predisposed to obtain pain relief from ketamine.

Methods

Patients with refractory neuropathic pain (n = 30) and healthy controls underwent quantitative sensory testing and resting-state functional magnetic resonance imaging and then completed validated questionnaires. Patients then received outpatient intravenous ketamine (0.5 to 2 mg · kg−1 · h−1; mean dose 1.1 mg · kg−1 · h−1) for 6 h/day for 5 consecutive days. Pain was assessed 1 month later. Treatment response was defined as greater than or equal to 30% pain relief (i.e., reduction in pain scores). We determined the relationship between our primary outcome measure of pain relief with pretreatment temporal summation of pain and with brain imaging measures of dynamic functional connectivity between the default mode network and the descending antinociceptive brain pathway.

Results

Approximately 50% of patients achieved pain relief (mean ± SD; Responders, 61 ± 35%; Nonresponders, 7 ± 14%). Pretreatment temporal summation was associated with the effect of ketamine (ρ = −0.52, P = 0.003) and was significantly higher in Responders (median [25th, 75th] = 200 [100, 345]) compared with Nonresponders (44 [9, 92]; P = 0.001). Pretreatment dynamic connectivity was also associated with the clinical effect of ketamine (ρ = 0.51, P = 0.004) and was significantly higher in Responders (mean ± SD, 0.55 ± 0.05) compared with Nonresponders (0.51 ± 0.03; P = 0.006). Finally, the dynamic engagement of the descending antinociceptive system significantly mediated the relationship between pretreatment pain facilitation and pain relief (95% CI, 0.005 to 0.065).

Conclusions

These findings suggest that brain and behavioral measures have the potential to prognosticate and develop ketamine-based personalized pain therapy.
Early Intervention to Improve Sucking in Preterm Newborns
Authors: Grassi* Angela , Sgherri* Giada , Chorna Olena , Marchi Viviana , Gagliardi Luigi , Cecchi Francesca , Laschi Cecilia , Guzzetta Andrea
Published: September 2018

Background:

Premature birth is associated with feeding difficulties due to inadequate coordination of sucking, swallowing, and breathing. Nonnutritive sucking (NNS) and oral stimulation interventions may be effective for oral feeding promotion, but the mechanisms of the intervention effects need further clarifications.

Purpose:

We reviewed preterm infant intervention studies with quantitative outcomes of sucking performance to summarize the evidence of the effect of interventions on specific components of sucking.

Methods:

PubMed, CINAHL, MEDLINE, EMBASE, and PSYCOLIST databases were searched for English language publications through August 2017. Studies were selected if they involved preterm infants, tested experimental interventions to improve sucking or oral feeding skills, and included outcome as an objective measure of sucking performance. Specific Medical Subject Headings (MeSH) terms were utilized.

Results:

Nineteen studies were included in this review: 15 randomized, 1 quasi-randomized, and 3 crossover randomized controlled trials. Intervention types were grouped into 6 categories (i) NNS, (ii) NNS with auditory reinforcement, (iii) sensorimotor stimulation, (iv) oral support, (v) combined training, and (vi) nutritive sucking. Efficiency parameters were positively influenced by most types of interventions, though appear to be less affected by trainings based on NNS alone.

Implications for Practice:

These findings may be useful in the clinical care of infants requiring support to achieve efficient sucking skills through NNS and oral stimulation interventions.

Implications for Research:

Further studies including quantitative measures of sucking performance outcome measures are needed in order to best understand the needs and provide more tailored interventions to preterm infants.
Air- and Bone-Conducted Sources of Feedback With an Active Middle Ear Implant
Authors: Banakis Hartl Renee M. , Easter James R. , Alhussaini Mohamed A. , Tollin Daniel J. , Jenkins Herman A.
Published: September 2018

Objectives:

Active middle ear implants (AMEI) have been used to treat hearing loss in patients for whom conventional hearing aids are unsuccessful for varied biologic or personal reasons. Several studies have discussed feedback as a potential complication of AMEI usage, though the feedback pathway is not well understood. While reverse propagation of an acoustic signal through the ossicular chain and tympanic membrane constitutes an air-conducted source of feedback, the implanted nature of the device microphone near the mastoid cortex suggests that bone conduction pathways may potentially be another significant factor. This study examines the relative contributions of potential sources of feedback during stimulation with an AMEI.

Design:

Four fresh-frozen, hemi-sectioned, human cadaver specimens were prepared with a mastoid antrostomy and atticotomy to visualize the posterior incus body. A Carina active middle ear implant actuator (Cochlear Ltd., Boulder, CO) was coupled to the incus by two means: (1) a stereotactic arm mounted independently of the specimen and (2) a fixation bracket anchored directly to the mastoid cortical bone. The actuator was driven with pure-tone frequencies in 1/4 octave steps from 500 to 6000 Hz. Acoustic sound intensity in the ear canal was measured with a probe tube microphone (Bruel & Kjær, Nærum, Denmark). Bone-conducted vibration was quantified with a single-axis laser Doppler vibrometer (Polytec Inc., Irvine, CA) from both a piece of reflective tape placed on the skin overlying the mastoid and a bone-anchored titanium screw and pedestal (Cochlear Ltd., Centennial, CO) implanted in the cortical mastoid bone.

Results:

Microphone measurements revealed ear-canal pressures of 60–89 dB SPL, peaking in the frequency range below 2 kHz. Peak LDV measurements were greatest on the mastoid bone (0.32–0.79 mm/s with mounting bracket and 0.21–0.36 mm/s with the stereotactic suspension); peak measurements on the skin ranged from 0.05 to 0.15 mm/s with the bracket and 0.03 to 0.13 mm/s with stereotactic suspension.

Conclusion:

AMEI produce both air- and bone-conducted signals of adequate strength to be detected by the implanted device microphone, potentially resulting in reamplification. Understanding the relative contribution of these sources may play an important role in the development of targeted mitigation algorithms, as well as surgical techniques emphasizing acoustic isolation.
Unexpected higher blood loss associated with higher dose ϵ-aminocaproic acid in pediatric scoliosis surgery
Authors: Lam Humphrey , Austin Thomas , Nguyen Thanh , Martus Jeffrey , Schoenecker Jonathan
Published: September 2018

The purpose of this study was to determine if a higher dosing of ϵ-aminocaproic acid (EACA) is associated with less perioperative blood loss than a lower dose. A total of 74 patients having scoliosis surgery were analyzed. Of the 74 patients, 36 patients received EACA (10 mg/kg/h) and 38 patients received EACA (33 mg/kg/h). After controlling for key variables, an infusion of 33 mg/kg/h of EACA was associated with an increase in intraoperative blood loss of 8.1 ml/kg compared with an infusion of 10 mg/kg/h of EACA. A 33 mg/kg/h intraoperative infusion is associated with higher intraoperative blood loss than an infusion at 10 mg/kg/h.
Midterm Results of the Ponseti Method for Treatment of Clubfoot in Patients With Spina Bifida
Authors: Arkin Cameron , Ihnow Stephanie , Dias Luciano , Swaroop Vineeta T.
Published: September 2018

Background:

Clubfoot occurs in 30% to 50% of patients with spina bifida. The Ponseti casting method has changed treatment of idiopathic clubfoot to a primarily nonoperative regimen. The Ponseti method is now widely applied to clubfoot in spina bifida, however, few studies report treatment outcomes. Most available studies include heterogeneous diagnoses or short-term results. The purpose of this study is to report midterm outcomes in patients with spina bifida and clubfoot treated with the Ponseti method.

Methods:

IRB-approved retrospective chart review of 17 consecutive patients (26 feet) below 1 year of age with spina bifida and clubfoot treated with Ponseti method. Charts reviewed for age at treatment initiation, number of casts, surgeries performed, recurrence of deformity, and further treatments. Primary outcome was recurrence of deformity requiring further treatment. Data were analyzed using t tests for means and χ2 tests for categorical data.

Results:

Initial correction was achieved in 26 of 26 feet patients. A total of 23 of 26 feet patients underwent a surgical procedure for the tendo-Achilles at an average age of 105 days, 12 percutaneous tenotomies (percT) and 11 open tendonectomy (openT). At average follow-up of 5 (1.8 to 7.5) years, 11 feet (42.3%) in 8 patients were successfully treated with Ponseti method. Of the 15 feet (57.7%) with recurrence, 10 required posterior releases, 4 posterior-medial-lateral releases and 1 tendon transfers. Average age at further treatment was 1.5 years (0.9 to 3.1 y). Those with recurrence required more casts before tendon surgery (7.6 vs. 6.1, P=0.02). A total of 100% patients (12/12) with percT had recurrence of deformity, compared with 18% (2/11) of patients with openT (P<0.0005).

Conclusions:

Midterm evaluation of Ponseti method for clubfoot in spina bifida shows a successful outcome in 42.3%. Recurrence with openT was significantly lower than percT and also substantially lower than previously published recurrence rates in spina bifida (33.3% to 68%). In spina bifida, Ponseti method leads to reliable initial correction and is useful to decrease extensive soft tissue release. An open excision of the Achilles should be performed. Families should be counseled about high risk of recurrence and potential need for further treatment.

Level of Evidence:

Level III—retrospective comparative study.
Validity, Reliability, and Responsiveness of the Banff Patellar Instability Instrument (BPII) in a Adolescent Population
Authors: Lafave Mark R. , Hiemstra Laurie A. , Kerslake Sarah
Published: September 2018

Background:

Health-related quality of life measures for the adolescent patellar instability population are limited. The Banff Patella Instability Instrument (BPII) is a disease-specific health-related quality of life that has been tested on a mixed adult and adolescent population but has not been exclusively tested with an adolescent population. The purpose of this study was to determine the validity, reliability, and responsiveness of the BPII within an adolescent population.

Methods:

Content validation was tested with 3 measures: floor and ceiling effects; the Cronbach alpha; readability grade level. Reliability was measured with an intraclass correlation coefficient (2, k) and the SEM. Responsiveness was measured using a 1-way analysis of variance comparing preoperative BPII scores to postoperative BPII scores at 6, 12, and 24 months. Eta squared was calculated to measure effect size.

Results:

The BPII demonstrated no floor or ceiling effects. The Cronbach alpha for the BPII ranged from 0.97 to 0.98 for the preoperative and postoperative time periods. The readability index was a mean grade level of 8.9. Test-retest reliability assessment demonstrated an intraclass correlation coefficient (2, k) of 0.99 indicating strong reliability. The SEM was 1.3. There was a statistically significant difference in BPII scores for the 4 different time interval measures (F
3, 176=50.04; P<0.001). Eta squared was 0.46 demonstrating a moderate to large effect.

Conclusions:

The BPII demonstrated validity, reliability, and responsiveness in an adolescent population. Furthermore, it has demonstrated an appropriate cognitive reading grade level of 8.9, commensurate with the mean age (16.08 y) of the population tested.

Level of Evidence:

Level III.
Ossification of the Proximal and Middle Phalangeal Condyles: Radiographic Aid in Phalangeal Neck Fracture Reduction
Authors: Dua Karan , O’Hara Nathan N. , Shusterman Igor , Abzug Joshua M.
Published: September 2018

Background:

Phalangeal neck fractures are commonly dorsally displaced and angulated. Surgical treatment is often necessary to restore the retrocondylar recess. The purpose of this study was to determine whether radiographic landmarks can serve as a reference tool for assessing phalangeal neck fracture alignment based on age and sex.

Methods:

In total, 1061 lateral finger radiographs that were interpreted as “normal” by pediatric radiologists in children aged 1 to 18 years were retrospectively reviewed. The proximal and middle phalanges of each digit had a line drawn along the volar cortex [termed the volar phalangeal line (VPL)] and a second perpendicular line was drawn at the level of the phalangeal condyle. A ratio of the anterior to posterior aspects of the phalangeal condyle was determined at the intersection of these lines. Sex of the patients was noted to determine whether it influenced the temporal course of ossification. A linear regression model was utilized to determine the annual coefficient of growth for the phalangeal condyles.

Results:

There is a temporal course of ossification of the proximal and middle phalangeal condyles. As children increase in age, the VPL will intersect the phalangeal condyle more dorsally due to the eccentric ossification. In children above 9 years of age, the VPL will reliably intersect the middle one third of the phalangeal condyle. No clinically significant difference exists between the ratios of the proximal and middle phalanges. Sex was not associated with a difference in growth. The greatest growth increase was observed in the 8 to 9-year-old interval.

Conclusions:

The phalangeal condyles ossify in an eccentric manner and the VPL will intersect the phalangeal condyle more dorsally with increasing age. The VPL and knowledge of where it should intersect the phalangeal condyle can be used as a reference guide for evaluating the reduction of proximal and middle phalangeal neck fractures in children.

Level of Evidence:

Level III.
Operative Treatment of Syndesmotic Injuries With Assisted Arthroscopic Reduction
Authors: Cabe Taylor N. , Rodriguez Kaitlyn A. , Drakos Mark C.
Published: September 2018

There continues to be a lack of consensus on the proper treatment of syndesmotic injuries in the literature. Currently, much of the operative debate lies between using a suture-button technique or transsyndesmotic screw fixation to treat the injury. There are further arguments surrounding screw fixation involving the size and number of the screws, the number of cortices, and whether or not the hardware is to be removed. For patients presenting with a syndesmotic injury, it is important to properly diagnose and address the type of injury in order to prevent long-term morbidity and ultimately, degenerative arthritis. In the case of unstable syndesmotic injuries, we advocate the use of screw fixation, using 2, fully threaded, 4.0-mm cortical screws through 4 cortices and removal of the hardware 3 months postoperatively.

Level of Evidence: Level IV.
ICU Management of Trauma Patients
Authors: Tisherman Samuel A. , Stein Deborah M.
Published: September 2018

Objectives:

To describe the current state of the art regarding management of the critically ill trauma patient with an emphasis on initial management in the ICU.

Data Sources and Study Selection:

A PubMed literature review was performed for relevant articles in English related to the management of adult humans with severe trauma. Specific topics included airway management, hemorrhagic shock, resuscitation, and specific injuries to the chest, abdomen, brain, and spinal cord.

Data Extraction and Data Synthesis:

The basic principles of initial management of the critically ill trauma patients include rapid identification and management of life-threatening injuries with the goal of restoring tissue oxygenation and controlling hemorrhage as rapidly as possible. The initial assessment of the patient is often truncated for procedures to manage life-threatening injuries. Major, open surgical procedures have often been replaced by nonoperative or less-invasive approaches, even for critically ill patients. Consequently, much of the early management has been shifted to the ICU, where the goal is to continue resuscitation to restore homeostasis while completing the initial assessment of the patient and watching closely for failure of nonoperative management, complications of procedures, and missed injuries.

Conclusions:

The initial management of critically ill trauma patients is complex. Multiple, sometimes competing, priorities need to be considered. Close collaboration between the intensivist and the surgical teams is critical for optimizing patient outcomes.
Use of Vasopressor Increases the Risk of Mortality in Traumatic Hemorrhagic Shock: A Nationwide Cohort Study in Japan
Authors: Aoki Makoto , Abe Toshikazu , Saitoh Daizoh , Hagiwara Shuichi , Oshima Kiyohiro
Published: September 2018

Objectives:

To evaluate the possible association of vasopressor use with mortality in traumatic hemorrhagic shock patients.

Design:

Retrospective cohort study.

Setting:

Traumatic hemorrhagic shock patients at 260 emergency hospitals in Japan between 2004 and 2015.

Patients:

Three-thousand five-hundred fifty-one traumatic hemorrhagic shock patients who had systolic hypotension (< 90 mm Hg) on arrival at the emergency department and a blood transfusion received within the first 24 hours.

Interventions:

The use of vasopressor for traumatic hemorrhagic shock within the first 24 hours.

Measurements and Main Results:

Among 236,698 trauma patients, 3,551 were included in the study. Overall, 198 of 459 patients (43%) in the vasopressor+ group expired compared with 481 of 3,092 patients (16%) in the vasopressor– group. Use of vasopressor had an odds ratio of 2.172 (95% CI, 1.666–2.833) for in-hospital mortality adjusted for age, gender, year of onset, cause of injury, mechanism of injury, vital signs at the emergency department, Injury Severity Score, use of prehospital IV fluid, and volume of blood transfusion within the first 24 hours. In the propensity score-matched cohort and two subgroup analyses (massive transfusion and survivable injury models), use of vasopressor was associated with higher mortality (odds ratio, 2.168; 95% C, 1.442–3.320), (odds ratio, 2.029; 95% CI, 1.414–2.911; massive transfusion model), and (odds ratio, 1.959; 95% CI, 1.364–2.814; survivable injury model).

Conclusions:

Use of vasopressor for traumatic hemorrhagic shock was associated with mortality after controlling for biases (trauma severity; volume of fluid resuscitation).
Outcomes for Invasive Melanomas Treated With Mohs Micrographic Surgery: A Retrospective Cohort Study
Authors: Degesys Catherine A. , Powell Helen B. , Hsia Ling-Lun B. , Merritt Bradley G.
Published: September 2018

BACKGROUND

Mohs micrographic surgery (MMS) has been used effectively to treat invasive melanoma.

OBJECTIVE

To further study the safety and efficacy of MMS in the treatment of invasive melanoma.

METHODS AND MATERIALS

A retrospective cohort study evaluated 123 melanomas excised using MMS with MART-1 immunostain. Local recurrence, metastasis, overall survival, and disease-free survival rates were calculated. These were compared with historical controls.

RESULTS

Among included patients, 78 were men (63%) and 45 were women (37%), with a mean age of 66.48 years. Mean follow-up time was 1,273 days (3.49 years). Local recurrence was identified in 2/123 (1.63%; 95% confidence interval, 0.20%–5.75%) lesions. Local recurrence was identified in 1/70 (1.43%; 95% confidence interval, 0.04%–7.70%) of head and neck cases. Tumor location was head and neck in 70 lesions (56.9%). Overall survival was 95.12% and disease-specific survival was 100%.

CONCLUSION

Mohs micrographic surgery is an effective treatment method for invasive melanoma, as evidenced by low recurrence rates and high rates of disease-free survival.
Trends in Medicare Billing Among Mohs Surgeons in the United States During 2012: A Retrospective Cohort Study
Authors: Tsai Sheena , Kooistra Laura J. , Conic Ruzica Z. , Bordeaux Jeremy S.
Published: September 2018

BACKGROUND

It is important to understand variability in practice patterns of Mohs surgeons.

OBJECTIVE

To examine the practice patterns of physicians performing Mohs micrographic surgery (MMS) in the United States.

METHODS and Materials

This retrospective cohort study of the 2012 Medicare Physician and Other Supplier Public Use Files includes all physicians who billed Medicare for MMS.

RESULTS

The authors found 2,067 physicians who billed Medicare for MMS in 2012. American College of Mohs Surgery (ACMS) members took a significantly higher average number of head and neck (H&N) and trunk layers compared with American Society for Mohs Surgery (ASMS) members and those with no membership (p < .001). Male surgeons, surgeons with more experience (21+ years out), surgeons in private practice, and those practicing in rural populations closed a significantly greater proportion of cases with flaps or grafts, as compared to females (p < .001), those with less experience (<21 years out) (p < .001), surgeons in academic practice (p = .004), and those practicing in urban or cluster populations (p < .001), respectively.

CONCLUSION

There is significant variability in practices of Mohs surgeons in the United States.
Traffic-related Air Pollution and Pregnancy Loss
Authors: Kioumourtzoglou Marianthi-Anna , Raz Raanan , Wilson Ander , Fluss Ronen , Nirel Ronit , Broday David M. , Yuval  , Hacker Michele R. , McElrath Thomas F. , Grotto Itamar , Koutrakis Petros , Weisskopf Marc G.
Published: September 2018

Background:

Traffic-related air pollution has been linked to multiple adverse pregnancy outcomes. However, few studies have examined pregnancy loss, targeting losses identified by hospital records, a large limitation as it does not capture events not reported to the medical system.

Methods:

We used a novel variation of the time-series design to determine the association, and identify the critical window of vulnerability, between week-to-week traffic-related air pollution and conceptions resulting in live births, using nitrogen dioxide (NO2) as a traffic emissions tracer. We used information from all live births recorded at Beth Israel Deaconess Medical Center in Boston, MA (2000–2013) and all live births in Tel Aviv District, Israel (2010–2013).

Results:

In Boston (68,969 live births), the strongest association was during the 15th week of gestation; for every 10 ppb of NO2 increase during that week, we observed a lower rate of live births (rate ratio [RR] = 0.87; 95% confidence interval [CI], 0.78, 0.97), using live birth–identified conceptions to infer pregnancy losses. In the Tel Aviv District (95,053 live births), the strongest estimate was during the 16th gestational week gestation (RR = 0.82; 95% CI, 0.76, 0.90 per 10 ppb of NO2).

Conclusions:

Using weekly conceptions ending in live birth rather than identified pregnancy losses, we comprehensively analyzed the relationship between air pollution and all pregnancy loss throughout gestation. The observed results, with remarkable similarity in two independent locations, suggest that higher traffic-related air pollution levels are associated with pregnancy loss, with strongest estimates between the 10th and 20th gestational weeks.
The acute effects of cannabis on human executive function
Authors: Oomen Priscilla P. , van Hell Hendrika H. , Bossong Matthijs G.
Published: September 2018

Cannabis remains the most frequently used illicit drug worldwide. It produces a broad range of acute effects, such as euphoria, increased heart rate and perceptual alterations. Over the last few decades, a substantial number of experiments have been conducted to provide insight into the acute effects of cannabis on cognition. Here, we systematically review studies that investigated the impact of administration of cannabis or ∆9-tetrahydrocannabinol, the main psychoactive constituent of cannabis, on human executive function, in particular, on the three principal domains of inhibition, working memory and reasoning/association. Our findings suggest that cannabis use results in acute impairment of inhibition, with the strongest effects after pulmonary administration of higher doses of ∆9-tetrahydrocannabinol. Results from neuroimaging studies indicate that these effects are predominantly modulated through neural processes in the inferior frontal gyrus. Working memory and reasoning/association are less clearly affected by cannabis administration, possibly because of compensational neural mechanisms to overcome the effects of cannabis intoxication on performance accuracy. Factors that may account for the variation in results are the extent to which a paradigm involves attentional processes, differences between studies in administration methods and variation in the patients’ history of cannabis use.
Dopamine and serotonin antagonists fail to alter the discriminative stimulus properties of ±methylenedioxymethamphetamine
Authors: Schenk Susan , Highgate Quenten
Published: September 2018

Most studies on discriminative stimulus effects of 3,4-methylenedioxymethamphetamine (MDMA) have been conducted using a relatively low dose (1.5 mg/kg), and those studies have invariably implicated serotonergic mechanisms. In contrast, dopaminergic mechanisms mediate the discriminative stimulus effects of amphetamine (AMPH). Some studies have suggested that the discriminative stimulus effects of a higher (3.0 mg/kg) dose of MDMA might rely on both serotonergic and dopaminergic mechanisms. This study aimed to determine effects of selective dopamine (DA) and serotonin (5HT) antagonists on the discriminative stimulus properties of AMPH (0.5 mg/kg) and MDMA (3.0 mg/kg). Separate groups of rats were trained to discriminate AMPH (0.5 mg/kg) or MDMA (3.0 mg/kg) from saline using a food-reinforced drug-discrimination procedure. Effects of DA (SCH 23390: 0.003–0.03 mg/kg and eticlopride: 0.03–0.3 mg/kg) or 5HT (ritanserin: 1.0–10.0 mg/kg, WAY-100635: 0.3–1.0 mg/kg and GR129375: 1.0–3.0 mg/kg) antagonists on the discriminative stimulus effects of both drugs were determined. Both DA antagonists dose-dependently decreased the AMPH but not the MDMA discrimination. None of the 5HT antagonists altered the discriminative stimulus effects of either drug. The MDMA (3.0 mg/kg) stimulus comprises both a DAergic and 5HTergic response, and the results suggest that either one is sufficient, but not required, to maintain the stimulus effects.
Antenatal Management of Placenta Accreta
Authors: HAUNSCHILD CAROLYN , YEATON-MASSEY AMANDA , LYELL DEIRDRE J.
Published: September 2018

Predelivery diagnosis of placenta accreta, increta, and percreta (from here referred to as placenta accreta, unless otherwise noted) has increasingly created opportunities to optimize antenatal management. Despite the increased frequency of placenta accreta today, occurring in as many as 1 in 533 to 1 in 272 deliveries, high-quality data are lacking for many aspects of antenatal management. This chapter will discuss antenatal management of, and risks faced by, women with suspected placenta accreta, a condition that most frequently requires a potentially morbid cesarean hysterectomy.
Efficacy of Contact Lens Care Solutions in Removing Cholesterol Deposits From Silicone Hydrogel Contact Lenses
Authors: Walther Hendrik , Subbaraman Lakshman N. , Jones Lyndon
Published: September 2018

Purpose:

To determine the efficacy of multipurpose solutions (MPSs) on the removal of cholesterol deposits from silicone hydrogel (SH) contact lens materials using an in vitro model.

Materials and Methods:

Five SH lens materials: senofilcon A, comfilcon A, balafilcon A, lotrafilcon A, and lotrafilcon B were removed from the blister pack (n=4 for each lens type), incubated for 7 days at 37°C in an artificial tear solution containing 14C radiolabeled cholesterol. Thereafter, lenses were stored in a preserved saline solution control (Sensitive Eyes Saline Plus) or cleaned with 1 of the 5 MPSs incorporating different preservatives (POLYQUAD/ALDOX, polyquaternium-1/alexidine, polyquaternium-1/PHMB, and 2 based on PHMB alone) using a rub and rinse technique, according to the manufacturer's recommendations, and stored in the MPS for a minimum of 6 hr. Lenses were then extracted with 2:1 chloroform:methanol, analyzed in a beta counter, and μg/lens of cholesterol was determined.

Results:

Balafilcon A and senofilcon A lens materials showed the highest amounts of accumulated cholesterol (0.93±0.02 μg/lens; 0.95±0.01 μg/lens, respectively), whereas lotrafilcon A and lotrafilcon B deposited the lowest amounts (0.37±0.03 μg/lens; 0.47±0.12 μg/lens, respectively). For all lens materials, the MPS preserved with POLYQUAD/ALDOX removed more deposited cholesterol than any other test solution; however, the amount of removed cholesterol contamination from the individual contact lenses was only statistically significant for balafilcon A and senofilcon A (P=0.006 and P=0.042, respectively). Sensitive eyes and the other evaluated MPSs showed no significant effect on cholesterol removal (P>0.05).

Conclusion:

Cholesterol-removal efficacy varies depending on the combination of lens material and solution. Only 1 MPS showed a statistically significant reduction of cholesterol deposit for only 2 of the 5 tested lens materials.
Acute Chemical Eye Injury and Limbal Stem Cell Deficiency—A Prospective Study in the United Kingdom
Authors: Ghosh Saurabh , Salvador-Culla Borja , Kotagiri Ajay , Pushpoth Sreekumari , Tey Adrian , Johnson Zoë K. , Figueiredo Francisco C.
Published: September 2018

Purpose:

To analyze the incidence, nature, outcomes, and complications of acute chemical eye injuries, including the incidence of limbal stem cell deficiency (LSCD) and to compare the 2 main classifications for ocular chemical injuries: Roper-Hall (RH) and Dua.

Methods:

This is a prospective, consecutive, interventional single-center study between April and October 2009 of all new patients with acute chemical eye injury presenting to the Royal Victoria Infirmary eye emergency department (EED).

Results:

Of 11,683 patients who attended the EED, 98 patients (110 eyes) presented with acute chemical eye injury (60% male). This represents an estimated annual incidence of 5.6 new cases per 100,000 population. Mean age was 36.5 years (1–78; SD 17.1 years), including 7 children (age <10 years). Fifty-one patients (52%) had work-related injuries. The most common chemical agent was alkali (78%). All 4 RH grade IV cases were unilateral, assault with ammonia, and required early amniotic membrane transplantation as per the protocol, but despite full treatment, they developed total LSCD in the affected eye.

Conclusions:

Acute chemical eye injuries are rare. Male patients in the working age group are more prone to work-related chemical injuries, whereas young children tend to have domestic injuries. Grade I, II, and III RH and Dua chemical injuries had a very good prognosis with topical treatment only, whereas RH grade IV (Dua grade IV-VI), mainly assaults with ammonia, progressed to total/severe LSCD despite appropriate management including early amniotic membrane transplantation. The Dua classification includes conjunctival involvement, having a greater value in predicting the final clinical outcome when grading chemical eye injuries.