bluuebunny/crossref_metadata_2025 huggingface dataset:
A
2A
adenosine receptor functional states characterized by
19
F-NMR
Authors: Sušac Lukas , Eddy Matthew T. , Didenko Tatiana , Stevens Raymond C. , Wüthrich Kurt
Published: November 2018

Significance

G protein-coupled receptor (GPCR) signaling from the extracellular orthosteric drug binding site across the cell membrane to the intracellular contact sites with G proteins and arrestins is enabled by inherent structural plasticity, which can be observed by NMR spectroscopy. Here, we use
19
F-NMR to characterize ensembles of different, simultaneously populated conformations of the human A
2A
adenosine receptor in function-related equilibria. The NMR data support an activation model involving both induced fit and reequilibration of conformational ensembles, and experiments with a constitutively active mutant of A
2A
adenosine receptor (A
2A
AR) established correlations between NMR parameters and GPCR basal activity. The present quantitative measurements with observation of judiciously engineered
19
F-NMR probes complement a previous qualitative overall view of A
2A
AR dynamics from high-resolution NMR.
Tissue-specific contributions of
Tmem79
to atopic dermatitis and mast cell-mediated histaminergic itch
Authors: Emrick Joshua J. , Mathur Anubhav , Wei Jessica , Gracheva Elena O. , Gronert Karsten , Rosenblum Michael D. , Julius David
Published: November 2018

Significance

Atopic dermatitis (AD) is a common skin disease affecting children, but the mechanisms underlying the accompanying itch remain poorly understood. Indeed, treatments to alleviate itch in AD and the substantial morbidity it represents for patients are often unsuccessful. Here, we shed light on a form of AD associated with the loss of Tmem79 and provide insights into cellular and molecular players in this genetically driven form of the disease that has been described in mice and humans. We propose a link between this inherited form of AD and the recognized contribution of oxidative stress to this disease. Our analysis may suggest pharmacological strategies for treating patients who suffer from AD and bear mutations in Tmem79.
ErbB4 tyrosine kinase inhibition impairs neuromuscular development in zebrafish embryos
Authors: Paatero Ilkka , Veikkolainen Ville , Mäenpää Matias , Schmelzer Etienne , Belting Heinz-Georg , Pelliniemi Lauri J. , Elenius Klaus
Published: November 2018

Tyrosine kinase inhibitors are widely used in the clinic, but limited information is available about their toxicity in developing organisms. Here, we tested the effect of tyrosine kinase inhibitors targeting the ErbB receptors for their effects on developing zebrafish ( Danio rerio) embryos. Embryos treated with wide-spectrum pan-ErbB inhibitors or erbb4a-targeting antisense oligonucleotides demonstrated reduced locomotion, reduced diameter of skeletal muscle fibers, and reduced expression of muscle-specific genes, as well as reduced motoneuron length. The phenotypes in the skeletal muscle, as well as the defect in motility, were rescued both by microinjection of human ERBB4 mRNA and by transposon-mediated muscle-specific ERBB4 overexpression. The role of ErbB4 in regulating motility was further controlled by targeted mutation of the endogenous erbb4a locus in the zebrafish genome by CRISPR/Cas9. These observations demonstrate a potential for the ErbB tyrosine kinase inhibitors to induce neuromuscular toxicity in a developing organism via a mechanism involving inhibition of ErbB4 function.
Exposure of the extracellular matrix and colonization of the ovary in metastasis of fallopian-tube-derived cancer
Authors: Dean Matthew , Jin Vivian , Russo Angela , Lantvit Daniel D , Burdette Joanna E
Published: November 2018

High-grade serous ovarian cancer (HGSOC) can originate in the fallopian tube epithelium (FTE), but the role of the ovary in these tumors is unclear. Tumorigenic murine oviductal epithelial (MOE) cells allografted in the ovarian bursa resulted in aggressive tumors that spread throughout the peritoneum whereas intraperitoneal xenografting the same number of cells did not form tumors, indicating that colonization of the ovary may play a role in metastasis. Physical tearing of the ovarian surface to mimic rupture of the ovary during ovulation (independent of hormonal changes) resulted in more MOE and HGSOC cells adhering to the ovary compared with intact ovaries. More MOE cells also adhered to three-dimensional (3D) collagen and primary ovarian stromal cells than to ovarian surface epithelia, indicating that FTE cells adhered to the extracellular matrix exposed during ovulation. However, plating cells on 3D collagen reduced the viability of normal FTE but not cancer cells. Mutation of p53 (R273H or R248W) and activation of Kirsten Rat Sarcoma Viral Oncogene Homolog (KRAS) (G12V) did not increase the viability of MOE cells on 3D collagen. In contrast, loss of phosphatase and tensin homolog (PTEN) allowed MOE cells to retain normal viability on 3D collagen. Loss of PTEN activated AKT and RAC1/c-jun N-terminal kinase signaling that each contributed to the increased viability, invasion and attachment in the collagen rich ovarian microenvironment. These results show that loss of PTEN activates multiple pathways that together enhance colonization of the ovary due to access to 3D collagen, which is a critical organ in the colonization of FTE-derived HGSOC.
Evaluating the implementation and use of the regional cancer plan in Western Sweden through concept mapping
Authors: Smith Frida , Gunnarsdóttir Katrín Ásta , Genell Anna , McLinden Daniel , Vaughn Lisa , Garelius Hege , Nilsson-Ehle Herman , Lönqvist Ulf , Björk-Eriksson Thomas
Published: November 2018

Quality problem or issue

Within healthcare, policy documents are often used to strategically standardize, streamline or change how general health issues are managed for a specific patient group or treatment. Despite significant effort in developing policy and strategic planning documents, these may not have the intended impact and their value has long been questioned by practitioners.

Choice of solution

To identify barriers and affordances for the implementation and use of a strategic plan for cancer care in the Western Sweden Healthcare Region, we used Concept Mapping; a participatory mixed method approach to inquiry consisting of both qualitative and quantitative tasks intended to elicit and integrate the diverse perspectives of multiple stakeholders.

Implementation

The study was carried out between April and October 2017 and consisted of several sequential data collection steps: idea generation, sorting and rating ideas for importance and feasibility. Stakeholders from different levels and professions in cancercare participated, but the number varied in the separate steps of data collection: idea generation (n = 112), sorting (n = 16) and rating (n = 38).

Evaluation

A concept map visualized seven areas that stakeholders throughout the cancer-care process considered necessary to address in order to enable the implementation of the plan. Skills provision was considered the most important cluster but also rated as least feasible. A consistent theme emerged that information, or lack thereof, might be a barrier for the plan being put into action to a greater extent in the cancer-care units. Nine actionable ideas rated highly on both importance and feasibility were presented as a go-zone.

Lessons learned

Our results suggest that efforts might be better spent on ensuring information about and accessibility to strategic documents throughout the organization, rather than frequently updating them or producing new ones. Having sufficient skills provision seems to be the prerequisite for successful implementation.
The Risk of Heart Failure and Other Cardiovascular Hospitalizations After Early Stage Breast Cancer: A Matched Cohort Study
Authors: Abdel-Qadir Husam , Thavendiranathan Paaladinesh , Austin Peter C , Lee Douglas S , Amir Eitan , Tu Jack V , Fung Kinwah , Anderson Geoffrey M
Published: November 2018

Background

Data are limited regarding the risk of heart failure (HF) requiring hospital-based care after early stage breast cancer (EBC) and its relationship to other types of cardiovascular disease (CVD).

Methods

We conducted a population-based, retrospective cohort study of EBC patients (diagnosed April 1, 2005–March 31, 2015) matched 1:3 on birth-year to cancer-free control subjects. We identified hospitalizations and emergency department visits for CVD through March 31, 2017. We used cumulative incidence function curves to estimate CVD incidence and cause-specific regression models to compare CVD rates between cohorts. All statistical tests were two-sided.

Results

We identified 78 318 EBC patients and 234 954 control subjects. The 10-year incidence of CVD hospitalization was 10.8% (95% confidence interval [CI] = 10.5% to 11.1%) after EBC and 9.1% (95% CI = 8.9% to 9.2%) in control subjects. Ischemic heart disease was the most common reason for CVD hospitalization after EBC. After regression adjustment, the relative rates compared with control subjects remained statistically significantly elevated for HF (hazard ratio [HR] = 1.21, 95% CI = 1.14 to 1.29, P < .001), arrhythmias (HR = 1.31, 95% CI = 1.23 to 1.39, P < .001), and cerebrovascular disease (HR 1.10, 95% CI = 1.04 to 1.17, P = .002) hospitalizations. It was rare for HF hospital presentations (2.9% of cases) to occur in EBC patients without recognized risk factors (age >60 years, hypertension, diabetes, prior CVD). Anthracycline and/or trastuzumab were used in 28 950 EBC patients; they were younger than the overall cohort with lower absolute rates of CVD, hypertension, and diabetes. However, they had higher relative rates of CVD in comparison with age-matched control subjects.

Conclusions

Atherosclerotic diagnoses, rather than HF, were the most common reasons for CVD hospitalization after EBC. HF hospital presentations were often preceded by risk factors other than chemotherapy, suggesting potential opportunities for prevention.
Patient–Physician Discussions on Lung Cancer Screening: A Missed Teachable Moment to Promote Smoking Cessation
Authors: Kathuria Hasmeena , Koppelman Elisa , Borrelli Belinda , Slatore Christopher G , Clark Jack A , Lasser Karen E , Wiener Renda Soylemez
Published: November 2018

Introduction

Little is known about whether patients and physicians perceive lung cancer screening (LCS) as a teachable moment to promote smoking cessation or the degree to which physicians in “real world” settings link LCS discussions with smoking cessation counseling. We sought to characterize patient and physician perspectives of discussions about smoking cessation during LCS.

Methods

We conducted a qualitative study (interviews and focus groups) with 21 physicians and 28 smokers screened in four diverse hospitals. Transcripts were analyzed for characteristics of communication about smoking cessation and LCS, the perceived effect on motivation to quit smoking, the degree to which physicians leverage LCS as a teachable moment to promote smoking cessation, and suggestions to improve patient–physician communication about smoking cessation in the context of LCS.

Results

Patients reported that LCS made them more cognizant of the health consequences of smoking, priming them for a teachable moment. While physicians and patients both acknowledged that smoking cessation counseling was frequent, they described little connection between their discussions regarding LCS and smoking cessation counseling. Physicians identified several barriers to integrating discussions on smoking cessation and LCS. They volunteered communication strategies by which LCS could be leveraged to promote smoking cessation.

Conclusions

LCS highlights the harms of smoking to patients who are chronic, heavy smokers and thus may serve as a teachable moment for promoting smoking cessation. However, this opportunity is typically missed in clinical practice.

Implications

LCS highlights the harms of smoking to heavily addicted smokers. Yet both physicians and patients reported little connection between LCS and tobacco treatment discussions due to multiple barriers. On-site tobacco treatment programs and post-screening messaging tailored to the LCS results are needed to maximize the health outcomes of LCS, including smoking quit rates and longer-term smoking-related morbidity and mortality.
Aerobic Exercise Reduces Pressure More Than Heat Pain Sensitivity in Healthy Adults
Authors: Jones Matthew D , Nuzzo James L , Taylor Janet L , Barry Benjamin K
Published: November 2018

Objectives

The hypoalgesic effects of exercise are well described, but there are conflicting findings for different modalities of pain; in particular for mechanical vs thermal noxious stimuli, which are the most commonly used in studies of exercise-induced hypoalgesia. The aims of this study were 1) to investigate the effect of aerobic exercise on pressure and heat pain thresholds that were well equated with regard to their temporal and spatial profile and 2) to identify whether changes in the excitability of nociceptive pathways—measured using laser-evoked potentials—accompany exercise-induced hypoalgesia.

Subjects

Sixteen healthy adults recruited from the University of New South Wales.

Methods

Pressure and heat pain thresholds and pain ratings to laser stimulation and laser-evoked potentials were measured before and after aerobic cycling exercise and an equivalent period of light activity.

Results

Pressure pain thresholds increased substantially after exercise (rectus femoris: 29.6%, d = 0.82, P < 0.001; tibialis anterior: 26.9%, d = 0.61, P < 0.001), whereas heat pain thresholds did not (tibialis anterior: 4.2%, d = 0.30, P = 0.27; foot: 0.44%, d = 0.02, P = 1). Laser-evoked potentials and laser heat pain ratings also changed minimally after exercise (d = −0.59 to 0.3, P > 0.06).

Conclusions

This is the first investigation to compare the effects of exercise on pressure and heat pain using the same stimulation site and pattern. The results show that aerobic exercise reduces mechanical pain sensitivity more than thermal pain sensitivity.
Pregnancy outcomes in women with a history of immunoglobulin A vasculitis
Authors: Nossent Johannes , Raymond Warren , Keen Helen , Inderjeeth Charles , Preen David
Published: November 2018

Objectives

Case series suggest an increased risk of pregnancy complications in women with a history of IgA vasculitis (IgAV); however, no large quantitative studies have examined this possible association to date. We compared pregnancy rates and outcomes between female IgAV patients and controls and assessed flare risk of IgAV during pregnancy.

Methods

Using state-wide hospital morbidity data we compared rates for live birth, preterm birth, abortive outcome and gestational complications between female IgAV patients (International Classification of Diseases-9-Clinical Modification 287.0; International Classification of Diseases-10-Australian Modification D69.0) (n = 121) and non-exposed age-matched controls (n = 284) in Western Australia. Results presented are means compared by Kruskal–Wallis test and proportions with odds ratios (ORs) (95% CI) compared by χ2 testing.

Results

There were 247 pregnancies in IgAV patients during which no disease flares were recorded and 556 pregnancies in controls. IgAV patients were younger at first pregnancy (24.7 vs 27.0 years, P < 0.01) and had 43 unsuccessful pregnancies (17.4%) and 204 live births with 17 preterm deliveries (8.3%). Women with IgAV had increased odds of spontaneous abortion (OR 1.9, 95% CI 1.1, 3.1, P = 0.04), preterm delivery (OR 2.0, 95% CI 1.1, 3.9, P = 0.02) and gestational hypertension (OR 4.7, 95% CI 2.3, 9.8). While gravidity did not differ (mean pregnancy number 2.4 vs 2.3, P = 0.36), IgAV patients had over a two-fold greater number of obstetric visits than controls (5.1 vs 2.5, P < 0.01).

Conclusions

Hospitalization for IgAV has little impact on fertility and IgAV rarely flares during pregnancy. However, a history of IgAV associates with increased odds of spontaneous abortions, gestational hypertension and preterm delivery.
Diagnosis and Management of Atopic Dermatitis: A Review
Authors: Maliyar Khalad , Sibbald Cathryn , Pope Elena , Gary Sibbald R.
Published: November 2018

Atopic dermatitis is a chronic, relapsing, intensely pruritic inflammatory skin disease that affects both children and adults. This article provides an overview of the epidemiology, clinical features, pathophysiology, complications, and specific investigations of atopic dermatitis. The current and novel therapies for the treatment of atopic dermatitis will be discussed.

GENERAL PURPOSE:

The purpose of this learning activity is to provide information about the diagnosis and management of atopic dermatitis (AD).

TARGET AUDIENCE:

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing education activity, you should be able to:

1. Recall the diagnostic process of AD.

2. Identify nonpharmacologic therapies for skin care in patients with AD.

3. Explain the pharmacologic management of AD.
Prognostic Value of Tissue Oxygen Monitoring and Regional Cerebral Oxygen Saturation Monitoring and Their Correlation in Neurological Patients with Sepsis: A Preliminary, Prospective, Observational Study
Authors: Das Badri P. , Sharma Megha , Bansal Sonia , Philip Mariamma , Umamaheswara Rao Ganne S.
Published: November 2018

Background:

There is paucity of literature on the prognostic value of tissue oxygen saturation (StO2) and regional cerebral oxygen saturation (rSO2) in neurological patients with sepsis. In this preliminary study, we investigated the prognostic value of StO2 and rSO2 in a group of neurological patients and correlated StO2 and rSO2 with hemodynamic and metabolic parameters.

Materials and Methods:

This preliminary, prospective observational study was conducted in 45 adult neurological patients admitted to intensive care unit. Once a diagnosis of sepsis or septic shock was established, parameters of oxygenation (StO2, rSO2, central venous oxygen saturation [ScvO2]), serum lactate, illness severity scores (Acute Physiology and Chronic Health Evaluation score, Sequential Organ Failure Assessment score, Glasgow Coma Scale) were recorded at 0, 6, 12, 24, 36, and 48 hours, and once daily thereafter. Outcomes were in-hospital mortality attributable to sepsis and the Glasgow outcome score at hospital discharge.

Results:

There was a moderately positive correlation between StO2 and rSO2 at baseline (r=0.599; P=0.001). StO2, illness severity scores and serum lactate, but not rSO2, were significantly different between survivors (n=29) and nonsurvivors (n=16) at baseline and during the first 48 hours. An rSO2 of 62.5% had a sensitivity of 83% and specificity of 67% to differentiate survivors and nonsurvivors of septic shock at 48 hours. StO2 had a higher correlation with ScvO2 and serum lactate than rSO2.

Conclusions:

StO2 prognosticates survival and favorable/unfavorable outcomes in neurological patients with sepsis. The role of rSO2 in predicting survival in milder form of sepsis is doubtful.
Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness
Authors: Riegel Barbara , Jaarsma Tiny , Lee Christopher S. , Strömberg Anna
Published: November 2018

The Middle-Range Theory of Self-Care of Chronic Illness has been used widely since it was first published in 2012. With the goal of theoretical refinement in mind, we evaluated the theory to identify areas where the theory lacked clarity and could be improved. The concept of self-care monitoring was determined to be underdeveloped. We do not yet know how the process of symptom monitoring influences the symptom appraisal process. Also, the manner in which self-care monitoring and self-care management are associated was thought to need refinement. As both of these issues relate to symptoms, we decided to enrich the Middle-Range Theory with knowledge from theories about symptoms. Here, we propose a revision to the Middle-Range Theory of Self-Care of Chronic Illness where symptoms are clearly integrated with the self-care behaviors of self-care maintenance, monitoring, and management.
A New Speech, Spatial, and Qualities of Hearing Scale Short-Form: Factor, Cluster, and Comparative Analyses
Authors: Moulin Annie , Vergne Judith , Gallego Stéphane , Micheyl Christophe
Published: November 2018

Objectives:

The objective of this work was to build a 15-item short-form of the Speech Spatial and Qualities of Hearing Scale (SSQ) that maintains the three-factor structure of the full form, using a data-driven approach consistent with internationally recognized procedures for short-form building. This included the validation of the new short-form on an independent sample and an in-depth, comparative analysis of all existing, full and short SSQ forms.

Design:

Data from a previous study involving 98 normal-hearing (NH) individuals and 196 people with hearing impairments (HI), non hearing aid wearers, along with results from several other published SSQ studies, were used for developing the short-form. Data from a new and independent sample of 35 NH and 88 HI hearing aid wearers were used to validate the new short-form. Factor and hierarchical cluster analyses were used to check the factor structure and internal consistency of the new short-form. In addition, the new short-form was compared with all other SSQ forms, including the full SSQ, the German SSQ15, the SSQ12, and the SSQ5. Construct validity was further assessed by testing statistical relationships between scores and audiometric factors, including pure-tone threshold averages (PTAs) and left/right PTA asymmetry. Receiver-operating characteristic analyses were used to compare the ability of different SSQ forms to discriminate between NH and HI (HI non hearing aid wearers and HI hearing aid wearers) individuals.

Results:

Compared all other SSQ forms, including the full SSQ, the new short-form showed negligible cross-loading across the three main subscales and greater discriminatory power between NH and HI subjects (as indicated by a larger area under the receiver-operating characteristic curve), as well as between the main subscales (especially Speech and Qualities). Moreover, the new, 5-item Spatial subscale showed increased sensitivity to left/right PTA asymmetry. Very good internal consistency and homogeneity and high correlations with the SSQ were obtained for all short-forms.

Conclusions:

While maintaining the three-factor structure of the full SSQ, and exceeding the latter in terms of construct validity and sensitivity to audiometric variables, the new 15-item SSQ affords a substantial reduction in the number of items and, thus, in test time. Based on overall scores, Speech subscores, or Spatial subscores, but not Qualities subscores, the 15-item SSQ appears to be more sensitive to differences in self-evaluated hearing abilities between NH and HI subjects than the full SSQ.
The Influence of Stimulus Repetition Rate on Tone-Evoked Post-Auricular Muscle Response (PAMR) Threshold
Authors: Zakaria Mohd Normani , Abdullah Rosninda , Nik Othman Nik Adilah
Published: November 2018

Objectives:

Post-auricular muscle response (PAMR) is a large myogenic potential that can be useful in estimating behavioral hearing thresholds when the recording protocol is optimal. The main aim of the present study was to determine the influence of stimulus repetition rate on PAMR threshold.

Design:

In this repeated-measures study, 20 normally hearing adults aged between 18 and 30 years were recruited. Tone bursts (500, 1000, 2000, and 4000 Hz) were used to record PAMR thresholds at 3 different stimulus repetition rates (6.1/s, 11.1/s, and 17.1/s).

Results:

Statistically higher PAMR thresholds were found for the faster stimulus rate (17.1/s) compared with the slower stimulus rate (6.1/s) (p < 0.05). For all stimulus rates and frequencies, significant correlations were found between PAMR and pure-tone audiometry thresholds (r = 0.62 to 0.82).

Conclusions:

Even though the stimulus rate effect was significant at most of the tested frequencies, the differences in PAMR thresholds between the rates were small (<5 dB). Nevertheless, based on the correlation results, we suggest the use of 11.1/s stimulus rate when recording PAMR thresholds.
Management of large-vessel vasculitis
Authors: Salvarani Carlo , Hatemi Gulen
Published: November 2018

Purpose of review

Glucocorticoids are the mainstay of therapy for large-vessel vasculitis, but potential toxicity and frequent relapses led to studies with nonbiologic and biologic glucocorticoid-sparing agents. The aim of this review is to discuss the recent evidence for the management of giant cell arteritis (GCA) and Takayasu arteritis (TAK).

Recent findings

Tocilizumab proved to be a powerful glucocorticoid-sparing agent for GCA in a randomized placebo-controlled trial, whereas the trials with tocilizumab and abatacept failed to show a significant difference from placebo in relapse-free survival rate in TAK. Further trials are awaiting for establishing the role of abatacept and ustekinumab for GCA, and rituximab and tumor necrosis factor inhibitors, including certolizumab for TAK, as well as nonbiologic agents for both indications.

Despite recent randomized controlled trials with biologic agents, management of large-vessel vasculitis largely depends on observational studies. Well designed controlled trials using validated outcome measures in large number of patients, identification of biologic markers that could guide the choice of targeted treatments, and standardization of disease assessment including imaging modalities are unmet needs for the management of large-vessel vasculitis.
Use of Magnetic Spinal Growth Rods (MCGR) With and Without Preoperative Halo-gravity Traction (HGT) for the Treatment of Severe Early-onset Scoliosis (EOS)
Authors: Welborn Michelle C. , Krajbich Joseph Ivan , D’Amato Charles
Published: November 2018

Background:

Correction of severe scoliosis through distraction-based techniques poses a challenge. Magnetically controlled growing rod (MCGR) hardware complications are common with a 27.8% to 46.7% revision rate in under 2 years. Loss of correction and diminishing returns are the norm. Treatment of severe scoliosis with halo-gravity traction (HGT) before MCGR has not been previously reported. The purpose of this study was to assess initial correction, maintenance of correction, and complication rate in patients with severe scoliosis treated with and without HGT before MCGR.

Methods:

IRB-approved retrospective single site cohort study of a prospectively collected database. Forty-two patients underwent MCGR between 2014 and 2017 at a single site, 12 with prior growing constructs were excluded, 30 patients were included, 12 patients underwent preoperative HGT. Charts were reviewed for demographic, clinical, and radiographic information.

Results:

The HGT group had larger major curves averaging 90 (69 to 114) degrees versus 77 (56 to 113) degrees in the non-HGT group P=0.018. Percent correction on preoperative flexibility films were 17% versus 40% for those in the HGT versus non-HGT group, P=0.000. An additional 22% correction of the curve magnitude occurred between the flexibility and in-traction films representing 43% of the total correction achieved, P=0.000, was achieved. EBL, and postoperative major curve and major curve correction were not significant. Thirteen percent of patients experienced complications. Average follow-up was 712 versus 561 days in the HGT versus non-HGT groups.

Conclusions:

Large, rigid curves can achieve equivalent correction to flexible curves with HGT. Forty-three percent of the total correction achieved occurred during traction. Thirty percent of the total correction occurred at implantation of the MCGR in the HGT group versus 28% in the non-HGT group. At most recent follow-up HGT patients had statistically maintained their major curve correction better than non-HGT patients.

Level of Evidence:

Level III—therapeutic study.
Bilateral Developmental Dysplasia of the Hip: Does Closed Reduction Have a Role in Management? Outcome of Closed and Open Reduction in 92 Hips
Authors: Tennant Sally J. , Hashemi-Nejad Aresh , Calder Peter , Eastwood Deborah M.
Published: November 2018

Background:

Bilateral developmental dysplasia of the hip (DDH) is believed to have a worse outcome than unilateral DDH with the optimal treatment unclear. To define indications for treatment we report a retrospective series of 92 hips (46 patients) who underwent closed reduction (CR) and/or open reduction (OR).

Methods:

A total of 58 hips in 29 patients underwent attempted CR using our standardized protocol. In the same 12 year time period, 54 hips in 27 patients underwent an OR. Outcome measures included resolution of acetabular dysplasia, need for further surgery, development of osteonecrosis (ON), and modified Severin Grade.

Results:

CR was successful in 57% of hips; in this group secondary surgery was required in 15% and ON was seen in 12%. In the OR group, 11% failed to stabilize and required further early surgery: ON rate was 15% overall, and secondary surgery was required in 5%. In Tonnis 2/3 hips younger than 2 years, Severin grading was comparable following CR and OR, with 92% and 90% graded as Severin 1, respectively. The rate of significant ON was higher after CR in Tonnis 2/3 hips (12%) than after OR (0%). Overall, Tonnis 4 hips did badly: 94% failed CR and following OR, further surgery for redislocation/residual dysplasia was required in 21%.

Conclusions:

CR can be successful in Tonnis 2/3 bilateral hips, with acceptable rates of secondary surgery, ON, and Severin grading, the latter equivalent to open reduction. Importantly, persisting with casting of a unilateral dislocation, to allow the contra-lateral hip to stabilize, does not have an adverse effect. CR is not advised in Tonnis 4 bilateral hips. Parents should be counseled that the outcome of surgery for bilateral hips is not as good as for unilateral DDH, particularly for Tonnis 4 hips which are more difficult to stabilize and more likely to require supplementary surgery even after open reduction.

Level of evidence:

Level IV—Therapeutic Study.
An Evaluation of PROMIS in Patients With Primary or Metastatic Spine Tumors
Authors: Bernstein David N. , Bakhsh Wajeeh , Papuga Mark Owen , Menga Emmanuel N. , Rubery Paul T. , Mesfin Addisu
Published: November 2018

Study Design.

Retrospective evaluation of prospectively collected data.

Objective.

In spine tumor patients: i) to assess the correlation of Patient-reported Outcomes Measurement Information System (PROMIS) physical function (PF), pain interference (PI), and Depression scores with Oswestry Disability Index (ODI) and Neck Disability Index (NDI) scores; and ii) to assess ceiling and floor effects of PROMIS PF, PI, and Depression domains and the ODI/NDI.

Summary of Background Data.

There remains no widely used patient-reported outcome (PRO) instrument for spine tumor patients. PROMIS, a universal PRO tool, may add notable value to patient care. A paucity of work exists comparing PROMIS to legacy PRO tools in primary and metastatic spine tumor patients.

Methods.

Patients confirmed to have a primary or metastatic spine tumor were asked to complete PROMIS PF, PI, and Depression domains and either an ODI or NDI questionnaire between May 2015 and December 2017. Pearson correlation coefficients (r) were calculated. Ceiling and floor effects were determined. P < 0.05 was significant.

Results.

Eighty unique visits from 51 patients with spine tumors (44 metastatic/67 visits; 7 primary/13 visits) met our inclusion criteria. A strong correlation existed between PROMIS PI and the ODI/NDI in both primary and metastatic tumor patient subgroups (range, r = 0.75–0.86, P < 0.05). PROMIS PF and the ODI/NDI demonstrated a strong correlation among all patients (r = –0.75, P < 0.05) and in the metastatic disease subgroup (r = –0.78, P < 0.05). A strong correlation existed between PROMIS Depression and the ODI/NDI in the primary tumor subgroup (r = 0.79, P < 0.05). PROMIS Depression demonstrated the largest floor effect (13.6%); there were similar ceiling effects.

Conclusion.

PROMIS PF and PI domains correlate well with the ODI/NDI in spine tumor patients and have a similar ceiling effect but decreased floor effect. PROMIS Depression was not as well captured, except in the primary tumor subgroup.

Level of Evidence: 2
The Influence of Body Mass Index on Functional Outcomes, Satisfaction, and Return to Work After Single-level Minimally-invasive Transforaminal Lumbar Interbody Fusion
Authors: Goh Graham Seow-Hng , Liow Ming Han Lincoln , Yeo William , Ling Zhixing Marcus , Yue Wai Mun , Guo Chang Ming , Tan Seang Beng
Published: November 2018

Study Design.

Retrospective study using prospectively collected registry data.

Objectives.

To evaluate the effect of obesity on patient-reported outcome measures of pain, disability, quality of life, satisfaction, and return to work after single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Summary of Background Data.

MIS-TLIF is an appealing alternative for obese patients with potentially lower complication risk. However, there is limited data investigating the influence of obesity on outcomes 5 years after MIS-TLIF.

Methods.

Prospectively collected registry data of 296 patients who underwent single-level MIS-TLIF at a single institution were reviewed. Patients had complete 2- and 5-year follow-up data. Patients were stratified into control (<25.0 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2) groups. Outcomes assessed were visual analogue scale for back pain, leg pain, Oswestry Disability Index, Short-form 36, North American Spine Society score for neurogenic symptoms, return to work (RTW), return to function (RTF), satisfaction, and expectation fulfilment. Length of operation, length of stay, and comorbidities were recorded.

Results.

Among the patients, 156 (52.7%) had normal weight, 108 (36.5%) were overweight, and 32 (10.8%) were obese. There was no difference in length of operation or hospitalization (P > 0.05). All three groups had comparable preoperative scores at baseline (P > 0.05). At 5 years, the control group had significantly higher PCS compared with the overweight (P = 0.043) and obese groups (P = 0.007), although the change in scores was similar (P > 0.05). The rate of MCID attainment, RTW, RTF, expectation fulfilment, and satisfaction was comparable.

Conclusion.

Nonobese patients had better physical well-being in the mid-term, although obese patients experienced a comparable improvement in clinical scores. Obesity had no impact on patients’ ability to RTW or RTF. Equivalent proportions of patients were satisfied and had their expectations fulfilled up to 5 years after MIS-TLIF.

Level of Evidence: 3
The Anatomic Characteristics of the Retroperitoneal Oblique Corridor to the L1-S1 Intervertebral Disc Spaces
Authors: Wang Kai , Zhang Can , Wu Hao , Chen Zan , Chou Dean , Jian Fengzeng
Published: November 2018

Study Design.

This is a cross-sectional study.

Objective.

To investigate the oblique corridor to the L1-S1 intervertebral disc space between the psoas muscle and the great vessels in cadaveric specimens bilaterally and the location of genitofemoral nerve and the diaphragmatic crura relative to the oblique corridor.

Summary of Background Data.

Although use of oblique lumbar interbody fusion is rapidly expanding, the morphometric data related to the procedure are limited.

Methods.

Twelve fresh-frozen full-torso cadaveric specimens were dissected to examine the oblique corridor to access the L1-S1 space in a static state and with mild retraction of the psoas. The level at which the genitofemoral nerve pierces from the psoas major and the diaphragmatic crura originate from the lumbar vertebral body was also investigated.

Results.

The mean width of oblique corridor in the static state and with mild psoas retraction, respectively, were as follows: on the right side: (L1–2) 13.33 and 16.75 mm; (L2–3) 15.42 and 21.42 mm; (L3–4) 16.58 and 22.67 mm; (L4–5) 12.75 and 21.17 mm; (L5–S1) 5.92 and 12.00 mm; on the left side: (L1–2) 16.75 and 19.67 mm; (L2–3) 18.50 and 25.33 mm; (L3–4) 20.58 and 28.00 mm; (L4-5) 18.17 and 26.08 mm; and (L5-S1) 5.83 and 12.00 mm. The level at which the genitofemoral nerve pierces from the psoas major was between L2 and L4. The diaphragmatic crura originates from L1 to L3.

Conclusion.

The oblique corridor allows access to the L1-L5 discs from both sides, but it is larger on the left side. The corridor between the iliac vessels and the psoas for L5-S1 is difficult to be applied clinically. Mild psoas retraction can moderately enlarge the oblique corridor. The genitofemoral nerve and diaphragmatic crura may be encountered in this approach and should be carefully observed.

Level of Evidence: 5
Palmar Capsuloligamentous Plication in Dorsal Capitolunate Instability: Technique and Preliminary Results
Authors: Farr Sebastian , Schachinger Florian , Girsch Werner
Published: November 2018

Midcarpal instability (MCI) is a form of the carpal instability nondissociative pattern and can be differentiated into dorsal, palmar, or extrinsic MCI. Dorsal MCI can frequently be observed in adolescent or adult patients due to trauma or hyperlaxity of the palmar intrinsic carpal ligaments. Clinical stress tests and cinematography are capable to depict the ligamentous instability centered around the capitolunate area. We describe a novel technique which aims to address palmar ligamentous hyperlaxity by plication of the radioscaphocapitate, radiolunotriquetral, and arcuate ligaments, thus closing the so-called space of Poirier. This palmar technique has been used in several cases in isolated form or in conjunction with other concomitant procedures. After the floor of the carpal tunnel and thus the palmar ligaments are exposed and the weak spot meticulously verified, 2 or rarely 3 deep FibreWire pulley sutures are used for capsuloligamentous plication. Among 11 patients, 4 cases (5 operated wrists) with isolated capitolunate capsuloligamentous plication were followed at an average of 2.6 years after surgery. The results were excellent with a mean postoperative Disabilities of the Arm, Shoulder and Hand Score of 9.7 (range, 6.9 to 15.0), mean numerical rating scale of 0 at rest and 1 (range, 0 to 2) during stress. All cases stated that they were very satisfied with the result and all would definitely elect to choose the surgery again. Palmar capsuloligamentous plication has been shown to be a quick, relatively easy and reliable procedure to reduce dorsal MCI in our patient cohort.
Late-Onset Nevus Comedonicus With Follicular Epidermolytic Hyperkeratosis—Case Report and Review of the Literature
Authors: Zanniello Ramona , Pilloni Luca , Conti Brunella , Faa Gavino , Rongioletti Franco
Published: November 2018

Nevus comedonicus is a rare cutaneous follicular hamartoma, characterized by the clustering of papules with firm, blackened horny buffers. It is usually present at birth or during childhood, although few cases of late-onset disease have been described. We present a case of postmenopausal-onset nevus comedonicus in a 55-year-old white woman without relevant medical history. Skin biopsy showed the typical features of several cyst-dilated follicular structures occupied by keratotic material and the peculiar finding of epidermolytic hyperkeratosis of the follicular epithelial walls. A brief review of the clinical and histological features of other similar cases published in the literature is performed.
A Pilot Project Using Pediatricians as Initial Diagnosticians in Multidisciplinary Autism Evaluations for Young Children
Authors: Ahlers Kaitlyn , Gabrielsen Terisa P. , Ellzey Allison , Brady Anna , Litchford April , Fox Jason , Nguyen Quang-Tuyen , Carbone Paul S.
Published: November 2018

Objectives:

Wait times for autism spectrum disorder (ASD) evaluations are long, thereby delaying access to ASD-specific services. We asked how our traditional care model (requiring all patients to see psychologists for ASD diagnostic decisions) compared to an alternative model that better utilizes the available clinicians, including initial evaluation by speech, audiology, and pediatrics (trained in Level 2 autism screening tools). Pediatricians could diagnose immediately if certain about diagnosis but could refer uncertain cases to psychology. Accuracy and time to diagnosis, charges, and parent satisfaction were our main outcome measures.

Methods:

Data were gathered through record extraction (n = 244) and parent questionnaire (n = 57). We compared time to diagnosis, charges, and parent satisfaction between traditional and alternative models. Agreement between pediatrician and psychologist diagnoses was examined for a subset (n = 18).

Results:

The alternative model's time to diagnosis was 44% faster (85 vs 152 d) and 33% less costly overall. Diagnostic agreement was 93% for children with ASD diagnoses and 100% for children without ASD diagnoses. Pediatricians expressed higher diagnostic certainty about children with higher levels of ASD symptoms. Parents reported no differences in high satisfaction with experiences, family-centered care, and shared decision making.

Conclusion:

Efficient use of available clinicians with additional training in Level 2 autism screening resulted in improvements in time to diagnosis and reduced charges for families. Coordination of multidisciplinary teams makes this possible, with strategic sequencing of patients through workflow. Flexibility was key to not only allowing pediatricians to refer uncertain cases to psychology for diagnosis but also allowing for diagnosis by a pediatrician when symptomatic presentation clearly met diagnostic criteria.
Diagnostic Uncertainty in a Complex Young Man: Autism Versus Psychosis
Authors: Fogler Jason , Kuhn Jocelyn , Prock Lisa , Radesky Jenny , Gonzalez-Heydrich Joseph
Published: November 2018

CASE:

James is a 7½-year-old boy born in Vietnam to a mother with mental illness. Little is known about his early history; he spent the first 6 months of his life in an orphanage, followed by foster care and a disrupted adoption. He moved to the U.S. at age 1½ and joined his current adoptive family at age 4 years. Shortly thereafter, James' psychiatric nurse practitioner diagnosed him with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Pragmatic language and syntax deficits were also noted from an early age.

James is now exhibiting anxiety, perseverative beliefs, and regression in his toileting. He began “talking to himself in his room” and using neologisms. A school-based evaluation resulted in educational diagnoses of ADHD and ASD based on social disconnectedness and invading others' personal space. James' parents felt “something else was going on” and sought a second opinion with a multidisciplinary team (consisting of a pediatric psychologist and a developmental pediatrician). Considering James' history, previous assessments, and their assessment battery (Behavior Assessment System for Children, Behavior Rating Inventory of Executive Function, and Autism Diagnostic Observation Schedule, and Rorschach Inkblot Test), the team characterized his current symptoms as an emerging psychotic disorder.

Several consultations occurred over the next 9 months of the school term. First, clinicians in the psychiatry department confirmed symptoms of functional decline, cognitive disorganization, and hallucinations, which were attributed to post-traumatic stress rather than a psychotic disorder. Second, adding to the diagnostic uncertainty, when James started an atypical antipsychotic medication and was under good symptom control, the school team believed that ADHD—not psychosis—best accounted for his presentation. There was significant contention between the medical team and consulting school psychologist regarding the extent to which data from the parental history and Rorschach should be considered in formulating the patient's diagnosis.

Two-and-a-half years later, James was weaned off risperidone to manage a new side effect of tics. He subsequently manifested significant paranoia with reactive aggression toward peers for imagined slights and insults that he could “swear he heard.” A different school-contracted psychologist's re-evaluation corroborated the diagnosis of schizophrenia based on the several years of unfolding clinical observations. Acting from the supposition that early-onset psychosis was too rare and too stigmatizing a condition to apply to a “kid who's just having trouble paying attention,” the first school psychologist remained adamant that ADHD and ASD were the most appropriate diagnoses, and James would be ill-served “pumped full of neuroleptics.”

He returns now to the original Developmental Behavioral Pediatric consulting team. What would you do to try to bridge this impasse?
Increased Risk of Inflammatory Bowel Disease in Families with Tonsillectomy
Authors: Bager Peter , Gørtz Sanne , Feenstra Bjarke , Nyboe Andersen Nynne , Jess Tine , Frisch Morten , Melbye Mads
Published: November 2018

Background:

The possible etiologic link between tonsillectomy and inflammatory bowel diseases remains unclear. To investigate the hereditary component, we assessed the risk of inflammatory bowel disease after own tonsillectomy as well as after tonsillectomy among family members.

Methods:

A nationwide Danish cohort of 7,045,288 individuals was established and linked to comprehensive national registers with data on kinship, tonsillectomy surgery, and diagnosis of inflammatory bowel disease from all health sectors. We used Poisson regression models to estimate hospital contact rate ratios (RR) for Crohn’s disease and ulcerative colitis, with 95% confidence intervals (CI), between individuals with or without tonsillectomy, as well as between individuals with or without tonsillectomized relatives.

Results:

During 189 million person-years of follow-up between 1977 and 2014, 276,673 individuals were tonsillectomized, 22,015 developed Crohn’s disease, and 49,550 developed ulcerative colitis. Rates of inflammatory bowel disease were elevated up to 20 years after own tonsillectomy (Crohn’s disease: RR 1.52 [95% CI = 1.43, 1.61]; ulcerative colitis: RR 1.24 [95% CI = 1.18, 1.29]). RRs for Crohn’s disease was 1.22 (95% CI = 1.17, 1.27) after first-degree relatives’ tonsillectomy, 1.14 (95% CI = 1.08, 1.19) after second-degree relatives’ tonsillectomy, and 1.08 (95% CI = 1.01, 1.15) after third-degree relatives’ tonsillectomy. Corresponding RRs for ulcerative colitis were 1.10 (95% CI = 1.07, 1.13), 1.05 (95% CI = 1.01, 1.08), and 1.03 (95% CI = 0.98, 1.09).

Conclusions:

Even individuals with tonsillectomized family members were at increased risk of inflammatory bowel disease. These findings call into question a direct influence of tonsillectomy on gastrointestinal inflammation and point instead toward shared hereditary or environmental factors. See video abstract at, http://links.lww.com/EDE/B464.
Accuracy of Self-reported Abnormal Pap Smears Among Reproductive-age African-American Women
Authors: Moore Kristen R. , Baird Donna D.
Published: November 2018

Background:

Self-reported history of abnormal Pap smear is used in large public health surveys. However, literature on the accuracy of this reporting is limited. We sought to assess the validity of self-reported abnormal Pap history in a community-based sample of African-American women 24–37 years of age in the Detroit, MI, recruited from 2010 to 2012.

Methods:

We compared self-reported data on 2-year history of abnormal Pap smear to medical Pap record data (the gold standard) obtained from eligible participants. Sensitivity and specificity were evaluated to summarize the accuracy of the self-reported data. We also explored the sensitivity by severity of abnormality.

Results:

We identified 345 participants with 480 eligible Pap records. Thirty-five percent of abnormal Pap results were not identified by self-report (sensitivity/specificity: 65%/91%; kappa = 0.54). The sensitivity of reporting an abnormal Pap tended to be higher for those with a more severe abnormality.

Conclusions:

A large proportion of abnormal Pap smears were not identified by self-report in this sample of African-American women. Public health studies utilizing self-reported abnormal Pap information should be interpreted with caution.