bluuebunny/crossref_metadata_2025 huggingface dataset:
FIH‐1 engages novel binding partners to positively influence epithelial proliferation via p63
Authors: Kaplan Nihal , Dong Ying , Wang Sijia , Yang Wending , Park Jong Kook , Wang Junyi , Fiolek Elaina , Perez White Bethany , Chandel Navdeep S. , Peng Han , Lavker Robert M.
Published: November 2019

Whereas much is known about the genes regulated by ΔNp63α in keratinocytes, how ΔNp63α is regulated is less clear. During studies with the hydroxylase, factor inhibiting hypoxia‐inducible factor 1 (FIH‐1), we observed increases in epidermal ΔNp63α expression along with proliferative capacity in a conditional FIH‐1 transgenic mouse. Conversely, loss of FIH‐1 in vivo and in vitro attenuated ΔNp63α expression. To elucidate the FIH‐1/p63 relationship, BioID proteomics assays identified FIH‐1 binding partners that had the potential to regulate p63 expression. FIH‐1 interacts with two previously unknown partners, Plectin1 and signal transducer and activator of transcription 1 (STAT1) leading to the regulation of ΔNp63α expression. Two known interactors of FIH‐1, apoptosis‐stimulating of P53 protein 2 (ASPP2) and histone deacetylase 1 (HDAC1), were also identified. Knockdown of ASPP2 upregulated ΔNp63α and reversed the decrease in ΔNp63α by FIH‐1 depletion. Additionally, FIH‐1 regulates growth arrest and DNA damage‐45 alpha (GADD45α), a negative regulator of ΔNp63α by interacting with HDAC1. GADD45α knockdown rescued reduction in ΔNp63α by FIH‐1 depletion. Collectively, our data reveal that FIH‐1 positively regulates ΔNp63α in keratinocytes via variety of signaling partners: (a) Plectin1/STAT1, (b) ASPP2, and (c) HDAC1/GADD45α signaling pathways.
Conventional and unconventional interactions of the transcription factor FOXL2 uncovered by a proteome‐wide analysis
Authors: Penrad‐Mobayed May , Perrin Caroline , Herman Laetitia , Todeschini Anne‐Laure , Nigon Fabienne , Cosson Bertrand , Caburet Sandrine , Veitia Reiner A.
Published: November 2019

Beyond the study of its transcriptional target genes, the identification of the various interactors of a transcription factor (TF) is crucial to understand its diverse cellular roles. We focused on FOXL2, a winged‐helix forkhead TF important for ovarian development and maintenance. FOXL2 has been implicated in diverse cellular processes, including apoptosis, the control of cell cycle or the regulation of steroid hormone synthesis. To reliably identify partners of endogenous FOXL2, we performed a proteome‐wide analysis using co‐immunoprecipitation in the murine granulosa cell‐derived AT29c and the pituitary‐derived alpha‐T3 cell lines, using three antibodies targeting different parts of the protein. Following a stringent selection of mass spectrometry data on the basis of identification reliability and protein enrichment, we identified a core set of 255 partners common to both cell lines. Their analysis showed that we could co‐precipitate several complexes involved in mRNA processing, chromatin remodeling and DNA replication and repair. We further validated (direct and/or indirect) interactions with selected partners, suggesting an unexpected role for FOXL2 in those processes. Overall, this comprehensive analysis of the endogenous FOXL2 interactome sheds light on its numerous and diverse interactors and unconventional cellular roles.
A Qualitative Analysis of Parturients’ Experiences Using Nitrous Oxide for Labor Analgesia: It is not Just About Pain Relief
Authors: Richardson M.G. , Raymond B.L. , Baysinger C.L. , Kook B.T. , Chestnut D.H.
Published: November 2019

(Birth. 2019;46(1):97–104)

Although nitrous oxide provides less effective labor analgesia compared with neuraxial modalities, its popularity is increasing in the United States. At the authors’ tertiary center, ∼20% of women choose to use nitrous oxide, and of those who use nitrous oxide and have vaginal deliveries, 40% convert to neuraxial analgesia. Although nearly half report low or intermediate analgesic effectiveness with nitrous oxide, 93% report high satisfaction with their overall analgesia experience. Satisfaction can be difficult to assess and is influenced by many factors, including perceived involvement in medical decisions, personal expectations and quality of the patient-caregiver relationship. This study aimed to identify determinants of satisfaction in women who use nitrous oxide as their sole labor analgesic in vaginal births to better understand patient motivations to use nitrous oxide despite variable analgesic effectiveness.
Remifentanil Patient-controlled Analgesia (PCA) in Labour–in the Eye of the Storm
Authors: Melber A.A.
Published: November 2019

(Anaesthesia. 2019;74:277–279)

A recent study published by Wilson and colleagues in the Lancet has attracted a lot of media attention regarding the use of intravenous remifentanil patient-controlled analgesia (PCA) to replace intramuscular pethidine for labor analgesia. The study reported that the need for conversion to neuraxial analgesia was approximately halved with remifentanil compared with pethidine, and the rate of instrumental delivery was decreased from 26% to 15%. The conclusions of this study contradicted previous recommendations that remifentanil PCA not be considered a standard analgesic option in labor due to safety concerns. This editorial addressed the ramifications of implementing routine remifentanil PCA labor analgesia and the measures that would need to be taken to ensure maternal and neonatal safety.
Association Among County-level Economic Factors, Clinician Supply, Metropolitan or Rural Location, and Neonatal Abstinence Syndrome
Authors: Patrick S.W. , Faherty L.J. , Dick A.W. , Scott T.A. , Dudley J. , Stein B.D.
Published: November 2019

(JAMA. 2019;321(4):385–393)

Opioid use in the United States increased between 1999 and 2014, including opioid analgesics, heroin, and fentanyl. Opioid overdose deaths also increased during this time. From 2000 to 2014, the rate of neonatal abstinence syndrome (NAS) in the United States increased from 1.2 per 1000 hospital births to 80 per 1000 hospital births. The increases in both opioid overdose deaths and the rate of NAS disproportionately affected impoverished rural communities. Opioid-related complications for adults have been associated with poor access to health care, lack of economic opportunity, and diminished social capital, but links between these economic factors and opioid-related outcomes for infants have not yet been evaluated. This study aimed to examine the associations between long-term unemployment, clinician supply, and rates of NAS, while evaluating how these affect rural versus urban communities.
Are Women Antenatally Diagnosed With Abnormally Invasive Placenta Receiving Optimal Management in England? An Observational Study of Planned Place of Delivery
Authors: Sargent W. , Collins S.L.
Published: November 2019

(Acta Obstet Gynecol Scand. 2019;98:337–341)

The incidence of abnormally invasive placenta (AIP), a pregnancy complication that is frequently life threatening, has been increasing worldwide. This increase is related to the increasing cesarean delivery rate. Maternal morbidity from AIP is high, due mainly to the complexity of surgery that often requires hysterectomy and is associated with severe hemorrhage. Currently available evidence regarding the treatment of AIP suggests that antenatal diagnosis and care provided by a multidisciplinary team with significant experience in managing these patients can reduce the maternal morbidity associated with AIP. Therefore, it has been recommended that women with AIP be managed at regionalized “specialist centers” where the health care team cares for a substantial volume of patients with this disorder on a regular basis However the current management plans of obstetric units in the United Kingdom when they are confronted with a patient with is unknown. This study aimed to determine the delivery location for women in the United Kingdom with AIP to determine whether obstetric centers managed AIP cases at their facility (in-house), referred patients to centers with a higher level of care, and if they considered themselves be an AIP “specialist center.”
Early Preterm Preeclampsia Outcomes by Intended Mode of Delivery
Authors: Coviello E.M. , Iqbal S.N. , Grantz K.L. , Huang C.C. , Landy H.J. , Reddy U.M.
Published: November 2019

(Am J Obstet Gynecol. 2019;220:100.e1–100.e9)

There is a paucity of studies investigating the optimal mode of delivery for pregnant patients with preeclampsia with severe features, superimposed preeclampsia, eclampsia, or the syndrome of hemolysis, elevated liver enzymes, and low platelets in early preterm births. There is no consensus on this topic, which has not been investigated by any randomized controlled trials. To reduce the risk of maternal mortality and morbidity, early preterm delivery is often recommended when preeclampsia with severe features is diagnosed. This study aimed to compare maternal and neonatal outcomes by intended mode of delivery in pregnancies complicated by early preterm preeclampsia.
Hospital Variation in Utilization and Success of Trial of Labor After a Prior Cesarean
Authors: Xu X. , Lee H.C. , Lin H. , Lundsberg L.S. , Campbell K.H. , Lipkind H.S. , Pettker C.M. , Illuzzi J.L.
Published: November 2019

(Am J Obstet Gynecol. 2019;220:98.e1–98.e14)

Although elective repeat cesarean is commonly performed to prevent uterine rupture during labor and other complications, cesarean delivery carries risks for mother and fetus, including increased risk of maternal and neonatal morbidity. Trial of labor after cesarean (TOLAC) delivery is recommended by the American College of Obstetricians and Gynecologists for women with no contraindications. The practice of TOLAC can be influenced by factors such as provider litigation concerns, patient preference and hospital support. The aim of this study was to understand varying utilization of TOLAC in California hospitals and how this affected patient outcomes. In addition, institutional characteristics associated with varying TOLAC utilization and success rates were analyzed.
Appendicectomy During Pregnancy and the Risk of Preterm Birth: A Population Data Linkage Study
Authors: Ibiebele I. , Schnitzler M. , Nippita T. , Ford J.B.
Published: November 2019

(Aust N Z J Obstet Gynaecol. 2019;59:45–53)

The most common emergency nonobstetric abdominal surgery performed in parturients is appendicectomy, which occurs in ∼0.3% of pregnancies. Establishing the diagnosis of appendicitis is more challenging in pregnant women as a result of the physiological changes of pregnancy and the many non-specific symptoms experienced during normal pregnancy. In addition, the use of ultrasound to make the diagnosis is less effective due to the presence of the gravid uterus and computed tomography scanning is sometimes avoided to prevent fetal radiation exposure. Appendiceal perforation may occur when there are delays in the diagnosis and treatment of appendicitis, and this complication is associated with adverse pregnancy outcomes. Appendicectomy is also associated with adverse fetal outcomes, including preterm birth, but higher rates of serious outcomes such as fetal loss and preterm labor have been reported with perforation. The current study was undertaken to examine the risk of preterm birth in parturients undergoing appendicectomy, with secondary aims of assessing the risk of other adverse maternal and neonatal outcomes as well as the effect of csurgical approach (laparoscopic or open) on these outcomes.
Induction of Labour at 41 Weeks Versus Expectant Management Until 42 Weeks (INDEX): Multicentre, Randomized Noninferiority Trial
Authors: Keulen J.K.J. , Bruinsma A. , Kortekaas J.C. , van Dillen J. , Bossuyt P.M.M. , Oudijk M.A. , Duijnhoven R.G. , van Kaam A.H. , Vandenbussche F.P.H.A. , van der Post J.A.M. , Mol B.W. , de Miranda E.
Published: November 2019

(BMJ. 2019;364:I344)

Because of the fact that postterm pregnancy (defined as pregnancy extended to or beyond 42 weeks gestation) has been associated with increased perinatal morbidity and mortality, induction of labor is recommended after 42 weeks gestation. Although the probability of positive outcomes for neonates born between 40 and 42 weeks gestation is overall considered good, the risk of adverse outcomes has been shown to increase gradually after 40 weeks gestation. Several studies have found that induction of labor at 41 weeks gestation and later, rather than waiting for the onset of spontaneous labor improves perinatal outcomes. However, there is much heterogeneity among these trials based on the different outcome measures, protocols, and time frames used in the various studies. This current study compared 2 management strategies: induction of labor at 41 weeks gestation or expectant management until 42 weeks gestation with subsequent induction of labor had not begun.
The International Childbirth Initiative: 12 Steps to Safe and Respectful MotherBaby-Family Maternity Care
Authors: Lalonde A. , Herschderfer K. , Pascali-Bonaro D. , Hanson C. , Fuchtner C. , Visser G.H.A.
Published: November 2019

(Int J Gynecol Obstet. 2019;146:65–73)

An initiative to guide and support quality maternity care has been launched by the International MotherBaby Childbirth Organization (IMBCO) and the International Federation of Gynecology and Obstetrics (FIGO). “The International Childbirth Initiative (ICI): 12 Steps to Safe and Respectful MotherBaby-Family Maternity Care” is a guide to implementing evidence-based maternity care with consideration of the MotherBaby dyad and family environment. The traditional medicine model has been shifted by the development of value-based care models focusing on the partnership between the provider and the care recipient. The ICI places the “MotherBaby-Family” unit as the central recipient of care, as the health of 1 member of the MotherBaby dyad has important impacts on the other. This model incorporates the practice of midwifery as a foundation of safe and respectful care.
External Cephalic Version at Term: A Cohort Study of 18 Years’ Experience
Authors: Melo P. , Georgiou E.X. , Hedditch A. , Ellaway P. , Impey L.
Published: November 2019

(BJOG. 2019;126:493–499)

Breech presentation has been managed in part by planned cesarean section, contributing to rising cesarean section rates. External cephalic version (ECV) has been used to avoid noncephalic birth and cesarean delivery and reduce complications, including uterine scarring. Although there have been large studies documenting successful and safe ECV, these studies have left out information regarding patients with a breech presentation who did not receive ECV. This study documented the outcomes of pregnancies, both low-risk and high-risk, with a breech presentation who were referred for ECV.
Successful Fat Grafting in a Patient With Thromboangiitis Obliterans
Authors: D’Alessio Ilenia , Settembrini Alberto M. , Romagnoli Silvia , Di Luca Gabriele , Domanin Maurizio , Gabrielli Livio
Published: November 2019

Thromboangiitis obliterans, or Buerger disease, is a rare nonatherosclerotic segmental inflammatory vasculitis that generally affects young tobacco smokers. Although no surgical treatment is available, the most effective way to halt the disease's progress is smoking cessation. In this case report, a 29-year-old smoker showed up to emergency department with gangrene of his fifth left toe and extensive plantar ulceration. After investigative angiography, he was diagnosed with Buerger disease. On November 2017, he underwent fifth left toe amputation and hyperbaric therapy. Five months after amputation, the patient was rehospitalized because of surgical wound dehiscence, wide ulceration, and pain. He was treated with lipofilling using the Coleman technique. Two weeks after the fat grafting procedure, the patient suspended pain control medication, and after 2 months, the surgical wound was almost healed. Fat grafting (lipofilling) is mostly used in plastic surgery; it offers regenerative effects, with minimal discomfort for the patient. This case report demonstrates a successful alternative use of lipofilling for this unique condition and opens up new options for use of this technique in other fields.
CE: Original Research: Experiences of Diabetes Burnout: A Qualitative Study Among People with Type 1 Diabetes
Authors: Abdoli Samereh , Hessler Danielle , Vora Amit , Smither Betsy , Stuckey Heather
Published: November 2019

Background:

People with type 1 diabetes are at increased risk for diabetes burnout, resulting in suboptimal diabetes care and quality of life. While the existence of diabetes burnout is widely acknowledged, there is no evidence-based definition, means of measurement, or interventions to address it.

Objective:

This study was aimed at increasing our understanding of the lived experiences of diabetes burnout among adults with type 1 diabetes.

Methods:

A qualitative descriptive study was conducted with a sample of 18 adults with type 1 diabetes who reported a current or previous experience of diabetes burnout. Data were collected using in-depth interviews and analyzed using qualitative content analysis.

Results:

Four main themes were identified: mental, emotional, and physical exhaustion from having diabetes; detachment from illness identity, diabetes self-care, and support systems; contributing factors to diabetes burnout; and strategies for preventing or overcoming diabetes burnout.

Conclusion:

Although exhaustion is an entry point for diabetes burnout, the findings suggest that detachment from illness identity, diabetes self-care, and support systems form a core component. Detachment may explain poor outcomes in individuals experiencing diabetes burnout.
Dietary and Feeding Modifications for Older Adults
Authors: Batchelor-Murphy Melissa K. , Steinberg Francene M. , Young Heather M.
Published: November 2019

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aim to help nurses provide caregivers with the tools they need to manage their family member's health care at home.

The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers. This article is the second of two that explain the nutritional principles nurses should consider and reinforce with caregivers. Each article includes an informational tear sheet—Information for Family Caregivers—that contains links to the instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
2018 Pathway Award® winner
Authors: Harris Patience , Li Leann , McHenry Karen , Dans Maricon
Published: November 2019

Pentec Health uses Pathway to Excellence® standards and technology to reduce pain and anxiety during targeted drug delivery
Health science librarianship
Authors: Mages Keith C.
Published: November 2019

Health science librarianship may interest nurses inclined toward research, technology, and education. This article discusses the role of health science librarians as part of the clinical team.
Vaccine safety in infants and children
Authors: Barbel Paula
Published: November 2019

Immunization is crucial to maintaining public health. This article addresses the benefits of childhood vaccinations and educates parents on the myths surrounding possible adverse reactions.
Antibiotic dosing during extracorporeal membrane oxygenation: does the system matter?
Authors: Abdul-Aziz Mohd H. , Roberts Jason A.
Published: November 2019

Purpose of review

The aims of this review are to discuss the impact of extracorporeal membrane oxygenation (ECMO) on antibiotic pharmacokinetics and how this phenomenon may influence antibiotic dosing requirements in critically ill adult ECMO patients.

Recent findings

The body of literature describing antibiotic pharmacokinetic and dosing requirements during ECMO support in critically adult patients is currently scarce. However, significant development has recently been made in this research area and more clinical pharmacokinetic data have emerged to inform antibiotic dosing in these patients. Essentially, these clinical data highlight several important points that clinicians need to consider when dosing antibiotics in critically ill adult patients receiving ECMO: physicochemical properties of antibiotics can influence the degree of drug loss/sequestration in the ECMO circuit; earlier pharmacokinetic data, which were largely derived from the neonatal and paediatric population, are certainly useful but cannot be extrapolated to the critically ill adult population; modern ECMO circuitry has minimal adsorption and impact on the pharmacokinetics of most antibiotics; and pharmacokinetic changes in ECMO patients are more reflective of critical illness rather than the ECMO therapy itself.

An advanced understanding of the pharmacokinetic alterations in critically ill patients receiving ECMO is essential to provide optimal antibiotic dosing in these complex patients pending robust dosing guidelines. Antibiotic dosing in this patient population should generally align with the recommended dosing strategies for critically ill patients not on ECMO support. Performing therapeutic drug monitoring (TDM) to guide antibiotic dosing in this patient population appears useful.
Relationships Between Psychological, Social, Physical Activity, and Sleep Measures and Somatosensory Function in Individuals With Spinal Pain
Authors: Othman Rani , Dassanayake Suranga , Jayakaran Prasath , Tumilty Steve , Swain Nicola , Mani Ramakrishnan
Published: November 2019

Objective:

Somatosensory abnormalities are linked to clinical pain outcomes in individuals with spinal pain. However, a range of factors might confound the relationship between altered somatosensory function and clinical pain outcomes. This systematic review aimed to evaluate the literature to assess the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function (assessed via sensory psychophysical testing) among individuals with spinal pain.

Methods:

A comprehensive literature search was performed in 6 electronic databases from their inception to June 2018. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for the Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest.

Results:

Among the 17 factors identified in the included studies, pain catastrophizing, depression, and pain-related fear have significant negative (small to fair) associations with pain thresholds. A “very low” to “moderate” quality of evidence was found for all the investigated factors. Subgroup analysis showed a smaller effect size for pain catastrophizing/fear of movement and pain thresholds in individuals with low back pain.

Conclusions:

Psychological factors are associated negatively with pain thresholds and they need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with spinal pain.
Differences in Current Procedures for Handling of Expressed Mother's Milk in Danish Neonatal Care Units
Authors: Simonsen Marie Bendix , Hyldig Nana , Zachariassen Gitte
Published: November 2019

Background:

Mother's own milk (MOM) is preferred when feeding preterm infants. When expressed mother's milk is stored and handled, there is a risk of bacterial contamination, decreased immunological activity, and less nutritional potential.

Purpose:

The aim of this study was to investigate current routines when handling MOM in Danish neonatal intensive care units (NICUs).

Methods:

A survey was sent to all 17 NICUs in Denmark in which current practices regarding human milk handling, storage, and preparation were evaluated. Furthermore, one question sought to establish when mother's milk was believed to be colostrum. Respondents of the survey were neonatal nurses.

Results:

All 17 units responded to the survey. Only 5 of 17 units answered that human colostrum was defined as milk from the first week after birth. Refrigerator storage time varied between 24 and 72 hours. In 6 of 17 units, parents were in charge of mixing milk and fortifier. Heating of human milk was done by using microwave ovens in 4 of 17 of the units.

Implications for Practice:

This national survey established that there is significant variability in the way mother's milk is handled. Some of the procedures performed may affect the quality of the milk. It is important to implement evidence-based practice regarding storage and handling of expressed mother's milk to ensure that the quality of the milk is the best possible alternative for all preterm infants.

Implications for Research:

Prospective studies are needed to examine the association between handling of human milk and changes in composition and nutritional potential of the milk.
Advocating for Pasteurized Donor Human Milk
Authors: Schmaltz Christopher H. , Bouchet-Horwitz Julie , Summers Lisa
Published: November 2019

Background:

The American Academy of Pediatrics and the National Association of Neonatal Nurses recognize that federal policies fail to reimburse for the provision of pasteurized donor human milk (PDHM) to the very low birth-weight neonate, and have encouraged members to advocate for the inclusion of PDHM into their respective state Medicaid programs.

Purpose:

This article describes what occurred in New York State as advocates worked for reimbursement of PDHM reimbursement by Medicaid.

Method:

Tactics utilized in New York have been presented with an advocacy framework to illustrate the necessary strategic foresight required for productive engagement within the healthcare policy arena.

Results:

Examination of employed advocacy efforts targeted to remove known cost barriers associated with PDHM.

Implications for Practice:

Full utilization of PDHM within intensive care.

Implications for Future Research:

The necessity to engage in scholastic/evidence-based advocacy work.
Incidence, predictors, and impact of valgus reduction of traumatic intertrochanteric femoral fractures (OTA 31A1-3) treated with the helical blade system: Is anatomic reduction necessary? A retrospective case series
Authors: Kusnezov Nicholas , Prabhakar Gautham , Vanden Berge Dennis , Dabash Sherif , Thabet Ahmed M. , Abdelgawad Amr
Published: November 2019

Background:

The purpose of this study was to describe the incidence and variables contributing to valgus distraction following cephalomedullary fixation of intertrochanteric femoral fractures with the helical blade system and to determine whether the resulting valgus reduction affected outcomes.

Methods:

We performed a retrospective case review of cephalomedullary fixation of intertrochanteric femoral fractures between 2009 and 2016. Patients treated with the helical blade system and with at least 6 mo of follow-up were included. Demographic, injury, and surgical variables were extracted from the medical record. At final follow-up complications, including implant failure, blade migration, cut-out, periprosthetic fracture, and reoperation were recorded.

Results:

Overall, 68 consecutive patients with unilateral intertrochanteric hip fractures were included. Postoperative radiographs demonstrated valgus reduction in 30 (44.1%) patients. At final follow-up, all fractures attained uneventful union. No patient experienced periprosthetic fracture or helical blade cut-out by the time of union and final follow-up. Two patients experienced postoperative infections, both requiring reoperation. Multivariate analysis revealed that only age was marginally predictive of valgus distraction (P=0.061), while fracture stability and blade position were not. Valgus reduction was not predictive of blade migration.

Conclusions:

Valgus distraction occurred in nearly half (44%) of the patients. While younger age was marginally predictive of this phenomenon, fracture stability and helical blade position were not. Furthermore, valgus reduction had no influence on the presence or degree of blade migration, cut-out, or complications. Therefore, while anatomic reduction may yield aesthetic appeal, time and effort should not be expended on direct anatomic reduction.

Level of Evidence:

Level IV.
Correlation between ACL injury and involvement of the anterolateral ligament: A retrospective study
Authors: Hegaze Adel , Khashoggi Khalid , Alsayyad Mohammed , Hafiz Rawan , Alqrache Abdulraof , Mustafa Hesham N.
Published: November 2019

Background:

Clinical testing has demonstrated the role of the anterolateral ligament (ALL) in controlling anterolateral laxity and knee instability at high angles of flexion. Few studies have discussed the association between an anterior cruciate ligament (ACL) injury and ALL injury, specifically after residual internal rotation and a post-ACL reconstruction positive pivot-shift that could be attributed to ALL injury. The goal of this study was to assess the correlation between ALL injury and ALL injury with concomitant ACL injury using MRI.

Material and Methods:

This was a retrospective study of 246 patients with unilateral ACL knee injuries from a database that was reexamined to identify whether ALL injuries occurred in association with ACL injuries. We excluded the postoperative reconstructed cases. The charts were reviewed on the basis of the presence or absence of diagnosed ACL injury with no regard for age or sex.

Results:

Of the 246 patients with ACL injury, there were 165 (67.1%) patients with complete tears, 55 (22.4%) with partial tears, and 26 (10.6%) with sprains. There were 176 (71.5%) patients with ALL and associated ACL injuries, whereas 70 (28.5%) did not have associated ACL injuries. There was a significant statistical relationship between ACL and ALL injuries (P<0.0001).

Conclusions:

There is high incidence of ALL tears associated with ACL injuries. Clinicians should be aware of this injury and consider the possibility of simultaneous ALL and ACL repair to prevent further knee instability.

Level of Evidence:

Level IV.
Mineral and bone disorder and management in the China Dialysis Outcomes and Practice Patterns Study
Authors: Wang Jun , Bieber Brian A. , Hou Fan-Fan , Port Friedrich K. , Anand Shuchi
Published: November 2019

Background

Despite a growing population of patients starting hemodialysis in China, little is known about markers of mineral bone disease (MBD) and their management. We present data on prevalence and correlates of hypocalcemia, hyperphosphatemia, and secondary hyperparathyroidism from the China Dialysis Outcomes and Practice Patterns Study (DOPPS), with evaluation of whether these laboratory markers triggered changes in management.

Methods

We compared the frequency of measurement and prevalence of poor control of MBD markers in China DOPPS with other DOPPS regions. We also used generalized estimating equations to assess correlates of MBD markers, and separate models to assess predictors of vitamin D and phosphate binder prescriptions in the China DOPPS.

Results

Severe hyperphosphatemia (>7 mg/dL) and secondary hyperparathyroidism (>600 pg/mL) were common (27% and 21% prevalence, respectively); both were measured infrequently (14.9% and 3.2% of patients received monthly measurements in China). Frequency of dialysis sessions was positively associated with hyperphosphatemia; presence of residual kidney function was negatively associated with both hyperphosphatemia and secondary hyperparathyroidism. Laboratory measures indicating poor control of MBD were not associated with subsequent prescription of active vitamin D or phosphate binder.

Conclusions

There are substantial opportunities for improvement and standardization of MBD management in China. Development of country-specific guidelines may yield realistic targets and standardization of medication use accounting for availability and cost.
Stratified pain management counseling and implementation improving patient satisfaction: a prospective, pilot study
Authors: Peng Li-Hua , Min Su , Jin Ju-Ying , Wang Wen-Jian
Published: November 2019

Background:

Post-operative pain is unpleasant for patients and may worsen surgical recovery. Peri-operative multimodal analgesia has been used for many years; however, its efficacy still needs improvement. In the present study, a thorough peri-operative pain counseling and stratified management program based on risk assessment was implemented, with the goal of improving post-operative analgesia and patient satisfaction.

Methods:

This prospective, controlled, pilot study included 361 patients who underwent elective surgery. Of these 361 patients, 187 received peri-operative pain risk assessment and stratified analgesia and counseling (stratified analgesia group), while 174 received conventional multimodal analgesia (conventional group). The two groups were compared regarding the post-operative pain intensity, rescue analgesia administration, post-operative quality of recovery as assessed via the quality of recovery 40 questionnaire, total dosage of peri-operative opioids, analgesic satisfaction, and analgesic costs.

Results:

Compared with the conventional group, the stratified analgesia group reported decreased pain intensity during motion at 24 h post-operatively and required lower dosages of rescue analgesia (P = 0.03). The total quality of recovery 40 questionnaire score and the scores for physical wellbeing and pain were significantly better in the stratified analgesia group than the conventional group (P = 0.04); the stratified analgesia group also reported better scores for analgesic satisfaction (P = 0.03) and received lower dosages of opioids (P = 0.03). Analgesic costs were lower in the stratified analgesia group than the conventional group; the cost-effective ratio was 109 in the conventional group and 62 in the stratified analgesia group.

Conclusions:

The analgesic efficacy was improved by the implementation of stratified analgesia based on surgical pain risk assessment and counseling. This stratified analgesia protocol increased the patients’ analgesic satisfaction and improved the quality of recovery without increasing healthcare costs. The present findings may help improve the efficacy of peri-operative multimodal analgesia in clinical practice.

Clinical Trial Registry:

NCT02728973; https://clinicaltrials.gov/ct2/show/NCT02728973?term=NCT02728973&draw=2&rank=1.
Impact of Brachytherapy Boost and Dose-escalated External Beam Radiotherapy in Margin Positive Cervical Cancer Treated With Chemotherapy and Radiation
Authors: Ager Bryan J. , Torgeson Anna , Francis Samual R. , Burt Lindsay M. , Gaffney David K. , Cannon Donald M.
Published: November 2019

Objectives:

We examined the impact of brachytherapy boost (BB) and external beam radiotherapy (EBRT) dose-escalation on overall survival (OS) for women with cervical cancer receiving postoperative chemotherapy and radiation (CRT) for a positive margin following hysterectomy.

Materials and Methods:

The National Cancer Database (NCDB) was queried from 2004 to 2015 for women with nonmetastatic squamous cell carcinoma or adenocarcinoma of the cervix who had a positive margin following hysterectomy and received postoperative CRT. Patient and treatment characteristics were assessed with multivariate logistic regression. Survival analyses were performed with univariate Cox regression and Kaplan-Meier analyses. Propensity-score weighted cohorts were generated with inverse probability of treatment weighting via generalized boosted regression modeling.

Results:

Of 630 women receiving CRT, 331 (53%) received EBRT alone and 299 (47%) received EBRT+BB. Eighty-two percent had chemotherapy initiation within 2 weeks of radiation, suggesting concurrent delivery. Median EBRT dose was 5040 cGy. Intracavitary high-dose rate was the most common BB (67%). Inclusion of BB was more likely with larger tumor sizes (odds ratio=1.03, P=0.002). Women receiving EBRT+BB had improved OS compared to EBRT alone for both unweighted (hazard ratio [HR], 0.72; P=0.020) and propensity-score weighted cohorts (HR, 0.70; P=0.017), and this finding was consistent across multiple patient subsets. EBRT dose-escalation >5040 cGy was not found to be associated with OS (unweighted HR, 1.38; P=0.065 and weighted HR, 1.16; P=0.450).

Conclusion:

The addition of BB to standard CRT improved OS for women with cervical cancer and a positive margin after hysterectomy. No consistent survival benefit was seen to EBRT dose-escalation beyond 5040 cGy.
Novel Dose Escalation Approaches for Stereotactic Body Radiotherapy to Adrenal Oligometastases
Authors: Figura Nicholas B. , Oliver Daniel E. , Mohammadi Homan , Martinez Kaylee , Grass George D. , Hoffe Sarah E. , Johnstone Peter A.S. , Frakes Jessica M.
Published: November 2019

Objectives:

The role of local disease control in the oligometastatic setting is evolving. Stereotactic body radiation therapy (SBRT) is a noninvasive treatment option for oligometastases; however, using ablative radiation doses for adrenal metastases raises concern given the proximity to radiosensitive organs. Novel treatment techniques may allow for selective dose escalation to improve local control (LC) while minimizing dose to nearby critical structures.

Materials and Methods:

We retrospectively reviewed patients with adrenal oligometastases treated with SBRT from 2013 to 2018. LC, disease-free survival, and overall survival were estimated using Kaplan-Meier methods. Predictors of outcomes were evaluated by log-rank and Cox proportional hazard analyses.

Results:

We identified 45 adrenal oligometastases in 41 patients treated with SBRT. The median age at treatment was 67 years (range, 40 to 80). The most common primary histologies were non–small cell lung cancer (51%), renal cell carcinoma (24%), and small cell lung cancer (10%). The median prescription dose was 50 Gy (range, 25 to 60 Gy), with 30 (67%) lesions receiving ≥50 Gy and 14 (31%) receiving 60 Gy. In total, 26 (58%) lesions received a simultaneous-integrated boost. Of the 42 treatment simulations, 26 (62%) were supine, 5 (12%) prone, and 11 (26%) in the left lateral decubitus position. At a median follow-up of 10.5 months, there were 3 local failures with a 12-month LC rate of 96%.

Conclusions:

Adrenal SBRT for oligometastatic disease is a feasible, noninvasive option with excellent LC and minimal toxicity. Lesions in close proximity to radiosensitive organs may benefit from dynamic patient positioning and selective simultaneous-integrated boost techniques to allow for dose escalation, while also limiting toxicity risks.
Genomic and Molecular Abnormalities in Gynecologic Clear Cell Carcinoma
Authors: Marks Eric I. , Brown Victoria S. , Dizon Don S.
Published: November 2019

Gynecologic clear cell carcinoma is a rare histology, accounting for ~5% of all ovarian and endometrial cancers in the United States. Compared to other types of gynecologic cancer, they are generally less responsive to standard therapy and have an overall worse prognosis. In addition, mounting evidence suggests that the landscape of genetic and molecular abnormalities observed in these tumors is distinct from other cancers that arise from the same sites of origin. On a molecular level, these tumors characteristically display upregulation of the PI3K-AKT-mTOR and RAS-RAF-MAPK signaling axes, frequent loss of ARID1a, and overexpression of MDM2. Evidence also suggests that these tumors are more likely to express programmed death ligand 1 or demonstrate microsatellite instability than other gynecologic cancers. Despite these important differences, there has been relatively little investigation into histology-specific treatment of clear cell gynecologic cancers, representing an opportunity for new drug development. In this article, we review the unique genetic and molecular features of gynecologic clear cell cancers with an emphasis on potential therapeutic targets. The results of completed studies of treatment for clear cell carcinoma are also presented. We conclude with a discussion of ongoing clinical trials and potential avenues for future study.
Tumor Deposits in Stage III Colon Cancer
Authors: Pricolo Victor E. , Steingrimsson Jon , McDuffie Tracey J. , McHale Joshua M. , McMillen Brian , Shparber Mark
Published: November 2019

Objectives:

National Comprehensive Cancer Network (NCCN) guidelines for stage III colon cancer define low-risk versus high-risk patients based on T (1 to 3 vs. 4) and N (1 vs. 2) status, with some variations in treatment. This study analyzes the impact of tumor deposits (TDs), T and N status, poor differentiation (PD), perineural invasion (PNI), and lymphovascular invasion (LVI) on survival.

Materials and Methods:

A retrospective analysis (2010-2015) of the National Cancer Database of stage III colon cancer patients treated with both surgery and chemotherapy was conducted. Data was extracted on sex, race, age at diagnosis, Charlson-Deyo Score, histopathologic variables, and survival rates. Statistical analysis used the test of proportions, log-rank test for Kaplan-Meier curves, and Cox proportional hazard models.

Results:

For the 42,901 patients analyzed, 5-year survival rates were similar for LN+TD−(59.8%) and LN−TD+(58.2%), but significantly worse for LN+TD+(41.5%) (P<0.001). The presence of LN+TD+was more often associated with T4 (36.9%), N2 (55.1%), PD+(37.4%), PNI+(34.5%), and LVI+(69.1%), than LN+TD−or LN−TD+(P<0.001). The hazard ratios for each variable were: TD: 1.34; T4: 1.71; N2: 1.44; PD+: 1.37; PNI: 1.11; LVI+: 1.18. LN−patients with ≥3 TD+(N1c) had worse overall survival than those with 1 to 2 TD+(P<0.01), but similar to ≥4 LN+TD−(N2) and 1 to 3 LN+TD+(N1a-b). In our model, 5-year survival ranged from 23.4% for high-risk to 78.1% for low-risk patients (P<0.001).

Conclusion:

This National Cancer Database (NCDB) analysis offers greater risk stratification and may prompt consideration of changes in American Joint Committee on Cancer (AJCC) classification (N2c, in addition to N1c) to reflect the different prognosis and guide management, as well as survivorship strategies, for TD+stage III colon cancer patients.
Elderly Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion May Have Similar Clinical Outcomes, Perioperative Complications, and Fusion Rates As Their Younger Counterparts
Authors: Goh Graham Seow-Hng , Tay You Wei Adriel , Liow Ming Han Lincoln , Gatot Cheryl , Ling Zhixing Marcus , Fong Poh Ling , Soh Reuben Chee Cheong , Guo Chang Ming , Yue Wai-Mun , Tan Seang-Beng , Chen John Li-Tat
Published: November 2019

Background

Although several studies have suggested that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be especially beneficial in the elderly population due to lower operative morbidity and faster postoperative recovery, there are limited studies investigating the functional outcomes, quality of life, and satisfaction in elderly patients after MIS-TLIF. Furthermore, existing studies had substantial clinical, diagnostic, and surgical heterogeneity.

Questions/purposes

We asked if elderly patients could experience comparable (1) patient-reported pain, disability and quality of life, (2) perioperative complications, and (3) radiological fusion rates as their younger counterparts after MIS-TLIF.

Methods

Prospectively collected registry data of patients undergoing primary, single-level, MIS-TLIF for degenerative spondylolisthesis between 2012 and 2014 were reviewed. We included 168 patients, 39 of whom were at least 70 years old. Of the 129 patients younger than 70 years old, propensity-score matching was used to select 39 younger controls with adjustment for sex, BMI, American Society of Anesthesiologists score, and baseline clinical outcomes. Perioperative complications and radiologic data were compared.

Results

There was no difference in back pain (mean difference -0.3 [95% confidence interval -1.0 to 0.5]; p = 0.52); leg pain (mean difference -0.1 [95% CI to 0.6-0.5]; p = 0.85); Oswestry Disability Index (mean difference -2.9 [95% CI -8.0 to 2.2]; p = 0.26); and SF-36 physical (mean difference 3.0 [95% CI -0.7 to 6.8]; p = 0.107); and mental component summary (mean difference 1.9 [95% CI -4.5 to 8.2]; p = 0.56); up to 2 years postoperatively; 85% of younger patients and 85% of elderly patients were satisfied (p > 0.99) while 87% and 80%, respectively, had fulfilled expectations (p = 0.36). Four perioperative adverse events occurred in each group. There was also no difference in the rate of fusion (87% in younger patients and 90% in elderly patients; p = 0.135).

Conclusions

When clinical and surgical heterogeneity were minimized, elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion not only had comparable rates of perioperative complications but also experienced similar improvements in pain, function, and quality of life. A high rate of satisfaction was achieved.

Level of Evidence

Level II, prognostic study.
Unilateral Periocular Intralymphatic Histiocytosis, Associated With Rosacea (Morbihan Disease)
Authors: Belousova Irena E. , Kastnerova Liubov , Khairutdinov Vladislav R. , Kazakov Dmitry V.
Published: November 2019

Intralymphatic histiocytosis is a rare reactive skin condition characterized by a nonspecific clinical presentation and, microscopically, by the collections of mononuclear histiocytes within the lumina of dilated lymphatic vessels. We report a rare case of intralymphatic histiocytosis associated with rosacea and prominent periocular edema (Morbihan disease). The patient is a 56-year-old woman with a 12-year history of rosacea who suddenly developed edema of the right upper eyelid that persisted 6 months before she sought medical advice. Because of an unclear clinical diagnosis, surgical excision of the edematous upper eyelid was performed. The histologic slides showed interstitial edema of the dermis with dilated vascular channels and small epithelioid cell granulomas around hair follicles. In addition, there were aggregates of cells inside numerous lymphatic vessels that were immunohistochemically positive for CD45, CD4, CD68, CD163, CD64, CD14, CD11c, and lysozyme and negative for CD3, CD20, CD30, CD56, S100, CD1a, and langerin.
Perceived Family Social Support for Healthy Eating Is Related to Healthy Dietary Patterns for Native Americans
Authors: Lemacks Jennifer L. , Greer Tammy
Published: November 2019

Native Americans continue to suffer health disparities ameliorated by healthy dietary patterns. The study objective was to determine moderating effects of perceived family social support on the relationship between ethnicity and diet behaviors. Dependent variables included dietary variables, and independent variable was family social support for healthy eating. Analyses included Pearson χ2 and correlation, one-way analysis of variance, and regression tests. Higher social support was related to lower consumption of added sugars, sugar-sweetened beverages, and red/processed meats for Native Americans. More research is needed to confirm the moderating effect of family social support on dietary behaviors.