bluuebunny/crossref_metadata_2025 huggingface dataset:
Perioperative Management and Implementation of Enhanced Recovery Programs in Gynecologic Surgery for Benign Indications
Authors: Carey Erin T. , Moulder Janelle K.
Published: June 2018

Enhanced recovery after surgery (ERAS) programs are a multimodal approach to optimize the surgical experience. Intraoperative and postoperative pain management is essential because the stress of surgery results in significant neurohormonal and metabolic shifts that can influence patient analgesia. Enhanced recovery after surgery programs address the physiologic and psychological factors that contribute to pain outcomes and overall satisfaction scores. A multimodal approach to recovery throughout the perioperative surgical experience is representative of successful pathways. Enhanced recovery after surgery programs begin in the outpatient and preadmission setting by targeting behavioral changes and modifiable risk factors for pain in addition to cultivating patient expectations. Preoperatively, ERAS allows for patients to enter surgery without a fluid deficit that was previously seen with prolonged fasting and mechanical bowel preparations. Opioid-sparing analgesic agents are provided preemptively and many have synergistic effects when administered together, resulting in fewer opioids administered in the postoperative setting. Intraoperatively, euvolemia and normothermia are essential in reducing the adverse metabolic effects of surgery. Postoperatively, pain management, reduction in postoperative nausea and vomiting, proactive mobilization, and early enteral feeing minimize patient discomfort and decrease the duration until return to baseline. Although incorporation of all phases of the ERAS pathway will maximize patient benefit, stepwise incorporation of the phases of the pathway can still improve the surgical experience at minimal cost.
What Is New in Insights and Strategies in Postpartum Hemorrhage?
Authors: Dunsmoor-Su Rebecca
Published: June 2018

This month we focus on current research in postpartum hemorrhage. Dr. Dunsmoor-Su discusses five recent publications, which are concluded with a “bottom line” that is a take-home message. A complete reference for each can be found in Box 1 on this page along with direct links to abstracts.
The Emotional Communication in Hearing Questionnaire (EMO-CHeQ): Development and Evaluation
Authors: Singh Gurjit , Liskovoi Lisa , Launer Stefan , Russo Frank
Published: June 2018

Objectives:

The objectives of this research were to develop and evaluate a self-report questionnaire (the Emotional Communication in Hearing Questionnaire or EMO-CHeQ) designed to assess experiences of hearing and handicap when listening to signals that contain vocal emotion information.

Design:

Study 1 involved internet-based administration of a 42-item version of the EMO-CHeQ to 586 adult participants (243 with self-reported normal hearing [NH], 193 with self-reported hearing impairment but no reported use of hearing aids [HI], and 150 with self-reported hearing impairment and use of hearing aids [HA]). To better understand the factor structure of the EMO-CHeQ and eliminate redundant items, an exploratory factor analysis was conducted. Study 2 involved laboratory-based administration of a 16-item version of the EMO-CHeQ to 32 adult participants (12 normal hearing/near normal hearing (NH/nNH), 10 HI, and 10 HA). In addition, participants completed an emotion-identification task under audio and audiovisual conditions.

Results:

In study 1, the exploratory factor analysis yielded an interpretable solution with four factors emerging that explained a total of 66.3% of the variance in performance the EMO-CHeQ. Item deletion resulted in construction of the 16-item EMO-CHeQ. In study 1, both the HI and HA group reported greater vocal emotion communication handicap on the EMO-CHeQ than on the NH group, but differences in handicap were not observed between the HI and HA group. In study 2, the same pattern of reported handicap was observed in individuals with audiometrically verified hearing as was found in study 1. On the emotion-identification task, no group differences in performance were observed in the audiovisual condition, but group differences were observed in the audio alone condition. Although the HI and HA group exhibited similar emotion-identification performance, both groups performed worse than the NH/nNH group, thus suggesting the presence of behavioral deficits that parallel self-reported vocal emotion communication handicap. The EMO-CHeQ was significantly and strongly (r = −0.64) correlated with performance on the emotion-identification task for listeners with hearing impairment.

Conclusions:

The results from both studies suggest that the EMO-CHeQ appears to be a reliable and ecologically valid measure to rapidly assess experiences of hearing and handicap when listening to signals that contain vocal emotion information.
Recommendations on Collecting and Storing Samples for Genetic Studies in Hearing and Tinnitus Research
Authors: Szczepek Agnieszka J. , Frejo Lidia , Vona Barbara , Trpchevska Natalia , Cederroth Christopher R. , Caria Helena , Lopez-Escamez Jose A.
Published: June 2018

Objectives:

Research on the genetic basis of tinnitus is still in its first steps. A group of scientists dedicated to tinnitus genetics within European Tinnitus Network (TINNET) network recognize that further progress requires multicenter collaborative efforts for defining contributing genes. The purpose of the present work is to provide instructions regarding collection, processing, storage, and shipment of samples intended for genetic studies in auditory research.

Design:

One part of the recommendations has a general character; another part is of particular importance for auditory healthcare practitioners such as otolaryngology physicians, audiologists, and general practitioners.

Results:

We provide a set of instructions and various options for obtaining samples. We give advice regarding sample processing, storage, and shipment and define the minimal and essential clinical information that should accompany the samples collected for genetic processing.

Conclusions:

These recommendations offer a basis to standardize and optimize collaborations between geneticists and healthcare practitioners specialized in tinnitus and hearing disorders.
An update on the role of type I interferons in systemic lupus erythematosus and Sjögren's syndrome
Authors: Thorlacius Gudny Ella , Wahren-Herlenius Marie , Rönnblom Lars
Published: June 2018

Purpose of review

Systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS) share several clinical and laboratory features, including an overexpression of type I interferon (IFN) regulated genes. The genetic background to this IFN signature and the role of the type I IFN system in the disease process have been partly clarified. Here, we summarize the latest information concerning the type I IFN system in both diseases.

Recent findings

A number of gene variants in the type I IFN signalling pathways associate with an increased risk for both SLE and pSS in several ethnicities. The function of some risk gene variants has been elucidated, as well as the importance of epigenetic changes in type I IFN regulated genes. MicroRNA-451 and miR-302d have been shown to target IFN regulatory factor 8 and 9, suggesting that noncoding RNAs can control the IFN system. A prominent type I IFN activation is related to several disease manifestations, and in SLE to a more severe disease phenotype. Phase II studies in SLE suggest beneficial effects of blocking the type I IFN receptor.

The activated type I IFN system in SLE and pSS has a strong genetic component, is important in the disease etiopathogenesis and can be targeted.
Lupus and vaccinations
Authors: Mathian Alexis , Pha Micheline , Amoura Zahir
Published: June 2018

Purpose of review

To review the latest data in the field of vaccinations in systemic lupus erythematosus (SLE), focusing on pneumococcal, seasonal influenza, herpes zoster and human papillomavirus infections.

Recent findings

Less than 40% of patients responded adequately to the 23-valent pneumococcal polysaccharide (PPS23) vaccine. A randomized controlled trial showed that sequential administration of the pneumococcal conjugate vaccine followed by the PPS23 vaccine was well tolerated but was not superior to the PPS23 vaccine alone in terms of immunogenicity. A real-life observation confirmed that annual influenza vaccination has an impact on morbidity and mortality in SLE. Three meta-analyses did not show any particular adverse effect of influenza vaccines in SLE. These vaccines are less immunogenic in SLE. A study confirmed that the quadrivalent human papillomavirus vaccine was well tolerated and highly immunogenic in SLE.

New data confirm the safety and the lower immunogenicity of pneumococcal and influenza vaccine in SLE patients. Current efforts to improve immunization coverage in SLE should focus on spreading to patients and physicians information on the safety, efficacy and usefulness of vaccines in this population.
Spondyloarthritis: new insights into clinical aspects, translational immunology and therapeutics
Authors: Bridgewood Charlie , Watad Abdulla , Cuthbert Richard J. , McGonagle Dennis
Published: June 2018

Purpose of review

The spondyloarthopathies (SpA), which encompass related diseases that were originally viewed as autoimmune, are now known to have a strong innate immune or autoinflammatory initiation phase characterized by disease localization to tissue-specific sites based on the nuances and microanatomy and immunology of those sites. This review covers recent translational advances in the field of SpA.

Recent findings

Imaging studies in SpA continue to add support for the pivotal role of enthesitis in disease initiation and expression. Although in its infancy, there is growing evidence for microbiotal intestinal dysbiosis in ankylosing spondylitis and psoriatic arthritis. The role of cytokines beyond tumour necrosis factor (TNF) continues to grow with support for the interleukin (IL)-23/17 axis being key to disease and emergent evidence for the importance of the IL-36 pathway. The treatment of inflammatory bowel disease (IBD) with vedolizumab an α4β7-integrin blocker has been associated with arthritis flares and small molecules with Janus kinase inhibition appear to be as effective as the anti-TNFs. The disparate response of different domains in SpA points towards immunological heterogeneity even within what was considered a homogeneous disease.

The clinical aspects and translational immunology and therapeutics of SpA continue to evolve and indicate the complexity of diagnosis and treatment of these conditions.
Use of the Dedicated Orthopaedic Trauma Room for Open Tibia and Femur Fractures: Does It Make a Difference?
Authors: Steeby Shaun F. , Harvin William H. , Worley John R. , Della Rocca Gregory J. , Volgas David A. , Stannard James P. , Crist Brett D.
Published: June 2018

Objective:

To assess the “Dedicated Orthopaedic Trauma Operating Room” (DOTOR) effect on management and outcomes of open tibia and femur fractures.

Design:

Retrospective chart review.

Location:

University Level I Trauma Center.

Methods:

Patients categorized into those managed in the DOTOR versus those managed in a standard on-call operating room (OCOR). Data collected include patient and injury characteristics, time to debridement, and patient outcomes.

Results:

A total of 297 patients with 347 open tibia and femur fractures were included; 154 patients (174 fractures) were managed in the DOTOR group and 143 patients (170 fractures) were managed in the OCOR group. The average time to debridement was significantly longer for DOTOR (12.9 hours) versus OCOR (5.4 hours). The DOTOR group was 9 times less likely to undergo debridement within 6 hours. The number of patients debrided within 24 hours was similar (90% for DOTOR vs. 96% OCOR). The rate of primary fracture union was significantly higher in the DOTOR (73.2% vs. 56.6%). OCOR patients were twice as likely to have an unplanned surgery. Rates of infection, nonunion, and amputation were similar.

Conclusion:

Despite earlier access to the Operating room for debridement in the OCOR group, there was no difference in the infection rate compared with the DOTOR group. However, patients managed in the DOTOR group were more likely to go on to uncomplicated fracture union and less likely to have an unplanned surgery.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Glove Perforation in Orthopaedics: Probability of Tearing Gloves During High-Risk Events in Trauma Surgery
Authors: Lakomkin Nikita , Cruz Aristides I. , Fabricant Peter D. , Georgiadis Andrew G. , Lawrence John Todd R.
Published: June 2018

Objective:

To assess the risk of glove perforation during common maneuvers or events in trauma-related orthopaedic surgical procedures.

Methods:

Four investigators executed 6 high-risk maneuvers in a simulated laboratory setting. Alternative techniques were also performed for most maneuvers. Glove integrity was examined by 2 standard methods of fluid leak testing. The rates of perforation were compared between techniques using χ2 and Fisher exact tests.

Results:

Investigators were only able to identify 14.3% of perforations. Cleaning drill bit flutes by hand had the highest overall tear rate (85%). Catching a glove along the guide wire when passing a cannulated drill bit resulted in a 50% perforation rate. Catching a glove around a rotating drill shaft had a tear rate of 40%. Palpating the end of a flexible nail cut with a wire cutter had a significantly higher perforation rate than a nail cut with a proprietary, nail-specific tool (35% vs. 5%, P = 0.022). Blind digital fracture reduction had a tear rate that was not statistically different than directly visualizing the reduction (20% vs. 15%, P = 0.5). Inserting screws while stabilizing the threads with one's fingers resulted in a perforation rate of 15%.

Conclusions:

Orthopaedic surgeons should be aware that microperforation of surgical gloves often goes undetected and should consider modifying or using alternative techniques when performing certain surgical maneuvers. The results of this study can be used by orthopaedic and surgical first assist training programs to promote safe surgical practice.
Image Analysis Software as a Strategy to Improve the Radiographic Determination of Fracture Healing
Authors: Duryea Jeffrey , Evans Christopher , Glatt Vaida
Published: June 2018

Objectives:

To develop and validate an unbiased, accurate, convenient, and inexpensive means of determining when an osseous defect has healed and recovered sufficient strength to allow weight bearing.

Methods:

A novel image processing software algorithm was created to analyze the radiographic images and produce a metric designed to reflect the bone strength. We used a rat femoral segmental defect model that provides a range of healing responses from complete union to nonunion. Femora were examined by x-ray, micro–computed tomography and mechanical testing. Accurate simulated radiographic images at different incident x-ray beam angles were produced from the micro–computed tomography data files.

Results:

The software-generated metric (SC) showed high levels of correlation with both the mechanical strength (τMech) and the polar moment of inertia (pMOI), with the mechanical testing data having the highest association. The optimization analysis yielded optimal oblique angles θB of 125 degrees for τMech and 50 degrees for pMOI. The Pearson R2 values for the optimized model were 0.71 and 0.64 for τMech and pMOI, respectively. Further validation using true radiographs also demonstrated that the metric was accurate and that the simulations were realistic.

Conclusions:

The preliminary findings suggest a very promising methodology to assess bone fracture healing using conventional radiography. With radiographs acquired at appropriate incident angles, it proved possible to accurately calculate the degree of healing and the mechanical strength of the bone. Further research is necessary to refine this approach and determine whether it translates to the human clinical setting.
Treatment failures and complications in patients with Blount disease treated with temporary hemiepiphysiodesis: a critical systematic literature review
Authors: Burghardt Rolf D. , Herzenberg John E. , Andre Strahl  , Bernius Peter , Kazim Murteza A.
Published: June 2018

This systematic review sums up the state of knowledge about complications and reasons for failure when children with Blount disease are treated with temporary hemiepiphysiodesis. Twelve studies meet the inclusion criteria. The main reported obstacles were under correction and the poor predictability of the amount of correction that was obtainable. Obese patients with severe deformity are the most challenging groups of patients in the treatment of angular deformities. Patients with Blount disease require a careful evaluation regarding the deformity, age, body weight, and social background to reach the optimal treatment strategy. If hemiepiphysiodesis fails, osteotomy remains the preferred salvage procedure. Level of Evidence: IV.
The Peritubercle Lucency Sign is a Common and Early Radiographic Finding in Slipped Capital Femoral Epiphysis
Authors: Maranho Daniel A. , Miller Patricia E. , Novais Eduardo N.
Published: June 2018

Background:

A rotational mechanism of slipped capital femoral epiphysis (SCFE) in which the epiphyseal tubercle acts as a fulcrum has been recently described. However, there is limited radiographic evidence supporting this theory. We aimed to investigate whether a radiographic lucency around the epiphyseal tubercle (peritubercle lucency sign) could be observed before or at the diagnosis of a subsequent slip in patients initially presenting with unilateral SCFE.

Methods:

We evaluated 70 patients with unilateral SCFE who were followed until a contralateral slip was diagnosed, and 180 patients with unilateral SCFE who had no contralateral slip until skeletal maturity between 2000 and 2017. We revised anteroposterior and lateral radiographs from the initial presentation, surveillance, and diagnosis of a contralateral SCFE. The presence or absence of the peritubercle lucency sign in the contralateral initially uninvolved hip was recorded for every radiograph. The presence of hip pain, and the presence of classic radiographic parameters for SCFE diagnosis (epiphyseal tilt and Klein’s line) were recorded when the peritubercle lucency sign became noticeable.

Results:

The peritubercle lucency sign was observed in 84% [59/70; 95% confidence interval (CI), 73%-92%] of the patients who developed contralateral slip. Most patients (46/59=78%; 95% CI, 65%-87%; P<0.001) had the peritubercle lucency sign visible within 9 months after the initial diagnosis of unilateral SCFE. The sign preceded the definitive diagnosis of the contralateral slip at a median of 9 weeks (interquartile range, 0 to 10 wk). At the time of first observation of the peritubercle lucency sign, 36% (25/70; 95% CI, 25%-48%) of the patients were asymptomatic and 49% (34/70; 95% CI, 36%-61%) of the hips showed no abnormalities in the tilt angle or the Klein line. Among patients who did not experience a contralateral slip (n=180), the sign was observed in 2 patients (1.1%; 95% CI, 0.2%-4.4%). The sensitivity was 84% and specificity was 99%.

Conclusions:

A peritubercle lucency is an early imaging sign, present in >80% of contralateral slips following an initial presentation of unilateral SCFE. The presence of the peritubercle lucency sign may be helpful for contralateral hip surveillance. Future studies are necessary to establish the clinical validity of the peritubercle lucency sign and whether it may serve as a predictor of contralateral involvement.

Level of Evidence:

Diagnostic level III.
Idiopathic Early-onset Scoliosis: Growing Rods Versus Vertically Expandable Prosthetic Titanium Ribs at 5-year Follow-up
Authors: Bachabi Malick , McClung Anna , Pawelek Jeff B. , El Hawary Ron , Thompson George H. , Smith John T. , Vitale Michael G. , Akbarnia Behrooz A. , Sponseller Paul D.
Published: June 2018

Background:

Distraction-based techniques allow spinal growth until skeletal maturity while preventing curve progression.

Methods:

Two multicenter early-onset scoliosis databases were used to identify patients with idiopathic spine abnormalities treated with traditional growing rods (TGR) or vertically expandable titanium ribs (VEPTR). Patients underwent at least 4 lengthenings and had at least 5-year follow-up. Significance was set at P<0.05.

Results:

In total, 50 patients treated with TGR and 22 treated with VEPTR were included. Mean (±SD) age at surgery was 5.5 (±2.0) years for the TGR group versus 4.3 (±1.9) years for the VEPTR group (P=0.044); other demographic parameters were similar. VEPTR patients had more procedures (mean 15±4.2) than TGR patients (mean 10±4.0) (P=0.001). Unilateral constructs were present in 18% (4 of 22) of VEPTR and 16% (8 of 50) of TGR patients. Bilateral constructs spanned a mean 2.1 additional surgical levels and exposed patients to 1.6 fewer procedures than unilateral constructs. Curve correction was similar between bilateral and unilateral constructs. TGR patients experienced greater curve correction (50%) than VEPTR patients (27%) (P<0.001) and achieved a greater percentage of thoracic height gain (24%) than VEPTR patients (12%) (P=0.024). At latest follow-up, TGR patients had better maintenance of curve correction, less kyphosis, and 15% greater absolute gain in thoracic height versus VEPTR patients. TGR patients had a lower rate of wound complications (14%) than VEPTR patients (41%) (P=0.011).

Conclusions:

In patients with idiopathic early-onset scoliosis, TGRs produced greater initial curve correction, greater thoracic height gains, less kyphosis, and lower incidence of wound complications compared with VEPTR.

Level of Evidence:

Level III.
Spondylolisthesis is Common, Early, and Severe in Loeys-Dietz Syndrome
Authors: Kirby David J. , Dietz Harry C. , Sponseller Paul D.
Published: June 2018

Background:

We studied the prevalence and treatment outcomes of spondylolisthesis in patients with Loeys-Dietz syndrome (LDS).

Methods:

Clinical data and lumbosacral imaging of 138 patients with LDS were reviewed. Spondylolisthesis (L4-L5 or L5-S1) and spondylolysis were characterized by multimodal imaging and correlated with clinical data. Treatments and outcomes were characterized for patients with spondylolisthesis. Associations were determined using the Fisher exact, Mann-Whitney, and Student t tests (α=0.05).

Results:

Twenty-four patients (17%) had spondylolysis and 23 (17%) had spondylolisthesis. Median age at spondylolisthesis diagnosis was 11 (interquartile range, 9.5) years. In patients in whom measurement was possible (n=20), mean (±SD) slip was 48% (±35%). Nineteen patients had L5-S1 slip and 4 had L4-L5 slip. Of the patients with spondylolisthesis, 5 had no evidence of spondylolysis; of those with spondylolysis, all but 6 had spondylolisthesis. Eleven patients with spondylolisthesis underwent posterior spinal fusion (PSF) to treat slip progression, pain, and/or neurological deficit. Spondylolisthesis recurred in 1 patient who underwent PSF with bone graft arthrodesis alone (no instrumentation). The other 10 patients underwent PSF with instrumentation and fusion. Three patients additionally underwent Bohlman interbody fusion. Two patients developed implant failure. S2 fixation was performed at revision to achieve fusion in these patients. Mean Meyerding grade improved in patients who underwent arthrodesis, from 3.9 (±1.2) to 1.9 (±1.3) (P=0.002). Complications were 2 cerebrospinal fluid leaks, 2 transient postoperative paresthesias, and 1 case each of pseudarthrosis at S1-S2, wound dehiscence, and transient urinary incontinence. No significant associations between LDS type and lumbosacral abnormalities were found.

Conclusions:

High-grade spondylolisthesis is common in LDS and usually associated with spondylolysis. Patients requiring surgery for spondylolisthesis present during childhood and do well after instrumented PSF. Interbody fusion and stabilization of S1 and S2 can prevent physeal deformation. LDS should be considered in patients with high-grade spondylolisthesis. Patients with LDS should be monitored for spondylolisthesis and spondylolysis starting when they are young.

Level of Evidence:

Level IV—retrospective study.
Henry J. Mankin
Authors: Sun Crystal M. , Schwab Joseph H. , Hornicek Francis J.
Published: June 2018

Dr. Henry Mankin has made a profound impact in the fields of skeletal surgery and orthopedics. In a career spanning over 50 years, Dr. Mankin conducted extensive research on and provided treatment for numerous patients with Gaucher disease and spinal tumors such as sacral chordomas. Dr. Mankin's prolific career includes many leadership positions in the field of skeletal surgery, including Chief of Orthopaedics at the Hospital for Joint Diseases and at Massachusetts General Hospital. He has touched the lives of over 19,000 patients with bone and soft tissue tumors and undoubtedly shaped the future of skeletal surgery.
Gait Alteration in Cervical Spondylotic Myelopathy Elucidated by Ground Reaction Forces
Authors: Haddas Ram , Ju Kevin L.
Published: June 2018

Study Design..

Prospective cohort study.

Objective..

Analyze GRF parameters in cervical spondylotic myelopathy (CSM) patients to elucidate gait alterations as compared with healthy controls.

Summary of Background Data..

During the human gait cycle, the magnitude and direction of the force each foot imparts on the ground varies in a controlled fashion to propel the body's center of mass forward. Alterations in GRF patterns can both point to subtle gait disturbances and explain altered gait patterns such as that seen in CSM.

Methods..

Thirty-two patients with symptomatic CSM who have been scheduled for surgery, along with 30 healthy controls (HC), underwent clinical gait analysis a week before surgery. Vertical GRF parameters and force magnitude and timing at various points of the gait cycle (i.e., heel contact, maximum weight acceptance, mid-stance, and push off) were analyzed and compared between groups.

Results..

Increased heel contact (CSM: 60.13% vs. HC: 27.82% of body weight, BW,P = 0.011), maximum weight acceptance (CSM: 120.13% vs. HC: 100.97% of BW, P = 0.016), and diminished push off (CSM: 91.35% vs. HC: 106.54% of BW, P = 0.001) forces were discovered in CSM patients compared with HC. Compared with controls CSM patients had delayed heel contact (CSM: 9.32% vs. HC: 5.12% of gait cycle, P = 0.050) and earlier push off (CSM: 54.96% vs. HC: 59.0% of gait cycle, P = 0.050), resulting in a shorter stance phase.

Conclusion..

This study reinforces how CSM patients commonly exhibit altered gait patterns, but also uniquely demonstrates the increased heel-contract and maximum weight acceptance forces, diminished toe-off forces, and the shorter stance phase to absorb the BW load. When examined from a global perspective, these altered GRF parameters reflect the difficulty CSM patients have with catching their center of mass during heel-contact to avoid falling and with subsequently propelling themselves forward.

Level of Evidence: 3
Whorling-Sclerosing Variant Meningioma of the Spine
Authors: Eghbal Keyvan , Dehghanian Amirreza , Ghaffarpasand Fariborz
Published: June 2018

Study Design.

Case report

Objective.

To report surgical resection of multiple ventral cervical and thoracic lesion being diagnosed as whorling-sclerosing variant meningioma (WSM) and subsequent stabilization of cervicothoracic spine.

Summary of Background Data.

WSM is a rare histopathology variant of meningioma which is mostly reported in brain and only one case of cervical spine WSM has been reported. Because of the rarity of WSM, there is a paucity of information regarding the clinical, radiological, and histopathologic characteristics.

Methods.

A 57-year-old lady presented with progressive quadriparesis and myelopathy since 10 days. The spine magnetic resonance imaging (MRI) revealed multiple ventral cervical and thoracic lesions which were hypointense in T2-weighted images with heterogeneous and scant enhancement with gadolinium. The patient underwent anterior cervical corpectomy and gross total resection of the lesion along with 360° fixation in the first stage. The thoracic lesions were also resected totally through laminectomy and right lateral extracavitary approach followed by pedicular screw fixation.

Results.

The patient improved muscle powers and spasticity and is not independent (Frankel D). The histopathology examination revealed hypocellular lobulated sclerotic mass with whorling pattern of growth in the sclerotic part suggestive of WSM. Immunohistochemical evaluation demonstrated negative staining for epithelial membrane antigen, cytokeratin, Olig-2 and S-100 and immunoactivity for progesterone receptor (PR) and glial fibrillary acidic protein in the tumoral cells located at the periphery. Ki-67 indexing was low.

Conclusion.

The spine multiple WSM is an extremely rare condition, which has a malignant behavior and it seems that it is spread by cerebrospinal fluid seeding. Surgical removal is hard and requires experience and appropriate equipment.

Level of Evidence: 4
Highly Cited Works in Spinal Disorders
Authors: Badhiwala Jetan H. , Nassiri Farshad , Witiw Christopher D. , Mansouri Alireza , Alotaibi Naif , Eagles Matthew , Almenawer Saleh A. , da Costa Leodante , Wilson Jefferson R. , Fehlings Michael G.
Published: June 2018

Study Design.

Bibliometric analysis.

Objective.

To identify, and summarize the key findings of, the top 100 most highly cited works published in spinal disorder topic-specific journals.

Summary of Background Data.

There is an abundance of published articles pertaining to spine surgery and spinal disorders. The number of citations a work receives provides a useful measure of its scientific impact. An understanding of the most cited works in spine surgery can identify literature that surgeons and researchers should be familiar with, point to the most active areas of research, inform the design of educational curricula, and help guide future research efforts.

Methods.

Journals relating to spinal disorders were identified using the Journal Citation Reports database. We then searched the Web of Science database for articles appearing in each of these journals. The top 100 most cited works were selected for analysis.

Results.

The top 100 most cited articles appeared in seven of eight journals dedicated to spinal disorders, with 84 in Spine and seven in the European Spine Journal. The citation count for individual articles ranged from 343 to 1949. Most works (73) were published between 1990 and 2004. The greatest number of articles (22) focused on low back pain, followed by biomechanics (13), degenerative disc disease (12), and lumbar spinal stenosis/lumbar fusion (9). With regard to study design, laboratory investigations were the most common (12), followed by guideline documents (11), reviews (10), and retrospective cohort studies (10).

Conclusion.

The most cited works in spinal disorder journals are guidelines for low back pain, descriptions of quality of life (QOL) metrics, or laboratory investigations into spinal biomechanics. A gap exists for work relating to neck pain or cervical spinal pathology (e.g., cervical myelopathy), representing opportunity for future work. Time of publication, topic of study, study design, and journal are possible determinants of likelihood of citation.

Level of Evidence: N/A
Sagittal Spinopelvic Alignment After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis
Authors: Pasha Saba , Ilharreborde Brice , Baldwin Keith
Published: June 2018

Study Design.

A systematic review and meta-analysis.

Objective.

The aim of this study was to determine the differences in the sagittal spinopelvic parameters between the nonscoliotic controls, preoperative, and different time points postoperative in Lenke 1 and 5 adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

The postoperative changes in the sagittal profile of Lenke 1 and 5 AIS at varying time points after posterior spinal fusion (PSF) has not been rigorously demonstrated; studies performed have had conflicting results.

Methods.

Sagittal spinal and pelvic parameters, T5-T12 thoracic kyphosis (TK), L1-S1 lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and sagittal vertical axis (SVA), for Lenke 1 and 5 preoperatively, at immediate, less than 2-year, and more than 2-year postoperatively, and for nonscoliotic adolescents were searched. Differences in the sagittal spinopelvic parameters between preoperative and the follow-ups and between the nonscoliotic and pre- and postoperative AIS subtypes were calculated through meta-analysis.

Results.

A total of 22 studies on Lenke1 (1229 patients), 13 studies on Lenke5 (437 patients), and 18 studies on controls (1636 patients) were reviewed. Among all the measured variables, only PI in Lenke1 was significantly different between the final follow-up and controls, P < 0.05. In Lenke 1, SVA was significantly more anterior at the immediate postoperative than preoperative, but continued moving posteriorly up to 2-year postoperative resulting in no significant difference in the SVA position between the final follow-up and preoperative, P > 0.05. In Lenke 5, SVA was significantly more posterior at the immediate postoperative and more anterior at the final follow-up than the preoperative measurements, p < 0.05.

Conclusions.

Continuous changes in the sagittal spinal parameters should be expected after PSF. Normalization of the sagittal spinal parameters appears to be the rule after PSF, and watchful waiting appears to be appropriate in this population when viewing the lateral X-ray postoperatively.

Level of Evidence: 4
Associations of Source-apportioned Fine Particles with Cause-specific Mortality in California
Authors: Berger Kimberly , Malig Brian J. , Hasheminassab Sina , Pearson Dharshani L. , Sioutas Constantinos , Ostro Bart , Basu Rupa
Published: June 2018

Background:

Exposure to ambient fine particulate matter (PM2.5) has been linked with premature mortality, but sources of PM2.5 have been less studied.

Methods:

We evaluated associations between source-specific PM2.5 exposures and cause-specific short-term mortality in eight California locations from 2002 to 2011. Speciated PM2.5 measurements were source-apportioned using Positive Matrix Factorization into eight sources and combined with death certificate data. We used time-stratified case–crossover analysis with conditional logistic regression by location and meta-analysis to calculate pooled estimates.

Results:

Biomass burning was associated with all-cause mortality lagged 2 days after exposure (lag2) (% changelag2 in odds per interquartile range width increase in biomass burning PM2.5 = 0.8, 95% confidence interval [CI] = 0.2, 1.4), cardiovascular (% changelag2 = 1.3, 95% CI = 0.3, 2.4), and ischemic heart disease (% changelag2 = 2.0, 95% CI = 0.6, 3.5). Vehicular emissions were associated with increases in cardiovascular mortality (% changelag0 = 1.4, 95% CI = 0.0, 2.9). Several other sources exhibited positive associations as well. Many findings persisted during the cool season. Warm season biomass burning was associated with respiratory/thoracic cancer mortality (% changelag1 = 5.9, 95% CI = 0.7, 11.3), and warm season traffic was associated with all-cause (% changelag0 = 1.9, 95% CI = 0.1, 3.6) and cardiovascular (% changelag0 = 2.9, 95% CI = 0.1, 5.7) mortality.

Conclusions:

Our results suggest that acute exposures to biomass burning and vehicular emissions are linked with cardiovascular mortality, with additional sources (i.e., soil, secondary nitrate, secondary sulfate, aged sea salt, and chlorine sources) showing associations with other specific mortality types.
Acute Changes in Community Violence and Increases in Hospital Visits and Deaths From Stress-responsive Diseases
Authors: Ahern Jennifer , Matthay Ellicott C. , Goin Dana E. , Farkas Kriszta , Rudolph Kara E.
Published: June 2018

Background:

Community violence may affect a broad range of health outcomes through physiologic stress responses and changes in health behaviors among residents. However, existing research on the health impacts of community violence suffers from problems with bias.

Methods:

We examined the relations of acute changes in community violence with hospital visits and deaths due to stress-responsive diseases (mental, respiratory, and cardiac conditions) in statewide data from California 2005–2013. The community violence exposure was measured as both binary spikes and continuous acute changes. We applied a combined fixed-effects and time-series design that separates the effects of violence from those of community- and individual-level confounders more effectively than past research. Temporal patterning was removed from community violence rates and disease rates in each place using a Kalman smoother, resulting in residual rates. We used linear regression with place fixed-effects to examine within-place associations of acute changes in community violence with residual rates of each outcome, controlling for local time-varying covariates.

Results:

We found acute increases in hospital visits and deaths due to anxiety disorders (0.31 per 100,000; 95% confidence interval [CI] = 0.02, 0.59), substance use (0.47 per 100,000; 95% CI = 0.14, 0.80), asthma (0.56 per 100,000; 95% CI = 0.16, 0.95), and fatal acute myocardial infarction (0.09 per 100,000; 95% CI = 0.00, 0.18) co-occurring with violence spikes. The pattern of findings was similar for the exposure of continuous acute violence changes.

Conclusions:

Although the associations were small, the identified increases in stress-responsive conditions suggest the possibility of health impacts of acute changes in community violence.
Implantation failure of endometrial origin: what is new?
Authors: Bellver José , Simón Carlos
Published: June 2018

Purpose of review

To review recent findings related to possible causes of recurrent implantation failure of endometrial origin in normal uterus.

Recent findings

Recent evidences suggest that in apparently normal endometria, RIF may associate with molecular and functional changes in the uterus such as abnormal endometrial microbiota, including the presence of chronic endometritis, poor synchronization between the blastocyst and endometrium, and/or excessive uterine peristalsis. An altered endometrial microbiota detected by molecular techniques has been recently related to poorer embryo implantation, even in apparently normal endometria. The use of the endometrial receptivity analysis test to obtain an objective signature of endometrial receptivity has shown to improve the reproductive performance in RIF patients. The diagnosis of uterine peristalsis, however, remains challenging since the usual evaluation by transvaginal ultrasound is not accurate, and drugs tested to reduce uterine peristalsis and enhance embryo implantation have not been clearly beneficial. Finally, endometrial injury to improve implantation rates remains controversial being definitive well-designed trials needed to assess its benefit, if any.

In recurrent implantation failure of endometrial origin an altered pattern of the microbial endometrial ecosystem, a displaced window of implantation leading to desynchronization between the blastocyst and the endometrium, or an altered pattern of uterine contractions during embryo transfer may be factors to consider in our attempt to solve this clinical issue. New diagnostics for assessing these conditions and new therapies to improve these dysfunctional situations are currently under investigation to be presumably included in the near future in the work-up of affected patients.
Minimally invasive gynecologic surgery in the pregnant patient: considerations, techniques, and postoperative management per trimester
Authors: Dizon Arthur M. , Carey Erin T.
Published: June 2018

Purpose of review

Nonobstetric surgery is performed in 1 : 200 to 1 : 500 of pregnant women in the United States annually. Previously, many argued that laparoscopy was contraindicated during pregnancy because of concerns for uterine injury and fetal malperfusion. Because surgeons have gained more experience with laparoscopy, it has become the preferred treatment modality for many surgical diseases in the gravid patient.

Recent findings

Specific preoperative considerations, intraoperative techniques, and postoperative management per trimester will be reviewed to optimize patient and surgical outcomes.

The advantages of laparoscopic surgery are similar for pregnant and nonpregnant women. Surgery during pregnancy should minimize risks to both the fetus and the mother. Whenever a pregnant woman undergoes nonobstetric surgery, consultations among her surgical team are important to coordinate management. Both anatomic and physiologic changes related to pregnancy may require modifications in management. Surgeons must be aware of considerations, techniques, and postoperative management used for pregnant patients to optimize outcomes for both the fetus and mother.
Preoperative evaluation for gynecologic surgery: a guide to judicious, evidence-based testing
Authors: Shields Jessica , Lupo Andrew , Walsh Teresa , Kho Kimberly
Published: June 2018

Purpose of review

Preoperative testing is a routine component of surgical planning, however, the majority of literature agree that laboratory and diagnostic studies are over utilized. We aim to summarize the available literature and provide gynecologists performing elective surgery for benign indications guidance to determine when, in whom, and in what time frame preoperative studies should be collected.

Recent findings

Current literature supports previous publications indicating routine laboratory and diagnostic testing for elective surgery is unnecessary and continues to be excessive. The frequency of abnormal results is high, whereas the impact on surgical planning and outcomes is negligible.

The preoperative evaluation including thorough history and physical examination should be the cornerstones for eliciting underlying disease, which may alter a surgical strategy. Devising a protocol to direct preoperative testing has been shown to decrease unnecessary tests without compromising prediction of perioperative morbidity/mortality or case cancellation and changes. Avoidance of ‘routine preoperative testing’ and instead, thoughtful risk stratification of individual patients, should be a goal of providing value-based care.
The Utility of a Master of Business Administration Degree in Plastic Surgery: Determining Motivations and Outcomes of a Formal Business Education Among Plastic Surgeons
Authors: Lee Cody S. , Ooi Adrian S. H. , Zenn Michael R. , Song David H.
Published: June 2018

Background:

With the increasing complexity of health care, the knowledge of business in medicine is growing more valuable. Plastic surgeons in all practice settings are constantly forced to navigate endeavors that could be better faced with the leadership, management, and administrative skills honed through a formal business education. The purpose of this study was to gather data and draw conclusions related to the motivations and outcomes of plastic surgeons with a Master of Business Administration degree (MBA).

Methods:

An online survey was distributed to plastic surgeons in the United States who have earned an MBA. The survey was divided into 4 main sections: demographics, MBA program description, objective assessment, and subjective assessment.

Results:

The majority of plastic surgeons with an MBA are in practice at an academic medical center. The 2 most popular tracks of completing the degree are during medical school and after 5 years of practice. A large proportion of plastic surgeons with an MBA experienced changes in their existing career position, namely in patient care and business roles outside of clinical practice. The most important skills surgeons subjectively felt they had improved as a result of their business education were in the areas of leadership, management, and administration.

Conclusions:

Overall, all the plastic surgeons felt that their MBA experience met their expectations and would recommend the degree to fellow physicians. Prime motivations included adding a new dynamic to their existing career, satisfying entrepreneurial drive, and gaining credibility in business, with monetary gains being low on the list.
Isotopic Split-skin Graft for Resurfacing of Deliberate Self-harm Scars
Authors: Goutos Ioannis , Ogawa Rei
Published: June 2018

We present a novel surgical approach for the revision of deliberate self-harm scars. The isotopic skin graft technique employs the harvest of a thin split-skin graft from the affected area, excision and closure of wide dermal scars with replacement of the graft back onto the harvest site. We present the sequential steps of the surgical technique and a case series of 2 patients treated with our novel approach.
Institutional Collaboration in Plastic Surgery Research: A Solution to Resource Limitations
Authors: Chi David , Curiel Daniel , Bucknor Alexandra , Peymani Abbas , Chattha Anmol , Chen Austin D. , Bletsis Patrick , Kamali Parisa , Lin Samuel
Published: June 2018

Background:

The current climate of health care reform and research funding restrictions presents new challenges for academic plastic surgery. Collaboration with private enterprise has been associated with greater research productivity in the general biomedical literature. This study seeks to analyze publication trends in Plastic and Reconstructive Surgery (PRS) to evaluate any changes in institutional collaboration over time.

Methods:

Bibliographic data were retrospectively analyzed for all original research and discussion articles published in PRS from 2012 to 2016. The institutional affiliation for each publication was characterized from its author list as solely academic, private, government, or combinations of these (defined here as “institutional collaborations”). Annual National Institutes of Health (NIH) funding data were also collected over the same period, and associations were analyzed by linear regression.

Results:

In total, 2,595 publications were retrieved from PRS between 2012 and 2016, of which 2,027 (78.1%) originated solely from academic institutions and 411 (15.8%) from institutional collaborations. Although the proportion of academic-only publications decreased from 82% to 74%, the proportion of institutional collaborations increased from 10% to 20% (P = 0.038). Concurrently, NIH funding declined from $33.4 billion to a low of $30.7 billion, which was associated with the decreasing proportion of academic-only publications (P = 0.025) and increasing proportion of institutional collaborations (P = 0.0053).

Conclusions:

Traditional sources of academic research funding have been restricted during the politically and financially tumultuous recent years. With no signs of improving access to financial resources from the NIH, academic plastic surgeons may consider diversifying their institutional partnerships to continue pioneering advances in the field.
Hormone Therapy: Key Points From NAMS 2017 Position Statement
Authors: PINKERTON JOANN V.
Published: June 2018

The goal of the 2017 North American Menopause Society Hormone Therapy (HT) Position Statement is to remove fear about HT and encourage individualized shared decision making, using best available evidence. Systemic HT is safe and effective for symptomatic menopausal women aged younger than 60 years and within 10 years of menopause. Special populations of early menopause, high risk for fracture, risk of breast or uterine cancer, and extended duration are discussed. With longer duration of use, periodic evaluation and reassessment of health risks are needed. Lowered doses, transdermal therapies or newer options may enhance the benefit:risk ratio for HT.