bluuebunny/crossref_metadata_2025 huggingface dataset:
The “House of Quality for Behavioral Science”—a user-centered tool to design behavioral interventions
Authors: Mullane Sarah L , Epstein Dana R , Buman Matthew P
Published: August 2018

Within the behavioral field, a plethora of conceptual frameworks and tools have been developed to improve transition from efficacy to effectiveness trials; however, they are limited in their ability to support new, iterative intervention design decision-making methodologies beyond traditional randomized controlled trial design. Emerging theories suggest that researchers should employ engineering based user-centered design (UCD) methods to support more iterative intervention design decision-making in the behavioral field. We present, an adaptation of a UCD tool used in the engineering field—the Quality Function Deployment “House of Quality” correlation matrix, to support iterative intervention design decision-making and documentation for multicomponent behavioral interventions and factorial trial designs. We provide a detailed description of the adapted tool—“House of Quality for Behavioral Science”, and a step-by-step use-case scenario to demonstrate the early identification of intervention flaws and prioritization of requirements. Four intervention design flaws were identified via the tool application. Completion of the relationship correlation matrix increased requirement ranking variance for the researcher (σ2 = 0.47 to 7.19) and participant (σ2 = 0.56 to 3.89) perspective. Requirement prioritization (ranking) was facilitated by factoring in the strength of the correlation between each perspective and corresponding importance. A correlational matrix tool such as the “House of Quality for Behavioral Science” may provide a structured, UCD approach that balances researcher and participant needs and identifies design flaws for pragmatic behavioral intervention design. This tool may support iterative design decision-making for multicomponent and factorial trial designs.
Ketones and pain: unexplored role of hydroxyl carboxylic acid receptor type 2 in the pathophysiology of neuropathic pain
Authors: Boccella Serena , Guida Francesca , De Logu Francesco , De Gregorio Danilo , Mazzitelli Mariacristina , Belardo Carmela , Iannotta Monica , Serra Nicola , Nassini Romina , de Novellis Vito , Geppetti Pierangelo , Maione Sabatino , Luongo Livio
Published: August 2018

The mechanisms underlying neuropathic pain are poorly understood. Here we show the unexplored role of the hydroxyl carboxylic acid receptor type 2 (HCAR2) in 2 models of neuropathic pain. We used an oral treatment with dimethyl fumarate and the HCAR2 endogenous ligand β‐hydroxybutyrate (BHB) in wild‐type (WT) and HCAR2‐null mice. We found an up‐regulation of the HCAR2 in the sciatic nerve and the dorsal root ganglia in neuropathic mice. Accordingly, acute and chronic treatment with dimethylfumarate (DMF) and BHB reduced the tactile allodynia. This effect was completely lost in the HCAR2‐null mice after a 2‐d starvation protocol, in which the BHB reached the concentration able to activate the HCAR2‐reduced tactile allodynia in female WT mice, but not in the HCAR2‐null mice. Finally, we showed that chronic treatment with DMF reduced the firing of the ON cells (cells responding with an excitation after noxious stimulation) of the rostral ventromedial medulla. Our results pave the way for investigating the mechanisms by which HCAR2 regulates neuropathic pain plasticity.—Boccella, S., Guida, F., De Logu, F., De Gregorio, D., Mazzitelli, M., Belardo, C., Iannotta, M., Serra, N., Nassini, R., deNovellis, V., Geppetti, P., Maione, S., Luongo, L. Ketones and pain: unexplored role of hydroxyl carboxylic acid receptor type 2 in the pathophysiology of neuropathic pain. FASEB J. 33, 1062–1073 (2019). www.fasebj.org
Sexual Orientation and Exposure to Violence Among U.S. Patients Undergoing Abortion
Authors: Jones Rachel K. , Jerman Jenna , Charlton Brittany M.
Published: August 2018

OBJECTIVE:

To assess the characteristics of patients undergoing abortion in the United States according to sexual orientation and exposure to sexual and physical violence.

METHODS:

Data for this observational study come from the Guttmacher Institute's 2014 Abortion Patient Survey, which obtained information from 8,380 individuals obtaining abortions at nonhospital facilities in the United States; 7,656 of those (91%) provided information on sexual orientation identity. We used simple logistic regression to assess differences between heterosexuals and three sexual minority groups—bisexual, lesbian, and something else—according to demographic characteristics and exposure to sexual and physical violence. Multivariate logistic regression was used to assess associations between sexual orientation and exposure to violence.

RESULTS:

Among patients undergoing abortion in 2014, 4.1% identified as bisexual (n=316), 1.1% as something else (n=81), and 0.4% as lesbian (n=28); 94.4% identified as heterosexual (n=7,231). Similar proportions of lesbian and heterosexual respondents reported a prior birth (53.6% and 58.2%, P=.62), whereas respondents who identified as something else were more likely to report having had a prior abortion (58.0% vs 43.9%, P=.01). Exposure to sexual violence was substantially and significantly higher among all three sexual minority groups compared with heterosexuals, and lesbian and bisexual respondents were also more likely than their heterosexual peers to report exposure to physical violence by the man involved in the pregnancy (33.3% and 8.7% vs 3.6%, P<.001).

CONCLUSION:

No patient should be presumed to be heterosexual. Understanding the disproportionate role of sexual violence in unintended pregnancies among sexual minorities may aid in the design of interventions and clinical guidelines that address the needs of sexual minority patients.
Female Sterilization and Cognitive Disability in the United States, 2011–2015
Authors: Li Henan , Mitra Monika , Wu Justine P. , Parish Susan L. , Valentine Anne , Dembo Robert S.
Published: August 2018

OBJECTIVE:

To compare female sterilization among three mutually exclusive groups of females: 1) those without any self-reported disability, 2) those with noncognitive disabilities (sensory or physical disabilities), and 3) those with cognitive disabilities.

METHODS:

We conducted a secondary analysis of nationally representative data from the National Survey of Family Growth 2011–2015, which surveyed individuals aged 15–44 years in the U.S. civilian population. Disability status (self-reported) was ascertained using a standard set of questions about hearing, vision, cognitive, ambulatory, self-care, and independent living difficulties. Regression models were used to calculate odds of female sterilization, hysterectomies, and age of sterilization while accounting for sociodemographic differences.

RESULTS:

Female sterilization rates were higher among females with cognitive (22.1% [n=272]) and noncognitive disabilities (24.7% [n=150]) than among those without disabilities (14.8% [n=1,132]). After adjusting for sociodemographic covariates, females with cognitive disabilities had significantly higher odds of female sterilization (adjusted odds ratio [OR] 1.54, 95% CI 1.19–1.98, P<.01) and hysterectomy (adjusted OR 2.64, 95% CI 1.53–4.56, P<.001) than those without cognitive disabilities. Females with cognitive disabilities also underwent sterilization at significantly younger ages (27.3 years, 95% CI 27.0–27.6) than those with noncognitive disabilities (28.3 years, 95% CI 27.9–28.8) and those without any disability (29.8 years, 95% CI 29.5–30.0).

CONCLUSION:

U.S. females with cognitive disabilities were more likely to have undergone female sterilizations and hysterectomies and at younger ages than those with other disabilities or without disabilities. Drivers of these disability-related differences in female sterilization patterns must be explored.
Risk of Severe Acute Maternal Morbidity According to Planned Mode of Delivery in Twin Pregnancies
Authors: Korb Diane , Deneux-Tharaux Catherine , Seco Aurélien , Goffinet François , Schmitz Thomas ,   for the JUmeaux MODe d'Accouchement (JUMODA) study group and the Groupe de Recherche en Obstétrique et Gynécologie (GROG)
Published: August 2018

OBJECTIVE:

To evaluate the association between the planned mode of delivery and severe acute maternal morbidity in women with twin pregnancies.

METHODS:

In this planned secondary analysis of the JUmeaux MODe d'Accouchement cohort, a national prospective population-based study of twin deliveries conducted from February 2014 to March 2015 in 176 hospitals performing more than 1,500 annual deliveries in France, we included women with twin pregnancies at 24 weeks of gestation or greater with two live fetuses. Women delivering before 24 weeks of gestation, those with recognized indications for cesarean delivery, and those with severe acute maternal morbidity symptomatic before labor were excluded to limit confounding by indication. The primary outcome was a composite measure of intra- or postpartum severe acute maternal morbidity. Multivariate Poisson regression models and propensity score matching were used to control for potential confounding by indication. Analyses were conducted for the overall study cohort as well as stratified by maternal age in years (younger than 30, 30–34, 35 years or older). No adjustments were made for multiple comparisons.

RESULTS:

Among the 8,124 women included in this analysis, 3,062 (37.7%) had planned cesarean deliveries and 5,062 (62.3%) had planned vaginal deliveries, of whom 4,015 (79.3%) delivered both twins vaginally. No significant overall association was found between the planned mode of delivery and severe acute maternal morbidity (6.1% in the planned cesarean delivery group and 5.4% in the planned vaginal group; adjusted relative risk 1.00, 95% CI 0.81–1.24). In women 35 years or older, the risk of severe acute maternal morbidity was significantly higher for those with planned cesarean delivery than planned vaginal delivery (7.8% vs 4.6%, adjusted relative risk 1.44, 95% CI 1.02–2.06). Propensity score and secondary analyses yielded similar results.

CONCLUSION:

In twin pregnancies, there is no overall association between planned mode of delivery and severe acute maternal morbidity. Women older than 35 years may be at higher risk of severe acute maternal morbidity after planned cesarean delivery.
Laparoscopic Surgical Algorithm to Triage the Timing of Tumor Reductive Surgery in Advanced Ovarian Cancer
Authors: Fleming Nicole D. , Nick Alpa M. , Coleman Robert L. , Westin Shannon N. , Ramirez Pedro T. , Soliman Pamela T. , Fellman Bryan , Meyer Larissa A. , Schmeler Kathleen M. , Lu Karen H. , Sood Anil K.
Published: August 2018

OBJECTIVE:

To estimate the effects of a laparoscopic scoring algorithm to triage patients with advanced ovarian cancer to immediate or delayed debulking to improve complete gross surgical resection rates and determine the resulting clinical outcomes.

METHODS:

We prospectively performed laparoscopic assessment on patients with suspected advanced-stage ovarian cancer from April 2013 to December 2016 to determine primary resectability at tumor reductive surgery. Patients with medically inoperable or distant metastatic disease received neoadjuvant chemotherapy. Two-surgeon scoring was performed in a blinded fashion using a validated scoring method. Patients with predictive index value scores less than 8 were offered primary surgery and those with scores 8 or greater received neoadjuvant chemotherapy. Univariate and multivariate analysis was performed for effects on progression-free survival.

RESULTS:

Six hundred twenty-one patients presenting with presumed advanced ovarian cancer were evaluated during the study period and 488 patients met inclusion criteria. Two hundred fifteen patients underwent laparoscopic scoring, of whom 125 had predictive index value scores less than 8 and 84 had predictive index value scores 8 or greater. Blinded two-surgeon predictive index value scoring resulted in bivariate discordance in only 2% of patients. Tumor cytoreduction led to no gross residual disease (R0 resection) in 88% of patients in the primary surgery group and 74% in the neoadjuvant chemotherapy group. Patients triaged to primary surgery had an improved progression-free survival of 21.4 months versus 12.9 months in those patients undergoing neoadjuvant chemotherapy (P<.001). Median progression-free survival by treatment group and residual disease status was as follows: primary surgery–R0 23.5 months; primary surgery–R1 (any gross residual disease) 17.6 months; neoadjuvant chemotherapy–R0 15.5 months; and neoadjuvant chemotherapy–R1 12.9 months (P<.001). On multivariate analysis for progression-free survival, baseline CA 125 (P=.001) and gross residual disease at tumor reductive surgery (P=.01) were significantly associated with progression-free survival.

CONCLUSION:

Laparoscopic triage assessment allowed for a personalized approach to the management of patients with advanced ovarian cancer and resulted in high complete surgical resection rates at tumor reductive surgery.
Role of Bridge Contraception in Postpartum Long-Acting Reversible Contraception and Sterilization Fulfillment Rates
Authors: Montague Mary , Ascha Mustafa , Wilkinson Barbara , Verbus Emily , Morris Jane , Mercer Brian M. , Arora Kavita Shah
Published: August 2018

OBJECTIVE:

To estimate the association of bridge contraception with interval long-acting reversible contraception (LARC) and sterilization fulfillment rates.

METHODS:

This is a secondary analysis of a retrospective single-center cohort chart review study examining 1,851 postpartum women who requested LARC or sterilization after discharge. Bridge contraception was requested by 597 of these women. Primary outcomes included LARC or sterilization fulfillment, time to fulfillment, postpartum visit attendance, and pregnancy within 365 days of delivery.

RESULTS:

The rate of LARC or sterilization fulfillment within 90 days of delivery was 147 of 597 (24.6%) women using bridge contraception and 287 of 1,254 (22.9%) women not using bridge contraception (P=.41). After adjusting for maternal age, parity, gestational age, mode of delivery, adequacy of prenatal care, race–ethnicity, and education level, the use of bridge contraception was associated with LARC or sterilization fulfillment (adjusted odds ratio [OR] 1.30, 95% CI 1.02–1.67). Adequacy of prenatal care and black race was associated with fulfillment. The use of bridge contraception was not associated with time to fulfillment (adjusted hazard ratio 1.17, 95% CI 0.95–1.44) or postpartum visit attendance (adjusted OR 0.97, 95% CI 0.77–1.23). The use of bridge contraception was not associated with increased pregnancy within 365 days of delivery (OR 1.00, 95% CI 0.95–1.05; adjusted OR 0.96, 95% CI 0.73–1.26).

CONCLUSION:

Bridge contraception is associated with increased LARC and sterilization fulfillment after postpartum discharge. Long-acting reversible contraception or sterilization fulfillment after discharge occurred in less than one in four women. Strategies to improve provision of LARC or sterilization before hospital discharge are necessary.
Evaluation of infantile and juvenile scoliosis and osteotomies in spinal deformity surgery
Authors: Collins Michael , Saleh Ahmed , Razi Afshin
Published: August 2018

Infantile and juvenile scoliosis are both forms of early onset scoliosis (EOS). Juvenile scoliosis (JS) is defined as scoliosis first diagnosed between the ages of 4 and 10 yr, while infantile scoliosis (IS) is defined as scoliosis that is first diagnosed between birth and 3 yr of age but before age 4. The diagnosis and management of these patients continue to remain a challenge to providers. Advanced imaging often is necessary to delineate anatomy and assess for any spinal cord abnormalities that may be contributing to the deformity. Early recognition and treatment may help facilitate treatment. Treatment of these patients may require both nonoperative and operative treatment modalities. Casting and bracing often are used as methods to try and control the curvature until patients are old enough for surgical intervention. Operative treatment for complex spinal deformity may require the use of spinal osteotomies. These osteotomies may be utilized in both pediatric and adult spinal deformity patients. A thorough understanding of each osteotomy is necessary to help properly plan surgical procedures and obtain the desired correction.
Indications for Open Reduction Internal Fixation of Anterior Pelvic Ring Disruptions
Authors: Wright Raymond D.
Published: August 2018

In acute trauma, pelvic ring instability can lead to hemorrhage and hemodynamic instability. Pelvic ring instability and displacement that is not stabilized may lead to chronic pain, sitting imbalance, and limb length inequality. Methods and timing of securing anterior pelvic ring injuries operatively is controversial and debatable. Many orthopaedic trauma surgeons would agree that acceptable methods to treat a disrupted anterior pelvic ring fracture include nonoperative care, external fixation, internal spanning fixators, intramedullary superior ramus screws, and open reduction internal fixation. We will review the indications for open reduction internal fixation fractures and disruptions of the anterior pelvic ring.
Mid-Term Patient Satisfaction and Residual Symptoms After Plate Fixation or Nonoperative Treatment for Displaced Midshaft Clavicular Fractures
Authors: Woltz Sarah , Krijnen Pieta , Schipper Inger B.
Published: August 2018

Objectives:

To evaluate mid-term patient-reported satisfaction and residual symptoms after plate fixation (PF) or nonoperative treatment (NOT) for displaced midshaft clavicular fractures.

Design:

Follow-up survey of randomized controlled trial.

Setting:

Sixteen teaching and nonteaching hospitals.

Participants:

All 160 patients with a fully displaced, midshaft clavicular fracture who had been randomized were approached by telephone.

Intervention:

Randomization for open reduction and internal PF or a sling for 2 weeks (NOT).

Main Outcome Measurements:

Outcomes were satisfaction with the received treatment, with the cosmetic result and with shoulder function (on a scale of 1–10), and presence of residual symptoms.

Results:

Seventy-nine patients (40 after PF and 39 after NOT) could be contacted. The median follow-up was 53 (34–79) months. Overall satisfaction was similar for PF and NOT (mean ± SD: 7.7 ± 2.1 vs. 6.9 ± 2.4, P = 0.12), as was satisfaction with the shoulder function (8.9 ± 1.6 vs. 8.4 ± 2.0, P = 0.27). Satisfaction with the cosmetic result was higher after PF (8.2 ± 1.6 vs. 6.8 ± 2.0, P = 0.002). Residual symptoms were frequently present in both groups (55% for PF vs. 41% for NOT, P = 0.26). After PF, 88% of patients would prefer the same treatment again compared with 41% after NOT (P < 0.001).

Conclusions:

Aspects of satisfaction seem higher after PF. Residual symptoms, however, were common after both treatments for clavicular fractures. The present results can be used to manage patients' expectations and provide objective information regarding both treatment options before a shared treatment decision is made.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Risk Factors for Kidney Dysfunction With the Use of Gentamicin in Open Fracture Antibiotic Treatment
Authors: Folse Jacob , Hill Charles E. , Graves Matthew L. , Russell George V. , Hydrick Josie , Jones LaRita C. , Replogle William H. , Bergin Patrick F. , Spitler Clay A.
Published: August 2018

Objectives:

To evaluate all patients who received gentamicin for open fracture treatment and determine the incidence of, and risk factors for, kidney injury in this population.

Design:

Retrospective, case control.

Setting:

Single institution; Level 1 trauma center.

Patients/Participants:

A retrospective chart review identified patients who received gentamicin for open fracture antibiotic treatment from January 2008 to December 2012. Overall, 371 patients met the inclusion criteria and were categorized into 2 groups using risk, injury, failure, loss of kidney function, and end-stage kidney disease criteria: normal kidney function (74.9%) versus abnormal kidney function (25.1%).

Intervention:

Use of gentamicin in open fracture antibiotic treatment.

Main Outcome Measurements:

Kidney function; injury and treatment characteristics (eg, mechanism of injury; Gustilo-Anderson classification; number of surgical debridements, timing of definitive wound coverage, and type of wound coverage); and patient information (eg, age, height, weight, and body mass index, tobacco use, diabetes mellitus, human immunodeficiency virus, hepatitis, and current chemotherapy treatment).

Results:

Those with abnormal kidney function had lower baseline creatinine (P < 0.001) and higher injury severity scores (16.5 vs. 11.8, P < 0.001) and were more likely to require intensive care unit admission (P < 0.001) than the normal group. Female sex (P = 0.015), and higher weight (P = 0.004), ICU admission (P < 0.001), and use of CT contrasted imaging (P < 0.001) were independently associated with abnormal kidney function. Abnormal kidney function incidence also sharply increased with age.

Conclusions:

Females and heavier individuals are at-risk of kidney injury while receiving gentamicin. ICU admission and concurent CT contrasted imaging are strongly associated with kidney injury in patients receiving gentamicin for open fracture treatment, and gentamicin should be avoided in those >60 years of age.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Establishment and characterization of melanoma patient-derived xenograft models for preclinical evaluation of novel therapeutics
Authors: Yan Junya , Wu Xiaowen , Yu Jiayi , Ma Meng , Yu Huan , Xu Tianxiao , Tang Huan , Xu Longwen , Dai Jie , Si Lu , Chi Zhihong , Sheng Xinan , Cui Chuanliang , Guo Jun , Kong Yan
Published: August 2018

Patient-derived xenograft (PDX) models mostly retain the histological and genetic features of their donor tumors, which have been used for investigating various types of cancer. However, PDX models for melanoma, especially acral melanoma, are reported occasionally. We aimed to establish a large panel of melanoma PDX models representing the predominant Asian melanomas. Ninety-three fresh melanoma samples were implanted subcutaneously into nonobese diabetic/severe combined immunodeficiency mice. The histological and genetic characteristics were analyzed in both patient tumors and PDX models using immunohistochemistry, PCR amplification, and Sanger sequencing. Furthermore, the sensitivities of PDX models harboring distinct mutation profiles to binimetinib (a MEK inhibitor), vemubrafenib (a BRAF inhibitor), and imatinib (a KIT inhibitor) were also evaluated. Twenty-five PDX models were established successfully [25/93 (26.9%)] and passaged to maintain tumors in vivo. Clinical stage and origin of tumor sample were correlated with successful establishment rates (P=0.008 and <0.001, respectively). The histological (expression of NRAS, P16, and RB) and genetic (mutation status of NRAS, BRAF, and KIT) characteristics were stably maintained from patient tumors to PDX models. Targeted drugs could inhibit the tumor growth of PDX models harboring the corresponding target gene mutations. These PDX models constitute a pharmacological platform, enabling personalized development of therapeutic strategies for Asian melanomas.
Simulation of Supralevator Abscesses and Complex Fistulas in Cadavers: Pelvic Dissemination and Drainage Routes
Authors: García-Granero Alvaro , Sancho-Muriel Jorge , Sánchez-Guillén Luis , Alvarez Sarrado Eduardo , Fletcher-Sanfeliu Delfina , Frasson Matteo , A. Valverde-Navarro Alfonso , Martinez Soriano Francisco
Published: August 2018

BACKGROUND:

Most perianal abscesses have a cryptoglandular origin, following the pathogenesis described by Parks in 1961. Supralevator abscesses have the most uncommon location. Nevertheless, such pathology results in a high morbidity because of their difficult diagnosis and treatment.

OBJECTIVE:

This study aimed to deepen the knowledge of the pathogenesis and management of supralevator abscesses, as well as the complications derived from incorrect treatment, by using simulation in cadavers.

DESIGN:

This study is an anatomosurgical description of pelvic and perianal zone and simulation of the different types of supralevator abscesses, their correct drainage routes, and secondary complex fistulas due to incorrect drainage.

SETTINGS:

This dynamic article is based on cadaveric simulation.

PATIENTS:

Three cadaveric pelvises (2 male and 1 female) were prepared in formalin and sagittally sectioned, and one perineal dissection was performed of a fresh male pelvis. This is an iconographic description of 3 patients treated for supralevator abscesses in our colorectal surgical unit.

MAIN OUTCOME MEASURES:

The virtual anatomical spaces map out a correct treatment.

RESULTS:

We reproduced the origin of the different types of supralevator abscesses, as well as their locations and possible drainage pathways, and we determined the definitive treatment of secondary fistulas and their morbidity due to their incorrect drainage.

LIMITATIONS:

The limitations of this study are inherent to anatomical studies without real case intervention.

CONCLUSIONS:

A proper anatomical knowledge of the supralevator abscesses and surgical training by using cadaveric simulations could improve the diagnostic criteria, facilitate the correct decision on surgical drainage pathways, and, thus, decrease postoperative morbidity in patients with this disease.
Impact of Tumor Deposits on Oncologic Outcomes in Stage III Colon Cancer
Authors: Wong-Chong Nathalie , Motl Jill , Hwang Grace , Nassif George J. , Albert Matthew R. , Monson John R.T. , Lee Lawrence
Published: August 2018

BACKGROUND:

The prognosis of tumor deposits in stage III colon adenocarcinoma is poorly described.

OBJECTIVE:

The purpose of this study was to determine the impact of tumor deposits on oncologic outcomes in patients with stage III colon cancer.

DESIGN:

This was a multicenter retrospective cohort study.

SETTINGS:

The 2010 to 2014 National Cancer Database was queried for patients with resected stage III colon adenocarcinoma on final pathology.

PATIENTS:

Patients were divided into 3 groups: lymph nodes+tumor deposits–, lymph nodes+tumor deposits+, and lymph nodes–tumor deposits+.

MAIN OUTCOME MEASURES:

The main outcome was 5-year overall survival.

RESULTS:

Of 74,577 patients, there were 55,800 patients with lymph nodes+tumor deposits–, 13,740 patients with lymph nodes+tumor deposits+, and 5037 patients with lymph nodes–tumor deposits+. The groups had similar patient and facility characteristics, but patients with lymph nodes+tumor deposits+ had more advanced tumor characteristics. Patients with lymph nodes–tumor deposits+ were less likely to receive adjuvant systemic therapy (52% vs 74% lymph nodes+tumor deposits– and 75% lymph nodes+tumor deposits+, p < 0.001) and had a longer delay to initiation of adjuvant treatment (>8 weeks; 43% vs 33% lymph nodes+tumor deposits– and 33% lymph nodes+tumor deposits+, p < 0.001). Patients with lymph nodes+tumor deposits+ had the lowest 5-year overall survival (46.0% vs 63.4% lymph nodes+tumor deposits– vs 61.9% lymph nodes–tumor deposits+, p < 0.001). On multivariate analysis, patients with lymph nodes–tumor deposits+ had similar 5-year overall survival compared with patients with lymph nodes+tumor deposits– with ≤3 positive lymph nodes (HR, 0.93; 95% CI, 0.87–1.01). Patients with lymph nodes+tumor deposits+ had worse prognosis regardless of the number of involved lymph nodes (≤3 +lymph nodes: HR, 1.37; 95% CI, 1.28–1.47 and ≥4 +lymph nodes: HR, 1.30; 95% CI, 1.22–1.38). Of those not receiving adjuvant treatment, patients with lymph nodes–tumor deposits+ were younger and had more adverse tumor features than lymph node+ disease. Lymph nodes–tumor deposits+ was independently associated with less delivery of adjuvant systemic therapy (OR, 0.81; 95% CI, 0.80–0.82).

LIMITATIONS:

This study was limited by its retrospective analysis of a prospective database.

CONCLUSIONS:

The prognosis of patients with N1c disease is similar to nodal involvement without tumor deposits, yet these patients were less likely to receive adjuvant systemic therapy. Improvement in the delivery of appropriate care in these patients may increase survival and should be a target of future quality initiatives. See Video Abstract at http://links.lww.com/DCR/A666.
Nomogram Predicting Survival After Recurrence in Patients With Stage I to III Colon Cancer: A Nationwide Multicenter Study
Authors: Kawai Kazushige , Nozawa Hiroaki , Hata Keisuke , Kiyomatsu Tomomichi , Tanaka Toshiaki , Nishikawa Takeshi , Sugihara Kenichi , Watanabe Toshiaki
Published: August 2018

BACKGROUND:

Although a number of studies have been conducted to investigate factors affecting colon cancer recurrence and patient overall survival after surgical treatment, no prognostic risk models have been proposed for predicting survival specifically after postsurgical recurrence.

OBJECTIVE:

We aimed to identify factors affecting the survival of the patients with recurrent colon cancer and to construct a nomogram for predicting their survival.

DESIGN:

This was a retrospective study.

SETTINGS:

This study used the Japanese Study Group for Postoperative Follow-Up of Colorectal Cancer database, which contains retrospectively collected data of all consecutive patients with stage I to III colorectal cancer who underwent surgical curative resection between 1997 and 2008 at 23 referral institutions.

PATIENTS:

A total of 2563 patients with stage I to III colon cancer who experienced recurrence after surgery were included in the present study.

MAIN OUTCOME MEASURES:

A nomogram predicting survival was constructed using a training cohort composed of patients from 15 hospitals (n = 1721) using a Cox regression hazard model analysis. The clinical applicability of this nomogram was validated in patients from the 8 remaining hospitals (the validation cohort; n = 842).

RESULTS:

Eight factors (age, location of the primary tumor, histopathological type, positive lymph node status, presence of peritoneal metastasis, number of organs involved in the first recurrence, treatment for recurrence, and the interval between initial surgery and recurrence) were identified as nomogram variables. Our nomogram showed good calibration, with concordance indexes of 0.744 in the training cohort and 0.730 in the validation cohort. The survival curves stratified by the risk score calculated by the nomogram were almost identical for the training and validation cohorts.

LIMITATIONS:

The study was conducted using the data until 2008, and more advanced chemotherapeutic agents and multidisciplinary therapies that might have improved the outcomes predicted by our nomogram were not available. In addition, treatment strategies for recurrence might differ between countries.

CONCLUSIONS:

Our nomogram, which is based on a nationwide multicenter study, is the first statistical model predicting survival after recurrence in patients with stage I to III colon cancer. It promises to be of use in postoperative colon cancer surveillance. See Video Abstract at http://links.lww.com/DCR/A687.
Salvage Treatment of Failed Free Jejunal Flap Transfer: Our Experiences and Literature Review
Authors: Kubo Tateki , Seike Shien , Kiya Koichiro , Tomita Koichi , Hosokawa Ko
Published: August 2018

Background:

Although there have been many reports on the success of free jejunal flap transfer for pharyngoesophageal reconstruction, reports on salvage procedures for failed transfers remain sparse. In this report, we retrospectively reviewed our salvage procedures for failed jejunal transfers and previous articles describing salvage treatment in failed jejunal flap cases.

Methods:

This report includes 6 cases of failed jejunal flap transfer, leading to necessary salvage surgery. We reviewed all cases to examine salvage procedures and early postoperative complications such as fistula formation. We also assessed postoperative late complications and swallowing function during long-term follow-up. A review of the literature was performed via PubMed.

Results:

Rejejunal transfer was performed successfully in 3 of 6 cases. Gastric pull-up reconstruction was adopted in 2 cases. In 1 case, an external stoma was created because of the patient’s poor medical condition. All 3 cases of rejejunal transfer and 1 gastric pull-up case recovered to resuming a normal diet. However, 1 gastric pull-up case required supplemental feeding with a jejunostomy tube. We reviewed 6 articles describing salvage treatment in failed jejunal flap cases.

Conclusion:

When free jejunal transfer fails, rejejunal transfer is optimal. However, in cases that lack suitable recipient vessels or have infection, a second jejunal transfer should not be considered. In such cases, gastric pull-up or colon interposition may be an alternative because they do not require vascular anastomosis. Pedicled pectoralis major flap is also an alternative, although the risk of salivary fistulas is very high.
The Use of Porcine Acellular Dermal Matrix in Single-stage, Implant-based Immediate Breast Reconstruction: A 2-center Retrospective Outcome Study
Authors: Loo Yew L. , Haider Sajjad
Published: August 2018

Background:

There have been many reported benefits of the usage of acellular dermal matrices (ADMs) in breast reconstruction. ADM reduces the need for rectus abdominis muscle and serratus anterior coverage by providing an inferolateral coverage of the implant/tissue expander. ADM can provide patients with a 1-staged reconstruction. This study was designed to look at the complication rates of 2 major hospitals in the United Kingdom.

Methods:

A large, 2-center retrospective cohort review of patients, who underwent implant-based breast reconstruction using Strattice (LifeCell Corp., Branchburg, N.J.) between March 2009 and November 2017, was performed. One-way analysis of variance was done to compare outcome significance between groups. Independent t test was performed to compare outcomes of 2 cohorts and regression analysis to include confounding factors using SPSS Statistics for Windows (Version 22.0. Armonk, NY: IBM Corp.).

Results:

A total of 450 and 400 breast reconstructions were carried out in University Hospital of South Manchester (UHSM) and Royal Free London Hospital (RFH), respectively. We recorded a total complication of 37.8% in RFH cohort and 28% in UHSM cohort. The seroma rate was 11.25% and 13.33% in the UHSM and RFH cohort, respectively. Other complications reported were major and minor infections, implant loss, skin necrosis, hematomas, and implant exposure. Multiple linear regression analysis reported that confounding factors affected certain outcomes.

Conclusion:

Our 2-center complication rates were comparable to other articles. Results were comparable despite being in 2 different breast units in the United Kingdom.
Fluorescein Aqueous Angiography in Live Normal Human Eyes
Authors: Huang Alex S. , Penteado Rafaella C. , Saha Sajib K. , Do Jiun L. , Ngai Philip , Hu Zhihong , Weinreb Robert N.
Published: August 2018

Purpose:

To evaluate aqueous humor outflow (AHO) in intact eyes of live human subjects during cataract surgery using fluorescein aqueous angiography.

Methods:

Aqueous angiography was performed in 8 live human subjects (56 to 86 y old; 2 men and 6 women). After anesthesia, fluorescein (2%) was introduced into the eye [either alone or after indocyanine green (ICG; 0.4%)] from a sterile, gravity-driven constant-pressure reservoir. Aqueous angiographic images were obtained with a Spectralis HRA+OCT and FLEX module (Heidelberg Engineering). Using the same device, anterior-segment optical coherence tomography (OCT) and infrared images were also concurrently taken with aqueous angiography.

Results:

Fluorescein aqueous angiography in the live human eye showed segmental AHO patterns. Initial angiographic signal was seen on average by 14.0±3.0 seconds (mean±SE). Using multimodal imaging, angiographically positive signal colocalized with episcleral veins (infrared imaging) and intrascleral lumens (anterior-segment OCT). Sequential aqueous angiography with ICG followed by fluorescein showed similar segmental angiographic patterns.

Discussion:

Fluorescein aqueous angiography in live humans was similar to that reported in nonhuman primates and to ICG aqueous angiography in live humans. As segmental patterns with sequential angiography using ICG followed by fluorescein were similar, these tracers can now be used sequentially, before and after trabecular outflow interventions, to assess their effects on AHO in live human subjects.
Efficacy and Safety of the Ab-interno Xen Gel Stent After Failed Trabeculectomy
Authors: Karimi Ayesha , Hopes Marina , Martin Keith R. , Lindfield Dan
Published: August 2018

Aims:

To assess the efficacy and safety of the Xen gel stent in reducing intraocular pressure (IOP) in eyes with prior failed trabeculectomy and to determine the frequency of complications and further intervention.

Methods:

Retrospective case note review of all patients with prior trabeculectomy undergoing Xen surgery across 5 centers from August 2015 to May 2017.

Results:

In total, 17 surgeries were reviewed. IOP reduced from 21.5 (±2.4) mm Hg preoperatively to 13.6 (±3.4) mm Hg at month 12 (P<0.05). Medication usage reduced from 2.8 (±0.6) preoperatively to 1.0 (±1.3) at month 12 (P<0.05). Adverse events included: numerical hypotony (IOP<6 mm Hg) in 4 cases (23.5%) that all resolved spontaneously, IOP spike of ≥30 mm Hg in 2 (11.8%) cases and transient occlusion of the implant by iris in 1 (5.9%) case. Secondary filtration surgery (Baerveldt tube implantation) was required in 2 (11.8%) cases. Postoperative bleb intervention was required in 9 cases (52.9%), usually in the first month after surgery.

Conclusions:

Xen reduces IOP and number of medications in eyes with failed trabeculectomy. Detailed preoperative conjunctival assessment and targeted stent placement is required. Prospective data and follow-up beyond 12 months are required but Xen seems a viable, effective, and safe option after failed trabeculectomy.
Neuroprotective effect of angiotensin II type 2 receptor stimulation in vincristine-induced mechanical allodynia
Authors: Bessaguet Flavien , Danigo Aurore , Bouchenaki Hichem , Duchesne Mathilde , Magy Laurent , Richard Laurence , Sturtz Franck , Desmoulière Alexis , Demiot Claire
Published: August 2018

Peripheral neuropathy is the major dose-limiting side effect of many currently used chemotherapies, such as vincristine (VCR). We recently demonstrated that candesartan, an angiotensin II type 1 receptor antagonist, was neuroprotective against resiniferatoxin-induced sensory neuropathy, and that this effect is mediated by stimulation of the angiotensin II type 2 receptor (AT2R). Thus, we evaluated the effect of preventive treatment with candesartan and a specific AT2R agonist, C21, on a mouse model of VCR-induced neuropathy. Vincristine was administered daily for 7 days to male Swiss mice. Treatment with candesartan and C21 was started on day 1, before VCR treatment, and continued until day 7. We evaluated the development of VCR-induced neuropathy and the effect of treatment by functional tests, immunohistochemical analyses of intraepidermal nerve fibers and dorsal root ganglia neurons, and ultrastructural analysis of the sciatic nerve. Mice treated with VCR showed high mechanical allodynia but no modifications of motor performance or mechanical/thermal nociception. Treatment with candesartan and C21 completely restored normal tactile sensitivity of VCR-treated mice. Both drugs prevented VCR-induced nonpeptidergic intraepidermal nerve fiber loss. Only C21 displayed neuroprotective effects against VCR-induced loss and enlargement of myelinated nerve fibers in the sciatic nerve. Our finding that candesartan and C21 are protective against VCR-induced neuropathic pain through AT2R stimulation favors evaluation of its therapeutic potential in patients receiving chemotherapy.
Development of a Novel Pathways Program for Pre-Health Students by a Private Four-Year University and a Private Health Professions University
Authors: Funk Phillip E. , Knott Patrick , Burdick Lindsey , Roberts Michael
Published: August 2018

Education in the health professions occurs at the graduate level, increasing the barriers to underrepresented and first-generation students. Some programs attempt to alleviate these barriers by streamlining passage from the undergraduate campus to the medical campus within a university or by accelerating entry to the professions by bypassing the bachelor's degree. These solutions each have their own limitations for students, including added pressure to maintain grades and a limited ability to explore multiple professions. The Alliance for Health Sciences, a partnership between DePaul University and Rosalind Franklin University of Medicine and Science (RFUMS), was formed to address these issues and has created the Pathways Honors program. Through this program, current DePaul students may apply for an early admission decision to one of 6 of RFUMS's programs and, if qualified, pursue an accelerated entry. They have the option to apply for early decision at any time during their undergraduate career to encourage exploration of career options and to allow students to adjust to college rigor with lower stakes. In addition, collaborative, innovative advising contributes to creating well-rounded students and admissions committee decisions not dictated solely by test metrics. The Pathways Honors program has continued to attract a diverse student pool to DePaul, and early indications are that many of these students are making a successful transition to professional programs. Currently, we have data on our first cohort of students. Continued development of this program will be necessary to ensure that it is preparing students for rigorous graduate programs and helping to diversify the health care workforce.
Integrating oral health curricula into nurse practitioner graduate programs: Results of a US survey
Authors: Dolce Maria C. , Haber Judith , Savageau Judith A. , Hartnett Erin , Riedy Christine A.
Published: August 2018

Background and purpose:

Nurse practitioners (NPs) are a significant segment of the US primary care workforce and have a pivotal role in improving access to oral health (OH) care. The purpose of this research was to assess OH curricular integration in primary care NP programs and to examine factors that influence integration and satisfaction with graduates' level of OH competence.

Methods:

A cross-sectional, national survey of NP programs (N = 466) was conducted using an electronically distributed 19-item, self-administered questionnaire. Data analysis included univariate, bivariate, multivariate statistics, and logistic regression modeling.

Conclusions:

The large majority of pediatric, family, and adult–gerontology primary care programs are educating NP graduates about OH. Significant factors promoting integration and satisfaction with graduates' level of competence included the presence of a faculty champion and routine teaching by a dental professional or nondental OH expert.

Implications for practice:

With adequate OH education, NPs are ideally positioned to integrate OH and primary care services in practice, thereby, improving access to OH care.
Effectiveness of early identification and electronic interventions for teens with risk factors for the development of heart disease and diabetes: Phase II findings
Authors: Jung Lorena , Courts Elizabeth , Webber Pam , Zhou Qiuping Pearl
Published: August 2018

Background and purpose:

Serum and physical risk factors for the development of heart disease and diabetes are detectable long before adulthood. The purpose of this two-part study was to assess the prevalence and associations of these risk factors in teens and determine the effectiveness of a customizable two-part electronic education program on minimizing identified risks.

Methods:

Data were collected from teens (n = 168) from two high schools (one urban and one rural) in the mid-Atlantic region. After baseline data were collected, the two-part electronic education program was initiated. Serum and physical risk factors were rechecked at 12-week intervals, and results were analyzed.

Conclusions:

Significant serum and physical risk factor associations were identified and remained present among teens over the course of the study. High-density lipoproteins showed significant, steady improvement. Low-density lipoproteins were positively associated with body mass index, diastolic blood pressure, and thyroid-stimulating hormone level.

Implications for practice:

Although serum and physical risk factors are identifiable in teens, routine screening of this age group and younger is not an established standard of care. Health care providers need effective, innovative methods to counteract these risks. Through increased awareness of the presence of risk factors in young patients, advanced nurse practitioners may implement earlier interventions to counteract these risks.
Factors related to colorectal cancer in advanced adenomas and serrated polyps: a further step toward individualized surveillance
Authors: Adán Merino Luisa , Mercedes Aldeguer-Martínez , Jose Barrio-Antoranz , Ana Burdaspal-Moratilla , Sonia Martín Chávarri
Published: August 2018

Aim

The risk of presenting synchronous or metachronous neoplasm, either adenoma or carcinoma, increases after an initial colonic lesion develops. It is known as tumor multicentricity and constitutes the rationale for surveillance programs. This study was designed to identify the clinical, pathologic, and molecular features related to previous or synchronous colorectal cancer (CRC) in patients with advanced adenomas (AA) or serrated polyps (SP).

Patients and methods

We carried out a prospective analysis of 4143 colonoscopies performed at our medical department between 1 September 2014 and 30 September 2015. Patients with AA/SP associated with previous or synchronous CRC are compared with patients with solitary AA/SP. We also performed immunohistochemical for the mismatch repair proteins in 120 AA or SP, 60 of them related to CRC.

Results

Three-hundred and seventy-nine AA or SP were removed. Among these, 66 (17.3%) were associated with a previous (n=31) or synchronous CRC (n=35). Age older than or equal to 65 years (odds ratio: 1.15, 95% confidence interval: 1.05–1.26,P=0.002) and male sex (odds ratio: 2.13, 95% confidence interval: 1.3–3.49,P=0.003) were found to be independent predictive factors for CRC in patients with AA/SP by multivariate analysis. Only one of the 120 AA/SP available for immunohistochemical testing showed loss of staining and it was not related to CRC.

Conclusion

In patients with AA or SP, it is possible to identify a subgroup that is more likely to be associated with CRC and then prone to tumor multicentricity. These results have potential implications for establishing criteria for a more targeted surveillance.