bluuebunny/crossref_metadata_2025 huggingface dataset:
A Phase II Study of Celecoxib With Irinotecan, 5-Fluorouracil, and Leucovorin in Patients With Previously Untreated Advanced or Metastatic Colorectal Cancer
Authors: Chen Emerson Y. , Blanke Charles D. , Haller Daniel G. , Benson Al B. , Dragovich Tomislav , Lenz Heinz-Josef , Robles Carlos , Li Hong , Mori Motomi , Mattek Nora , Sanborn Rachel E. , Lopez Charles D.
Published: May 2018

Objective:

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Cyclooxygenase-2 (COX-2) overexpression is associated with increased tumor invasiveness and proliferation in CRC, and COX-2 inhibition has demonstrated chemopreventive activity. This study investigated the addition of celecoxib, a selective COX-2 inhibitor, to the irinotecan, 5-fluorouracil, and leucovorin (IFL) regimen for patients with previously untreated metastatic CRC.

Patients and Methods:

Forty-seven patients enrolled in this single-arm phase II study received celecoxib at 400 mg orally twice daily in combination with weekly irinotecan (125 mg/m2), 5-fluorouracil (500 mg/m2), and leucovorin (20 mg/m2) for 4 weeks every 6 weeks. The primary endpoint was response rate (RR) as measured by Response Evaluation Criteria in Solid Tumors. The protocol was amended midway to additionally exclude patients with Eastern Cooperative Oncology Group performance status 2 and require all patients with specific cardiovascular risk factors to take daily aspirin (81 mg).

Results:

The objective RR was 31.9% (95% confidence interval [CI], 19%-47%). Median progression-free survival was 8.7 months (95% CI, 5.8-10.6), and the median overall survival was 19.7 months (95% CI, 15.4-22.8). All cardiac events were observed before protocol modification. The median overall survival before and after protocol modification was 11.4 versus 24.2 months, respectively (P<0.0001); tumor RR and progression-free survival were not statistically different before or after protocol modification. The trial was halted after an interim analysis demonstrated that the primary endpoint would not be met.

Conclusions:

Celecoxib plus IFL chemotherapy for patients with metastatic CRC is tolerable, but does not appear to increase the efficacy of IFL.
Twenty years of adverse drug reactions: a look back – part 1
Authors: Ferner Robin E. , Anton Christopher
Published: May 2018

After 20 years, Robin Ferner and Christopher Anton, who took on responsibility for the Adverse Drug Reaction Bulletin from its founder Professor Dai Davies, are handing over responsibility to Professor Kim Dalhoff and his colleague Dr Jon Andersen in Copenhagen. They take the opportunity to review some interesting, important, or unusual adverse drug reactions (ADRs) encountered over the last 20 years.
The effects of mindfulness and relaxation training for insomnia (MRTI) on postmenopausal women: a pilot study
Authors: Garcia Marcelo C. , Kozasa Elisa H. , Tufik Sergio , Mello Luiz Eugênio A. M. , Hachul Helena
Published: May 2018

Objective:

The aim of the study was to evaluate the effects of mindfulness and relaxation training for insomnia on insomnia and quality of life in postmenopausal women.

Methods:

Thirty postmenopausal women aged 50 to 65 years, who were not using hormone therapy, and had a diagnosis of insomnia and an apnea–hypopnea index of less than 15, were randomly assigned to two groups: a mindfulness intervention group and a control group. They were assessed before the intervention, and 8 weeks after its completion using questionnaires assessing sleep quality (Pittsburgh Sleep Quality Index), insomnia (Insomnia Severity Index), quality of life in menopause (Menopause-Specific Quality of Life), menopausal symptoms (Kupperman Menopausal Index), and level of attention (Mindfulness Awareness Attention Scale). They were also assessed through ambulatory polysomnography. This is a pilot study and is limited by its small sample size.

Results:

The results of the questionnaires showed significant differences in the group that received mindfulness training compared with the control group, namely, improvements in sleep quality, a reduction in the severity of insomnia, a better quality of life, improved attention levels, and a reduction in menopausal and vasomotor symptoms. Polysomnography results showed no differences between the groups.

Conclusions:

Eight weeks mindfulness meditation training improved sleep quality, quality of life, attention levels, and reduced vasomotor symptoms in postmenopausal women with insomnia.
Physical performance in relation to menopause status and physical activity
Authors: Bondarev Dmitriy , Laakkonen Eija K. , Finni Taija , Kokko Katja , Kujala Urho M. , Aukee Pauliina , Kovanen Vuokko , Sipilä Sarianna
Published: May 2018

Objective:

The aim of this study was to examine differences in physical performance (muscle power, muscle strength, aerobic capacity, and walking speed) across menopausal stages and potential of leisure physical activity (PA) to modify the impact of menopause on physical performance.

Methods:

In this cross-sectional study, women aged 47 to 55 were randomly selected from the Finnish National Registry and categorized as premenopausal (n = 233), perimenopausal (n = 381), or postmenopausal (n = 299) based on serum concentrations of follicle-stimulating hormone and bleeding diary. Physical performance was measured by knee extension force, handgrip force, vertical jumping height, maximal walking speed, and 6-minute walking distance. PA level was assessed by self-report and categorized as low, moderate, or high. Multivariate linear regression modeling was used for data analysis.

Results:

After including fat mass, height, PA, and education in the model, the postmenopausal women showed 12.0 N weaker (P < 0.001) handgrip force and 1.1 cm lower (P < 0.001) vertical jumping height than the premenopausal women. There was no significant interaction between menopausal stage and PA on physical performance. The peri- and postmenopausal women with a high PA, however, showed better performance in the maximal knee extension strength and 6-minute walking test, and showed greater lower body muscle power than those with a low PA.

Conclusions:

Menopause status is associated with muscle strength and power, whereas the association between menopause status and mobility/walking is clearly weaker. A high leisure PA level provides more capacity to counteract the potential negative influence of menopausal factors on muscle function.
Chest Wall Reconstruction with Porcine Acellular Dermal Matrix (Strattice) and Autologous Tissue Transfer for High Risk Patients with Chest Wall Tumors
Authors: Khalil Haitham H. , Kalkat Maninder , Malahias Marco N. , Rhobaye Saif , Ashour Tarek , Djearaman Madava G. , Naidu Babu
Published: May 2018

Background:

Tenets of chest wall reconstruction for malignancy are well known; however, the insertion of synthetic prosthetic material to achieve rigid and nonrigid skeletal reconstruction could be associated with more complications including infection and extrusion especially in high risk patients. This includes fungating, infected tumors, previous radiotherapy, scars, smoking, diabetes, and morbid obesity. Bioprosthesis Acelluar Dermal Matrix Strattice would be a substitute to resist infection and provide stable coverage.

Methods:

A retrospective data analysis study on 8 high-risk patients who underwent chest wall resection and reconstruction with bioprosthesis (Strattice) with/without titanium plates in the period between 2012 and 2017 was performed. Patient’s demographics, risk factors, clinico-pathological, radiological, operative details, adjuvant therapy, postoperative morbidity, and follow-up data were recorded.

Results:

Sarcoma was the pathology in 7 and recurrent breast cancer in 1 with age range from 21 to 71 years (mean, 50) and preponderance of female patients (n = 5). Defects were located anterior/anterolateral with size ranging from 270 to 1,050 cm2 (mean, 511). Reconstruction was performed using Strattice only in 4 patients, whereas in 4 it was combined with titanium plates. All patients required flap reconstruction (3 pedicled and 5 free). The follow-up ranged from 9 to 52 months (mean, 24.8). Minor complications occurred in 2 patients; however, good functional outcome was achieved in all.

Conclusion:

Strattice would act as a safe alternative modality for chest wall reconstruction to resist infection in high-risk patients with extensive defects. It should be considered as a valuable tool in the armamentarium of chest wall reconstruction.
Irreducible Dislocations of the Proximal Interphalangeal Joint: Algorithm for Open Reduction and Soft-tissue Repair
Authors: Frueh Florian S. , Vogel Philippe , Honigmann Philipp
Published: May 2018

The “jammed finger” is among the most common hand injuries and may include simple sprains, dislocations, fractures, and fracture-dislocations. In contrast, irreducible dislocations of the proximal interphalangeal joint are rare injuries. However, they must not be overlooked in the primary assessment, because persistent subluxation may lead to joint contracture, severely compromising hand function. Irreducible dislocations are challenging injuries with interposed soft tissues, preventing closed reduction. Thorough preoperative diagnosis and soft-tissue imaging guide the approach to open reduction and repair of injured periarticular structures. We introduce a systematic algorithm with considerations on classification and management of irreducible proximal interphalangeal joint dislocations. The algorithm is useful for the primary assessment and for hand surgeons responsible for open reduction and rehabilitation.
Serial Injections of Cryopreserved Fat at −196°C for Tissue Rejuvenation, Scar Treatment, and Volume Augmentation
Authors: Ohashi Masanori , Chiba Akihiko , Nakai Hirokazu , Fukuda Etsu , Higuchi Takao
Published: May 2018

Background:

Fat grafting has become popular since the first report of structural fat grafting in 2001. Fat grafting is effective not only for volume augmentation but also for tissue revitalization. However, fat harvesting is necessary before fat grafting can be performed. Therefore, the performance of serial fat injections is very challenging when treating such patients.

Methods:

From August 2015 to March 2017, we investigated 219 patients who underwent fat grafting using the fat that had already been cryopreserved at −196°C.

Results:

Follow-up ranged from 3 months to 2 years. No complications occurred, and all outcomes were satisfactory. Three representative cases were also reviewed.

Conclusions:

The cryopreserved fat at −196°C could be served as a useful method for serial fat grafting for clinical use; however, further research involving longer follow-up and pathological findings are needed.
A Predictive Model for Determining Permanent Implant Size During 2-Stage Implant Breast Reconstruction
Authors: Gabrick Kyle S. , Markov Nickolay P. , Chouairi Fouad , Wu Robin , Persing Sarah M. , Abraham Paul , Avraham Tomer , Alperovich Michael
Published: May 2018

Background:

Two-stage tissue expander (TE)/permanent implant (PI) breast reconstruction remains the most commonly performed technique in breast reconstruction. Predictions for the PI size preoperatively impact on the number and range of implants made available at TE exchange. This study aims to identify critical preoperative variables and create a predictive model for PI size.

Methods:

Patients who underwent 2-stage implant breast reconstruction from 2011 to 2017 were included in the study. Linear and multivariate regression analyses were used to identify significant preoperative variables for PI volume.

Results:

During the study period, 826 patients underwent 2-stage TE/PI breast reconstruction. Complete records were available for 226 breasts. Initial TE fill ranged from 0% to 102% with a mean final fill of 100.6% of TE volume. The majority of PIs were smooth round (98.2%), silicone (90%) implants. In a multivariate analysis, significant variables for predicting PI size were TE final fill volume (P < 0.0001), TE size (P = 0.03), and a history of preoperative radiation (P = 0.001). Relationships between these 3 variables were utilized to form a predictive model with a regression coefficient of R2 = 0.914.

Conclusions:

Significant variables for predicting PI volume were TE final fill volume, TE size, and a history of preoperative radiation. The ability to more accurately predict the PI volume can improve surgical planning, reduce consignment inventory, and simplify operating room workflow.
First Insights Into the M2 Inflammatory Response After Adipose-Tissue-Derived Stem Cell Injections in Radiation-Injured Muscles
Authors: Riccobono Diane , Nikovics Krisztina , François Sabine , Favier Anne-Laure , Jullien Nicolas , Schrock Gerrit , Scherthan Harry , Drouet Michel
Published: May 2018

The cutaneous radiation syndrome is the clinical consequence of local high-dose irradiation. It is characterized by extensive inflammation, necrosis, and poor revascularization of the skin, resulting in muscle inflammation and fibrosis. Based on these physiopathological processes, subcutaneous injections of adipose-tissue-derived stem/stromal cells have shown favorable effects on skin-wound healing in a minipig model of cutaneous radiation syndrome, in which muscle fibrosis persisted. Since fibrosis is mainly due to the inflammatory processes that often affect underlying tissues as well, the beneficial effects of intramuscular injections of adipose-tissue-derived stem/stromal cells on tissue recovery were evaluated. The polarization of the inflammatory response of irradiated muscle in a minipig model of cutaneous radiation syndrome was determined after acute local irradiation with 50 Gy gamma rays in a preliminary study (six minipigs). Analysis of the main inflammatory cytokines of the inflammatory response M1 (IL‐1‐beta and IL‐6) and M2 (IL‐10 and TGF-beta) by western blotting and in situ hybridization, as well as analysis of CD80/CD206 M1/M2 macrophage-specific markers by immunohistochemistry on minipig muscle samples, was performed 76 d after irradiation. The treatment of irradiated muscles with autologous adipose-tissue-derived stem/stromal cells led to an increase in IL‐10 and TGF-beta, being associated with an increase in CD68+/CD206+ cells in this area. This highlights a polarization of M2 in the inflammatory response and indicates that adipose-tissue-derived stem/stromal cells may direct the irradiated tissues’ inflammatory response towards a proregenerative outcome.
Old Data—New Concepts: Integrating “Indirect Effects” Into Radiation Protection
Authors: Mothersill Carmel , Seymour Colin
Published: May 2018

Purpose: To address the following key question, what are the consequences of nontargeted and delayed effects for linear nonthreshold models of radiation risk? This paper considers low-dose “indirect” or nontargeted effects and how they might impact radiation protection, particularly at the level of the environment. Nontargeted effects refer to effects in cells, tissues, or organisms that were not targeted by irradiation and that did not receive direct energy deposition. They include genomic instability and lethal mutations in progeny of irradiated cells and bystander effects in neighboring cells, tissues, or organisms. Low-dose hypersensitivity and adaptive responses are sometimes included under the nontargeted effects umbrella, but these are not considered in this paper. Some concepts emerging in the nontargeted effects field that could be important include historic dose. This suggests that the initial exposure to radiation initiates the instability phenotype which is passed to progeny leading to a transgenerational radiation-response phenotype, which suggests that the system response rather than the individual response is critical in determining outcome. Conclusion: Nontargeted effects need to be considered, and modeling, experimental, and epidemiological approaches could all be used to determine the impact of nontargeted effects on the currently used linear nonthreshold model in radiation protection.
A randomised, placebo-controlled clinical trial with the α2/3/5 subunit selective GABAA positive allosteric modulator PF-06372865 in patients with chronic low back pain
Authors: Gurrell Rachel , Dua Pinky , Feng Gang , Sudworth Maria , Whitlock Mark , Reynolds David S. , Butt Richard P.
Published: May 2018

The effect of PF-06372865, a subtype-selective positive allosteric modulator of the γ-aminobutyric acid type A (GABAA) receptor, on chronic low back pain was investigated in a randomised, placebo- and active-controlled phase 2 clinical trial. The parallel treatment group trial consisted of a 1-week single-blind placebo run in the phase, followed by 4-week double-blind treatment. Patients were randomised to receive either PF-06372865, naproxen, or placebo twice a day for 4 weeks. The primary end point was the numerical rating score of low back pain intensity after 4 weeks of active treatment. Secondary end points included the Roland Morris Disability Questionnaire and the Hopkins Verbal Learning Test–Revised. The trial had predefined decision rules based on the probability that PF-06372865 was better than placebo. The study was stopped at the interim analysis for futility. At this time, a total of 222 patients were randomised and the mean PF-06372865 4-week response on the low back pain intensity was 0.16 units higher (worse) than placebo (90% confidence interval −0.28 to 0.60). There were small, statistically significant reductions in the delayed recall test score with PF-06372865, as measured by Hopkins Verbal Learning Test–Revised. The effects of naproxen were in line with expectations. PF-06372865 was well tolerated. The most common treatment-related adverse events in the PF-06372865 arm were somnolence (5 mild and 4 moderate), dizziness (2 mild and 3 moderate), and nausea (2 mild). Although the reason for the lack of analgesic effect is not completely clear, it may be a result of not achieving sufficient receptor occupancy to drive efficacy.
Introducing a Clinical Documentation Specialist to Improve Coding and Collectability on a Surgical Service
Authors: Castaldi Maria , McNelis John
Published: May 2018

Introduction:

Inadequate electronic medical record (EMR) documentation remains a significant source of revenue loss. The Department of Surgery in a trauma and tertiary care teaching hospital developed a revenue optimization initiative for inpatients on general, vascular, and trauma surgery and surgical intensive care unit services to enhance clinical documentation and increase revenue capture.

Methods:

Clinical documentation management program included six trained clinical documentation specialists (CDSs), five physician assistants (PAs), directors of health information management (HIM), and two surgical champions. Lean methodology was applied to develop a coding and documentation program wherein trained CDS polled ICD-10 codes in the surgical EMR for accuracy in diagnoses documentation. An opportunity for improved documentation prompted query generation for a specially trained PA review. Physician assistant adjusted EMR documentation according to query to more accurately describe high impact diagnoses. Outcomes included PA query response rate, potential revenue opportunities, validated revenue gains, and missed revenue opportunity.

Results:

Twelve thousand EMRs were queried in the study interval. $2,206,620.16 in validated revenues were realized. Interestingly, we identified $1,792,591.91 in potential opportunities and $65,097.30 in lost opportunities. Query response rate increased from 17% to 94.7%.

Conclusions:

The authors demonstrate a concentrated Coding and Documentation Program involving CDS, and Surgical PAs results in significant revenue gains for an inpatient surgery service in a public hospital.
Hospital Value-Based Purchasing and Trauma-Certified Hospital Performance
Authors: Spaulding Aaron , Hamadi Hanadi , Martinez Luis , Martin Timothy , Purnell Justin M. , Zhao Mei
Published: May 2018

Introduction:

Hospital Value-Based Purchasing (HVBP) is an initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide. A hospital's trauma certification has the potential to influence HVBP scores as attaining the certification provides indication of the service quality offered by the hospital. As such, this study focuses on hospitals' level of trauma certification attainment through the American College of Surgeons and whether this certification is associated with greater HVBP.

Methods:

A retrospective review of the 2015 HVBP database, 2015 Area Health Resources Files (AHRF) database, and the 2015 American Hospital Association (AHA) database is utilized, and propensity score matching was employed to determine the association between level of trauma certification and scores on HVBP dimensions.

Results:

Results reveal trauma certification is associated with lower HVBP domain scores when compared to hospitals without trauma certification. In addition, hospitals with a greater degree of trauma specialization were associated with lower total performance score and efficiency domain scores.

Conclusions:

Although payers attempt to connect hospital reimbursements with quality and outcomes, unintended consequences may occur. In response to these results, HVBP risk adjustment and scoring methods should receive further scrutiny.
Impact of a Required Service-Learning Curriculum on Preclinical Students
Authors: Forest Christopher P. , Lie Désirée A.
Published: May 2018

Purpose

The impact of brief service-learning curricula on physician assistant (PA) students is not well reported. This study explores student learning immediately and then one to 2 years after a preclinical service-learning experience through written reflections and a survey.

Methods

The 16-hour curriculum within a behavioral science course involved community immersion and engagement with underserved clients. Reflections written by students from 3 consecutive classes were coded for major themes, and theme frequency was assessed. We then administered a survey to explore the curricular impact after students completed their clinical clerkships.

Results

All students (132/132) completed the required curriculum. We identified 4 major themes from 132 reflections. The themes were (most to least frequent) self-discovery (54/132), patient focus (30/132), community resources (28/132), and patient–provider relationship (20/132). The primary attitude change (self-discovery) was student awareness of their own biases and recognition of the need for cultural humility when caring for underserved clients. In the postcurriculum survey (response 69/95), students recalled community resources as the most important learning, followed by self-discovery. Students viewed the curriculum positively and noted that the exposure increased their comfort with caring for underserved patients in their clerkships.

Conclusions

Immersion in a community-based service-learning experience with underserved clients is associated with increased self-awareness and intent to change behavior. Students perceive the experience as important for future clerkships. Preclinical service-learning curricula prepare students to care for underserved patients.
Potential Role of Gut Microbiota in ALS Pathogenesis and Possible Novel Therapeutic Strategies
Authors: Mazzini Letizia , Mogna Luca , De Marchi Fabiola , Amoruso Angela , Pane Marco , Aloisio Irene , Cionci Nicole Bozzi , Gaggìa Francesca , Lucenti Ausiliatrice , Bersano Enrica , Cantello Roberto , Di Gioia Diana , Mogna Giovanni
Published: May 2018

Background:

Recent preclinical studies suggest that dysfunction of gastrointestinal tract may play a role in amyotrophic lateral sclerosis (ALS) pathogenesis through a modification of the gut microbiota brain axis. Our study is the first focused on microbiota analysis in ALS patients.

Aim:

Our aim was to study the main human gut microbial groups and the overall microbial diversity in ALS and healthy subjects. Moreover we have examined the influence of a treatment with a specific bacteriotherapy composed of Lactobacillus strains (Lactobacillus fermentum, Lactobacillus delbrueckii, Lactobacillus plantarum, Lactobacillus salivarius) acting on the gastrointestinal barrier.

Methods:

We enrolled 50 ALS patients and 50 healthy controls, matched for sex, age, and origin. Fecal samples were used for total genomic DNA extraction. Enterobacteria, Bifidobacterium spp., Lactobacillus spp., Clostridium sensu stricto, Escherichia coli and yeast were quantified using quantitative polymerase chain reaction approach. Denaturing gradient gel electrophoresis analyses were performed to investigate total eubacteria and yeasts populations. Patients were randomized to double-blind treatment either with microorganisms or placebo for 6 months and monitored for clinical progression and microbiota composition.

Results:

The comparison between ALS subjects and healthy group revealed a variation in the intestinal microbial composition with a higher abundance of E. coli and enterobacteria and a low abundance of total yeast in patients. Polymerase chain reaction denaturing gradient gel electrophoresis analysis showed a cluster distinction between the bacterial profiles of ALS patients and the healthy subjects. The complexity of the profiles in both cases may indicate that a real dysbiosis status is not evident in the ALS patients although differences between healthy and patients exist. The effects of the progression of the disease and of the bacteriotherapy on the bacterial and yeast populations are currently in progress.

Conclusions:

Our preliminary results confirm that there is a difference in the microbiota profile in ALS patients.
Genetic testing of XY newborns with a suspected disorder of sex development
Authors: Alimussina Malika , Diver Louise Ann , McGowan Ruth , Ahmed Syed Faisal
Published: May 2018

Purpose of review

The current review focuses on the neonatal presentation of disorders of sex development, summarize the current approach to the evaluation of newborns and describes recent advances in understanding of underlying genetic aetiology of these conditions.

Recent findings

Several possible candidate genes as well as other adverse environmental factors have been described as contributing to several clinical subgroups of 46,XY DSDs. Moreover, registry-based studies showed that infants with suspected DSD may have extragenital anomalies and in 46,XY cases, being small for gestational age (SGA), cardiac and neurological malformations are the commonest concomitant conditions.

Considering that children and adults with DSD may be at risk of several comorbidities a clear aetiological diagnosis will guide further management. To date, a firm diagnosis is not reached in over half of the cases of 46,XY DSD. Whilst it is likely that improved diagnostic resources will bridge this gap in the future, the next challenge to the clinical community will be to show that such advances will result in an improvement in clinical care.
New developments in the genetic diagnosis of short stature
Authors: Jee Youn Hee , Baron Jeffrey , Nilsson Ola
Published: May 2018

Purpose of review

Genome-wide approaches including genome-wide association studies as well as exome and genome sequencing represent powerful new approaches that have improved our ability to identify genetic causes of human disorders. The purpose of this review is to describe recent advances in the genetic causes of short stature.

Recent findings

In addition to SHOX deficiency which is one of the most common causes of isolated short stature, PAPPA2, ACAN, NPPC, NPR2, PTPN11 (and other rasopathies), FBN1, IHH and BMP2 have been identified in isolated growth disorders with or without other mild skeletal findings. In addition, novel genetic causes of syndromic short stature have been discovered, including pathogenic variants in BRCA1, DONSON, AMMECR1, NFIX, SLC25A24, and FN1.

Isolated growth disorders are often monogenic. Specific genetic causes typically have specific biochemical and/or phenotype characteristics which are diagnostically helpful. Identification of additional subjects with a specific genetic cause of short stature often leads to a broadening of the known clinical spectrum for that condition. The identification of novel genetic causes of short stature has provided important insights into the underlying molecular mechanisms of growth failure.
Human leukocyte antigen mismatch and precision medicine in transplantation
Authors: Wiebe Chris , Nickerson Peter
Published: May 2018

Purpose of review

Pretransplant and posttransplant alloimmune risk assessment needs to evolve towards a precision medicine model already used in other areas of medicine. Although this has not been possible with traditional risk factors available at the time of transplant, new methods of human leukocyte antigen (HLA) molecular mismatch have generated hope that alloimmune risk assessment may be precise enough for personalized treatment strategies.

Recent findings

This review describes the various HLA molecular mismatch methods and some of the recent publications for each method. These include studies that have evaluated HLA molecular mismatch in the context of lung, pancreas and kidney transplant as a correlate with short and long-term outcomes. The limitations of traditional alloimmune risk assessment strategies are highlighted in the context of individualized patient care.

Conclusion

Recent studies that have evaluated HLA molecular mismatch in the context of immunosuppression minimization are examples of how more precise measurements of alloimmune risk can lead to novel insights that may help personalize immunosuppression protocols.
Does the Shoe Fit? Considerations for Proper Shoe Fitting
Authors: Blazer Marie Mantini , Jamrog Laura Beth , Schnack Lauren Lindsay
Published: May 2018

It is important to be properly evaluated for shoes to avoid complications. Ill-fitting shoes can lead to pathologies in different populations. The focus of this article is to review the components and function of a basic athletic-type shoe, general shoe-fitting techniques, and selecting appropriate footwear for various populations including those with diabetes, elderly, and females. Poorly fitting shoes can exacerbate structural foot deformities. Unevenly distributed plantar pressures and wear can lead to ulcerations in diabetic populations. Resources and transportation may impact the elderly population when obtaining new shoes. Esthetics is of superior consideration for females. The Brannock Device measurements are important to ensure a correct fit in guiding shoe selection. The orthopaedic nurse should be able to recognize foot ailments caused by ill-fitting shoe gear. Seeking the advice of a podiatrist should be considered before purchasing shoes.
A Robust Approach to Implementing Fascia Iliaca Compartment Nerve Blocks in Hip Fracture Patients
Authors: Williams Mark G. , Jeffery Zachary , Corner Henry W. , Charity John , Quantick Marina , Sartin Natalie
Published: May 2018

BACKGROUND:

A clear imperative exists to optimize the preoperative pain management of hip fracture patients. Increasingly, fascia iliaca compartment blocks (FICBs) are being effectively utilized as an adjunct to oral analgesia in the emergency department.

PURPOSE:

We investigated the feasibility, safety, and delivery rate when junior doctors and specialist nurses are trained in FICBs delivery, alongside the introduction of a step-by-step proforma.

METHODS:

We conducted a retrospective study of hip fractures patients presenting preinterventions (n = 138) between October and December 2014 and postinterventions (n = 246) between April and August 2015. Outcomes analyzed included delivery frequency, anesthetic dosages used, and procedure documentation.

RESULTS:

Preintervention, FICB was performed in 40% (n = 51) of eligible patients, with an improvement to 72% (n = 160) postintervention. Postinterventions, 98% of FICBs were performed with the anesthetic dose recommended—a prescription between 75 and 100 mg of 0.25% levobupivacaine. No adverse patient outcomes, relating to the interventions implemented, were noted during the study period.

CONCLUSION:

Delivery of FICB by junior doctors and specialist nurses in the emergency department is feasible, safe, and improves the proportion of patients receiving blocks.
Historical and Current Trends in the Epidemiology of Early Syphilis in San Francisco, 1955 to 2016
Authors: Nguyen Trang Quyen , Kohn Robert P. , Ng Rilene Chew , Philip Susan S. , Cohen Stephanie E.
Published: May 2018

Background

Seventeen years into a sustained epidemic, early syphilis (ES) rates in San Francisco (SF) are continuing to increase and the demographics of the affected population are changing. We provide a historical overview of ES in SF among men who have sex with men (MSM) and describe trends in the epidemiology and disease investigation outcomes.

Methods

We examined data from the SF Department of Public Health's patient-based registry of integrated STD surveillance, clinical, and field investigation data to describe demographic and behavioral characteristics of ES cases, as well as outcomes of syphilis partner services (PS). χ2 Tests were performed to examine categorical differences across periods. Analysis of variance was used to examine differences in continuous variables.

Results

In 2016, 1095 ES cases were reported among males in SF, a 219% increase from the 343 cases identified 10 years ago. Between 1996–1999 and 2010–2016, an increasing proportion of ES cases were among MSM younger than 25 years, nonwhite, and HIV negative (P < 0.05). A decreasing proportion of ES cases were assigned for PS, among whom a smaller proportion of reported sex partners were identified by name, resulting in an overall decline in the proportion of cases who had at least one named partner treated as a result of PS (Disease Intervention Rate) from 30.5 in 2000–2004 to 14.8 in 2010–2016.

Conclusions

Syphilis case rates continue to increase in SF and the epidemic is expanding beyond a core population. Additional resources and innovative prevention approaches are needed to reduce the burden of syphilis among MSM.
Post-therapy Functional Magnetic Resonance Imaging in Adults with Symptomatic Convergence Insufficiency
Authors: Widmer Douglas E. , Oechslin Tamara S. , Limbachia Chirag , Kulp Marjean Taylor , Toole Andrew J. , Kashou Nasser H. , Fogt Nicklaus
Published: May 2018

SIGNIFICANCE

Prior studies have demonstrated the effectiveness of vergence-accommodative therapy in the treatment of convergence insufficiency (CI). These results show the changes in brain activation following therapy through the use of functional magnetic resonance imaging (fMRI).

PURPOSE

The purpose of this study was to investigate changes in brain activation following office-based vergence-accommodative therapy versus placebo therapy for CI using the blood oxygenation level–dependent signal from fMRI.

METHODS

Adults (n = 7, aged 18 to 30 years) with symptomatic CI were randomized to 12 weeks of vergence-accommodative therapy (n = 4) or placebo therapy (n = 3). Vergence eye movements were performed during baseline and outcome fMRI scans.

RESULTS

Before therapy, activation (z score ≥ 2.3) was observed in the occipital lobe and areas of the brain devoted to attention, with the largest areas of activation found in the occipital lobe. After vergence-accommodative therapy, activation in the occipital lobe decreased in spatial extent but increased in the level of activation in the posterior, inferior portion of the occipital lobe. A new area of activation appeared in the regions of the lingual gyrus, which was not seen after placebo therapy. A significant decrease in activation was also observed in areas of the brain devoted to attention after vergence-accommodative therapy and to a lesser extent after placebo therapy.

CONCLUSIONS

Observed activation pre-therapy consistent with top-down processing suggests that convergence requires conscious effort in symptomatic CI. Decreased activation in these areas after vergence-accommodative therapy was associated with improvements in clinical signs such as fusional vergence after vergence-accommodative therapy. The increase in blood oxygen level–dependent response in the occipital areas following vergence-accommodative therapy suggests that disparity processing for both depth and vergence may be enhanced following vergence-accommodative therapy.
Case Report: Hydroxychloroquine Retinopathy
Authors: Eldeeb Mohab , Chan Errol W. , Omar Amer
Published: May 2018

SIGNIFICANCE

Hydroxychloroquine retinopathy causes irreversible central visual loss and can progress despite medication discontinuation. Appropriate dosing and recognition of early disease are important to minimize adverse visual sequelae. In 2016, the American Academy of Ophthalmology updated its 2011 recommendations for dosing, screening, and monitoring of hydroxychloroquine retinopathy.

PURPOSE

The aim of this study was to report a case of hydroxychloroquine retinopathy in a patient who developed toxicity on a dose meeting safety thresholds from the 2011 guidelines (i.e., 6.5 mg/kg ideal body weight and cumulative dose <1000 g), but exceeding that from the 2016 revised recommendations (i.e., 5.0 mg/kg real body weight).

CASE REPORT

A 61-year-old woman with rheumatoid arthritis treated with 400 mg/kg hydroxychloroquine daily for 6 years (daily dose, 5.72 mg/real body weight or 6.5 mg/kg ideal body weight; cumulative dose, 876 g) experienced progressive central vision loss and a scotoma affecting her reading ability and was referred to the Retina service. Prior yearly examination with only Ishihara color vision and Amsler grid testing was normal. On examination, visual acuity was 20/40 in the right eye and 20/30 in the left eye. A fundus examination showed bilateral bull's-eye maculopathy, a classic finding of hydroxychloroquine retinal toxicity. Fundus autofluorescence showed a parafoveal ring of speckled hypoautofluorescence and an external ring of increased signal. There were characteristic structural changes on spectral domain–optical coherence tomography, including parafoveal loss of the ellipsoid zone and outer nuclear layer. Humphrey visual field testing of the central 10-2 revealed incomplete paracentral annular scotoma. Subsequently, hydroxychloroquine was switched to sulfasalazine.

CONCLUSIONS

The 2016 American Academy of Ophthalmology guidelines for hydroxychloroquine retinopathy were revised to reflect new dosing and care guidelines for early detection of retinal toxicity and to minimize the extent of irreversible vision loss.
Detecting Cheating when Testing Vision: Variability in Acuity Measures Reveals Misrepresentation
Authors: Ravensbergen Henrike (Rianne) Joanna Cornelie , van Bree Belle I. N. A. , Broekens Douwe M. , Mann David Lindsay
Published: May 2018

SIGNIFICANCE

In certain scenarios, it is advantageous to misrepresent one's ability and “cheat” on vision tests. Our findings suggest that increased variability when testing visual acuity holds promise as a novel means to help detect this cheating and may generalize to other subjective tests of visual function.

PURPOSE

People who cheat on vision tests generally do so to make their vision appear better than it actually is (e.g., for occupational or driving purposes). However, there are particular settings in which it is advantageous for their vision to appear to be worse than is the case (e.g., to qualify for benefits available to people with low vision). Therefore, a method to help detect cheating in these scenarios is desirable. The aim of this study was to investigate whether the intentional underrepresentation of vision could be detected when testing visual acuity.

METHODS

We tested the visual acuity of 13 participants with simulated vision impairment using the Berkeley Rudimentary Vision Test. Participants were tested in an honest condition when providing their best effort and in a cheating condition when attempting to make their visual acuity appear to be markedly worse. We also tested visual acuity of 17 participants with a wide range of vision impairments.

RESULTS

Participants were successfully able to “cheat” on the tests; however, their responses were significantly more variable when cheating (P < .001). Although the variability in visual acuity was larger in individuals with actual vision impairment compared with those providing honest answers with simulated impairment (P < .01), their responses remained significantly less variable than those for individuals in the cheating condition (P = .01).

CONCLUSIONS

The variability in the estimations of vision provides a promising novel means of detecting the intentional underrepresentation of vision and could help to minimize the chance of successfully cheating on tests of vision.
Fatal Airway Obstruction in a Man With a Cystic Hygroma
Authors: Wygant Cassandra Maria , Cohle Stephen D.
Published: May 2018

We describe a 24-year-old man with a cystic hygroma of the left side of the lower neck that led to sudden death. Cystic hygroma (cystic lymphangioma) is a congenital malformation of the lymphatic system. The patient, who had a tracheostomy because of airway obstruction from the cystic hygroma, was found dead with his tracheostomy tube on the floor next to him. Complications of cystic hygroma include infiltration of the neck causing airway obstruction, dysphagia, pain, and obstructive sleep apnea.
Data-Powered Participatory Decision Making
Authors: Wheeler Stephanie B. , Leeman Jennifer , Hassmiller Lich Kristen , Tangka Florence K.L. , Davis Melinda M. , Richardson Lisa C.
Published: May 2018

A robust evidence base supports the effectiveness of timely colorectal cancer (CRC) screening, follow-up of abnormal results, and referral to care in reducing CRC morbidity and mortality. However, only two-thirds of the US population is current with recommended screening, and rates are much lower for those who are vulnerable because of their race/ethnicity, insurance status, or rural location. Multiple, multilevel factors contribute to observed disparities, and these factors vary across different populations and contexts. As highlighted by the Cancer Moonshot Blue Ribbon Panel working groups focused on Prevention and Early Detection and Implementation Science inadequate CRC screening and follow-up represent an enormous missed opportunity in cancer prevention and control. To measurably reduce CRC morbidity and mortality, the evidence base must be strengthened to guide the identification of (1) multilevel factors that influence screening across different populations and contexts, (2) multilevel interventions and implementation strategies that will be most effective at targeting those factors, and (3) combinations of strategies that interact synergistically to improve outcomes. Systems thinking and simulation modeling (systems science) provide a set of approaches and techniques to aid decision makers in using the best available data and research evidence to guide implementation planning in the context of such complexity. This commentary summarizes current challenges in CRC prevention and control, discusses the status of the evidence base to guide the selection and implementation of multilevel CRC screening interventions, and describes a multi-institution project to showcase how systems science can be leveraged to optimize selection and implementation of CRC screening interventions in diverse populations and contexts.
Risk Factors for Delays in Adjuvant Chemotherapy following Immediate Breast Reconstruction
Authors: Cohen Oriana , Lam Gretl , Choi Mihye , Ceradini Daniel , Karp Nolan
Published: May 2018

Background:

Concerns exist that immediate breast reconstruction may delay adjuvant chemotherapy initiation, impacting oncologic outcomes. Here, the authors determine how postoperative complications impact chemotherapy timing, and identify factors associated with greater risk for delays.

Methods:

Retrospective chart review identified patients undergoing immediate breast reconstruction and adjuvant chemotherapy at a single institution from 2010 to 2015. Patients were analyzed based on occurrence of postoperative complications and time to chemotherapy.

Results:

A total of 182 patients (244 breast reconstructions) were included in the study; 210 (86 percent) reconstructions did not experience postoperative complications, and 34 (13.9 percent) did. Patients who experienced postoperative complications had an older mean age (53.6 years versus 48.1 years; p = 0.002) and higher rates of diabetes (23.5 percent versus 3.8 percent; p < 0.001). The complication group had delays in initiation of chemotherapy (56 versus 45 days; p = 0.017). Patients who initiated chemotherapy more than 48.5 days after reconstruction were of older mean age (55.9 years versus 50.7 years; p = 0.074) and had increased rates of diabetes (36.8 percent versus 6.7 percent; p = 0.053) and immediate autologous reconstruction (31.6 percent versus 0 percent; p = 0.027). A predictive model determined that patients with at least one of these three risk factors have a 74 percent chance of experiencing prolonged times to chemotherapy initiation.

Conclusions:

Risk factors for delayed chemotherapy in the context of postoperative complications are age older than 51.7 years, diabetes, and autologous reconstruction. Reconstructive candidates who fit this profile are at highest risk and merit extra consideration.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Microanatomy of Sensory Nerves in the Upper Eyelid: A Cadaveric Anatomical Study
Authors: Higashino Takuya , Okazaki Mutsumi , Mori Hiroki , Yamaguchi Kumiko , Akita Keiichi
Published: May 2018

Background:

Plastic surgery requires detailed knowledge of upper eyelid anatomy, but few authors have sufficiently described the specifics of upper eyelid nerve anatomy. This study aimed to provide a thorough description of sensory nerve anatomy in the upper eyelid and to propose considerations for upper eyelid surgery.

Methods:

Sixteen orbits were dissected from 16 fixed, adult human cadavers. Microscopically, the authors identified the main trunks of the infratrochlear, supratrochlear, and supraorbital nerves and all branches that projected toward the upper eyelid. The number, size, and distribution of nerve branches were recorded.

Results:

The branches of the infratrochlear, supratrochlear, and supraorbital nerves covered a wide range in the upper eyelid. The mean numbers of branches per nerve were 1.6 ± 1.2, 3.2 ± 1.5, and 2.6 ± 1.4, respectively. The branches of the infratrochlear nerve were distributed throughout the medial area of the upper eyelid. Those of the supratrochlear nerve were distributed throughout the medial and central areas, and the palpebral branches of the supraorbital nerve were distributed throughout the central and lateral areas of the upper eyelid. The lateral branches of the supraorbital nerve and the cutaneous branches of the lacrimal nerve were distributed in the lateral region of the orbit.

Conclusions:

The authors show that upper eyelid sensation is transmitted mainly by the supratrochlear and supraorbital nerves, and the authors provide a map of the distribution of upper eyelid sensory nerves. This precise anatomical knowledge about upper eyelid sensory nerves will facilitate pain control and help minimize nerve injuries during surgery.