bluuebunny/crossref_metadata_2025 huggingface dataset:
Salvage Debridement, Antibiotics and Implant Retention (“DAIR”) With Local Injection of a Selected Cocktail of Bacteriophages: Is It an Option for an Elderly Patient With Relapsing Staphylococcus aureus Prosthetic-Joint Infection?
Authors: Ferry Tristan , Leboucher Gilles , Fevre Cindy , Herry Yannick , Conrad Anne , Josse Jérôme , Batailler Cécile , Chidiac Christian , Medina Mathieu , Lustig S , Laurent Frédéric ,   Lyon BJI Study Group, Ferry Tristan , Ferry Tristan , Valour Florent , Perpoint Thomas , Boibieux André , Biron François , Miailhes Patrick , Ader Florence , Becker Agathe , Roux Sandrine , Triffault-Fillit Claire , Conrad Anne , Bosch Alexie , Daoud Fatiha , Lippman Johanna , Braun Evelyne , Chidiac Christian , Lustig Sébastien , Servien Elvire , Gaillard Romain , Schneider Antoine , Gunst Stanislas , Batailler Cécile , Fessy Michel-Henry , Besse Jean-Luc , Herry Yannick , Viste Anthony , Chaudier Philippe , Courtin Cyril , Louboutin Lucie , Martres Sébastien , Trouillet Franck , Barrey Cédric , Jouanneau Emmanuel , Jacquesson Timothée , Mojallal Ali , Boucher Fabien , Shipkov Hristo , Chateau Joseph , Aubrun Frédéric , Dziadzko Mikhail , Macabéo; Caroline , Laurent Frederic , Beraud Laeticia , Josse Jérôme , Kolenda Camille , Dupieux Céline , Craighero Fabien , Boussel Loic , Pialat Jean-Baptiste , Morelec Isabelle , Janier Marc , Giammarile Francesco , Tod Michel , Gagnieu Marie-Claude , Goutelle Sylvain , Grisi Béatrice , Dananche Cédric , Mabrut Eugénie
Published: October 2018

Local injection of a bacteriophages mix during debridement, antibiotics and implant retention (“DAIR”) was performed to treat a relapsing Staphylococcus aureus chronic prosthetic joint infection (PJI). This salvage treatment was safe and associated with a clinical success. Scientific evaluation of the potential clinical benefit of bacteriophages as antibiofilm treatment in PJI is now feasible and required.
Overproduction of IL-6 and Type-I IFN in a Lethal Case of Chikungunya Virus Infection in an Elderly Man During the 2017 Italian Outbreak
Authors: Colavita Francesca , Vita Serena , Lalle Eleonora , Carletti Fabrizio , Bordi Licia , Vincenti Donatella , Pozzetto Irene , Aiuti Massimo , Vairo Francesco , Capobianchi Maria Rosaria , Lichtner Miriam , Castilletti Concetta
Published: October 2018

Chikungunya fever is caused by Chikungunya virus (CHIKV) and is generally considered a self-limiting disease. However, severe clinical presentations with a high mortality rate have been reported in association with underlying medical conditions. This study reports the molecular characterization of the virus and an abnormal pattern of circulating cytokines in a unique lethal CHIKV case during the 2017 outbreak in Italy, which involved an elderly patient with underlying cardiac disease. Analysis of inflammatory cytokines revealed a strong increase of interferon (IFN)-α and IFN-β, as well as interleukin-6, suggesting a possible role of type-I IFN in the cytokine storm, which may be correlated with unfavorable prognosis of CHIKV infection.
Inflammatory Mediator Expression Associated With Antibody Response Induced by Live Attenuated vs Inactivated Influenza Virus Vaccine in Children
Authors: Martin Judith M , Avula Raghunandan , Nowalk Mary Patricia , Lin Chyongchiou Jeng , Horne William T , Chandran Uma R , Nagg Jennifer P , Zimmerman Richard K , Cole Kelly S , Alcorn John F
Published: October 2018

Background

The reasons for differences in vaccine effectiveness between live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) are not clear.

Methods

Blood samples were obtained before vaccination and at days 7 and 21 postvaccination with 2015–2016 quadrivalent IIV or LAIV. Serologic response to the vaccine was measured by hemagglutination inhibition assay. Targeted RNA sequencing and serum cytokine analysis were performed. Paired analyses were used to determine gene expression and were compared between IIV and LAIV recipients. Classification And Regression Trees analysis (CART) identified the strongest associations with vaccine response.

Results

Forty-six enrollees received IIV, and 25 received LAIV. The mean age was 11.5 (±3.7) years. Seroconversion with IIV was associated with changes in expression of PRKRA and IFI6. Nonseroconversion for both IIV and LAIV was characterized by increased interferon-stimulated gene expression. Seroprotection with both vaccines was associated with altered expression of CXCL2 and CD36. For LAIV, CART showed that changes in expression of CD80, CXCL2, and CASP1 were associated with seroprotection. Serum cytokines showed that IIV seroconversion was associated with decreased CCL3. LAIV seroprotection tracked with decreased tumor necrosis factor–α and interferon-γ.

Conclusions

Distinct markers of seroconversion and seroprotection against IIV and LAIV were identified using immunophenotyping and CART analysis.
Development and Validation of a Model to Predict Growth of Potentially Antibiotic-Resistant Gram-Negative Bacilli in Critically Ill Children With Suspected Infection
Authors: Karsies Todd , Moore-Clingenpeel Melissa , Hall Mark
Published: October 2018

Background

Risk-based guidelines aid empiric antibiotic selection for critically ill adults with suspected infection with Gram-negative bacilli with high potential for antibiotic resistance (termed high-risk GNRs). Neither evidence-based guidelines for empiric antibiotic selection nor validated risk factors predicting high-risk GNR growth exist for critically ill children. We developed and validated a model for predicting high-risk GNR growth in critically ill children with suspected infection.

Methods

This is a retrospective cohort study involving 2 pediatric cohorts admitted to a pediatric intensive care unit (ICU) with suspected infection. We developed a risk model predicting growth of high-risk GNRs using multivariable regression analysis in 1 cohort and validated it in a separate cohort.

Results

In our derivation cohort (556 infectious episodes involving 489 patients), we identified the following independent predictors of high-risk GNR growth: hospitalization >48 hours before suspected infection, hospitalization within the past 4 weeks, recent systemic antibiotics, chronic lung disease, residence in a chronic care facility, and prior high-risk GNR growth. The model sensitivity was 96%, the specificity was 48%, performance using the Brier score was good, and the area under the receiver operator characteristic curve (AUROC) was 0.722, indicating good model performance. In our validation cohort (525 episodes in 447 patients), model performance was similar (AUROC, 0.733), indicating stable model performance.

Conclusions

Our model predicting high-risk GNR growth in critically ill children demonstrates the high sensitivity needed for ICU antibiotic decisions, good overall predictive capability, and stable performance in 2 separate cohorts. This model could be used to develop risk-based empiric antibiotic guidelines for the pediatric ICU.
Pain Catastrophizing Is Independently Associated with Quality of Life in Patients with Severe Hip Osteoarthritis
Authors: Hayashi Kazuhiro , Morishima Takkan , Ikemoto Tatsunori , Miyagawa Hirofumi , Okamoto Takuya , Ushida Takahiro , Deie Masataka
Published: October 2018

Objective. Pain catastrophizing is an important pain-related variable, but its impact on patients with osteoarthritis is uncertain. The aim of the current study was to determine whether pain catastrophizing was independently associated with quality of life (QOL) in patients with osteoarthritis of the hip. Design. Cross-sectional study conducted between June 2017 and February 2018. Setting. Tertiary center. Subjects. Seventy consecutively enrolled patients with severe hip osteoarthritis who had experienced pain for six or more months that limited daily function, and who were scheduled for primary unilateral total hip arthroplasty. Methods. QOL was measured using the EuroQOL-5 Dimensions questionnaire, the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire, and a dissatisfaction visual analog scale. Covariates included pain intensity, pain catastrophizing, range of hip motion, and gait speed. The variables were subjected to multivariate analysis with each QOL scale. Results. The median age was 68 years, and the median Pain Catastrophizing Scale score was 26. In multiple regression analysis, pain catastrophizing, pain intensity in both hips, pain intensity on the affected side, hip flexion on the affected side, and gait speed were independently correlated with QOL. Conclusions. Pain catastrophizing was independently associated with each QOL scale in preoperative patients with severe hip osteoarthritis. Pain catastrophizing had either the strongest or second strongest effect on QOL, followed by pain intensity.
Association of HLA-DRB1 shared epitope alleles and immune checkpoint inhibitor-induced inflammatory arthritis
Authors: Cappelli Laura C , Dorak Mehmet T , Bettinotti Maria P , Bingham Clifton O , Shah Ami A
Published: October 2018

Objective

To evaluate the frequency of HLA class I and II alleles associated with traditional forms of inflammatory arthritis in patients with immune checkpoint inhibitor (ICI)-induced inflammatory arthritis as compared with population controls.

Methods

High-resolution HLA typing was performed on 27 patients with ICI-induced inflammatory arthritis and 726 healthy controls. Genotyping at the shared epitope (SE) locus (HLA DRB1) was performed on 220 RA cases. Allele-positivity rates and frequency of having at least one SE allele were compared using Fisher’s exact test between ICI-induced inflammatory arthritis and healthy controls. Frequency of having at least one SE allele was also compared between ICI-induced inflammatory arthritis and RA cases.

Results

Twenty-six patients with ICI-induced inflammatory arthritis were of European descent, and one was African American. In those 26 patients, 16 (61.5%) had at least one SE allele, significantly different from healthy controls of European descent, in whom 299 (41.2%) had at least one SE allele (odds ratio 2.3, P = 0.04). The allele-positivity rate of DRB1*04: 05 was also higher in the ICI-induced inflammatory arthritis group. The ICI-induced inflammatory arthritis population and RA patients of European descent did not differ in frequency of having at least one SE allele, but ICI-induced inflammatory arthritis patients were more likely to be autoantibody-negative for RF and anti-CCP antibodies.

Conclusion

Patients with ICI-induced inflammatory arthritis of European descent were more likely to have at least one SE allele than healthy controls. Further studies are needed to validate these findings and investigate whether a unique immunogenetic framework increases risk for different immune-related adverse events.
Democracy Misunderstood: Authoritarian Notions of Democracy around the Globe
Authors: Kirsch Helen , Welzel Christian
Published: October 2018

An intriguing phenomenon consists in the fact that widespread support for democracy coexists in many countries with the persistent absence of democracy itself. Addressing this phenomenon, we show that in most places where it exists people understand democracy in ambiguous ways, such that “authoritarian” notions of what democracy means mix with—and even overshadow—liberal notions, in spite of the contradiction between these two notions. Underlining this contradiction, our evidence shows that authoritarian notions of democracy question the authenticity of liberal notions when both are endorsed conjointly. Worse, the evidence further suggests that authoritarian notions reverse the whole meaning of support for democracy, indeed indicating support for autocracy instead. Arguably, this reversal in the meaning of support for democracy lends legitimacy to authoritarian rule, which helps to explain where autocracy endures. Testing alternative explanations of authoritarian notions of democracy, we find that emancipative values are most influential, exerting a two-fold “enlightening” effect in (a) making people recognize the contradiction between liberal and authoritarian notions of democracy and (b) turning them against authoritarian notions. In a nutshell, the prospects of democracy are bleak where emancipative values remain weak.
Unmet Needs in Nutritional Care in African Paediatric Oncology Units
Authors: Schoeman Judy , Ladas Elena J , Rogers Paul C , Aryal Suvekshya , Kruger Mariana
Published: October 2018

Background

Up to 50% of children diagnosed with cancer in low- and middle-income countries are malnourished, which likely affects survival.

Subjects and methods

An online survey to paediatric oncology units (POUs) in Africa was done regarding nutritional assessment and care.

Results

Sixty-six surveys were received from POUs in 31 countries. Only 44.4% had a dedicated dietician for nutritional assessment and support; 29.6% undertook routine nutritional assessment during treatment. None reported defined criteria for nutritional intervention. Total parenteral nutrition was not available for 42.6% of POUs, while 51.8% did not have access to commercial enteral nutrition for inpatients, and 25.9% of the hospitals could not supply any home-based nutritional supplements.

Conclusion

Nutritional assessment in POUs in Africa is neither routinely undertaken nor are there defined criteria to initiate nutritional interventions. Standardized guidelines for nutritional assessment and interventions are needed for African POUs to enable improved outcome.
Theory-Driven Integrative Process/Outcome Evaluation of a Concept-Based Nursing Curriculum
Authors: Fromer Rosemary F.
Published: October 2018

The study aim was to evaluate the effects of concept-based learning by comparing ATI Nursing Education test scores for a traditional curriculum and a concept-based curriculum. The study also examined effects of the concept-based curriculum on critical thinking and motivation. No statistically significant differences were noted in ATI scores for the two groups; students neither agreed nor disagreed that they were engaged in critical thinking but did agree with motivation statements. Faculty were surveyed about their approach to teaching.
Team Communication Influence on Procedure Performance: Findings From Interprofessional Simulations with Nursing and Medical Students
Authors: Reising Deanna L. , Carr Douglas E. , Gindling Sally , Barnes Roxie , Garletts Derrick , Ozdogan Zulfukar
Published: October 2018

Interprofessional team performance is believed to be dependent on the development of effective team communication skills. Yet, little evidence exists in undergraduate nursing programs on whether team communication skills affect team performance. A secondary analysis of a larger study on interprofessional student teams in simulations was conducted to determine if there is a relationship between team communication and team procedure performance. The results showed a positive, significant correlation between interprofessional team communication ratings and procedure accuracy in the simulation. Interprofessional team training in communication skills for nursing and medical students improves the procedure accuracy in a simulated setting.
Pharmacology Goes Concept-Based: Course Design, Implementation, and Evaluation
Authors: Lanz Amelia , Davis Rebecca G.
Published: October 2018

Although concept-based curricula are frequently discussed in the nursing education literature, little information exists to guide the development of a concept-based pharmacology course. Traditionally, nursing pharmacology courses are taught with an emphasis on drug class where a prototype drug serves as an exemplar. When transitioning pharmacology to a concept-based course, special considerations are in order. How can educators successfully integrate essential pharmacological content into a curriculum structured around nursing concepts? This article presents one approach to the design and implementation of a concept-based undergraduate pharmacology course. Planning methods, supportive teaching strategies, and course evaluation procedures are discussed.
Surviving the NCLEX Dip
Authors: Mager Diana , Beauvais Audrey , Kazer Meredith Wallace
Published: October 2018

Schools of nursing are charged with preparing graduates to meet minimal practice standards upon workforce entry. To that end, students must pass the National Council of State Boards of Nursing Licensure Examination (NCLEX-RN®) upon graduation. Increased rigor and higher recent passing standards for the exam can contribute to declining scores, which negatively impact graduates and the nursing program. The purpose of this article is to describe a successful 10-step action plan implemented to remediate a brief dip in NCLEX-RN pass rates at one university. The plan contributed to a 10 percent increase in NCLEX scores within one year.
The Competency/Outcomes Model: Advancing Academic Progression
Authors: Sroczynski Maureen , Close Liz , Gorski Mary Sue , Farmer Pat , Wortock Jean
Published: October 2018

AIM

This article describes the Competency Model (CM) as a promising curriculum framework to foster academic progression from the associate to the baccalaureate degree in nursing.

BACKGROUND

The CM was identified by the Center to Champion Nursing in America as one of four seamless nursing academic progression models to streamline nursing academic progression. It is built on a foundation of authentic collaboration between education and practice partners to develop and maintain explicit, current, practice-relevant nursing education outcomes.

METHOD

Salient features and exemplars were collected from a convenience sample of education practice partnerships across the country that have implemented the CM.

RESULTS

Characteristics, trends, and variations in the CM from different state, regional, and local approaches are described and contrasted.

CONCLUSION

A comparison of varied approaches in CM design and implementation demonstrates its versatility to support seamless academic progression and fortify education and practice collaboration.
Texas Team: Academic Progression and IOM Toolkit
Authors: Reid Helen , Tart Kathryn , Tietze Mari , Joseph Nitha Mathew , Easley Carson
Published: October 2018

BACKGROUND

The Institute of Medicine (IOM) Future of Nursing report, identified eight recommendations for nursing to improve health care for all Americans.

AIM

The Texas Team for Advancing Health Through Nursing embraced the challenge of implementing the recommendations through two diverse projects.

METHOD

One group conducted a broad, online survey of leadership, practice, and academia, focusing on the IOM recommendations. The other focused specifically on academic progression through the use of CABNET (Consortium for Advancing Baccalaureate Nursing Education in Texas) articulation agreements.

RESULTS

The survey revealed a lack of knowledge and understanding of the IOM recommendations, prompting development of an online IOM toolkit. The articulation agreements provide a clear pathway for students to the RN-to-BSN degree students.

CONCLUSION

The toolkit and articulation agreements provide rich resources for implementation of the IOM recommendations.
Site-specific Surgical Site Infection Rates for Rib-based Distraction
Authors: Striano Brendan M. , Refakis Christian A. , Anari Jason B. , Campbell Robert M. , Flynn John M.
Published: October 2018

Background:

Implantable rib-based distraction devices have revolutionized the treatment of children with early onset scoliosis and thoracic insufficiency syndrome. Unfortunately, the need for multiple skin incisions and repeated surgeries in a fragile patient population creates considerable infection risk. In order to assess rates of infection for different incision locations and potential risk factors, we generated a prospectively collected database of patients treated with rib-based distraction devices.

Methods:

We analyzed a cohort of patients with thoracic insufficiency syndrome from various etiologies that our institution treated with rib-based distraction devices from 2013 to 2016. Surgery type (implantation, expansion, revision/removal), and surgeon adjudicated surgical site infection (SSI) were collected. For this study, we developed a novel, rib-based distraction device surgical site labeling system in which incisions could be labeled as either proximal or distal surgical exposure areas. Treating surgeons documented the operative site, procedure, and SSI site in real-time.

Results:

A total of 166 unique patients underwent 670 procedures during the study period, producing 1537 evaluable surgical sites; 1299 proximal and 238 distal. Patients were 6.81±4.0 years of age on average. Forty-seven procedures documented SSIs (7.0%), while 40 (24.1%) patients experienced an infection. Analysis showed significant variation in the rate of infection between implantation, and expansion, and revision procedures, with implantation procedures having the highest infection rate at 13.1% (P<0.01). Infections occurred more frequently at distal sites than proximal ones (P=0.02).

Conclusions:

Our novel, surgeon-entered, prospective quality improvement database has identified distal surgical sites as being at higher risk for SSI than proximal ones. Further, rib-based distraction device implantation procedures were identified as being at a greater risk for SSI than expansion or revision procedures. We believe this data can lead to improved prevention measures, anticipatory guidance, and patient care.

Level of Evidence:

Level II—prognostic study.
A Quartet of Elastic Stable Intramedullary Nails for More Challenging Pediatric Femur Fractures
Authors: Busch Michael T. , Perkins Crystal A. , Nickel Brian T. , Blizzard Daniel J. , Willimon Samuel Clifton
Published: October 2018

Introduction:

The insertion of 2 elastic stable intramedullary nails (ESINs) is a common treatment for pediatric femur fractures. However, the use of this technique in length-unstable or metadiaphyseal fractures has historically been associated with higher complication rates. To improve stability, the addition of a third ESIN has been assessed biomechanically and clinically, but the addition of a fourth nail has only been evaluated biomechanically. The purpose of this study is to report our surgical technique and radiographic outcomes using a quartet of ESINs in pediatric femur fractures.

Methods:

A retrospective review was performed of pediatric patients with length-unstable or metadiaphyseal femur fractures who were treated with 4 ESINs by a single surgeon from 2008 to 2013. Nails were inserted in a retrograde manner, 2 each from medial and lateral starting points. Patients were followed clinically and radiographically until the union and routine removal of hardware. Primary outcomes included fracture union, sagittal, and coronal plane alignment, and complications.

Results:

Fourteen patients underwent quartet ESIN placement. Two patients were excluded: one for early loss to follow-up and another with a diagnosis of osteogenesis imperfecta. The average patient age was 9.3 years (range, 4 to 14 y) and weight was 47 kg (range, 21 to 95 kg). All fractures achieved radiographic union at mean 5.5 months (range, 2 to 9 mo). Hardware was removed at a mean of 9.4 months (range, 2 to 22 mo) following implantation. At final mean follow-up of 18 months, patients and families reported no functional limitations. There were no hardware failures or revision surgeries. There were no limb length discrepancies or malalignment at the time of final radiographic follow-up. There were 2 minor complications—1 patient with pain secondary to nail migration resulting in prominence at the knee and another with refracture following a fall. The stable refracture occurred before complete fracture union and hardware removal and went on to the union without the need for any additional treatment.

Conclusions:

Treatment with a quartet of ESINs should be considered for skeletally immature children with length-unstable or metadiaphyseal femur fractures. In this series, all fractures achieved union without major complications or hardware failure. This modification to traditional elastic nailing techniques is an option for the surgeon to consider as an alternative to rigid intramedullary nailing, submuscular plating, or external fixation.

Level of Evidence:

Level IV.
Treatment of Acute Seymour Fractures
Authors: Lin James S. , Popp James E. , Balch Samora Julie
Published: October 2018

Background:

Seymour fractures are distal phalanx fractures in children with a juxta-epiphyseal pattern. The purpose of our study was to investigate the treatments, outcomes, operative ;indications, and antibiotic choice for acute Seymour fractures (presenting within 24 h of injury), to better define optimal management. We hypothesized that: (1) cephalexin provides adequate antibiotic coverage for acute Seymour fractures; (2) most injuries will achieve good outcomes with management in the emergency department (ED) alone; and (3) indication for operative intervention is unsuccessful or unstable reduction in the ED.

Methods:

We performed a retrospective study of patients under 18 years old treated at a large pediatric hospital from 2009 to 2017 for an acute Seymour fracture. Study outcomes included management and antibiotic type, infection, fracture healing, malunion, physeal disturbance, nail dystrophy, antibiotic failure, and need for unplanned operative intervention.

Results:

Mean age of patients was 10 years, with 43 males and 22 females sustaining 65 Seymour fractures. Fifty-eight cases (89%) were initially managed in the emergency department. Seven cases were initially managed with an operative intervention that included I&D, open reduction, and K-wire fixation. The most commonly cited surgical indication was unsuccessful closed reduction. Four patients initially managed in the ED required an unplanned operation, usually because of fracture redisplacement. Complications were rare, with superficial infections being most common.

Conclusions:

Most acute Seymour fractures can be successfully managed in the emergency department if stable reduction is achieved.

Level of Evidence:

Level IV, therapeutic.
Pediatric Sports Medicine, A New Subspeciality in Orthopedics: An Analysis of the Surgical Volume of Candidates for the American Board of Orthopaedic Surgery Part II Certification Exam Over the Past Decade
Authors: Obey Mitchel R. , Lamplot Joseph , Nielsen Ena D. , Andras Lindsay M. , Mignemi Megan , Sawyer Jeffrey , Flynn John M. , Albanese Stephen A. , Hosseinzadeh Pooya
Published: October 2018

Background:

Pediatric orthopaedic surgery has become increasingly subspecialized over the past decade. The purpose of this study was to analyze the volume of pediatric sports medicine cases performed by surgeons applying for the American Board of Orthopaedic Surgeons (ABOS) Part II certification exam over the past decade, comparing caseloads according to the type(s) of fellowship completed.

Methods:

The ABOS database was reviewed for all surgeons applying for the ABOS Part II certification exam from 2004 to 2014. Fellowship training of the candidates was recorded as Pediatrics, Sports, and Dual-Fellowship (fellowship in both Pediatrics and Sports). All other candidates were categorized as “Other”. A total of 102,424 pediatric cases (patients below 18 years) were reviewed to identify sports medicine cases performed by CPT code. Multiple linear regression and Mann-Whitney U tests were used to determine trends in case volume overall and according to fellowship training for all patients, patients ≥13 and patients <13. One-way ANOVA testing was used to compare multiple means followed by multiple post hoc comparisons using a Tukey all pairwise approach using SPSS.

Results:

A total of 14,636 pediatric sports medicine cases were performed. There was an increase in the number of sports medicine cases performed in patients <13 (117.5±31.8 from 2004-2009 to 212.4±70.1 from 2010-2014, P=0.035; r
2=0.743, P=0.0007). The number of Pediatrics (r
2=0.601, P=0.005), Sports (r
2=0.741, P=0.0007) and Dual-Fellowship candidates increased (r
2=0.600, P=0.005) from 2004-2014. Dual-Fellowship surgeons performed 21.4% of pediatric sports medicine cases in 2014 when compared to 2.1% in 2004 (919% increase). As a group, the number of pediatric sports cases performed by Dual-Fellowship (r
2=0.630, P=0.004) and Sports (r
2=0.567, P=0.007) candidates has increased, while the number performed by “Other” candidates has decreased (r
2=0.758, P=0.0005). Per surgeon, Dual-Fellowship candidates performed a greater number of pediatric sports cases per collection period (36.5±9.18) than Pediatrics (6.71±0.94), Sports (5.99±0.46), and “Other” (1.21±0.15, P<0.0001 for each) candidates from 2004 to 2014.

Conclusions:

Over the past decade operative sports injuries have increased in children with a similar increase in the number of orthopedic surgeons specializing in pediatric sports medicine. On a per surgeon basis, these dual fellowship-trained candidates have performed on average five times the number of pediatric sports medicine cases compared to all other ABOS Part II candidates. These trends may point towards the development of a new subspecialty of pediatric sports medicine among orthopedic surgeons.

Level of Evidence:

Level IV—Retrospective Database Review.
Serial CAD/CAM Bracing: An Alternative to Serial Casting for Early Onset Scoliosis
Authors: Thometz John , Liu Xue-Cheng
Published: October 2018

Background:

Years of casting for infantile scoliosis can lead to significantly detrimental quality of life for both the child and parents. Concerns have been raised about the long-term negative neurodevelopmental effects of repeated anesthesia on young children. We developed an elongation bending derotation brace (EBDB) that uses primarily a bending derotation force applied to the curve to achieve the same goals as the cast. The goal of the study is to describe the preliminary results of a technique for creation of EBDB for infantile idiopathic scoliosis using computer-aided design/computer-aided milling (CAD/CAM) technology with at least 24 months follow-up.

Methods:

Nine patients with infantile idiopathic scoliosis had minimum 2-year follow-up (mean, 3.4 y; range, 2 to 6 y). Mean age at the treatment was 11 months (4 to 24 mo). There were 2 right thoracic, 7 left thoracic curves. CAD/CAM technology was used to create the EBDB after the child was placed in traction and a derotation strap applied. The same rotational forces that are used in the creation of the Mehta-type cast can also be utilized in creating the brace. A laser scanner was used to obtain the spinal geometry. Compliance can be monitored with a heat sensor.

Results:

Four patients were full corrected with serial bracing alone (curve ≤10 degrees). Five patients with more rigid curves showed improvement from mean 57 degrees (48 to 62 degrees) to mean 21 degrees (10 to 44 degrees).

Conclusions:

This paper describes the preliminary results of a new methodology for creating a patient-specific brace for infantile scoliosis using CAD/CAM technology. This methods shows promising potential to treat the infantile curve without the drawbacks of casting.

Level of Evidence:

Level IV.
In Vitro Analysis of the Degradation of Calcium Hydroxylapatite Dermal Filler: A Proof-of-Concept Study
Authors: Robinson Deanne M.
Published: October 2018

BACKGROUND

A dissolving agent for calcium hydroxylapatite (CaHA, Radiesse) soft-tissue filler would be of value should inadvertent intravascular injection, vascular compromise, nodule formation, or overcorrection occur.

METHODS

In a prospective, single-center, proof-of-concept study, 12 cadaveric porcine skin samples were injected with CaHA (0.4–0.8 mL). Samples were then randomized to intralesional injection of 0.2-mL sodium thiosulfate (STS, 12.5 g/50 mL); 1 to 2 g of topical sodium metabisulfite (SMB, 25% SMB in 120-mL gel) applied with occlusion, or both intralesional STS and topical SMB. Control samples were not treated after CaHA injection. A 4-mm punch biopsy was obtained 24 hours after treatment, and tissue sections were stained with hematoxylin and eosin and prepared for light microscopy. A board-certified dermatopathologist estimated the amount of CaHA present in each sample.

RESULTS

Intralesional STS alone or combined with topical SMB completely dissolved CaHA in the porcine skin samples. Topical SMB treatment reduced, but did not entirely clear CaHA from the tissue samples. The control samples contained easily identifiable CaHA microspheres.

CONCLUSION

This proof-of-concept study illustrates the potential reversibility of CaHA filler with intralesional STS, topical SMB, and the combination of both agents. Larger, in vivo, studies are now warranted to provide further insight.
Appreciation of the Vascular Anatomy of Aesthetic Forehead Reflation
Authors: Carruthers Jean D.A. , Carruthers J. Alastair
Published: October 2018

BACKGROUND

Worldwide, the brow is the most common facial site to receive aesthetic treatment. However, the forehead above the brows has been comparatively less well studied with respect to both neuromodulators and fillers. Age-related remodeling of the forehead with loss of facial bone has been demonstrated on detailed radiographic studies. Concurrent loss of facial fat deposits also adds to the volume depletion. The resulting shallow scalloped depressions in the central 2/3 of the forehead give a tired and aged appearance as do the deep etched horizontal forehead lines which are often associated. Temporal hollowing may be an important associated feature.

METHODS

Combination treatment of the upper face with neuromodulators to elevate the brows and diluted hyaluronic acid (HA) fillers to smooth the medial glabellar complex and reflate the forehead and temple has recently become a desired and popular treatment. Several techniques have been described in the literature. All these techniques are designed to allow forehead reflation with reduction of the possibility of vascular compromise.

CONCLUSION

Avoidance of the supratrochlear and supraorbital vasculature with cosmetic filler injections is possible by insertion of needle or cannula into the subgaleal space above their transition from preperiosteal to subcutaneous level. Using this technique we have so far not seen any vascular compromise and we present this technique in the interest of patient safety.
Effectiveness and Safety of Acne Scar Treatment With Nonanimal Stabilized Hyaluronic Acid Gel
Authors: Dierickx Christine , Larsson Markus K. , Blomster Stina
Published: October 2018

BACKGROUND

Acne scarring affects most patients with acne and have a negative impact on quality of life. New effective treatment options offering minimal downtime are therefore needed.

OBJECTIVE

To evaluate improvement in overall facial appearance after hyaluronic acid (HA) treatment of atrophic acne scars.

METHODS

Twelve subjects with moderate-to-severe acne scars were treated at 3 sessions 4 weeks apart. At each session, up to 2-mL HA gel was injected into each side of the face. Acne scar severity, global facial aesthetic improvement, and subject satisfaction were assessed up to 36 weeks after treatment. Safety assessments included subject diaries and adverse events.

RESULTS

The overall facial appearance and the appearance of atrophic acne scars improved after treatment. Scar severity and subject satisfaction with the overall facial appearance and with the sensation and perception of the skin improved in most subjects. Subjects' self-esteem and self-confidence also improved. Adverse events were typically mild to moderate, expected, and procedure-related.

CONCLUSION

Hyaluronic acid gel injections were effective and safe for treatment of moderate-to-severe atrophic acne scars. The treatment effect developed gradually over time with the highest improvement observed at the end of the study.
Aromatase and estrogen receptor immunoreactivity in the coronary arteries of monkeys and human subjects
Authors: Diano Sabrina , Horvath Tamas L. , Mor Gil , Register Thomas , Adams Michael , Harada Nobuhiro , Naftolin Frederick
Published: October 2018

Objective:

The objective of this study was to determine whether estrogen could be formed locally in the coronary arteries.

Design:

Coronary arteries were examined from monkeys (Macaca fascicularis, one male and one female) and human subjects (one premenopausal woman, one postmenopausal woman, and one man) by immunocytochemistry, using purified antisera against human placental estrogen synthetase (aromatase) and ER α. The arteries were graded for the amount of atherosclerosis.

Results:

There was clear immunopositivity for both aromatase and estrogen receptors in all arteries studied. Although all endothelial cells (CD31 positive) stained for both antigens, the staining in macrophages, fibroblasts, and smooth muscle cells was irregular.

Conclusion:

The present results provide the first evidence for the local formation of estrogen in the coronary arteries. In addition to complementing the evidence of a cardioprotective effect of estrogen on the coronary circulation, our results highlight the potential importance of local regulation of estrogen formation and the role of available precursor androgens in maintaining the cardiovascular system.
Comparison of the antioxidant effects of equine estrogens, red wine components, vitamin E, and probucol on low-density lipoprotein oxidation in postmenopausal women
Authors: Bhavnani Bhagu R. , Cecutti Anthony , Gerulath Alan , Woolever Allan C. , Berco Mauricio
Published: October 2018

Objective:

Oxidized low-density lipoprotein (LDL) seems to play an important role in the etiology of atherosclerosis. To further study this, we performed two studies: (1) we determined the ability of 10 estrogen components of the drug, conjugated equine estrogen (CEE), trans-resveratrol (t-resveratrol) and quercetin (red wine components), trolox (vitamin E analog), and probucol (a serum cholesterol-lowering drug) to delay or prevent the oxidation of plasma LDL isolated from untreated postmenopausal women, and (2) we assessed the effect of long-term (>1 year) estrogen replacement therapy and hormone replacement therapy on LDL oxidation by ex vivo methods.

Design:

For the in vivo study, three groups of postmenopausal women were selected based on whether they were on long-term CEE therapy (group A: 0.625 mg CEE; n = 21), on combination CEE plus progestogen therapy (group B: 0.625 mg CEE + 5.0 mg medroxyprogesterone acetate, 10 days; n = 20), or not on any hormone therapy (group C; n = 37). For the in vitro study, only LDL samples obtained from group C were used. The kinetics of LDL oxidation were measured by continuously monitoring the formation of conjugated dienes followed by determination of the lag time.

Results:

All compounds tested protected the LDL from oxidative damage. The relative antioxidant potency of estrogen components was generally greater than that of the other compounds. The minimum dose (nmoles) required to double the lag time from the control lag time of 57 ± 2 min was 0.47 for 17β-dihydroequilenin, 17α-dihydroequilenin, Δ8-estrone; 0.6 to 0.7 for Δ8-17β-estradiol, equilenin, and quercetin; 0.9 for 17β-dihydroequilin and 17α-dihydroequilin; 1.3 for equilin, estrone, 17β-estradiol, 17α-estradiol; 1.4 for trolox; 1.9 for probucol; and 3.0 for t-resveratrol. The data from the in vivo study indicate that after long-term estrogen replacement therapy (group A) and hormone replacement therapy (group B), the LDL was significantly (p < 0.01) protected (higher lag time) against oxidation compared with the control (group C). There was no difference between groups A and B.

Conclusions:

The oxidation of LDL isolated from postmenopausal women is inhibited differentially by various estrogens and other antioxidants. The unique ring B unsaturated estrogen components of CEE were the most potent, and t-resveratrol, the red wine component, was the least potent. Long-term CEE or CEE + medroxyprogesterone acetate administration to postmenopausal women protects the LDL against oxidation to the same extent. These combined data support the hypothesis that some of the cardioprotective benefits associated with CEE therapy and perhaps red wine consumption may be due to the ability of their components to protect LDL against oxidative modifications.
Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy
Authors: Brotman Rebecca M. , Shardell Michelle D. , Gajer Pawel , Fadrosh Doug , Chang Kathryn , Silver Michelle I. , Viscidi Raphael P. , Burke Anne E. , Ravel Jacques , Gravitt Patti E.
Published: October 2018

Objective:

The vaginal microbiota helps protect the female genital tract from disease. We sought to describe the composition of the vaginal microbiota in premenopausal, perimenopausal, and postmenopausal women and to explore the association between the microbiota and vulvovaginal atrophy (VVA).

Methods:

Eighty-seven women (aged 35-60 y) were classified as premenopausal (n = 30), perimenopausal (n = 29), or postmenopausal (n = 28) according to Stages of Reproductive Aging Workshop guidelines. Midvaginal bacterial community composition was characterized by 16S ribosomal RNA gene analysis.

Results:

Bacterial communities clustered into six community state types (CSTs), of which four were dominated by Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, or Lactobacillus jensenii, and two (CST IV-A and CST IV-B) had low relative abundance of Lactobacillus. CST IV-A was characterized by Streptococcus and Prevotella, whereas CST IV-B was characterized by Atopobium. There were significant associations between menopause stage and CST (P = 0.004) and between VVA and CST (P = 0.002). Perimenopausal women were more likely to be classified as CST IV-A or L. gasseri CST, whereas postmenopausal women were often classified as CST IV-A. CSTs dominated by L. crispatus and L. iners were more prevalent in premenopausal women. Nineteen participants had signs of mild or moderate VVA. Compared with women with no VVA, the vaginal microbiota of women with mild or moderate atrophy had 25-fold greater odds of being classified as CST IV-A versus L. crispatus CST (adjusted odds ratio, 25.89; 95% credible interval, 2.98-406.79).

Conclusions:

A distinct bacterial community state (CST IV-A) with a low relative abundance of Lactobacillus is associated with VVA. Future studies recruiting a larger number of women are needed to replicate the findings. This study provides an impetus for future longitudinal studies designed to manage, modulate, and restore vaginal microbiota homeostasis, which would provide stronger evidence for a causal relationship with VVA and ultimately improve the treatment and prevention of atrophic vaginitis in menopause.
Physiologically assessed hot flashes and endothelial function among midlife women
Authors: Thurston Rebecca C. , Chang Yuefang , Barinas-Mitchell Emma , Jennings J. Richard , von Känel Roland , Landsittel Doug P. , Matthews Karen A.
Published: October 2018

Objective:

Hot flashes are experienced by most midlife women. Emerging data indicate that they may be associated with endothelial dysfunction. No studies have tested whether hot flashes are associated with endothelial function using physiologic measures of hot flashes. We tested whether physiologically assessed hot flashes were associated with poorer endothelial function. We also considered whether age modified associations.

Methods:

Two hundred seventy-two nonsmoking women reporting either daily hot flashes or no hot flashes, aged 40 to 60 years, and free of clinical cardiovascular disease, underwent ambulatory physiologic hot flash and diary hot flash monitoring; a blood draw; and ultrasound measurement of brachial artery flow-mediated dilation to assess endothelial function. Associations between hot flashes and flow-mediated dilation were tested in linear regression models controlling for lumen diameter, demographics, cardiovascular disease risk factors, and estradiol.

Results:

In multivariable models incorporating cardiovascular disease risk factors, significant interactions by age (P < 0.05) indicated that among the younger tertile of women in the sample (age 40-53 years), the presence of hot flashes (beta [standard error] = −2.07 [0.79], P = 0.01), and more frequent physiologic hot flashes (for each hot flash: beta [standard error] = −0.10 [0.05], P = 0.03, multivariable) were associated with lower flow-mediated dilation. Associations were not accounted for by estradiol. Associations were not observed among the older women (age 54-60 years) or for self-reported hot flash frequency, severity, or bother. Among the younger women, hot flashes explained more variance in flow-mediated dilation than standard cardiovascular disease risk factors or estradiol.

Conclusions:

Among younger midlife women, frequent hot flashes were associated with poorer endothelial function and may provide information about women's vascular status beyond cardiovascular disease risk factors and estradiol.
Parent-Infant Closeness, Parents' Participation, and Nursing Support in Single-Family Room and Open Bay NICUs
Authors: Tandberg Bente Silnes , Frøslie Kathrine Frey , Flacking Renée , Grundt Hege , Lehtonen Liisa , Moen Atle
Published: October 2018

This was a prospective survey study, comparing parent-infant closeness, parents' perceptions of nursing support, and participation in medical rounds in single-family room (SFR) and an open bay (OB) neonatal intensive care units. Nurses' assessments of provided support were also measured. In total, 115 parents of 64 preterm infants less than 35 weeks' gestational age and 129 nurses participated. Parents recorded the presence and skin-to-skin care. Parents were sent 9 text message questions in random order. Nurses answered corresponding Internet-based questions. SFR mothers were more present, 20 hours daily (median) versus 7 hours (P < .001), initiated skin-to-skin contact (SSC) at 4 versus 12 hours (P = .03), and preformed SSC 180 min/24 h versus 120 min/24 h for mothers in the OB unit (P = .02). SFR fathers were also more present, 8 versus 4 hours (P < .001), initiated SSC at 3 versus 40 hours (P = .004), and performed SSC 67 min/24 h versus 31 min/24 h (P = .05). SFR parents rated participation in medical rounds and emotional support higher than OB parents. Parental trust was rated higher by nurses in the OB unit (P = .02). SFR facilitated parent-infant closeness, parents' participation in medical rounds, and increased support from nurses.
Financial Toxicity in Crohn’s Disease
Authors: Voit Antanina , Cross Raymond K. , Bellavance Emily , Bafford Andrea C.
Published: October 2018

Background:

A patient-reported outcome measure called Comprehensive Score for Financial Toxicity (COST) was previously developed and validated in patients with cancer.

Goals:

We sought to assess the financial toxicity associated with Crohn’s disease (CD) by administering the COST questionnaire to patients treated at a tertiary care center.

Study:

Forty-eight patients diagnosed with CD completed questionnaires, which included the COST quality of life instrument as well as questions with regard to sociodemographics and clinical characteristics. Analysis of results was performed with Minitab.

Results:

Forty-eight completed questionnaires were scored. The mean age of the cohort was 37.6±13.4 years and 58% of patients were women. COST scores had a normal distribution (Anderson-Darling, P=0.31). The median COST score was 22, a result associated with mild negative impact on health-related quality of life. Patients’ COST score stratum differed based on their education level (P<0.001), employment status (P=0.037), disability status (P=0.016), household income (P=0.004), and housing arrangement (P=0.006). Disease activity in the past 6 months and more frequent feelings of anxiety and depression also correlated with higher COST score.

Conclusions:

In this survey study, we found that the majority of our patients with CD experienced at least mild financial distress. Lower income and education level increased disease activity, and the presence of anxiety and depression increased the financial distress experienced by patients. Further research is needed to develop effective interventions to minimize financial toxicity in this patient population.