bluuebunny/crossref_metadata_2025 huggingface dataset:
Complex Clubfoot Treatment With Ponseti Method: A Latin American Multicentric Study
Authors: Allende Victoria , Paz Miguel , Sanchez Sergio , Lanfranchi Lucas , Torres-Gomez Armando , Arana Erika , Nogueira Mónica P. , Masquijo J. Javier
Published: November 2019

Background:

Complex clubfoot is a term used to describe those feet that present after treatment with a short first metatarsal, severe plantar flexion of all metatarsals, rigid equinus, and deep folds through the sole of the foot and above the heel. Ponseti has described a modification of his original technique for the treatment of the deformity. Few series have reported the treatment outcomes of this group of patients. The purpose of this study is to analyze mid-term results and complications of a large multicenter cohort.

Methods:

Patients with complex clubfoot treated at 6 tertiary-care institutions with a minimum of 1-year follow-up were retrospectively analyzed. Demographic data, previous treatment, number of casts, Achilles tenotomy, recurrences, complications, and additional procedures were documented. The patients were clinically evaluated at the time of presentation, after treatment, and at the last follow-up according to the Pirani score. All variables had a nonparametric distribution and are thus described as median (interquartile range (IQR), minimum-maximum). A comparison between the variables was performed using a Mann-Whitney U test, the change within each group was performed with a Wilcoxon-designated range test. A P-value <0.05 was used to indicate statistical significance.

Results:

One hundred twenty-four feet (79 patients) were evaluated. The median age at initial treatment was 7 months (IQR, 15; min-max, 1 to 53 mo). The mean follow-up was 49 months (IQR, 42; min-max, 12 to 132 mo). A median of 5 casts (IQR, 5; min-max, 3 to 13) was required for correction. Percutaneous tenotomy of the Achilles tendon was performed in 96% of the feet. One hundred twenty-two feet (98%) were initially corrected; 2 feet could not be corrected and required a posteromedial release. The Pirani score improved significantly from a pretreatment mean of 6 points (IQR, 1; min-max, 4.5 to 6) to 0.5 (IQR, 0.5; min-max, 0 to 2.5) at the last follow-up (P <0.001). Seven feet (6%) presented minor complications related to casting. Relapses occurred in 29.8% (37/124). In this subgroup, the number of casts required at initial treatment was higher (6; IQR, 5; min-max, 1 to 12 vs. 4 IQR, 4; min-max, 1 to 13; P<0.001), and follow-up was significantly longer (62 mo; IQR, 58; min-max, 28 to 132 vs. 37 mo; IQR, 48, min-max, 7 to 115; P<0.001).

Conclusions:

Ponseti method is safe and effective for the correction of complex clubfeet. Early diagnosis and strict adherence to the Ponseti principles are key to achieve deformity correction. Patients with complex clubfoot require frequent follow-up because of a higher recurrence rate.

Level of Evidence:

Level III—therapeutic study.
Does Cervical Sagittal Balance Affect the Preoperative Neck Disability Index in Patients With Cervical Myelopathy?
Authors: Lin Taotao , Chen Penghong , Wang Zhenyu , Chen Gang , Liu Wenge
Published: November 2019

Study Design:

This was a retrospective study.

Objective:

This study aimed to ascertain the relationship between preoperative Neck Disability Index (NDI) scores and cervical sagittal alignment in patients with cervical spondylotic myelopathy (CSM).

Summary of Background Data:

Cervical alignment may influence postoperative clinical outcomes. However, the effect of preoperative sagittal balance on the preoperative status in CSM patients remains uncertain.

Materials and Methods:

From 2010 to 2016, 90 patients who underwent cervical surgery for CSM were enrolled. The inclusion criteria for this study included preoperative standing cervical radiographs and a preoperative NDI score. The following radiographic parameters were measured: (1) C0–C2 lordosis, (2) C2–C7 lordosis, (3) C2–C7 sagittal vertical axis (SVA), (4) neck tilt, (5) thoracic inlet angle, (6) T1 slope, and (7) T1 slope minus cervical lordosis (T1S-CL). The Pearson product-moment correlation coefficients were calculated between all radiographic variables and the NDI scores, and multiple regression analysis was performed to determine the independent predictors of high preoperative NDI scores.

Results:

Both C2–C7 SVA and T1S-CL were positively correlated with NDI scores (r=0.732, P<0.001 and r=0.333, P=0.001). Cervical lordosis was negatively correlated with NDI scores (r=−0.267, P=0.011). Significant correlations were found between C2–C7 SVA and the C0–C2 Cobb angle (r=0.244, P=0.020), C2–C7 SVA and the C2–C7 Cobb angle (r=−0.359, P=0.001), the C2–C7 Cobb angle and the C0–C2 Cobb angle (r=−0.457, P<0.001), and the C2–C7 Cobb angle and T1 slope (r=−0.385, P<0.001).

Conclusions:

The disability of the neck increased with increasing C2–C7 SVA and T1S-CL and decreasing cervical lordosis before surgical reconstruction. High C2–C7 SVA, low thoracic inlet angle, and high neck tilt values are independent predictors of high preoperative NDI scores.
Magnesium and Hemorrhage Volume in Patients With Aneurysmal Subarachnoid Hemorrhage
Authors: Liotta Eric M. , Karmarkar Ameeta , Batra Ayush , Kim Minjee , Prabhakaran Shyam , Naidech Andrew M. , Maas Matthew B.
Published: November 2019

Objectives:

We tested the hypothesis that admission serum magnesium levels are associated with extent of hemorrhage in patients with aneurysmal subarachnoid hemorrhage.

Design:

Single-center prospective observational study.

Setting:

Tertiary hospital neurologic ICU.

Patients:

Patients with aneurysmal subarachnoid hemorrhage.

Interventions:

Clinically indicated CT scans and serum laboratory studies.

Measurements and Main Results:

Demographic, clinical, laboratory, and radiographic data were analyzed. Extent of initial hemorrhage was graded semi-quantitatively on admission CT scans using the modified Fisher scale (grades: 0, no radiographic hemorrhage; 1, thin [< 1 mm in depth] subarachnoid hemorrhage; 2, thin subarachnoid hemorrhage with intraventricular hemorrhage; 3, thick [≥ 1 mm] subarachnoid hemorrhage; 4, thick subarachnoid hemorrhage with intraventricular hemorrhage). We used both ordinal (modified Fisher scale) and dichotomized (thick vs thin subarachnoid hemorrhage) univariate and adjusted logistic regression models to assess associations between serum magnesium and radiographic subarachnoid hemorrhage severity. Data from 354 patients (mean age 55 ± 14 yr, 28.5% male, median admission Glasgow Coma Scale 14 [10–15]) were analyzed. Mean magnesium was lower in patients with thick versus thin subarachnoid hemorrhage (1.92 vs 1.99 mg/dL; p = 0.022). A monotonic trend across categories of modified Fisher scale was found using analysis of variance and Spearman rank correlation (p = 0.015 and p = 0.008, respectively). In adjusted ordinal and binary regression models, lower magnesium levels were associated with higher modified Fisher scale (odds ratio 0.33 per 1 mg/dL increase; 95% CI, 0.14–0.77; p = 0.011) and with thick subarachnoid hemorrhage (odds ratio 0.29 per 1 mg/dL increase; 95% CI, 0.10–0.78; p = 0.015).

Conclusions:

These data support the hypothesis that magnesium influences hemorrhage severity in patients with aneurysmal subarachnoid hemorrhage, potentially through a hemostatic mechanism.
Effects of Hyaluronic Acid on Stability of Bleomycin Foam
Authors: Zhang Hao , Song Yu-Tong , Zhang Han-Shu , Zhang Fan , Liu Shao-Hua
Published: November 2019

BACKGROUND

Bleomycin (BLM) foam sclerotherapy is effective in the treatment of venous malformations (VMs). Foam stability is influenced by factors such as sclerosant concentration, viscosity, and liquid–gas ratio.

OBJECTIVE

To investigate whether hyaluronic acid (HA) could increase the stability of BLM foam and to evaluate the safety and efficacy of HA—BLM foam.

MATERIALS AND METHODS

Experiment: BLM 6.0 IU + human serum albumin (HSA, 2, 1.95, 1.90, and 1.85 mL, respectively) + 1% HA (0, 0.05, 0.10, and 0.15 mL, respectively) + air 6 mL to create foam using the Tessari method. The foam half-life (FHL) was used to evaluate foam stability. Clinical study: Twenty-eight patients with head and neck VMs were enrolled between June 2018 and August 2019 treated by HA-BLM foam to evaluate the safety and efficacy.

RESULTS

The FHL of the BLM foam was 8.46, 8.95, 10.45, and 14.51 minutes, respectively. All patients achieved significant efficacy, and no obvious side effects were observed.

CONCLUSION

Addition of HA could improve the stability of BLM foam.
Barriers to Performing Soft Tissue Reconstruction Procedures among Orthopedic Surgeons in Low- and Middle-income Countries: Results of a Surgical Skills Training Course
Authors: Holler Jordan T. , Albright Patrick , Challa Sravya , Ali Syed H , Martins Deborah , Keys Kari , Shearer David W. , Terry Michael J.
Published: November 2019

Background:

Appropriate management of soft tissue injury associated with orthopedic trauma is challenging in low- and middle-income countries (LMICs) due to the lack of available reconstructive surgeons. The Surgical Management and Reconstructive Training (SMART) course teaches orthopedic surgeons reconstructive techniques aimed at improving soft tissue management. This study aims to identify additional barriers to implementing these techniques for surgeons in LMICs who have attended SMART courses.

Methods:

This is a mixed-methods study including a Likert-scale-based survey administered to 150 surgeons from LMICs attending the 2018 SMART courses in Tanzania and San Francisco and key informant interviews with 20 surgeons who perform soft tissue coverage procedures.

Results:

In surveys, respondents reported inadequate local plastic surgeon availability for lower extremity fracture requiring muscle flaps (88%). Surgeons agreed that flap surgeries are important for patients with significant soft tissue injury following open fractures (97%). They reported inadequate access to instruments, such as dermatomes (59%) and Humby knives (32%), and senior-level support (31%). Fewer than half of surgeons with flap experience (n = 85) felt confident in training peers (45%). In interviews, delays in returning patients to operating rooms were frequently cited as a barrier (90%).

Conclusions:

Our study demonstrates that soft tissue procedures are perceived as a high priority among orthopedic surgeons, but there are multiple barriers, including a lack of plastic surgeons, and many modifiable barriers including a lack of surgical equipment, peer training, and senior colleague support.
Nerve Transfer from the Long Head Triceps Nerve to Posterior Interosseous Nerve for Restoration of Wrist, Finger, and Thumb
Authors: Zermeño-Rivera Jesús Jaime , Flores-Moltedo Nicolás Ignacio , Gutiérrez-Amavizca Bianca Ethel
Published: November 2019

In brachial plexus injuries where the radial nerve is damaged, there is loss of wrist, finger, and thumb extension. Surgical options for treating brachial plexus injuries are case dependent. To restore finger and wrist extension, the median nerve is primarily utilized for nerve transfer. We describe a new technique in a young man who suffered a gunshot wound in the left axilla, injuring the radial, median, and ulnar nerves. To restore wrist, finger, and thumb extension, we designed and performed a new technique consisting of nerve transfer, an interposition sural nerve graft from the motor branch of the long triceps portion to the posterior interosseous nerve. Positive outcomes were seen after 18 months with postoperative recovery of the functionality of finger and wrist extension.
Epidemiologic Characteristics and Postoperative Complications following Augmentation Mammaplasty: Comparison of Transgender and Cisgender Females
Authors: Cuccolo Nicholas G. , Kang Christine O. , Boskey Elizabeth R. , Ibrahim Ahmed M.S. , Blankensteijn Louise L. , Taghinia Amir , Lee Bernard T. , Lin Samuel J. , Ganor Oren
Published: November 2019

Background:

Breast augmentation in transgender women can be an important first step in addressing gender incongruence and improving psychosocial functioning. The aim of this study was to compare postoperative outcomes of augmentation mammoplasty in transgender and cisgender females.

Methods:

We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2017 to establish 2 cohorts: (1) transgender females undergoing gender-affirming breast augmentation (“top surgery”) and (2) cisgender females seeking cosmetic breast augmentation (CBA). Demographic characteristics and postoperative outcomes were compared between the 2 cohorts. Multivariable regression analysis was used to control for confounders.

Results:

A total of 1,360 cases were identified, of which 280 (21%) were feminizing top surgeries and 1,080 (79%) were CBA cases. The transfeminine cohort was significantly older, had a higher average body mass index, and was more racially diverse than the CBA cohort. Transfeminine patients also had higher rates of smoking, diabetes, and hypertension. The rates of all-cause complications were low in both cohorts, and differences were not significant (1.6% transfeminine versus 1.8% CBA, P = 0.890) for the first 30-days after operation. After controlling for confounding variables, transfeminine patients had postoperative complication profiles similar to their cisgender counterparts. Multivariable regression analysis revealed no statistically significant predictors for all-cause complications.

Conclusions:

Transfeminine breast augmentation is a safe procedure that has a similar 30-day complication profile to its cisgender counterpart. The results of this study should reassure and encourage surgeons who are considering performing this procedure.
Restoration of Elbow Flexion with a Pedicled Latissimus Dorsi Myocutaneous Flap to a Brachial Plexus Injury at the Terminal Nerve Level
Authors: Kameda Takuya , Soichi Ejiri , Yokota Takeru , Konno Shin-ichi
Published: November 2019

A pedicled latissimus dorsi (LD) myocutaneous flap is a reliable reconstructive method for elbow flexion, though there are no reports regarding its application to a terminal nerve level injury of the brachial plexus. A 29-year-old man presented with dysfunction of elbow flexion, wrist extension, and finger extension. Physical examination and electromyography showed that the palsy was caused by an injury at the terminal nerve level of the brachial plexus without dysfunction of the axillary nerve. Bipolar transfer of LD for reconstruction of elbow flexion and subsequent tendon transfer for wrist and finger extension were performed. The final British Medical Research Council grade was 4 for elbow flexion, and active range of motion was 0/135. An injury at the terminal nerve level of the brachial plexus should be listed in the differential diagnosis of elbow flexion dysfunction even if shoulder function is intact, and a suitable reconstructive method for this atypical type of palsy could be bipolar transfer of a LD flap.
Small Finger Osteocutaneous Fillet Flap for Reconstruction in Ring Finger Trauma
Authors: Parent Brodie , Camison Liliana , Barreiro Guilherme , Spiess Alexander
Published: November 2019

Finger amputations are common injuries which result in significant long-term morbidity and loss of function. In this report, we describe a creative operative solution for a 21-year-old man who was in a motorcycle crash and sustained severely comminuted open fractures of the left small and ring fingers with severe crush injury and soft tissue avulsion. Of the tissues and bones in the small finger, only the distal half of the proximal phalanx remained intact and was vascularized via the remaining ulnar neurovascular bundle. In the ring finger, the extensor mechanism and ulnar neurovascular bundle were avulsed and the distal half of the proximal phalanx was absent, but the flexor tendons were intact. A small finger ray amputation was performed. Then, using an osteocutaneous fillet flap based on the ulnar neurovascular bundle from the small finger, the bony gap and soft tissue deficits in the ring finger were reconstructed. The ring finger extensor tendon was then reconstructed. Subsequently, the patient had evidence of bony union on follow-up X-rays and he had a sensate filet flap over the ulnar aspect of the ring finger. This case demonstrates the creative use of a “spare-parts” osteocutaneous fillet flap in the reconstruction of a traumatic finger injury. This example highlights the importance of assessing all available reconstructive options to avoid the morbidity of a finger amputation.
Cost Utility of Breast Tissue Expansion using Carbon Dioxide versus Saline: An Analysis of Infection Risk
Authors: Chopra Karan , Slavin Benjamin , Khavanin Nima , Kraenzlin Franca , Darrach Halley , Holton Luther , Landford Wilmina N. , Singh Devinder P.
Published: November 2019

Background:

The AeroForm System, a needle-free, patient-controlled carbon dioxide-filled tissue expander, represents a novel option for tissue expansion in 2-stage breast reconstruction. This technology has previously been found to decrease time to expansion, health-care utilization, and infection rates. The purpose of this study was to determine the economic impact of the reduced infection rate observed with the AeroForm tissue expander as compared with saline tissue expansion.

Methods:

A decision model incorporating costs, quality-adjusted life years, and clinical outcomes of infection was designed to evaluate the cost-efficacy of AeroForm tissue expanders versus conventional saline expanders. All statistical calculations were performed in the R statistical computing environment.

Results:

Pooled infection rates from the published literature following saline and AeroForm tissue expander placement were 5.83% and 2.62%, respectively. Cost-utility analysis resulted in a baseline expected savings of $253.29 and an expected gain of 0.00122 quality-adjusted life years with AeroForm tissue expanders. One-way sensitivity analysis revealed that AeroForm tissue expanders were dominant when the surgical site infection rate was greater than 4.56% with traditional saline expanders.

Conclusions:

Clinical benefits of an innovation are no longer sufficient to justify its acquisition costs. Novel technologies must also demonstrate favorable economic outcomes. This cost-utility analysis demonstrates that the use of AeroForm expanders is likely a cost-saving technology for 2-stage breast reconstruction.
Benefits of Cardiac Rehabilitation in Coronary Artery Disease
Authors: Braga Marta , Nascimento Helena , Pinto Roberto , Araújo Paulo , Nunes Alzira , Rodrigues Joana , Araújo Vítor , Parada-Pereira Fernando , Maciel Maria Júlia , Rocha Afonso
Published: November 2019

Purpose:

To evaluate the response of patients with obesity to a cardiac rehabilitation program (CRP), compared with patients without obesity.

Methods:

We performed a retrospective analysis of 731 patients who completed phase II of a CRP after an acute coronary syndrome. The response to the CRP was assessed using the relative changes in exercise capacity (EC), resting heart rate (HR), and chronotropic index (CI).

Results:

Only 23% of patients had obesity. Patients with obesity showed lower EC and CI at baseline and at the end of phase II of the CRP. Despite that, we reported a higher relative improvement for EC in patients with obesity (median [interquartile range], 23.9% [5.2, 40.8] vs 17.6% [8.1, 35.9], P = .043) and similar improvements in CI (10.9% [−1.4 to 34.2] vs 7.1% [−7.1 to 28.2], P = .100), compared with patients without obesity. There were no significant changes in resting HR.

Conclusion:

Regardless of their lower exercise performance at baseline, patients with obesity had a remarkably positive response to the CRP compared with patients without obesity.
Cardiovascular Reactivity to Acute Mental Stress
Authors: Gecaite Julija , Burkauskas Julius , Brozaitiene Julija , Mickuviene Narseta
Published: November 2019

Purpose:

Links between psychophysiological reactions to stress stimuli and perceived mental distress, including type D personality, anxiety, and depression, are still under debate. The aim of this study was to examine associations between cardiovascular reactivity to social stress and mental distress in patients after acute coronary syndrome.

Methods:

Patients (n = 116, 86% males, 52 ± 8 yr) with coronary artery disease 2 wk after acute coronary syndrome were evaluated for sociodemographic, clinical characteristics and coronary artery disease risk factors. The Trier Social Stress Test was employed to measure cardiovascular reactions to social stress (systolic and diastolic blood pressure and heart rate). Mental distress assessment included type D personality (Type D Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), and state and trait anxiety (State-Trait Anxiety Inventory).

Results:

Multiple linear regression analysis showed associations between type D personality and lower heart rate during Trier Social Stress Test periods of task instruction (β = −.196, P < .04), preparation time (β = −.232, P < .01), and recovery time (β = −.209, P < .029). Higher trait anxiety was linked with lower heart rate during baseline rest (β = −.287, P < .01), task instruction (β = −.286, P < .01), preparation time (β = −.241, P < .01), and recovery period (β = −.209, P < .05). Depressive symptoms were associated with higher systolic blood pressure during baseline rest (β =.187, P < .05), task instruction (β = .306 P < .01), and free speech (β = .264, P < .05).

Conclusions:

Mental distress was associated with cardiovascular stress reactions independent from possible covariates, suggesting dysregulated psychophysiological reactions to acute stress.
Neuroendocrine tumor mixed with adenoma in rectum: a case report and literature review
Authors: Hu Jiancong , Chen Xiaochuan , Lin Dezheng , Yu Zhaoliang , Li Juan , Guo Xuefeng
Published: November 2019

Neuroendocrine tumor (NET) mixed with adenoma in rectum is rare. A 63-year-old man with a rectal adenoma underwent endoscopic submucosal dissection. A 3.2 cm neoplasm was dissected, which histologically corresponded to a villous adenoma with high-grade intraepithelial neoplasia. More interestingly, cells arranged in strip were found in the submucosa, with SyN(+) and CgA(−) in immunohistochemical staining, which were correspond to an NET. Although mixed adenoma with NET is rare, but we should alert it especially in large adenoma and full-scale preoperative evaluation should be taken before endoscopic operation.
Dengue Fever in End-Stage Renal Failure Patient
Authors: Lim Xue Meng , Lim Christopher Thiam Seong
Published: November 2019

Dengue viral infection is common in tropical and subtropical parts of the world and may lead to death. There are an estimated 390 million cases of dengue viral infections reported worldwide each year, putting 2.5 billion individuals at risk of this arthropod-borne viruses. The cornerstone of its management is prompt diagnosis, appropriate monitoring, and careful fluid replacement. This is particularly difficult in end-stage renal failure (ESRF) patients on maintenance dialysis, as there is a complex issue of the ability of making a prompt diagnosis, the presence of coagulopathy, and the risk of fluid overload due to constant evolving fluid dynamic as part of the dengue fever disease process. There is a serious lack of literature report in the area of dengue infection in ESRF patient. We report a case of a man with ESRF with a delayed diagnosis of dengue viral infection, who admitted at the critical phase of the illness. Despite that, he managed to recover uneventfully with tailored management in his fluid replacement, medication adjustment, and dialysis prescription. Hence, a high index of suspicion is needed when an ESRF patient presents with fever in a dengue-endemic area. A multidisciplinary approach with good collaboration between physician and nephrologist is needed to ensure the best outcome. Renal replacement therapy and medications should be individually tailored according to the patient's clinical condition. We hope that our reported clinical case will contribute to the understanding of the complex issue of management of dengue fever in ESRF patients.
A Successful Aztreonam Desensitization Protocol
Authors: Schorsch Philip , Brillante Christie , Yaqoob Maidah , Pappalardo Andrea A. , Benken Scott T.
Published: November 2019

Drug desensitization involves slowly increasing the dose of a medication until an induced tolerance is achieved and is typically performed when therapeutic options are limited and hypersensitivity reactions are a concern. We present a patient with an extensive history of hypersensitivity to multiple antibiotics and symptoms of potential gentamicin toxicity requiring aztreonam desensitization for the treatment of bacteremia. A desensitization protocol was created, and sequential rapid aztreonam desensitization was executed with no hypersensitivity reactions. This protocol provides guidance to other providers who need to use aztreonam where drug hypersensitivity is a concern.
Herpes Simplex Virus 1 Hepatitis Leading to Liver Failure and Hemophagocytic Lymphohistiocytosis
Authors: Cheney-Peters Dianna , Weber Devin M.
Published: November 2019

A 65-year-old immunocompetent adult presented with fever, fatigue, and laboratory evidence of acute liver failure. He was unable to undergo liver biopsy secondary to coagulopathy. His herpes simplex virus 1 (HSV-1) polymerase chain reaction level was elevated in the serum, leading to presumptive diagnosis of HSV-1–associated hepatitis. His course was complicated by rising ferritin, and workup revealed hemophagocytic lymphohistiocytosis suspected to be secondary to infection with HSV-1. He improved on intravenous acyclovir and completed a 21-day course. Review of the literature demonstrates that this is the fourth case of hemophagocytic lymphohistiocytosis associated with HSV-1 alone in an immunocompetent adult. Case reports have described treatment regimens including antivirals, antivirals in combination with immunosuppressant agents, and liver transplantation with immunosuppression with successful outcomes.
Bowel obstruction in advanced cancer
Authors: Ferraz Gonçalves José António , Faria Magda , Araújo Vânia , Monteiro Ana Raquel , Silva Ana Vítor , Jamal Sheila , Moutinho Adelaide
Published: November 2019

Purpose:

Assessment of treatment of cancer patients with bowel obstruction, identification of prognostic factors, and assessment of reference to palliative care.

Methods:

Records of patients with a diagnosis of bowel obstruction over a 6-month (January–June 2013) period were reviewed.

Results:

Seventy-five patients were diagnosed with bowel obstruction. Fifty-one (68%) were female and the median age was 65 years (27–100). The most frequent cancer was colorectal, 30 (40%), followed by gynecological cancer, 20 (27%). Forty-three (57%) patients underwent conservative treatment; 26 (35%) underwent surgery; and 6 (8%) had a stent placement. In 68 (91%), the bowel obstruction was resolved. Three years after the bowel obstruction episode, 15 (20%) patients were still alive. An analysis of the possible association of variables recorded with mortality was carried out, and for death at the first admission, only the resolution of the obstruction was significant (P < .001); for the 3-year survival the significant factors were hemoglobin >10.7 g/dL (P < .001) and ascites (P = .001) at the time of obstruction. Thirty-seven (49%) patients were referred to palliative care.

Conclusions:

Although bowel obstruction in cancer patients is usually associated with a short life expectancy, some patients have relatively long survivals. Only about half of the patients were referred to palliative care.
Long-Term Response to Clozapine and Its Clinical Correlates in the Treatment of Tardive Movement Syndromes
Authors: Lee Dongbin , Baek Ji Hyun , Bae Moonoh , Choi Yujin , Hong Kyung Sue
Published: November 2019

Purpose

Given that switching to clozapine is an important treatment option for tardive movement syndrome (TMS), its effect and clinical correlates have not been fully explored yet. This study investigated the improvement of TMS after switching to clozapine and factors associated with the response in a naturalistic outpatient setting.

Methods

Subjects were 35 patients with schizophrenia or bipolar disorder receiving only clozapine as an antipsychotic drug for more than 12 months. Their prior antipsychotics were switched to clozapine after the onset of tardive dyskinesia and/or tardive dystonia. Tardive movement syndrome and clinical characteristics were assessed through direct examination and review of hospital records.

Findings

Offending antipsychotics administered at the time of TMS onset were second-generation antipsychotics in 88.6% of patients. Tardive movement syndrome symptoms were remitted in 65.7% of patients after switching to clozapine. Younger age, younger age at onset of TMS, and lower baseline Abnormal Involuntary Movement Scale score were significantly associated with remission of TMS. Female sex and good antipsychotic effects of clozapine showed a trend of association with better response.

Implications

Clozapine seems to be an excellent treatment option for TMS in the era of second-generation antipsychotics, especially for younger patients with mild tardive dyskinesia. Clinical trials comparing the effect of switching antipsychotics to clozapine with add-on therapy of new drugs targeting TMS are difficult to design in ordinary clinical settings. Therefore, more naturalistic observational studies are warranted to identify predictors of TMS response to clozapine.
Adjunctive Memantine Treatment of Schizophrenia
Authors: Hassanpour Fatemeh , Zarghami Mehran , Mouodi Sussan , Moosazadeh Mahmood , Barzegar Fatemeh , Bagheri Maedeh , Hendouei Narjes
Published: November 2019

Purpose/Background

This double-blind, placebo-controlled clinical trial was designed to assess the efficacy and safety of memantine augmentation to standard regimen of antipsychotic treatment on psychotic symptoms and cognitive function in individuals with chronic schizophrenia for 8 weeks.

Methods/Procedures

Forty stabilized individuals with chronic schizophrenia were randomized in a 1:1 ratio to memantine (20 mg/d) and control (placebo) groups, along with their antipsychotic regimen for 8 weeks. The efficacy of treatment was assessed by the Positive and Negative Syndrome Scale (PANSS) and Brief Assessment of Cognition Scale, and the safety was measured by the Abnormal Involuntary Movement Scale and Barnes Akathisia Rating Scale at baseline and at weeks 4 and 8.

Findings/Results

No significant differences were observed in demographic or clinical variables between both groups at baseline. During the study, all subscales and total scores of PANSS decreased significantly within both groups, except the subscale score in memantine, which was found to be positive. Reduction in general subscale and total scores of PANSS was significantly higher in the control group compared with the memantine group. All subscale scores of the Brief Assessment of Cognition Scale increased significantly only in the memantine group. The increase in the Verbal Memory, Working Memory, Verbal Fluency Letter, and Verbal Fluency Total subscale scores was significantly higher in the memantine group than in the control group. There was no significant difference in the Abnormal Involuntary Movement Scale and Barnes Akathisia Rating Scale scores between the 2 groups during the study.

Implications/Conclusions

This study showed that adjunctive memantine to antipsychotic regimen improved the verbal memory, learning, verbal letter fluency, and working memory without improvement on psychotic symptoms in individuals with chronic schizophrenia.
The Relationship Between Cumulative Exogenous Corticosteroid Exposure and Volumes of Hippocampal Subfields and Surrounding Structures
Authors: Nguyen Duc M. , Yassa Michael A. , Tustison Nicholas J. , Roberts Jared M. , Kulikova Alexandra , Nakamura Alyson , Ivleva Elena I. , Van Enkevort Erin , Brown E. Sherwood
Published: November 2019

Purpose/Background

Glucocorticoids are a class of hormones that include naturally occurring cortisol and corticosterone, as well as prescription drugs commonly used to manage inflammatory, autoimmune, and allergic conditions. Adverse effects, including neuropsychiatric symptoms, are common. The hippocampus appears to be especially sensitive to the effects of glucocorticoids. However, to our knowledge, no studies to date have examined hippocampal subfields in humans receiving glucocorticoids. We examined patients on chronic glucocorticoid regimens to determine relationships between dose and duration of treatment, and hippocampal subfields, and related regions volumes.

Methods/Procedures

The study included adult men and women receiving at least 5 mg daily of prednisone equivalents for at least 6 months. Volumes of brain regions were measured via magnetic resonance imaging. A multivariate general linear model was used for analysis, with brain volumes as dependent variables and age, sex, and cumulative corticosteroid exposure, as predictors.

Findings/Results

The study population consisted of 81 adult outpatients (43 male) on corticosteroids (mean dose, 7.88 mg; mean duration, 76.75 months). Cumulative glucocorticoid exposure was negatively associated with left and right hippocampal dentate gyrus/CA3 volume. In subsequent subgroup analysis, this association held true for the age group older than the median age of 46 years but not for the younger age group.

Implications/Conclusions

This finding is consistent with previous studies showing detrimental effects of elevated glucocorticoids on the hippocampus but further suggests that the dentate gyrus and CA3 regions are particularly vulnerable to those effects, which is consistent with animal models of chronic stress but has not been previously demonstrated in humans.
Serotonin Toxicity
Authors: Moss Michael J. , Hendrickson Robert G.
Published: November 2019

Background

Serotonin toxicity is a common cause of drug-induced altered mental status. However, data on the causes of serotonin toxicity, symptomatology, complications, and rate of antidotal treatment are limited.

Methods

This study evaluated cases of serotonin toxicity in the ToxIC registry, an international database of prospectively collected cases seen by medical toxicologists. Serotonin toxicity was diagnosed by bedside evaluation of medical toxicology specialists and explicit criteria were not used. The database was searched for “serotonin syndrome” between January 1, 2010, and December 31, 2016.

Results

There were 1010 cases included. Females made up 608 (60%) cases. Ages are as follows: younger than 2 years (3, 0.3%), 2 to 6 years (8, 0.8%), 7 to 12 years (9, 0.9%), 13 to 18 years (276, 27.3%), 19 to 65 years (675, 67%), older than 66 years (33, 3.4%), unknown (6, 0.6%). Reasons for encounter: intentional (768, 76%), adverse drug event/reaction (127, 12.6%), unintentional (66, 6%), and unknown (55, 5.4%). Signs/symptoms: hyperreflexia/clonus/myoclonus (601, 59.5%), agitation (337, 33.4%), tachycardia (256, 25.3%), rigidity (140, 13.9%), seizures (139, 13.7%), and hyperthermia (29, 2.9%). Complications: rhabdomyolysis (97, 9.7%), dysrhythmias (8, 0.8%), and death (1, 0.1%). Treatments: benzodiazepines 67% (677/1010), cyproheptadine 15.1% (153/1010). There were 192 different xenobiotics reported with 2046 total exposures. Antidepressants were most common (915, 44.7%) with bupropion the most frequent overall (147, 7.2%). Common non-antidepressants were dextromethorphan (95, 6.9%), lamotrigine (64, 3.1%), and tramadol (60, 2.9%).

Discussion

Serotonin toxicity most often occurred in adult patients with intentional overdose. Antidepressants were the most common agents of toxicity. Interestingly, bupropion, a norepinephrine/dopamine reuptake inhibitor, was the most frequently mentioned xenobiotic. Though often cited as a potential antidote, only 15% of patients received cyproheptadine. Severe toxicity was rare. A single death was reported.
Relative Effectiveness of Monoamine Oxidase Inhibitor and Tricyclic Antidepressant Combination Therapy for Treatment-Resistant Depression
Authors: Amsterdam Jay D. , Kim Thomas T.
Published: November 2019

Purpose/Background

We examined the relative safety and effectiveness of adding a monoamine oxidase inhibitor (MAOI) to a failed tricyclic antidepressant (TCA) trial versus adding a TCA to a failed MAOI trial or adding a TCA to a failed TCA trial in treatment-resistant depression.

Methods/Procedures

Data were retrospectively harvested from approximately 2500 treatment charts of subjects with treatment-resistant depression who attended a university mood disorders clinic between 1983 and 2015. Hierarchical linear modeling was used to examine the effectiveness of treatment condition on outcome. Relative adverse event profiles were also examined.

Findings/Results

Eighty-four treatment outcome observations were made from 54 subjects who received combination therapy: TCA plus TCA (n = 22), TCA plus MAOI (n = 44), and MAOI plus TCA (n = 18). Treatment condition predicted a poorer (albeit not statistically significant) outcome for TCA plus TCA compared with TCA plus MAOI, or MAOI plus TCA therapy (P= 0.098). Specific adverse events occurred with significantly greater frequency between treatment groups; that is, impotence was more frequent with TCA plus MAOI therapy; headaches and insomnia were more frequent with MAOI plus TCA therapy; and constipation was more frequent with TCA plus TCA therapy. There were no reported or observed hypertensive or serotonergic events.

Implications/Conclusions

In contrast to conventional wisdom that combined TCA and MAOI therapy should be avoided, the judicious use of this combination may be relatively safe and effective compared with combined TCA plus TCA therapy. However, sample sizes were limited, and the analysis was nonrandomized and retrospective.
Validity and Reliability of the Responses to Ischemic Stroke Symptoms Questionnaire
Authors: Beal Claudia C. , Ogola Gerald , Allen Leigh
Published: November 2019

BACKGROUND

Prehospital delay remains an important reason for low intravenous tissue plasminogen activator administration rates. Study of ischemic stroke patients' responses to stroke onset may be hampered by lack of a questionnaire designed specifically to examine their cognitive, emotional, and behavioral responses to symptoms.

METHODS

We provide evidence for content validity and reliability for the Responses to Ischemic Stroke Symptoms Questionnaire (RISQ) through, expert panel review and calculation of a content validity index and a study to examine stability reliability among hospitalized acute ischemic stroke patients.

RESULTS

Expert panel review demonstrated agreement on the relevance of questionnaire items and an overall content validity index of 0.97. The study to examine stability reliability demonstrated acceptable stability of the items on the RISQ over the short term in a sample of white and black stroke patients.

CONCLUSION

Preliminary evidence was gathered to support the content validity and stability reliability of the RISQ. Study of the RISQ with other population groups is needed.
The Ribbon-shaped Femoral Footprint of the Medial Patellofemoral Ligament: Implications for Reconstruction
Authors: Tanaka Miho J. , Farr Jack
Published: November 2019

The medial patellofemoral ligament (MPFL) is the primary static stabilizer to lateral translation of the patella and serves as part of the medial patellar soft tissue restraints. Because of the sensitivity of MPFL graft function after reconstruction to the position of the femoral tunnel, many studies have aimed to identify the exact point of the femoral origin, as well as defining techniques to confirm this position intraoperatively. We describe the ribbon-shaped footprint of the MPFL on the medial femur and the associated difficulty in identifying the origin as a single “point.” Varying isometry and biomechanical functions have been shown to exist within the most proximal and most distal fibers, suggesting the function of the MPFL may not be fully recreated with a tubular graft in a round tunnel. We review the anatomical descriptions of the elongated femoral footprint of the MPFL and describe our surgical technique to recreate this.
Accuracy testing of a new optical device for noninvasive estimation of systolic and diastolic blood pressure compared to intra-arterial measurements
Authors: Pellaton Cyril , Vybornova Anna , Fallet Sibylle , Marques Luisa , Grossenbacher Olivier , De Marco Bastien , Chapuis Valentin , Bertschi Mattia , Alpert Bruce S. , Solà Josep
Published: November 2019

Objective

The objective of this study was to compare the systolic (S) and diastolic (D) blood pressure (BP) estimations from a new optical device at the wrist with invasive measurements performed on patients scheduled for radial arterial catheterization in the ICU. Optical signals were automatically processed by a library of algorithms from Aktiia SA (OBPM – optical blood pressure monitoring algorithms).

Methods

A total of 31 participants from both sexes, aged 32–87 years, were enrolled in the study (NCT03837769). The measurement protocol consisted of the simultaneous recording of reflective photoplethysmographic signals (PPG) from the cuffless optical device and the reference BP values recorded by a contralateral radial arterial catheter. From the 31 participants, 23 subjects whose reference data quality requirements were adequate were retained for further analysis. The PPG signals from these patients were then automatically processed by the Aktiia OBPM library of algorithms, which generated uncalibrated estimates of SBP and DBP. After the automatic assessment of optical signal quality, 326 pairs of uncalibrated SBP and DBP determinations from 16 patients were available for analysis. These values were finally transformed into calibrated estimations (in mmHg) using arterial catheter SBP and DBP values, respectively.

Results

For SBP, a mean difference (±SD) of 0.0 ± 7.1 mmHg between the arterial catheter and the optical device values was found, with 95% limits of agreement in the Bland-Altman method of –11.9 to + 12.2 mmHg (correlation of r = 0.87, P < 0.001). For DBP, a mean difference (±SD) of 0.0 ± 2.9 mmHg between arterial catheter and the optical device values was found, with 95% limits of agreement in the Bland-Altman method of –4.8 to + 5.5 mmHg (correlation of r = 0.98, P < 0.001).

Conclusion

SBP and DBP values obtained by radial artery catheterization and those obtained from optical measurements at the wrist were compared. The new optical technique appears to be capable of replacing more traditional methods of BP estimation.
Acute kidney injury associated with glomerular diseases
Authors: Fenoglio Roberta , Sciascia Savino , Baldovino Simone , Roccatello Dario
Published: November 2019

Purpose of review

This review focuses on acute kidney injury (AKI) associated with glomerular diseases and specifically the mechanisms of development of AKI in the wide spectrum of glomerulopathies.

Recent findings

The immune system and the kidneys are closely linked. In healthy individuals, the kidneys contribute to immune homeostasis, whereas components of the immune system mediate many acute forms of kidney disease. Both crescentic and noncrescentic forms of acute glomerulonephritis can present as AKI. The diagnosis of glomerular diseases underlying AKI requires a high degree of suspicion coupled with an algorithmic approach to laboratory investigations. Renal biopsy represents the gold standard for the diagnosis of medical conditions of the kidney. The main clinical–biological presentations of glomerular diseases are acute nephritic syndrome, nephrotic syndrome and rapidly progressive glomerulonephritis (RPGN). All these presentations can be worsened by AKI both in the onset and in the clinical course. Heavy proteinuria and macroscopic hematuria can be directly involved in the development of AKI.

AKI associated with glomerular diseases is not uncommon. Sometimes it represents an emergency case. The understanding of the various mechanisms underlying kidney diseases is improving, and may aid in their prevention and treatment.
Osteonecrosis of the medial tibial plateau after intra-articular corticosteroid injection
Authors: Lee Ju Hong , Wang Sung il , Noh Sang Jae , Ham Dong Hun , Kim Ki Bum
Published: November 2019

Rationale:

Intra-articular corticosteroid injection (IACI) is a cost-effective conservative treatment of mild-to-moderate osteoarthritis. Adverse events after this procedure range from life-threatening systemic reactions to self-limiting local reactions. To our knowledge, this is the 1st report of osteonecrosis (ON) in the medial tibial plateau after IACI.

Patient concerns:

An 81-year-old female visited our hospital due to left knee pain of increasing intensity. She presented the sudden onset of severe acute knee pain with long lasting knee pain for several years.

Diagnosis:

The diagnosis was confirmed ON of medial tibial plateau of knee joint by pathologic finding.

Interventions:

We conducted a posterior stabilized total-knee arthroplasty with no requirement for bone grafting or additional prosthesis, such as metal augments or stems.

Outcomes:

At the postoperative 1 year follow-up, the patient was satisfied with the surgery and had no pain during walking and active knee motion.

Lessons:

This case especially stress the possibility of ON in medial tibia plateau after IACI. Therefore, clinicians should monitor symptoms after IACI to enable early detection of this complication.
Effectiveness of electroacupuncture for pain after osteosarcoma post surgery
Authors: He Chi , Tang Qing-xi , Li Ying-xia , He Kai , Hou Zhi-ling
Published: November 2019

Background:

This study will assess the effectiveness of electroacupuncture (EA) for pain in patients with osteosarcoma post surgery (OSPS).

Methods:

In this study, we will comprehensively search the following electronic databases from inception to the present without language restrictions: Cochrane Library, EMBASE, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. Two authors will independently carry out study selection, data extraction, and methodological assessments. RevMan 5.3 software will be used for statistical analysis.

Results:

The primary outcome is pain intensity. The secondary outcomes consist of event-free survival, overall survival, quality of life, and adverse events.

Conclusion:

The findings of this study will provide helpful evidence of EA treatment for patients with OSPS.

PROSPERO registration number:

PROSPERO CRD42019146696.