bluuebunny/crossref_metadata_2025 huggingface dataset:
Opportunistic Salpingectomy: An Appropriate Procedure During All Pelvic Surgeries
Authors: Nezhat F.R. , Martinelli V.T.
Published: November 2019

(Am J Obstet Gynecol. 2019;220(1):10–11)

Ovarian cancer is the deadliest gynecological disease in the United States, with 70% of patients presenting with late-stage III and IV disease. As there is no standard screening method for detecting early ovarian cancer, prevention has become an important goal. Salpingo-oophorectomy has been recommended for those with high risks of ovarian cancer once they are finished having children. The role of the uterine tubes in the development of ovarian cancer has come into focus in recent studies. Portions left in situ after bilateral tubal ligation may still pose a risk of cancer with no added benefit to health. A prior study found that opportunistic salpingectomy compared with tubal ligation at the time of pelvic surgery decreased the risks of developing ovarian cancer.
Transient Tachypnea of Newborns Is Associated With Maternal Spinal Hypotension During Elective Cesarean Delivery: A Retrospective Cohort Study
Authors: Singh S. , Lumbreras-Marquez M. , Farber M.K. , Xu X. , Singh P. , Gorman T. , Palanisamy A.
Published: November 2019

(Anesth Analg. 2019;129(1):162–167)

During the newborn stage, transient tachypnea is a frequent element involved in respiratory distress, and is thought to be connected to delayed fetal lung fluid clearance. Transient tachypnea of newborns is found to be more common in cesarean deliveries than in vaginal deliveries, but not much research has been done to examine potential transient tachypnea risk factors found in an elective cesarean delivery setting. Because neuraxial anesthesia (frequently used during cesarean delivery) is associated with maternal hypotension, Singh and colleagues conducted their study to examine the relationship between predelivery maternal hypotension and transient tachypnea of newborns born via elective cesarean delivery.
The DiPEP Study: An Observational Study of the Diagnostic Accuracy of Clinical Assessment, D-dimer and Chest X-ray for Suspected Pulmonary Embolism in Pregnancy and Postpartum
Authors: Goodacre S. , Horspool K. , Nelson-Piercy C. , Knight M. , Shephard N. , Lecky F. , Thomas S. , Hunt B.J. , Fuller G.
Published: November 2019

(BJOG. 2019;126(3):383–392)

Pulmonary embolism (PE) is a leading cause of maternal mortality during pregnancy and postpartum, therefore symptomatic at-risk women are commonly seen in emergency departments and maternity units to rule out PE. Recommendations regarding diagnosis of PE vary among various professional societies. Recent reviews have not found sufficient evidence to suggest that D-dimer is an effective tool in detecting PE, mainly due to the low prevalence of PE in study subjects. The aim of this study was to determine whether clinical features or D-dimer could be used during pregnancy and postpartum to select women for diagnostic imaging.
Epidural Hematoma Following Low Molecular-weight Heparin Prophylaxis and Spinal Anesthesia for Cesarean Delivery
Authors: Pujic B. , Holo-Djilvesi N. , Djilvesi D.J. , Palmer C.M.
Published: November 2019

(Int J Obstet Anesth. 2019;37:118–121)

Epidural hematoma is a rare complication of spinal anesthesia while cesarean delivery (CD) is a risk factor for maternal venous thromboembolism. The more frequent use of pharmacologic prophylaxis with unfractionated or low–molecular-weight heparin (LMWH) in higher risk women has been recommended as a strategy to decrease venous thromboembolism. This case report described the development of a spinal-epidural hematoma in a parturient who received spinal anesthesia for a planned, repeat CD after receiving LMWH thromboprophylaxis.
Anticipating a Banner Year for Nursing
Authors: Kennedy Maureen Shawn
Published: November 2019

What do you want to accomplish?
Nonpharmacological Therapies have Modest Benefits for Adults at Risk for Suicide
Authors: Rosenberg Karen
Published: November 2019

According to this study:

Both cognitive behavioral therapy and dialectical behavior therapy showed a modest benefit in reducing suicidal ideation compared with treatment as usual.

Cognitive behavioral therapy also reduced suicide attempts.

Compared with placebo, both ketamine and lithium demonstrated a modest benefit in reducing the rate of suicide.
School-Based Telehealth Programs May Benefit Children with Chronic Diseases
Authors: Rosenberg Karen
Published: November 2019

According to this study:

School-based telehealth programs that focus on asthma and other chronic pediatric diseases may improve the health of children living in rural and medically underserved communities.

Analysis of the asthma subsample in this study showed that the telehealth program was associated with an approximately 21% relative decrease in the likelihood of ED visits.
Heart Rate Control during Experimental Sepsis in Mice
Authors: Bedet Alexandre , Voiriot Guillaume , Ternacle Julien , Marcos Elisabeth , Adnot Serge , Derumeaux Geneviève , Mekontso Dessap Armand
Published: November 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Tachycardia is a hallmark of sepsis. An elevated heart rate could impair ventricular filling and increase myocardial oxygen demand. β-Blockers and ivabradine (a selective inhibitor of If channels in the sinoatrial node) are both able to control sinus tachycardia, with the latter drug being devoid of negative inotropic effect. This work aimed at assessing the hemodynamic effects of ivabradine as compared with a β-blocker (atenolol) during murine peritonitis.

Methods

Ivabradine (3 μg/g), atenolol (3 μg/g), or placebo was administered intraperitoneally 2 h after induction of peritonitis (cecal ligation and puncture) in male C57BL6 mice. The authors used invasive (left ventricular catheterization) and noninvasive (transthoracic echocardiography) monitoring to assess hemodynamics 20 h after surgery, including heart rate, blood pressure, left ventricular systolic, and diastolic function (n = 10 mice/group). The authors also assessed overall mortality 30 and 60 h after surgery in a distinct subset of animals (n = 20 mice/group). Descriptive data are presented as median (25th to 75th percentile).

Results

As compared with placebo (601 beats/min [547 to 612]), ivabradine (447 beats/min [430 to 496]) and atenolol (482 beats/min [412 to 505]) blunted sepsis-induced tachycardia assessed by transthoracic echocardiography in awake animals (P < 0.001 and P = 0.004, respectively). Unlike ivabradine, atenolol reduced cardiac output, systolic blood pressure, and left ventricular systolic function (as assessed by ejection fraction, maximal left ventricular pressure rise, and anterior wall strain rate) as compared with septic mice receiving placebo. There was no difference in survival 60 h after sepsis induction with ivabradine (6 of 20, 30%) or atenolol (7 of 20, 35%), as compared with placebo (5 of 20, 25%; P = 0.224).

Conclusions

Heart rate control could be similarly achieved by ivabradine or atenolol, with preservation of blood pressure, cardiac output, and left ventricular systolic function with the former drug.
Development of an Innovative Nonanimal Training Model for Infant Pleural Effusion Drainage via Pigtail Catheter Placement
Authors: Zurca Adrian D. , Diaz-Sanchez Angel , Mackley Lisa , Rodgers David L.
Published: November 2019

Background:

Chest tube placement is an important skill for providers and bedside nurses caring for critically ill infants, allowing for the evacuation of pleural fluid and pneumothoraces. No realistic simulation models are commercially available for trainees to practice and learn this skill on infants.

Purpose:

Our objective was to develop an inexpensive and reproducible model for percutaneous pleural pigtail placement for pleural fluid removal via the Seldinger technique.

Methods:

The model was developed using hardware material and a discarded infant resuscitation manikin. The rib cage was constructed using electrical cable wires. Discarded and expired 250-mL bags of intravenous fluids were placed inside the chest cavity to simulate pleural fluid. Shelf liner was wrapped around the chest and abdomen of the infant model to simulate the skin layer. Pediatric critical care faculty performed the procedure on the final model and scored it for realism and utility for teaching. Without including the discarded manikin and fluid bags, the cost of the materials for the model was less than $20.

Results:

Eight pediatric critical care faculty tested the pleural pigtail placement model. All faculty agreed the model provides a realistic simulated reproduction of placing a pleural pigtail, felt the model was simple to use, and indicated they would use it as a teaching tool in the future.

Implications for Practice:

An effective model for pleural pigtail placement can be inexpensively constructed using discarded bags of intravenous fluid and easy-to-find hardware materials.

Implications for Research:

Future studies are needed to assess whether this model helps providers and nurses develop and maintain the clinical skills for successful percutaneous pleural pigtail catheter placement.

Video Abstract available at
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=35&autoPlay=true
Comparison of Clinical Outcomes After Intramedullary Fixation of Tibia Fractures Caused by Blunt Trauma and Civilian Gunshot Wounds: A Retrospective Review
Authors: Metcalf Kathryn B. , Smith Eric J. , Wetzel Robert J. , Sontich John K. , Ochenjele George
Published: November 2019

Objective:

To assess the outcomes of patients who sustained blunt trauma tibia fractures compared with tibia fractures from civilian gunshot injuries when treated with intramedullary fixation.

Design:

Retrospective chart review.

Setting:

Level I trauma center.

Patients/Participants:

Two hundred and seven patients underwent intramedullary nailing for 211 tibia fractures.

Methods:

A retrospective review of tibia fracture(s) treated with intramedullary fixation with comparison of closed, open, and gunshot wound (GSW) fracture outcomes.

Main Outcome Measurements:

Outcomes included infection and nonunion.

Results:

The infection rate in closed and GSW tibia fractures was significantly lower compared with the infection rate of open fractures (1% vs. 9% vs. 20%; P = 0.00005). Significantly lower rates of nonunion in closed fractures compared with open fractures and GSW fractures were appreciated (8% vs. 20% vs. 30%; P = 0.003). There was no difference in infection or nonunion between GSW fractures with small wounds, no exposed bone, and minimal comminution and closed injuries (P = 0.24, P = 0.60). Conversely, there was a significantly higher nonunion rate in GSW fractures with large wounds, exposed tibia, and comminution compared with blunt injuries (P = 0.0014).

Conclusions:

This study suggests that tibia fractures from civilian GSWs are heterogeneous injuries, and outcomes are dependent on the extent of soft-tissue injury, bone exposure, and bone loss. There are comparable infection rates in all fractures due to civilian GSWs and closed fractures, which are lower than high-grade open fractures. Tibia GSW fractures with exposed bone and comminution have higher complication rates and should be treated accordingly.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The alternatively spliced RECK transcript variant 3 is a predictor of poor survival for melanoma patients being upregulated in aggressive cell lines and modulating MMP gene expression in vitro
Authors: Jacomasso Thiago , Ribas Hennrique Taborda , Trombetta-Lima Marina , Silberspitz Konig Michelle , Trindade Edvaldo da Silva , Martinez Glaucia Regina , Sogayar Mari Cleide , Winnischofer Sheila Maria Brochado
Published: November 2019

The reversion-inducing cysteine-rich protein with kazal motifs (RECK) gene was described as a tumor suppressor gene two decades ago. Recently, novel alternatively spliced products of this gene have been identified. Of these, the transcript variant 3 (RECKVar3) was shown to display tumor-facilitating effects in astrocytoma cells in vitro, with a higher RECKVar3/canonical RECK expression ratio being correlated with lower survival rates of patients. However, the regulatory mechanisms through which the cell controls the production and maintenance of these alternative transcripts, as well as their expression in other tumor types, remain elusive. Thus, the aim of this study is to investigate the role of the alternatively spliced transcripts from the RECK gene in melanoma progression as well as their regulation mechanism. To this end, we analyzed data from the Cancer Genome Atlas network and experimental data obtained from a panel of cell lines to show that high levels of RECKVar3 are predictive of poor survival. We also show that the MAPK and PI3K signaling pathways clearly play a role in determining the alternative-to-canonical ratio in vitro. Finally, we show that overexpression of the RECKVar3 protein upregulates matrix metalloproteinases (MMP)-9 and MMP-14 mRNA, while downregulating their inhibitor, tissue inhibitor of metalloproteinase (TIMP)3, and that RECKVar3-specific knockdown in the 1205Lu melanoma cell line hampered upregulation of the MMP9 mRNA promoted by the MEK1/2 inhibitor U0126. Taken together, our data complement the evidence that the RECK gene has a dual role in cancer, contributing to better understanding of the signaling cues, which dictate the melanoma invasive potential.
Long-Term Survival Rates and Prognostic Factors of Cervix Cancer Treated by Different Modalities
Authors: Viani Gustavo A. , dos Santos Fred M. , Pavoni Juliana F.
Published: November 2019

Objective:

To assess the overall survival (OS) and prognostic factors in patients with cervix cancer treated by different modalities.

Material and Methods:

The authors studied a cohort of patients with cervix cancer International Federation of Gynecology and Obstetrics stage I-IVa treated in the last 15 years. Patients were treated with surgery followed by radiotherapy (S+RT), or surgery plus chemoradiation (S+CRT), or radiotherapy alone (RT), or chemoradiation alone (CRT). Univariate and multivariate analyses were conducted to identify significant prognostic factors (P<0.05).

Results:

A total of 380 patients with cervix cancer were included. The treatment groups were S+CRT (37.5%), CRT (33%), RT (20%), and S+RT (9.5%). The median follow-up was 7.6 years, the OS in 5 and 10 years according to the treatment groups was 43.3%, and 17.3% for S+RT, 47.8% and 41.9% for S+CRT, 40.7% and 27.9% for CRT, and 29.1% and 19.4% for RT (P<0.0001). The stage IIb-IVa, age 60 years or older, RT, and 2DRT were significant factors in the univariate and multivariate analyses. In stage I-IIa, no significant difference was found among the treatment groups (P=0.907). In stage IIb-IVa, a significant difference was observed (P=0.0001). CRT versus RT had significance, and no difference between S+RT versus S+CRT, and S+CRT versus CRT was seen for stage IIb-IVa.

Conclusions:

In a long-term follow-up, no significant difference among the treatment modalities was found for early disease. For stage IIb-IVa, significant differences were observed, with RT having the worst survival, and CRT similar to S+CRT. These outcomes show that tumor and patients characteristics can be used to decide the best treatment option outside a clinical trial.
Study of L-Asparaginase, Vincristine, and Dexamethasone Combined With Intensity-modulated Radiation Therapy in Early-Stage Nasal NK/T-Cell Lymphoma
Authors: Hu Yunfei , Chen Mengxiang , Song Yang , Liu Xiaomei , Gou Feng , Zhang Jing , Huang Yunhong
Published: November 2019

Objectives:

Natural killer/T-cell lymphoma (NKTCL) is aggressive, and carries a poor prognosis worldwide. This retrospective study aimed to evaluate the clinical efficacy and safety of the LVD regimen (L-asparaginase, vincristine, and dexamethasone) combined with intensity-modulated radiation therapy (IMRT) for the treatment of early-stage nasal NKTCL in a Chinese population.

Methods:

The clinical data were collected from patients treated between March 2010 and January 2017. Patients received LVD chemotherapy combined with IMRT, and were followed for 30 to 90 months. All received radiotherapy at the end of the first/second cycle of chemotherapy. The survival curves were generated by the Kaplan-Meier method.

Results:

Among 94 patients who received 2 to 6 cycles (mean, 4 cycles) of treatments, 56 and 25 achieved complete and partial remission, respectively; 2 and 11 experienced stable disease and progressive disease. The overall objective response was 86.2%. Patients with elevated lactate dehydrogenase and skin invasion had a lower objective response rate. The progression-free survival rates at 1, 3, and 5 years were 90.3%, 73.5%, and 71.3%; the corresponding overall survival rates were 91.4%, 74.3%, and 74.3%. The main adverse events were myelosuppression (63.8% grades I to II, 12.8% grade III), gastrointestinal symptoms (63.8% grades I to II), hepatic lesion (55.3% grades I to II), hypoproteinemia (46.8% grades I to II), skin allergies (77.7% grades I to II, 3.2% grade III), and oral mucosal lesions (44.7% grades I to II, 33% grade III). No severe pancreatitis, anaphylaxis, or toxicity-related death was observed.

Conclusion:

In patients with early-stage nasal NKTCL, our LVD-IMRT regimen produced excellent, durable therapeutic benefit in most patients, with acceptable toxicity and no acute mortality.
BACILLARY LAYER DETACHMENT OVERLYING REDUCED CHORIOCAPILLARIS FLOW IN ACUTE IDIOPATHIC MACULOPATHY
Authors: Fernández-Avellaneda Pedro , Breazzano Mark P. , Fragiotta Serena , Xu Xiaoyu , Zhang Qinqin , Wang Ruikang K. , Freund K. Bailey
Published: November 2019

Purpose:

To report new multimodal imaging features that enhance our understanding of the inflammatory and ischemic nature of acute idiopathic maculopathy (AIM) and to correlate structural and functional changes due to a reversible initial choroidal ischemia over a clinical course of 3.5 months.

Methods:

A 31-year-old man presented with acute central vision loss in his right eye due to coxsackievirus-associated AIM. Serial multimodal retinal imaging including confocal true color fundus photography, blue-light fundus autofluorescence (BAF), near-infrared reflectance (NIR), spectral domain optical coherence tomography and swept-source optical coherence tomography (SD-OCT + SS-OCT), and en face SS-OCT angiography (SS-OCTA) were performed over a 3.5-month follow-up. Eidon true color confocal scanner camera (Centervue, Padova, Italy) was used for color and BAF imaging. Near-infrared reflectance and SD-OCT images were obtained with the Heidelberg Spectralis OCT (HRA2 + OCT; Heidelberg Engineering, Heidelberg, Germany). For SS-OCT and en face SS-OCT and SS-OCTA images, the PLEX Elite 9,000 (Carl Zeiss Meditec, Inc, Dublin, CA) was used. Central alterations in choriocapillaris flow were analyzed with SS-OCTA using the University of Washington choriocapillaris (CC) flow deficit quantification algorithm available through the ARI Network. Flow deficit area and density values were analyzed and compared between the first and last examinations. Corresponding en face OCT imaging was used to distinguish true flow defects from artifacts secondary to shadowing.

Results:

In the acute stage of AIM, a bacillary layer detachment appearing as a yellow-grayish foveal elevation surrounded by a hypopigmented parafoveal ring was evident in a Bull's eye configuration, corresponding to a hyperreflective ring upon NIR and a hyperautofluorescent ring with BAF. SD + SS-OCT showed mostly intraretinal fluid consistent with a bacillary layer detachment in conjunction with a thickened inner choroid. At presentation, SS-OCTA demonstrated a marked reduction of choriocapillaris flow signal. At 1 week, early resolution of retinal fluid was followed by restoration of the ellipsoid zone at 5 weeks, while restoration of the interdigitation zone and reduction in retinal pigment epithelium/Bruch membrane complex thickening occurred more slowly. Swept-source OCT angiography showed a gradual, but incomplete, recovery of inner choroidal flow signal at 3.5-month follow-up.

Conclusion:

Acutely, AIM may present with a photoreceptor splitting foveal bacillary layer detachment associated with a marked reduction in inner choroidal flow signal on SS-OCTA. Thereafter, restoration of the outer retinal layers and gradual normalization of choroidal flow signal appear to support the often-benign nature of the disease.
New procedure of high-frequency repetitive transcranial magnetic stimulation for central neuropathic pain: a placebo-controlled randomized crossover study
Authors: Quesada Charles , Pommier Benjamin , Fauchon Camille , Bradley Claire , Créac'h Christelle , Murat Marion , Vassal François , Peyron Roland
Published: November 2019

Repetitive transcranial magnetic stimulation (rTMS) is a procedure increasingly used to treat patients with central neuropathic pain, but its efficacy is still under debate. Patients with medically refractory chronic central neuropathic pain were included in 2 randomized phases (active/sham), separated by a wash-out period of 8 weeks. Each phase consisted of 4 consecutive rTMS sessions and a final evaluation session, all separated from one another by 3 weeks. High-frequency (20 Hz) rTMS was delivered over the primary motor cortex (M1) contralateral to the patient's pain using a neuronavigated robotic system. Patients and clinicians assessing outcomes were blinded to treatment allocation during the trial. The primary outcome measured the percentage of pain relief (%R) from baseline. Secondary outcomes were VAS score, Neuropathic Pain Symptom Inventory, analgesic drug consumption, and quality of life (EQ-5D). Thirty-six patients performed the entire study with no adverse effects. The analgesic effect for the main criterion (%R) was significantly higher in the active (33.8% confidence interval [CI]: [23.88-43.74]) than in the sham phase (13.02% CI: [6.64-19.76]). This was also the case for the secondary outcome VAS (−19.34% CI: [14.31-25.27] vs −4.83% CI: [1.96-8.18]). No difference was observed for quality of life or analgesic drug consumption. Seventeen patients (47%) were identified as responders, but no significant interaction was found between clinical and technical factors considered here and the analgesic response. These results provide strong evidence that 3 weeks spaced high-frequency rTMS of M1 results in a sustained analgesic effect and support the clinical interest of this stimulation paradigm to treat refractory chronic pain.
Implementation of Systematic Community Resource Referrals at Small Primary Care Practices to Promote Cardiovascular Disease Self-Management
Authors: Makelarski Jennifer A. , DePumpo Megan , Boyd Kelly , Brown Tiffany , Kho Abel , Navalkha Chenab , Lindau Stacy T.
Published: November 2019

Quality improvement (QI) models and evidence-based self-management guidelines for reducing cardiovascular disease (CVD) risk require patients to access community resources. The purpose of this study is to describe outcomes from implementation of a community resource referral system into small clinical practices to reduce CVD risk. Practices were given the opportunity to complete an inventory of local CVD-related resources; these data were used to create a printed list of resources for patients (“HealtheRx-H3”). Practices could request updates to HealtheRx-H3s. We assessed implementation outcomes, including appropriateness, feasibility, and adoption. Practice populations were at high risk for CVD. It was feasible to create practice-specific HealtheRx-H3s. Systematic distribution of HealtheRx-H3s using digital electronic health record (EHR) integration was infeasible due to inconsistent use of EHR systems, workflow variation, and lacking data-sharing infrastructure. Of 76 practices, 38 completed the inventory; completion was similar by patient and practice characteristics. HealtheRx-H3 updates were requested by 39% of practices; practices that completed the inventory were significantly more likely to request an update compared with those that did not (61% vs. 18%, p-value <.01). Successful implementation of QI strategies to systematize community resource referral solutions is feasible at small practices, but more research is needed to understand what motivates small practices to participate in implementation of these solutions.
Observation of immediate and mid-term effects of partial spleen embolization in reducing hepatic venous pressure gradient
Authors: Zhao Yiming , Guo Liangliang , Huang Qiyang , Zhang Rugang , Sun Xuyang , Zhao Li , Li Chao , Nie Yan , Sun Gang , Liu Jiangtao
Published: November 2019

Objective:

To observe the immediate and mid-term effects of partial spleen embolization (PSE) in reducing hepatic venous pressure gradient (HVPG) in patients with cirrhotic esophagogastric varices.

Methods:

Patients diagnosed with cirrhosis and esophagogastric varices in our hospital between July 2016 and March 2018 were consecutively selected. Forty-three patients were selected based on the eligibility criteria to undergo PSE. The change in HVPG 5 minutes before and after embolization, was used to determine the immediate effect of PSE on HVPG reduction. HVPG was retested after 6 months to observe the change in the antihypertensive effect along with time.

Results:

Forty-three patients successfully underwent PSE and HVPG measurements. The HVPG was 17.7 ± 3.9 mmHg and 13.9 ± 3.1 mmHg before and after PSE, respectively, showing a significant decrease (21.5%, P < .05). Among them, 18 cases were retested for HVPG at 6 months after PSE, and the results showed significant differences in the HVPG levels before, immediately and 6 months after PSE. Compared with preoperative PSE, HVPG was decreased by 22.9% and 17.7% (P < 0.05) immediately and at 6 months after operation, respectively. There was no significant change at 6 months after PSE when compared with immediate postoperative PSE. No serious complications were observed in patients during their postoperative hospital stay.

Conclusion:

PSE immediately reduced the portal pressure, and HVPG remained stable at 6 months after surgery. PSE is considered as a safe and easy to implement method, and is expected to be one of the treatments for reducing the portal pressure.
A ball-slide-type interbody distractor is effective in posterior reduction and internal fixation for patients with mid- to high-grade isthmic spondylolisthesis enrolled in a randomized clinical trial
Authors: Li Pengfei , Zhao Zongmao , Jia Nan , Wang Litao , Sun Zhaosheng , Jin Xianhui
Published: November 2019

Study Design:

Clinical and radiographic results of a randomized, controlled, double-blind clinical trial

Objective:

To investigate the clinical applicability of a ball-point slide-type interbody distractor in posterior reduction and internal fixation for mid- to high-grade isthmic spondylolisthesis.

Summary of Background Data:

Posterior reduction and internal fixation is the effective treatment for spondylolisthesis. However, for the mid and high-grade isthmic spondylolisthesis patients with the conditions of vertebral osteoporosis and extremely narrow intervertebral space, the reduction is difficult; post-surgery intervertebral space height lost becomes serious; the fracture and loosening rate of fixation system is higher. No study regarding the prevention of these adverse outcomes in this technique is reported.

Methods:

A total of 59 patients of mid and high-grade isthmic spondylolisthesis were randomly divided into random groups (investigational group and control group) applying simple randomized method in this study. In addition, 30 patients received posterior reduction and internal fixation as control. Twenty-nine patients received posterior reduction and internal fixation by ball-point slide-type interbody distractor were assigned to the investigational group. X-ray examination was performed before and after operation. The degree of reduction, height of intervertebral space were compared. The preoperative and postoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were evaluated. Additionally, rate of the fixation system fracture was also assessed.

Results:

Before treatment, there were no significant differences in ISH (P = .72), DR (P = .85), VAS of back pain (P = .55), VAS of leg pain (P = .83) and ODI (P = .68) were found between 2 groups. After 12-month treatment, there were no significant differences in ISH (P = .26), VAS of back pain (P = .09) and VAS of leg pain (P = .96) between two groups. Significant differences of DR (P = .02), ODI (P = .03) and adverse events (P = .00) were found between 2 groups.

Conclusions:

The results of this prospectively study showed that the ball-point slide-type interbody distractor in the posterior reduction and internal fixation produced good outcomes after 12-month treatment. More high quality randomized controlled trials and cases should still be needed to warrant the results of this study.
Efficacy and safety of bifid triple viable plus aminosalicylic acid for the treatment of ulcerative colitis
Authors: Chen Mu-yuan , Qiu Zhen-wen , Tang Hong-mei , Zhuang Kun-hai , Cai Qing-qun , Chen Xin-lin , Li Hui-biao
Published: November 2019

Objective:

Ulcerative colitis (UC), one of the most stubborn diseases, is mainly treated by aminosalicylic acid (ASA). However, the side effects of ASA include vomiting, nausea, rash, diarrhea, headache, etc, which seriously affect life-quality of UC patients. Probiotics such as bifid triple viable (BTV) could reduce drug-induced adverse reactions and has a good clinical effect on UC. Therefore, we aimed to evaluate the clinical efficacy and safety of BTV plus ASA in treating UC.

Methods:

PubMed, Cochrane Library, Embase, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, Chinese National Knowledge Infrastructure, and Wanfang databases were searched from the inception dates to October 12, 2018. Randomized controlled trials (RCTs) were included by comparing BTV plus ASA programs with ASA alone in patients with UC. Methodological quality was assessed by 2 independent researchers according to the inclusion criteria and exclusion criteria. Meta-analysis was performed by using the Review Manager 5.3 Software. Risk ratios (RRs), 95% confidence interval (CI), and standardized mean difference were calculated.

Results:

Sixty RCTs involving 4954 participants were selected for final review. Compared with ASA, BTV plus ASA significantly improved the clinical effect rate [RR = 1.23, 95% CI (1.20, 1.26), P < .00001]; reduced the relapse rate [RR = 0.34, 95% CI (0.18, 0.62), P = .0005]; and adverse effect rate [RR = 0.66, 95% CI (0.53, 0.82), P = .0002]. Compared with the controls, levels of tumor necrosis factor-α, interleukin-6 (IL-6), IL-8, C-reactive protein (CRP), hypersensitive CRP, erythrocyte sedimentation rate, and malondialdehyde were reduced; levels of IL-10, CD3+, CD4+, and superoxide dismutase were increased in BTV plus ASA group.

Conclusions:

BTV plus ASA has positive therapeutic effects on UC, and it might be a safe way to treat UC. However, comprehensive clinical trials are needed to obtain high level of clinical evidence.
Vaginal stones caused by urethrovaginal fistula
Authors: Wei Dongmei , Xie Yao , Niu Xiaoyu
Published: November 2019

Rationale:

Vaginal stone is a rare condition that is often misdiagnosed due to its low incidence. It can be divided into 2 types, primary vaginal and secondary vaginal, based on the etiology of the disease. Vaginal stones involve pathologic calcification. The formation of vaginal stones is mainly due to stasis and urine infection. We describe a procedure for the safe extraction of vaginal stones.

Patient concerns:

We report a case of a 25-year-old female patient with congenital genitourinary malformation and urethrovaginal fistula. A urogenital tract malformation repair operation was performed before she was 21 years old. Frequency of urination occurred before and after menstruation for 9 years, and dyspareunia occurred for 1 year.

Diagnoses:

B ultrasound examination showed a 59 × 55 × 23 mm fusiform region of increased signal intensity in the vagina followed by a sound shadow. We performed a gynecologic examination and found that the long diameter of the vaginal opening was 20 mm. A brown substance observed in her vagina had a hard texture and felt like a stone, and a palpation hand test revealed the size was approximately 60 × 50 mm. A cystoscope was inserted into the urethra and revealed that the broken end of the urethra was connected to the vagina. The proximal broken end of the urethra was 20 mm from the distal end.

Interventions:

The purpose of this operation was to make a definite diagnosis and remove the stones. We performed vaginal stone removal surgery and cystoscopy under anesthesia.

Outcomes:

We removed the stone successfully. The patient was discharged from the hospital after a smooth recovery without any complications. Follow-up was conducted 1 month after the operation and then every 3 months.

Lessons:

Although vaginal stones are rare, we must pay attention to this disease, especially in patients with congenital genitourinary malformations and urethrovaginal or vesicovaginal fistulas. Obstruction of urine discharge combined with repeated urinary tract infection is the main cause of vaginal stone formation. For these patients, follow-up every 3 months, including a physical examination, B-mode ultrasonography of the urinary system and cystoscopy if necessary, can avoid the occurrence of the disease.
Comparison of survival outcomes of alcohol-related hepatocellular carcinoma with or without liver cirrhosis; a ten-year experience
Authors: Shin Jongbeom , Yu Jung Hwan , Jin Young-Joo , Chae Myoung Hun , Yoon Chang Hwi , Lee Jin-Woo
Published: November 2019

We evaluated overall survivals (OSs) of alcohol-related hepatocellular carcinoma (HCC) patients without LC compared to those with LC.

Between 2005 and 2015, 1343 patients were initially diagnosed as having HCC in our hospital. Of these, 186 alcohol-related HCC patients were enrolled in this study, and their medical records were retrospectively analyzed. Significant alcohol intake was defined as more than 210 grams/week for men and more than 140 grams/week for women.

Non-cirrhotic HCC was observed in 37.1% of the 186 patients. Cumulative OS rates were significantly higher in non-cirrhotic patients (P = .006). For the 117 cirrhotic patients, cumulative OS rate was significantly higher in the CTP class A patients than in the CTP class B (P < .001) or CTP class C (P < .001) patients, respectively. In the 69 non-cirrhotic patients, cumulative OS rate was significantly higher in the CTP class A patients than in the CTP class C patients (P < .001), but, not than in the CTP class B patients (P = .157). Multivariate analyses revealed that CTP class B (P 
< .001), CTP class C (P 
< .001), and tumor size (P = .006) were significant predictors for OS in cirrhotic patients, and that CTP class C (P 
= .002) and tumor size (P = .023) were significant predictors for OS in non-cirrhotic patients.

OS was found to be better for non-cirrhotic than cirrhotic patients with alcohol-related HCC. Survivals of alcohol-related HCC patients without cirrhosis were comparable between patients with CTP class A and B.
Are inferior facetectomies adequate and suitable for surgical treatment of adolescent idiopathic scoliosis?
Authors: Yoshihara Hiroyuki , Penny Gregory S. , Kaur Harleen , Shah Neil V. , Paulino Carl B.
Published: November 2019

Study Design:

Retrospective review.

Background:

Inferior facetectomies, with the utilization of segmental pedicle screw constructs for corrective fixation, can provide adequate flexibility and post less risk of neural tissue and blood loss. We analyzed outcomes of surgical treatment for adolescent idiopathic scoliosis (AIS) using inferior facetectomies and segmental pedicle screw constructs. We hypothesized that adequate main curve correction and suitable surgical outcomes would be observed using this technique.

Methods:

We reviewed 38 AIS patients who underwent inferior facetectomies and segmental pedicle screw constructs by 2 surgeons at a single institution between May 2014 and December 2016. Coronal and sagittal radiographic measurements were evaluated over 1-year follow-up by 2 trained observers not associated with the surgeries. Surgical details, complications, and hospital length of stay (LOS) were also recorded.

Results:

Mean fusion levels were 11.0 ± 1.7. The mean Cobb angle of main AIS curves improved from 48.6± 10.1 degree preoperatively to 11.8± 6.2 degree postoperatively and 12.4± 6.2 degree at 1-year follow-up, which percentage correction was 75.9% and 74.6%, respectively. The mean thoracic kyphosis (T5-12) angle was 20.7± 11.6 degree preoperatively, 17.4± 8.0 degree postoperatively, and 16.8± 8.4 degree at 1-year follow-up. The mean surgical time, estimated blood loss, and LOS were 232.4 ± 35.7 minutes, 475.0 ± 169.6 mL, and 3.5 ± 1.3 days. Twelve patients received blood transfusion. There were no neurological or wound complications.

Conclusions:

This case series demonstrated adequate correction of main AIS curves, acceptable thoracic kyphosis and blood loss, and short surgical time and LOS in AIS patients treated with inferior facetectomies and segmental pedicle screw constructs, potentially indicating that inferior facetectomies are adequate and suitable for AIS surgery when segmental pedicle screw constructs are utilized.
Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty
Authors: Hsu Robert Wen-Wei , Hsu Wei-Hsiu , Shen Wun-Jer , Hsu Wei-Bin , Chang Shr-Hsin
Published: November 2019

It remains unclear if computer-assisted surgery (CAS) technique actually improves the clinical outcomes of total knee arthroplasty (TKA) and decreases the failure rate. The purpose of this retrospective study was to compare the functional results of TKA in a series of patients who underwent staged bilateral TKAs with CAS TKA in 1 knee and conventional TKA in the contralateral knee.

From January 1997 to December 2010, we collected 60 patients who were randomly assigned to receive CAS TKA in 1 limb and conventional TKA in the other. The Brainlab Vector Vision navigation system was used for CAS TKA, and the DePuy press-fit condylar sigma guide system was used for conventional TKA. Patients were assessed before surgery, 3 months and 1 year after surgery, and annually thereafter. IKS criteria were used for radiographic evaluation. Clinical and functional evaluation using the scoring system of hospital for special surgery (HSS), international knee society (IKS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form-36 (SF-36) were obtained on each knee, before surgery, and at each follow-up visit. Pertinent statistical methods were adopted for data analysis.

Fifty-six patients were available for analysis and 44 of the patients were female. The mean duration of follow-up was 8.1 years. Less blood loss (P = .007) and longer operation time were noted for CAS TKAs when compared with conventional TKAs. Precise alignment and fewer outliers of the lower limb and prosthetic component positions were found for CAS TKAs (P < .001). There were no differences between the 2 groups before surgery and at the latest follow-up with regard to scores for HSS, IKS, WOMAC, and SF-36 as well as active range of motion.

The clinical outcomes of CAS TKAs at the 8-year follow-up were similar to those of conventional TKAs despite the better radiographic alignment and fewer outliers achieved with navigation assistance.
Hemodynamic effects of inotropic drugs in heart failure
Authors: Long Ling , Zhao Hao-tian , Shen Li-min , He Cong , Ren Shan , Zhao He-ling
Published: November 2019

Background:

There is currently no consensus on the appropriate selection of inotropic therapy in ventricular dysfunction. The objective of the study was to detect the effects of different inotropes on the hemodynamics of patients who developed low cardiac output.

Methods:

PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched (all updated December 31, 2017). The inclusion criteria were as follows: low cardiac index (CI < 2.5 L/min/m2) or New York Heart Association class II–IV, and at least 1 group receiving an inotropic drug compared to another group receiving a different inotropic/placebo treatment. The exclusion criteria were studies published as an abstract only, crossover studies, and studies with a lack of data on the cardiac index.

Results:

A total of 1402 patients from 37 trials were included in the study. Inotropic drugs were shown to increase the cardiac index (0.32, 95%CI:0.25, 0.38), heart rate (7.68, 95%CI:6.36, 9.01), and mean arterial pressure (3.17, 95%CI:1.96, 4.38) than the placebo. Overall, the pooled estimates showed no difference in terms of cardiac index, heart rate, mean arterial pressure, systemic vascular resistance, and mean pulmonary arterial pressure among the groups receiving different inotropes.

Conclusions:

Our systematic review found that inotrope therapy is not associated with the amelioration of hemodynamics. An accurate evaluation of the benefits and risks, and selection of the correct inotropic agent is required in all clinical settings.
Neurocutaneous Melanocytosis and Leptomeningeal Melanoma
Authors: Mitre Victoria , Heym Kenneth , Clark Gary D. , Venkatramani Rajkumar
Published: November 2019

Neurocutaneous melanocytosis (NCM) is a disorder characterized by multiple or large congenital nevi and excessive proliferation of melanocytes in the leptomeninges and brain parenchyma. The majority of NCM is a result of somatic mosaicism due to a single postzygotic mutation in codon 61 of NRAS. Patients with NCM are at high risk of developing leptomeningeal melanoma. The prognosis for leptomeningeal melanoma is poor with no known effective treatment options. We describe the clinical features, treatment, and outcome of 4 children with NCM and leptomeningeal melanoma and discuss the latest molecular findings and treatment options for this rare condition.
The Impact of Low Socioeconomic Status in Adults With Chronic Pain
Authors: Booher Lydia
Published: November 2019

OBJECTIVE:

The objective of this study was to describe evidence about chronic pain (CP) in lower socioeconomic status (SES) adult populations.

DESIGN:

The study design was an integrative review.

DATA SOURCES used were MEDLINE, CINAHL, and PsycINFO, published from January 2008 to February 2018.

REVIEW/ANALYSIS METHOD:

Whittemore and Kanfl's 5 staged methodology (problem identification, literature search, data evaluation, data analysis, and presentation) was used to guide the review.

RESULTS:

Disparities based on SES affect CP development and management. Childhood risk factors impact CP experience over the life course. Neighborhood SES affects pain-related outcomes, and those with lower SES in rural settings have a higher prevalence of prescription opioid use.

NURSING IMPLICATIONS:

Findings from this review will support nurses to interpret CP through the lens of SES.
Elective Revisions after Breast Reconstruction: Results from the Mastectomy Reconstruction Outcomes Consortium
Authors: Nelson Jonas A. , Voineskos Sophocles H. , Qi Ji , Kim Hyungjin M. , Hamill Jennifer B. , Wilkins Edwin G. , Pusic Andrea L.
Published: November 2019

Background:

Rates of breast reconstruction following mastectomy continue to increase. The objective of this study was to determine the frequency of elective revision surgery and the number of procedures required to achieve a stable breast reconstruction 2 years after mastectomy.

Methods:

Women undergoing first-time breast reconstruction after mastectomy were enrolled and followed for 2 years, with completion of reconstruction occurring in 1996. Patients were classified based on the absence or presence of complications. Comparisons within cohorts were performed to determine factors associated with revisions and total procedures. Mixed-effects regression modeling identified factors associated with elective revisions and total operations.

Results:

Overall, 1534 patients (76.9 percent) had no complications, among whom 40.2 percent underwent elective revisions. The average number of elective revisions differed by modality (p < 0.001), with abdominally based free autologous reconstruction patients undergoing the greatest number of elective revisions (mean, 0.7). The mean total number of procedures also differed (p < 0.001), with tissue expander/implant reconstruction patients undergoing the greatest total number of procedures (mean, 2.4). Complications occurred in 462 patients (23.1 percent), with 67.1 percent of these patients undergoing elective revisions, which was significantly higher than among patients without complications (p < 0.001). The mean number of procedures again differed by modality (p < 0.001) and followed similar trends, but with an increased mean number of revisions and procedures overall. Mixed-effects regression modeling demonstrated that patients experiencing complications had increased odds of undergoing elective revision procedures (OR, 3.2; p < 0.001).

Conclusions:

Breast reconstruction patients without complications undergo over two procedures on average to achieve satisfactory reconstruction, with 40 percent electing revisions. If a complication occurs, the number of procedures increases.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Five Challenges in the Design and Conduct of IS Trials for HIV Prevention and Treatment
Authors: Hargreaves James R. , Hassan Syreen , Schellenberg Joanna , Hayes Richard , Webster Jayne , Lewis James J.
Published: November 2019

Background:

Implementation science (IS) trials in HIV treatment and prevention evaluate implementation strategies that deliver health-enhancing tools such as antiretroviral medicines or prevention technologies to those who need them, rather than evaluating the tools themselves.

Method:

Opinion piece drawing on a non-systematic review of HIV prevention and treatment trials to inform an assessment of 5 key challenges for IS trials.

Results:

Randomized controlled trials (RCTs) are an appropriate design for IS but must address 5 challenges. IS trials must be feasible to deliver, which will require addressing challenges in maintaining multisectoral partnerships, strengthening routine data, and clarifying ethical principles. IS trials should be informative, evaluating implementation strategies that are well designed and adequately described, and measuring implementation outcomes, coverage of tools, and, when appropriate, epidemiological impacts. IS trials should be rigorous, striving for internally valid estimates of effect by adopting best practices, and deploying optimal nonrandomized designs where randomization is not feasible. IS trials should be relevant, considering and documenting how “real-life” is the implementation monitoring and whether research participants are representative of the target population. Finally, IS trials should be useful, deploying process evaluations to provide results that can be used in onward decision-making.

Conclusions:

IS trials can help ensure that efficacious tools for HIV prevention and treatment have maximum impact in the real world. These trials will be an important component of this scientific agenda if they are feasible to deliver and if their results are informative, rigorous, relevant, and useful.