bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Continuous Femoral Nerve Catheters Beneficial for Pain Management After Operative Fixation of Tibial Plateau Fractures? A Randomized Controlled Trial
Authors: Cooke Margaret E. , Welch Tyler , Gusakov Oleg , Tornetta Paul
Published: July 2019

Objective:

To determine whether a continuous femoral nerve block after open reduction internal fixation of tibial plateau fractures would diminish Visual Analog Scale (VAS) scores and/or systemic narcotic intake.

Design:

Randomized controlled trial.

Setting:

Level 1 academic trauma center.

Patients:

Forty-two consecutive patients with operatively treated tibial plateau fractures.

Intervention:

Continuous femoral nerve catheter for postoperative pain management was performed in the experimental group.

Main Outcome Measures:

Both the VAS scores for pain and narcotic intake were assessed at 4, 8, 12, 24, 36, 48, and 72 hours postoperatively.

Results:

Forty-two patients were enrolled in this study. There were 21 women and 21 men 21-70 years of age (avg 49) with operatively treated tibial plateau fractures. Twenty-one patients were randomized to receive a femoral nerve block with 5 crossovers for technical reasons. Accordingly, we analyzed 16 patients with femoral nerve blocks and 26 with standard care. There were no significant differences between the study groups regarding age, sex, or fracture type. There was no significant difference in VAS scores between the control and experimental group at any time point. The total systemic morphine equivalent for the femoral nerve block group and the control group was 375 and 397 respectively (P = 0.76). Across groups, patients with bicondylar fractures tended to have higher VAS than those with unicondylar fractures and to use more narcotics, although neither was statistically significant.

Conclusion:

Femoral nerve blocks for postoperative pain management in tibial plateau fractures did not demonstrate an improvement in pain relief or narcotic use.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Is a radiograph needed one week after internal fixation of a supracondylar humeral fracture?
Authors: Mansor Yosif , Givon Amir , Sherr-Lurie Nir , Seltser Anna , Schindler Amos , Givon Uri
Published: July 2019

Displaced supracondylar fractures of the humerus (SCFH) require surgical treatment, most commonly closed reduction with pin fixation. Postoperative displacement following pin fixation is uncommon. Routinely, an early follow-up visit with a radiograph was recommended after fixation of SCFH. The aim of this study was to examine the rate of displacement of SCHF treated with pin fixation using objective radiologic measurements and to determine the need for the early follow-up radiographs. We retrospectively reviewed 161 patients with displaced SFCH treated surgically. The primary outcome measure was loss of reduction (LOR). We examined patient and fracture characteristics and postoperative complications. LOR was defined as a change of 5° or more in measurement of Bauman’s angle or the lateral capitellohumeral angle. After applying exclusion criteria, the study group consisted of 131 patients; 87 (66.4%) were male; the left limb was involved in 76 patients (58%); 98 were classified as Gartland type 3 (74.8%); 118 patients had extension type fractures (90%); complications included nerve injury in 32 patients (24.4%), mostly involving the ulnar nerve (17, 13%). Pin-tract infection occurred in four patients (3%). LOR was found in five patients (3.8%). In all these patients, there was evidence of inadequate fixation in the intraoperative radiographs. When adequate fixation is obtained intraoperatively, the next follow-up radiograph is recommended after 3 weeks, at the time of pin removal.
Effect of Distal Ulna Osteochondroma Excision and Distal Ulnar Tether Release on Forearm Deformity in Preadolescent Patients With Multiple Hereditary Exostosis
Authors: Belyea Christopher , Pulos Nicholas , Ezaki Marybeth , Wall Lindley , Mills Janith , Beckwith Terri , Oishi Scott N.
Published: July 2019

Background:

Multiple hereditary exostosis is a benign condition that can lead to significant forearm deformity secondary to physeal disturbances. As the child grows, the deformity can worsen as relative shortening of the ulna causes tethering, which may lead to increased radial articular angle, carpal slippage, and radial bowing, over time this tethering can also result in radial head subluxation or frank dislocation. Worsening of forearm deformities often require corrective reconstructive osteotomies to improve anatomic alignment and function. The purpose of this study is to evaluate the effectiveness of osteochondroma excision and distal ulnar tether release on clinical function, radiographic anatomic forearm alignment, and need for future corrective osteotomies.

Methods:

The authors reviewed a retrospective cohort of preadolescent patients who underwent distal ulna osteochondroma resection and ulnar tethering release (triangular fibrocartilage complex). Patients were invited back and prospectively evaluated for postoperative range of motion, pain scores, self-reported and parent-reported Disabilities of the Arm, Shoulder, and Hand (DASH) and Pediatric Outcomes Data Collection Instrument (PODCI) scores. In addition, preoperative and final postsurgical follow-up forearm x-rays were reviewed.

Results:

A total of 6 patients and 7 forearms were included in our study with an average age of 7.9 years at time of surgery. The average final follow-up was 7.4 years. With respect to range of motion, only passive radial deviation demonstrated improvement −20 to 14 degrees (P=0.01). Although there was not statistically significant change in radial articular angle, this study did find an improvement in carpal slip 75.7% to 53.8% (P=0.03). At final follow-up DASH score was 5.71 (σ=5.35), PODCI Global Function score was 95.2 (σ=5.81), and PODCI-Happiness score 98 (σ=2.74). Visual analogue scale appearance and visual analogue scale pain assessment were 1.67 (σ=1.21) and 1.00 (σ=1.26), respectively, at final follow-up. No patient in the cohort developed a radial head dislocation. Only one of 7 forearms required a corrective osteotomy within the study’s follow-up time period.

Conclusions:

Surgical excision of forearm osteochondromas with ulnar tether release in the preadolescent patients improves carpal slip, may help to prevent subsequent surgical reconstruction and provides satisfactory clinical results at an average 7-year follow-up.

Level of Evidence:

Level III—therapeutic study.
Postoperative Blood Salvage and Autotransfusion for Adult Spinal Deformity
Authors: Nemani Venu M. , Kim Han Jo , Mina Curtis A. , Sheha Evan D. , Ross Thomas , Boachie-Adjei Oheneba
Published: July 2019

Study Design.

Randomized controlled trial.

Objective.

The aim of this study was to determine whether postoperative blood salvage and autotransfusion versus traditional closed suction drainage reduces the rate of homologous blood transfusions in patients undergoing surgery for adult spinal deformity.

Summary of Background Data.

The use of intraoperative blood salvage has become commonplace in spine surgery; however, the collection and reinfusion of blood drained from the wound postoperatively have not been employed routinely because of increased cost and questionable benefit.

Methods.

Adult patients undergoing long posterior fusions were randomized to either a blood salvage and reinfusion system (OrthoPat – Group 1) or a standard subfascial closed suction drain (Group 2). Blood collected in Group 1 was reinfused according to the manufacturer's protocol. Reinfusion drains were converted to standard closed suction drains when output was <50 mL during 4 hours, and drains were removed when output was minimal. Patients received autologous or homologous blood transfusions when hemoglobin (Hg) <8 g/dL or they had symptomatic anemia.

Results.

Thirty-four patients were randomized into Group 1 and 36 patients into Group 2. There were no differences in preoperative or intraoperative parameters. Patients in Group 1 had higher hemoglobin levels on postoperative day (POD) 2 and POD 3 compared to those in Group 2. However, there was no significant difference in the percentage of patients requiring homologous blood transfusion between the two groups (41% Group 1 vs. 60% Group 2, P = 0.17). Similarly a subgroup analysis in patients with estimated blood loss >2000 mL also showed no difference in homologous blood transfusion rates (67% Group 1 vs. 76% Group 2, P = 0.58). There were no differences in the rate or type of postoperative complications.

Conclusion.

Postoperative blood salvage and reinfusion result in a higher hemoglobin level in the early postoperative period, but does not significantly reduce the need for homologous blood transfusion.

Level of Evidence: 1
Impact of Thoracic Cage Dimension and Geometry on Cardiopulmonary Function in Patients With Congenital Scoliosis
Authors: Lin Youxi , Tan Haining , Rong Tianhua , Chen Chong , Shen Jianxiong , Liu Shufen , Yuan Wangshu , Cong Hui , Chen Lixia , Luo Jinmei , Kwan Kenny Yat Hong
Published: July 2019

Study Design.

A prospective study of cardiopulmonary function in patients with congenital scoliosis (CS).

Objective.

To investigate the relationship of thoracic cage deformity and exercise tolerance in CS patients.

Summary of Background Data.

Congenital thoracic scoliosis and chest deformity lead to restrictive pulmonary dysfunction and in some severe cases cause cardiopulmonary failure. However, it is still unknown the relationship between thoracic deformity and exercise performance.

Methods.

Patients with congenital thoracic spinal deformity were included and had radiological assessment of thoracic cage, pulmonary function testing, and cardiopulmonary exercise testing. Thoracic dimension including height, width, and depth were measured and geometry parameters were calculated. Two-tailed Pearson and Spearman correlation test and linear regression analysis were performed to investigate correlation of radiographic parameters, pulmonary function, and physical capacity.

Results.

Sixty patients (41 females and 19 males) were included, with an average age of 18.9 years. Patients with smaller thoracic height (P < 0.001) and width (P < 0.01) and larger depth (P < 0.05) had significantly worse static pulmonary function. In exercise testing, these patients showed significant tendency of ventilation insufficiency, including lower minute ventilation (P < 0.05), faster breathing frequency (P < 0.05), and smaller tidal volume (P < 0.01). Thoracic depth was negatively correlated to exercise capacity, reflected by work rate (P < 0.001), peak oxygen intake (P < 0.001), and heart rate (P = 0.043). Patients with abnormal thoracic geometry, especially a lower ratio of height to depth and a lower ratio of width to depth, have significantly worse static pulmonary function and exercise capacity (all P < 0.05).

Conclusion.

Decreasing thoracic height and width results in restrictive pulmonary dysfunction. Distortion and asymmetry of the thoracic cage are associated with abnormal breathing pattern and reduction of exercise capacity.

Level of Evidence: 3
Prechemotherapy Hemoglobin Levels as a Predictive Factor of Ovarian Cancer Survival
Authors: Pergialiotis Vasilios , Daskalakis Georgios , Thomakos Nikolaos , Bellos Ioannis , Haidopoulos Dimitrios , Loutradis Dimitrios , Rodolakis Alexandros
Published: July 2019

Objectives:

The impact of anemia on cancer survival has been previously mentioned in various oncological fields. To date, however, it remains unknown whether prechemotherapy hemoglobin (Hgb) levels are predictive of ovarian cancer survival (OC). The purpose of the present systematic review is to accumulate evidence in this field.

Materials and Methods:

We used the Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases in our primary search. The date of our last search was set for July 30, 2018. Statistical meta-analysis was performed with the RevMan 5.3 software.

Results:

Overall, 11 articles were included that recruited 1816 women with OC. Five articles that involved 856 OC patients were included in the meta-analysis. Compared with patients with anemia, patients with Hgb levels >12 g/dL had increased odds of overall survival (odds ratio, 1.72; 95% confidence interval: 1.41, 2.10). Similarly, the progression-free survival of patients was significantly affected, although the available data could not be accumulated in a meta-analysis because of the heterogeneity in outcome reporting measures.

Conclusions:

Current evidence suggests that prechemotherapy Hgb levels below the threshold of 12 g/dL can potentially predict worse overall survival of OC patients. Future research is required in the field to elucidate whether several independent variables such as the stage and histology of disease and rates of optimal debulking affect the clinical significance of this association.
Multiple Scrotal Cysts Composed of Combined Syringomas and Epidermal Inclusion Cysts: A Previously Unreported Association
Authors: Diep My , Cassarino David S.
Published: July 2019

Epidermal inclusion cyst (EIC) and syringoma are both benign lesions that are primarily asymptomatic and occur at various places on the body. Although both EIC and syringoma are common, their joint appearance has not been previously reported. These benign proliferations target different populations, and with differing clinical presentations. Syringomas tend to develop in young females as smaller multiple lesions, while EICs often present in older males as single or multiple variants that are typically larger in size. They also possess distinctive histopathological appearances that can used for their diagnosis. Furthermore, despite both having unclear etiologies, the involvement of the eccrine duct has been a proposed mechanism in the development of both lesions. Thus, further investigation of eccrine ducts in the pathology of these lesions can be the basis for assessing the association between EICs and syringomas. We report a unique case of a 16-year-old boy who presented to the clinic with multiple cysts (at least 20) on the scrotum, most of which consisted of both EIC and syringoma histologically. We are not aware of any previous reports of patients with multiple combined syringomas and EICs, and their potential association should be further explored.
Kaposi Sarcoma in Association With an Extracavitary Primary Effusion Lymphoma Showing Unusual Intravascular Involvement: Report of a Case Harboring a FAM175A Germline Mutation
Authors: Kastnerova Liubov , Belousova Irena E. , Michal Michael , Ptakova Nikola , Michal Michal , Kazakov Dmitry V.
Published: July 2019

Primary effusion lymphoma (PEL) is a rare form of aggressive B-cell lymphoma characterized by a malignant serous effusion involving body cavities. It usually associated with human herpes virus–8 (HHV-8) and coexpression of Epstein–Barr virus and mostly affects patients with HIV. We report a rare case of cutaneous PEL with an unusual intravascular presentation, combined with Kaposi sarcoma involving the skin, lung, and gastrointestinal tract. The molecular genetic analysis of the sarcoma and lymphoma components, using next-generation sequencing was performed. The patient was a 67-year-old man who presented with multiple cutaneous tumors and mass in the left lung. He died 17 hours after the admission to the hospital. At autopsy, in addition to the cutaneous lesions, tumors in the left lung and gastrointestinal mucosa were detected, and no effusions in the body cavities were seen. The biopsy from the cutaneous lesions, pulmonary, and intestinal tumors revealed histological and immunohistochemical features of Kaposi sarcoma. In addition, the skin biopsy specimens contained a diffuse infiltrate composed of large pleomorphic cells, with focal intravascular growth that were negative for pan B-cell markers, weakly positive for CD38 and CD138 but expressed CD3, HHV-8, and Epstein–Barr virus. Molecular genetic studies in this specimen revealed monoclonal rearrangements of the IgH gene. The diagnosis of PEL, solid variant, was made. Next-generation sequencing analysis of the tumorous and normal tissue detected a pathogenic germline mutation of the FAM175A gene and somatic mutations in BRCA2 and RAD51B (in both sarcoma and lymphoma specimens), and INPP4B and RICTOR (in lymphoma specimen only).
Spitz Tumors With ROS1 Fusions: A Clinicopathological Study of 6 Cases, Including FISH for Chromosomal Copy Number Alterations and Mutation Analysis Using Next-Generation Sequencing
Authors: Donati Michele , Kastnerova Liubov , Martinek Petr , Grossmann Petr , Sticová Eva , Hadravský Ladislav , Torday Tomas , Kyclova Jitka , Michal Michal , Kazakov Dmitry V.
Published: July 2019

Spitz tumors represent a heterogeneous group of melanocytic neoplasms with a spectrum of biological behavior ranging from benign (Spitz nevus) to malignant (spitzoid melanoma). Prediction of the behavior of these lesions based on their histological presentation is not always possible. Recently, mutually exclusive activating kinase fusions, involving ALK, NTRK1, NTRK3, RET, MET, ROS1, and BRAF, have been found in a subset of spitzoid lesions. Some of these genetic alterations were associated with specific morphological features. Here, we report the histological presentation of 6 Spitz tumors with ROS1 fusion. The age of the patients ranged from 6 to 34 years, with strong female prevalence (5:1). All neoplasms were compound melanocytic proliferations with a predominant dermal growth but a conspicuous junctional component displaying atypical microscopic features qualifying them as atypical Spitz tumor. FIP1L1 and CAPRIN1 were identified as 2 novel 5′-fusion partners of ROS1 along with the known PWWP2A–ROS1 fusion. FISH for copy number changes of 9p21, 6p25, and 11q13 was negative in all but 1 neoplasm harboring isolated gain of 8q24. TERT-promoter hotspot mutation analysis was negative in all tumors. All patients are disease-free after a mean follow-up period of 30 months. It is concluded that ROS1-fused spitzoid neoplasms seem to have no distinctive histopathological features although consistent findings were spindled melanocytes arranged in confluent whorling nests, prominent transepidermal elimination of melanocytic nests, and myxoid/mucinous changes.
G-Protein–Coupled Estrogen Receptor Agonist G1 Improves Diastolic Function and Attenuates Cardiac Renin–Angiotensin System Activation in Estrogen-Deficient Hypertensive Rats
Authors: da Silva Jaqueline S. , Sun Xuming , Ahmad Sarfaraz , Wang Hao , Sudo Roberto T. , Varagic Jasmina , Ferrario Carlos M. , Zapata-Sudo Gisele , Groban Leanne
Published: July 2019

This study was aimed to clarify differences in how specific agonists of the 3 estrogen receptors (ERs) influence diastolic function and the renin–angiotensin system (RAS) after ovariectomy (OVX) in 24 female spontaneously hypertensive rat (SHR) undergoing bilateral OVX at 12 weeks of age. Eight weeks after surgery, rats were randomized (n = 6/group) to receive equipotent, daily treatments of one of the ER agonists (ERα agonist, propyl pyrazole trisphenol 94 μg/kg; ERβ agonist, diarylpropionitrile 58 μg/kg; G-protein–coupled estrogen receptor [GPER] agonist, G1 100 μg/kg), or vehicle (peanut oil). After 4 weeks of treatment, left ventricular function/structure and systemic/intracardiac pressure measurements were obtained by echocardiography and a fluid-filled catheter attached to a pressure transducer, respectively. Selective ER agonist treatment with G1 or propyl pyrazole trisphenol led to improvements in diastolic function after estrogen loss when compared with vehicle-treated OVX rats. Although mean arterial blood pressure was not overtly different among groups, chronic G1, but not the other ER ligands, enhanced the in vitro vasorelaxant responsiveness to acetylcholine in aortic rings. These favorable effects of G1 were further linked to reductions in cardiac angiotensin-converting enzyme activity, AT1R protein expression, and Ang II immunoreactivity. Activation of ERβ had no effect on cardiac function and did not alter components of the canonical cardiac RAS in comparison with vehicle-treated OVX SHR. These data imply that of the 3 ERs, GPER has a unique role in preserving diastolic function and favorably modulating the cardiac RAS independent of arterial pressure. Specifically, if GPER is pharmacologically activated, it could provide a therapeutic opportunity to limit the development and/or progression of diastolic dysfunction in hypertensive women after estrogen loss.
Regimen Study of High Myopia–Partial Reduction Orthokeratology
Authors: Lyu Tianbin , Wang Liya , Zhou Lutan , Qin Jian , Ma Hui , Shi Menghai
Published: July 2019

Objective:

This study aims to compare the increase in refractive error and axial length, variation of endothelium cells, and ratio of corneal staining between two regimens of high myopia–partial reduction orthokeratology (ortho-k) in children.

Methods:

The present clinical prospective study recruited 102 high-myopia subjects (204 eyes). These subjects were randomly divided into three groups: (1) ortho-k group 1, subjects with a target myopia reduction of 6.00 D; (2) ortho-k group 2, subjects with a target myopia reduction of 4.00 D; and (3) control group, the refractive error of subjects was corrected using a pair of single-vision spectacles. Vision acuity, refractive error, and the cornea were examined at baseline, and at 2 days, 1 week, 1, 3, 6, and 12 months after commencing lens wear. The measurement of the axial length of the eyeball and a corneal endothelium examination were performed at baseline and at 12 months.

Results:

The uncorrected vision acuities improved in subjects in these groups after treatment with ortho-k. Furthermore, the diopters of myopia and corneal curvature significantly decreased at 1 month, and the values continuously improved at 12 months, when compared with subjects at 1 month (P<0.05). Subjects in the control group had a significant increase in refractive error (0.565±0.313 D) and axial length (0.294±0.136 mm), when compared with subjects in the ortho-k–treated groups (P<0.05). However, there were no significant differences in changes in refractive error and axial length between ortho-k groups 1 (0.101±0.176 mm) and 2 (0.123±0.193 mm) at 12 months (P>0.05). Furthermore, subjects in group 1 (28.97%) had a higher rate of corneal staining, when compared with subjects in group 2 (13.06%) (P<0.05).

Conclusion:

The two ortho-k regimens, target reduction of 6.00 D and target of 4.00 D, had similar effects in controlling the increase in axial length and refractive error in high-myopia children. However, subjects with a target myopia reduction of 6.00 D had a higher rate of corneal staining than in subjects with a target myopia reduction of 4.00 D.
Pyogenic Granuloma Formation Following Ahmed Valve Glaucoma Implant
Authors: Chendran Prema , Seng Fai Tang , Wan Abdul Halim Wan H. , Md. Din Norshamsiah
Published: July 2019

Ocular pyogenic granuloma is a benign tumor seen after ocular insult secondary to ocular surgeries, trauma or infection. Although benign, intervention is sometimes necessary. Previous authors have reported pyogenic granuloma formation following oculoplastic surgeries. We report a pyogenic granuloma after an Ahmed glaucoma valve implantation. A 65-year-old gentleman presented with right eye redness associated with pain and swelling ~2 months after Ahmed glaucoma valve implantation. Examination found a sessile growth on the tube extruding puss with signs of endophthalmitis. The glaucoma drainage device was explanted and culture results grew Staphylococcus aureus. This article discusses the formation of pyogenic granuloma on a glaucoma drainage device and its management.
Combat and Noncombat Musculoskeletal Injuries in the US Military
Authors: Grimm Patrick D. , Mauntel Timothy C. , Potter Benjamin K.
Published: July 2019

Musculoskeletal Injuries (MSKI) are exceedingly common in the US Military, resulting in compromised military medical readiness and a substantial burden on both health care and financial resources. Severe combat-related MSKI sustained during nearly 2 decades of conflict in Iraq and Afghanistan have resulted in frequently devastating injuries that challenge acute care capabilities, require extensive rehabilitation, and often result in long-term disability. Non–combat-related MSKI, while often less severe, are far more common than combat-related MSKI and overall cause a substantially greater number of lost duty days and nondeployable Service Members. Given the strain placed on health care and financial resources by MSKI, further efforts must be directed towards prevention, treatment, and rehabilitative strategies in order to mitigate the burden of MSKI in the US Military.
Advanced Functional Bracing in Lower Extremity Trauma: Bracing to Improve Function
Authors: Franklin Nathan , Hsu Joseph R. , Wilken Jason , McMenemy Louise , Ramasamy Arul , Stinner Daniel J.
Published: July 2019

There are many bracing options for patients with functional limitations of the lower extremity following trauma. The first question that the provider must ask when evaluating a patient with a foot and ankle functional limitation because of weakness or pain is, “what are the patient’s expectations?” One option for the patient who desires to return to a higher level of function is a novel, custom dynamic orthosis (CDO) that, when coupled with an advanced rehabilitation program, has improved outcomes in patients following lower extremity trauma who have plateaued after traditional rehabilitation pathways. Although this CDO and rehabilitation program has demonstrated success following lower extremity trauma in heterogenous patient populations, research is ongoing to identify both ideal referral diagnoses or injury characteristics, and to further optimize outcomes with the use of the CDO.
Magnetic Resonance–guided High-intensity Focused Ultrasound (MRgHIFU) Virtual Treatment Planning for Abdominal Neuroblastoma Utilizing Retrospective Diagnostic 3D CT Images
Authors: Tung Stephanie , Fahy Aodhnait S. , Lamberti-Pasculli Maria , Waspe Adam C. , Pichardo Samuel , Gerstle Justin T.
Published: July 2019

Magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU) is a novel treatment for neuroblastoma using ultrasound-induced thermal ablation with real-time MR thermometry. It is unclear which patients would be amenable to MRgHIFU given the retroperitoneal location of many neuroblastomas within the smaller pediatric abdomen. In addition, planning relies on MR scans, which are not routine in the standard pediatric neuroblastoma workup. This study sought to demonstrate that neuroblastomas are targetable with MRgHIFU and available computed tomographic imaging could be utilized for MRgHIFU virtual treatment. Cross-sectional images of 88 pediatric abdominal neuroblastoma patients were retrospectively processed with custom software to be made compatible with the Sonalleve MRgHIFU platform. Targetability measured percent treatment to lesion volume, within adequate safety margins from critical structures. All images were successfully converted into treatment planning files. Median lesion size was 191±195 cm3 and depth was 29±17 mm. Up to 78 (85%) patients had targetable lesions with a median targetable volume of 15% and ranging up to 79%. Targetability was highest in superficial, right upper quadrant lesions >200 cm3, but limited by proximity to bowel and ribs. This study demonstrates the capacity for MRgHIFU to potentially treat the majority of abdominal neuroblastomas and the feasibility of using computed tomographic images for MRgHIFU virtual treatment planning.
Patient Transfer to Receive Proton Beam Therapy During Intensive Multimodal Therapy is Safe and Feasible for Patients With Newly Diagnosed High-risk Neuroblastoma
Authors: Hosaka Sho , Fukushima Hiroko , Nakao Tomohei , Suzuki Ryoko , Yamaki Yuni , Tanaka Keiichi , Saito Takashi , Mizumoto Masashi , Sakurai Hideyuki , Fukushima Takashi , Takada Hidetoshi
Published: July 2019

Neuroblastoma (NB) predominantly presents as high-risk disease, requiring intensive multimodal therapy. Proton beam therpy (PBT) is a promising option for many childhood cancers, but is not widely available. Patients with NB hoping to receive PBT may therefore need to be transferred between institutions during intensive multimodal therapy, risking undesirable effects. We evaluated patients with high-risk NB who received PBT at our institute as part of first-line therapy, mainly focusing on the safety and feasibility of mid-treatment patient transfer. Eighteen patients with newly diagnosed high-risk NB who received PBT between April 2010 and June 2016 were retrospectively analyzed for local control, outcomes, and toxicity. Survival (3-y overall survival 71%±11%; 3-y event-free survival 44%±12%) and local control rate (100%) were comparable with previous studies. Few acute adverse events were recorded, and all patients completed PBT without treatment delay. PBT for high-risk NB was safe and feasible for patients requiring mid-treatment interinstitutional transfer.
Pulmonary Artery Pseudoaneurysm in a Child With β-Thalassemia Major
Authors: Qureshi Tabinda N. , Haider Syed R. , Al Rawas Abdulhakim , Al Sukaiti Rashid , Al Kindi Hussein , Al Senaidi Khalfan S. , Elshinawy Mohamed , Wali Yasser
Published: July 2019

Pulmonary artery aneurysms and pseudoaneurysms are rare vascular anomalies in children that can lead to massive hemoptysis resulting in severe morbidity and even mortality. High level of clinical suspicion, timely diagnosis, and prompt management are important for a better outcome. Here, we report a case of a 14-year-old adolescent with β-thalassemia major who presented with life-threatening hemoptysis due to pulmonary artery pseudoaneurysm and was successfully treated with coil embolization.
A Comprehensive Review of Ovarian Serous Carcinoma
Authors: Hatano Yuichiro , Hatano Kayoko , Tamada Maho , Morishige Ken-ichirou , Tomita Hiroyuki , Yanai Hiroyuki , Hara Akira
Published: July 2019

Although ovarian serous carcinoma is a well-studied human gynecologic malignancy, this high-grade tumor remains fatal. The main purpose of this review is to summarize the accumulated evidence on serous malignant tumors and to clarify the unresolved issues. We discuss the 8 dichotomies of serous carcinoma: high grade versus low grade, ovarian versus extraovarian primary, extrauterine versus uterine primary, sporadic versus hereditary, orthodox versus alternative histology, p53 overexpression versus complete absence of immunophenotype, TP53-mutated versus intact precursor, and therapy responsive versus refractory. In addition, we summarize the molecular classification of high-grade serous carcinoma. This review would lead readers to rapid and parallel developments in understanding high-grade serous carcinoma.
“Teratoid” Wilms Tumor
Authors: D’Hooghe Ellen , Mifsud William , Vujanić Gordan M.
Published: July 2019

Wilms tumor (WT) may show a diverse range of heterologous elements (HEs). Cases with predominant/prominent HEs have been reported as “teratoid” WT, albeit on the basis of poorly defined criteria. It has been suggested that “teratoid” WTs are rare, and associated with a poor response to chemotherapy, but a good outcome. However, these claims have not been tested previously in any large cohort of cases. Here, we performed a systematic study to determine the incidence, diversity, and clinicopathologic association of HEs in 691 WTs, all of which were treated according to the same protocol, which included preoperative chemotherapy, and all with central pathology review. We found that 4% (28/691) of WTs showed ≥3 HEs (“teratoid” WT in our study), which was comparable to the numbers of completely necrotic, epithelial, focal anaplastic, and blastemal WTs. “Teratoid” WTs were strongly associated with younger age at presentation (21 vs. 39 mo, P=0.0001), bilateral disease (28.6% vs. 7.2%, P=0.001), stromal-type WT (57.1% vs. 11.0%, P<0.00001), and intralobar nephrogenic rests (35.7% vs. 11.9%, P=0.0001), when compared with non-“teratoid” WT. We also found that stromal-type WT, regardless of HE differentiation, was itself associated with younger age, bilateral disease, and intralobar nephrogenic rest. Furthermore, >80% of cases with ≥3 HEs, and also of cases with 2 HEs and 1 HE, showed ≥50% stroma in their viable components. We conclude that a tendency toward stromal differentiation is a strong and unifying factor in HE formation. “Teratoid” WT represents the more extreme end of HE differentiation, rather than a separate entity, and therefore the term should not be used in the final diagnosis. The prognosis of WTs depends only on their overall histologic type and stage, and it is not additionally influenced by the presence of “teratoid” features.
Indolent In Situ B-Cell Neoplasms With MYC Rearrangements Show Somatic Mutations in MYC and TNFRSF14 by Next-generation Sequencing
Authors: Kumar Jyoti , Butzmann Alexandra , Wu Sharon , Easly Samantha , Zehnder James L. , Warnke Roger A. , Bangs Charles D. , Jangam Diwash , Cherry Athena , Lau James , Nybakken Grant , Ohgami Robert S.
Published: July 2019

Systemic high-grade B-cell lymphomas (HGBCLs) with MYC gene rearrangements are clinically aggressive. In situ lesions with indolent behavior have not been described to date. We have identified 2 cases of in situ B-cell neoplasms with MYC rearrangements (IS-BCN, MYC
+) occurring, and focally confined to ≤4 lymphoid follicles in otherwise healthy individuals and without clinical progression despite minimal intervention (surgical only). Morphologically similar to systemic HGBCLs, the low power view of these lesions showed a starry sky pattern with numerous mitotic figures. High power imaging demonstrated these cells to be medium-large in size with irregular nuclear contours, immature chromatin, and prominent nucleoli. Immunophenotypically these cells were light chain restricted, positive for CD20, CD10, c-Myc, and dim or negative for BCL2 with a Ki67 proliferative index of >95%. By fluorescence in situ hybridization studies, we detected MYC translocations in these cells but no rearrangements in BCL2 or BCL6. Microdissection of neoplastic cells in these patients followed by targeted next-generation sequencing identified a mutation in MYC, D2N, and an indel in TNFRSF14. Mutations in ID3 or TCF3 were not identified. Although rare, these lesions should be separated from HGBCLs involving follicles but with systemic spread which has been previously described. Unlike systemic lymphomas with MYC gene rearrangements, these in situ B-cell neoplasms with MYC rearrangements did not require systemic therapy and no progression has been seen in either patient beyond 1 year (29 and 16 mo). Our work offers pathologic and biologic insight into the early process of B-cell neoplasia.
The Use of Ultrasonography in Expediting Septic Joint Identification and Treatment
Authors: Kim Samuel , Baradia Hussein , Sambasivan Ajai
Published: July 2019

This case report describes the use of ultrasonography in the identification of a joint effusion to guide diagnosis and management of septic arthritis. Our patient presented with pain, swelling, and erythema of the right thumb after having punctured her thumb with a cactus thorn. Results of physical examination demonstrated tenderness and restricted range of motion. Initial imaging with plain films was unrevealing, without bony and soft tissue abnormalities; however, ultrasound imaging of the interphalangeal joint revealed a focal effusion, and the patient was started on empiric Keflex. Because a focal effusion was visualized with ultrasonography, despite negative x-ray imaging, our patient underwent expedited surgical incision and drainage, foregoing joint aspiration. Intraoperative cultures grew Enterobacter 3 days after surgery, and the empiric antibiotic was adjusted to reflect sensitivities. At 2-wk follow-up, our patient showed near-complete resolution of her symptoms. This case report demonstrates the utility of ultrasonography in the early diagnosis of septic arthritis with the presence of a joint effusion that expedited successful treatment by foregoing joint aspiration in lieu of surgical intervention.
Kinetics of Ringer's Solution in Extracellular Dehydration and Hemorrhage
Authors: Hahn Robert G. , Drobin Dan , Li Yuhong , Zdolsek Joachim
Published: July 2019

Background:

Ringer's solution might be used to treat volume depletion (extracellular dehydration) and hemorrhage, but there is no integrated view of how these fluid balance disorders influence the kinetics of the infused volume.

Methods:

Acute dehydration (mean 1.7 L) was induced by repeated doses of furosemide (5 mg) in 10 healthy male volunteers, and 0.5 L and 0.9 L of blood was withdrawn in random order on different occasions in another 10 male volunteers, just before administration of Ringer's acetate solution. Infusions performed in the normovolemic state served as controls. Measurements of blood hemoglobin and urinary excretion were used to create volume kinetic profiles that were analyzed using mixed-effects modeling software.

Results:

Infusions over 15 to 30 min showed a marked distribution phase during which the plasma volume transiently increased by 50% to 75% of the administered volume. Dehydration and hemorrhage accelerated redistribution but retarded the elimination; the half-life of the infused fluid increased from 36 to 51 min (mean) from 1 L of dehydration and to 95 min from 1 L of hemorrhage. Extravascular accumulation decreased with the dehydration volume and increased with the hemorrhage volume.

Simulations show that 60% as much Ringer is needed to replace volume depletion amounting to 1 L as compared with hemorrhage over a 2-h period. A continued but slower drip after the initial fluid resuscitation prevents rebound hypovolemia.

Conclusions:

Furosemide-induced dehydration and blood withdrawal in normotensive volunteers had modest effects on the Ringer's acetate kinetics. Urinary excretion was inhibited more by hemorrhage than by dehydration.
Necrosis Rather Than Apoptosis is the Dominant form of Alveolar Epithelial Cell Death in Lipopolysaccharide-Induced Experimental Acute Respiratory Distress Syndrome Model
Authors: Tamada Nao , Tojo Kentaro , Yazawa Takuya , Goto Takahisa
Published: July 2019

Alveolar epithelial cell (AEC) death, which is classified as apoptosis or necrosis, plays a critical role in the pathogenesis of acute respiratory distress syndrome (ARDS). In addition to apoptosis, some types of necrosis are known to be molecularly regulated, and both apoptosis and necrosis can be therapeutic targets for diseases. However, the relative contribution of apoptosis and necrosis to AEC death during ARDS has not been elucidated. Here, we evaluated which type of AEC death is dominant and whether regulated necrosis is involved in lipopolysaccharide (LPS)-induced lung injury, an experimental ARDS model. In the bronchoalveolar lavage fluid from the LPS-induced lung injury mice, both the levels of cytokeratin 18-M65 antigen (a marker of total epithelial cell death) and cytokeratin 18-M30 antigen (an epithelial apoptosis marker) were increased. The M30/M65 ratio, which is an indicator of the proportion of apoptosis to total epithelial cell death, was significantly lower than that in healthy controls. In addition, the number of propidium iodide-positive, membrane-disrupted cells was significantly higher than the number of TUNEL-positive apoptotic cells in the lung sections of lung injury mice. Activated neutrophils seemed to mediate AEC death. Finally, we demonstrated that necroptosis, a regulated necrosis pathway, is involved in AEC death during LPS-induced lung injury. These results indicate that necrosis including necroptosis, rather than apoptosis, is the dominant type of AEC death in LPS-induced lung injury. Although further studies investigating human ARDS subjects are necessary, targeting necrosis including its regulated forms might represent a more efficient approach to protecting the alveolar epithelial barrier during ARDS.
Primary Fascial Closure During Laparoscopic Ventral Hernia Repair Improves Patient Quality of Life
Authors: Bernardi Karla , Olavarria Oscar A. , Holihan Julie L. , Kao Lillian S. , Ko Tien C. , Roth John S. , Tsuda Shawn , Vaziri Khashayar , Liang Mike K.
Published: July 2019

Background:

Observational studies have reported conflicting results with primary fascial closure (PFC) versus bridged repair during laparoscopic ventral hernia repair (LVHR).

Objective:

The aim of the study was to determine whether when evaluated in a randomized controlled trial (RCT), PFC compared to bridged repair would improve patient quality of life (QoL).

Methods:

In this blinded, multicenter RCT, patients scheduled for elective LVHR (hernia defects 3 to 10 cm on computed tomography scan) were randomized to PFC versus bridged repair. Primary outcome was change in QoL after LVHR using a validated, hernia-specific survey (1 = poor QoL and 100 = perfect QoL) that measures pain, function, cosmesis, and satisfaction. Secondary outcomes were postoperative surgical site occurrences (including hematoma, seroma, surgical site infection, and wound dehiscence), abdominal eventration, and hernia recurrence. The trial was powered to detect a difference in change in QoL of 7 points between the study groups. Outcomes were compared with Mann-Whitney U test or chi-square.

Results:

A total of 129 patients underwent LVHR and 107 (83%) completed follow-up at 2 years. Patients from both groups were similar at baseline. On median follow-up of 24 months (range: 9–42), patients treated with LVHR-PFC had on average a 12-point higher improvement in QoL compared to bridged repair (improvement in QoL, 41.3 ± 31.5 vs 29.7 ± 28.7, P value = 0.047). There were no differences in surgical site occurrence, eventration, or hernia recurrence between groups.

Conclusions:

Among patients undergoing elective LVHR, the fascial defect should be closed. This is the first RCT demonstrating that PFC with LVHR significantly improves patient QoL.

Trial Registration:

This trial was registered with clinicaltrials.gov (NCT02363790)
Evaluating Cognitive-Linguistic Deficits Postconcussion in Adults
Authors: Brown Jessica , Knollman-Porter Kelly
Published: July 2019

Purpose:

We sought to document the cognitive-linguistic challenges experienced by 3 adults with concussion at varying lengths postinjury.

Method:

A multiple case study design utilized motivational interviewing techniques, 4 self-report measurement tools, and 5 standardized neurocognitive tests. The 1 female and 2 male participants were 1, 21, and 37 months postconcussion.

Results:

All participants self-reported cognitive and linguistic challenges significantly impacting daily functioning and quality of life. Cognitively, participants demonstrated deficits in independence, metacognition, and cognitive flexibility. Linguistically, participants demonstrated deficits in verbal memory, verbal fluency, and reading. The participant 1-month postconcussion demonstrated deficits on multiple standardized measures; however, participants in the chronic phase of recovery demonstrated substantially more self-reported deficits than were noted on standardized testing.

Discussion:

Evaluation of cognitive-linguistic deficits postconcussion requires both self-report and standardized measurement; however, limitations of both tools exist. We discuss clinical implications for professionals selecting testing measures for use in this population.
Management and Recovery Patterns Following Sport-Related Mild Traumatic Brain Injury in Male and Female College Athletes
Authors: Knollman-Porter Kelly , Thaxton Sarah , Hughes Michael R. , Constantinidou Fofi
Published: July 2019

Purpose:

We examined patterns in mild traumatic brain injury (mTBI) management and recovery exhibited by male and female athletes over the 19-year history of a Division 1 University Concussion Management Program.

Methods:

We examined 234 diagnosed mTBIs and compared time required to return to baseline on neurocognitive and self-report symptom measures for male and female athletes.

Results:

Males and females sustained 63.3% and 36.7% of mTBI, respectively. Athletes required on average 11.89 days to return to baseline on neurocognitive assessments and 11.83 days to report being symptom-free. There was a significant difference in the number of days until genders were symptom-free, with males and females requiring on average 10.11 days and 14.30 days, respectively.

Discussion:

More collegiate athletes received pre- and post-mTBI management than in the past. There is a continued need to examine patterns of neurocognitive and symptom recovery, which may lead to earlier detection of athletes at risk for persistent post-mTBI symptoms.
Looking Beyond Test Results
Authors: Mashima Pauline , Waldron-Perrine Brigid , Seagly Katharine , Milman Lisa , Ashman Teresa , Mudar Raksha , Paul Diane
Published: July 2019

Patients with cognitive concerns following mild traumatic brain injury (mTBI), often referred to as concussion, present with complex constellations of strengths and limitations. Increasing evidence indicates that psychosocial factors, as opposed to the injury itself, predict persistent symptoms. As an alternative to the traditional medical model, a person-centered model empowers the patient to move forward past the injury in order to optimize function and maximize quality of life. Patient-centered assessment and treatment by speech–language pathologists, neuropsychologists, and rehabilitation psychologists can engender change, reduce perceived limitations, and increase participation in meaningful activities and roles. This article outlines several collaborative, process-oriented approaches to managing cognitive concerns subsequent to mTBI. The emphasis is on maximizing patient participation to guide clinical decision making and build self-efficacy. The authors are members of the Joint Committee on Interprofessional Relations Between the American Psychological Association (APA) and the American Speech–Language–Hearing Association (ASHA).
A Comparison of Student and Parent Knowledge and Perceived Confidence About Brain Injury and Concussion
Authors: O'Brien Katy H. , Schellinger Sarah K. , Hwang Brenda L. , LaPlaca Michelle C.
Published: July 2019

Purpose:

The public has long had misconceptions about traumatic brain injury (TBI) and its effects. Concussion education targeted toward athletes has been increasing with passage of return-to-play laws in all 50 states. The current study examined differences in public knowledge about TBI and concussion, and the extent to which students and parents in the general public may have benefited from increased availability of education around concussion.

Methods:

At a public fair, 246 students, parents, and other adults completed a survey adapted from existing TBI and concussion knowledge surveys. Participants also rated their confidence in accuracy of their responses.

Results:

There were no group differences on TBI knowledge or confidence. Parents scored slightly higher on concussion knowledge than students, and knowing someone with a TBI or concussion was also associated with higher scores. Confidence was only weakly related to concussion knowledge. Overall concussion knowledge scores were higher than TBI knowledge scores. Knowledge and confidence were not associated with sports participation.

Discussion:

Given similarities in TBI knowledge across groups, but that parents outpace students in concussion knowledge, parents may have greater exposure or heightened awareness of concussion information education opportunities. Lower confidence in students suggests an openness to education and opportunities for prevention of injuries.