bluuebunny/crossref_metadata_2025 huggingface dataset:
The British West India Interest and Its Allies, 1823–1833
Authors: Taylor Michael
Published: November 2018

Between the foundation of the Anti-Slavery Society in 1823 and the passage of the Slave Emancipation Act in 1833, the British West India interest mounted a pervasive and influential campaign in defence of colonial slavery. This article gives the fullest account yet of the strength and activities of the West India interest during that decade of debate and argument. Moreover, this article demonstrates that the West Indians—far from a reactionary political rump—successfully created a broader pro-slavery lobby. First, the West Indians cultivated the support of numerous leading conservative periodicals such as Blackwood’s Edinburgh Magazine, the Quarterly Review, and Fraser’s Magazine. Secondly, the West Indians courted the political favour of several leading Tories of the day, among them Canning, Huskisson, Peel and Wellington. Consequently, this article shows that pro-slavery sympathies were prevalent and influential with British print and political culture until 1833. It concludes that, for many Britons and especially British conservatives, colonial slavery—as much as the monarchy, the aristocracy and the Established Church—was an essential element of national life.
Local environment affecting northern shrimp recruitment: a comparative study of Gulf of St. Lawrence stocks
Authors: Brosset Pablo , Bourdages Hugo , Blais Marjolaine , Scarratt Michael , Plourde Stéphane
Published: November 2018

Climate and density-dependent effects are important drivers of recruitment (R). In the Gulf of St. Lawrence (GSL), recent years indicated an exceptional warming of water associated with variations in plankton phenology and fish abundance. At the same time, northern shrimp (Pandalus borealis) recruitment and stock dynamics fluctuated greatly, but the underlying mechanisms remain poorly understood. We estimated recruitment from yearly fisheries independent abundance estimates for three different northern shrimp stocks in the GSL (Sept-Iles, Anticosti, and Esquiman). For 2001–2016, we quantified how northern shrimp R changed in relation to physical variables, phytoplankton bloom characteristics, zooplankton abundance and phenology, and predator biomass. Results indicated that northern shrimp R seemed related to phytoplankton bloom characteristics and resulting zooplankton phenology in addition to northern shrimp adult abundance, rather than to fish predator biomass. Importantly, the significant variables explaining the R were stock specific, implying that environmental variability and stock abundance effects depend on the area considered. In future, Esquiman area might show increasing northern shrimp R under moderate warming but northern shrimp Sept-Iles R might be impaired. These results improve our understanding of stock-specific northern shrimp recruitment dynamics in a changing environment and can ultimately improve its management in the GSL.
Highest Weights for Categorical Representations
Authors: Ben-Zvi David , Gunningham Sam , Orem Hendrik
Published: November 2018

We present a criterion for establishing Morita equivalence of monoidal categories and apply it to the categorical representation theory of reductive groups $G$. We show that the “de Rham group algebra” $\mathcal D(G)$ (the monoidal category of $\mathcal D$-modules on $G$) is Morita equivalent to the universal Hecke category $\mathcal D({N}\backslash{G}/{N})$ and to its monodromic variant $\widetilde{\mathcal D}({B}\backslash{G}/{B})$. In other words, de Rham $G$-categories, that is, module categories for $\mathcal D(G)$, satisfy a “highest weight theorem”—they all appear in the decomposition of the universal principal series representation $\mathcal D(G/N)$ or in twisted $\mathcal D$-modules on the flag variety $\widetilde{\mathcal D}(G/B)$.
Estimating Lactase Nonpersistence Distributions in the Multi-Ethnic Canadian Demographic: A Population-Based Study
Authors: Fung Manyan , Xue Xiaoqing , Szilagyi Andrew
Published: November 2018

Objectives

The lactase persistence/nonpersistence (LP/LNP) phenotypes follow a geographic pattern that is rooted in the gene-culture coevolution observed throughout the history of human migrations. The immense size and relatively open immigration policy have drawn migrants of diverse ethnicities to Canada. Among the multicultural demographic, two-thirds of the population are derived from the British Isles and northwestern France. A recent assessment of worldwide lactase distributions found Canada to have an LNP rate of 59% (confidence interval [CI] 44%–74%). This estimate is rather high compared with earlier reports that listed Canada as a country with a 10% LNP rate; the authors had also noted that biases were likely because their calculations were based largely on Aboriginal studies. We hereby present an alternate LNP prevalence estimate at the national, provincial and territorial level.

Methods

We applied the referenced LNP frequency distribution data to the 2016 population census to account for the current multi-ethnic distributions in Canada. Prevalence rates for Canada, the provinces and territories were calculated.

Results

The national LNP rate is estimated at 44% (CI 41%–47%) after accounting for the 254 ethnic groups, with the lowest rates found in the eastern provinces and the highest rates in the Northwest Territories (57%) and Nunavut (66%), respectively.

Conclusion

Despite the heterogeneous nature of the referenced data and the inference measures taken, evidently, the validity of our LNP estimate is anchored on the inclusion of multi-ethnic groups representing the current Canadian demographic.
Assembly of a parts list of the human mitotic cell cycle machinery
Authors: Giotti Bruno , Chen Sz-Hau , Barnett Mark W , Regan Tim , Ly Tony , Wiemann Stefan , Hume David A , Freeman Tom C
Published: November 2018

The set of proteins required for mitotic division remains poorly characterized. Here, an extensive series of correlation analyses of human and mouse transcriptomics data were performed to identify genes strongly and reproducibly associated with cells undergoing S/G2-M phases of the cell cycle. In so doing, 701 cell cycle-associated genes were defined and while it was shown that many are only expressed during these phases, the expression of others is also driven by alternative promoters. Of this list, 496 genes have known cell cycle functions, whereas 205 were assigned as putative cell cycle genes, 53 of which are functionally uncharacterized. Among these, 27 were screened for subcellular localization revealing many to be nuclear localized and at least three to be novel centrosomal proteins. Furthermore, 10 others inhibited cell proliferation upon siRNA knockdown. This study presents the first comprehensive list of human cell cycle proteins, identifying many new candidate proteins.
Glomerular filtration rate: when to measure and in which patients?
Authors: Agarwal Rajiv , Delanaye Pierre
Published: November 2018

Of the glomerular, tubular and endocrine functions of the kidney, nephrologists have mostly focused their attention on the glomerular functions—albuminuria and glomerular filtration rate (GFR)—to grade the severity of chronic kidney disease (CKD). Although both albuminuria and GFR are associated with renal and cardiovascular morbidity and mortality, the utility of measured GFR (mGFR) has been questioned. GFR when measured adequately is the most precise measure of glomerular function and can be useful to individualize therapy among patients with CKD. In situations where estimated GFR is known to provide imprecise estimates of glomerular function, for example, sarcopenia and advanced cirrhosis, the measurement of GFR may be especially important. We discuss several clinical situations where mGFR can potentially influence the quality of life or complications of therapy because of interventions based on imperfect knowledge of GFR. We reason that although large databases may not detect the benefits of mGFR at the population level, precision medicine requires that therapy be individualized based on the best estimate of GFR that can be obtained particularly when the risk of harm is increased. The recent standardization of mGFRs is a step in the right direction and may help in treating the individual patient with CKD with a lower risk of complications and a better quality of life. We call for research in these subgroups of patients where it is clinically felt that mGFR is useful for clinical decision-making.
International Consensus Statement on the Management of Hypotension With Vasopressors During Caesarean Section Under Spinal Anaesthesia
Authors: Kinsella S.M. , Carvalho B. , Dyer R.A. , Fernando R. , McDonnell N. , Mercier F.J. , Palanisamy A. , Sia A.T.H. , Van de Velde M. , Vercueil A.
Published: November 2018

(Anaesthesia. 2018;73:71–92)

The objective of this comprehensive consensus statement was to provide practical and independent advice to physicians for treating and managing spinal anesthesia-induced maternal hypotension in both resource-rich and resource-poor environments. This clinical best practices summary was necessary as there has been much variation in the methods used to manage spinal anesthesia-induced hypotension during cesarean section, and maternal hypotension increases risks to both maternal and fetal/neonatal health. While generalized recommendations have been made for the management of this problem by professional organizations, the authors indicated this was the first consensus statement providing specific, pragmatic recommendations for managing spinal anesthesia-induced hypotension.
A Randomized Comparison of Bolus Phenylephrine and Ephedrine for the Management of Spinal Hypotension in Patients With Severe Preeclampsia and Fetal Compromise
Authors: Dyer R.A. , Emmanuel A. , Adams S.C. , Lombard C.J. , Arcache M.J. , Vorster A. , Wong C.A. , Higgins N. , Reed A.R. , James M.F. , Joolay Y. , Schulein S. , van Dyk D.
Published: November 2018

(Int J Obstet Anesth. 2018;33:23–31)

Ephedrine and phenylephrine have both been used to prevent and treat the spinal hypotension that is common during cesarean delivery. When compared with phenylephrine, ephedrine is associated with greater fetal acidosis in healthy parturients. However, there are limited data regarding the relative efficacy of these 2 drugs for managing hypotension in women with fetal compromise. The present trial examined the effects of bolus ephedrine versus phenylephrine for the treatment of spinal hypotension in women with severe preeclampsia and a nonreassuring fetal heart tracing who were undergoing cesarean delivery.
Maternal Cardiac Output Response to Colloid Preload and Vasopressor Therapy During Spinal Anesthesia for Cesarean Section in Patients With Severe Preeclampsia: A Randomized, Controlled Trial
Authors: Dyer R.A. , Daniels A. , Vorster A. , Emmanuel A. , Arcache M.J. , Schulein S. , Reed A.R. , Lombard C.J. , James M.F. , van Dyk D.
Published: November 2018

(Anaesthesia. 2018;73:23–31)

Minimally invasive cardiac output monitors have been used in parturients to assess the hemodynamic effects of spinal anesthesia and the commonly used vasopressors phenylephrine and ephedrine. However, studies utilizing these devices have been performed mostly in healthy parturients, with data lacking for those with severe preeclampsia. This randomized study’s objective was to compare the cardiac output response to phenylephrine or ephedrine administered for spinal hypotension during cesarean delivery in women with severe early-onset preeclampsia as well as to measure the stroke volume response to administration of a colloid preload.
Learning From the Law: A Review of 21 Years of Litigation for Pain During Cesarean Section
Authors: McCombe K. , Bogod D.G.
Published: November 2018

(Anaesthesia. 2018;73:223–230)

In the United Kingdom, the majority of cesarean deliveries are now performed under neuraxial anesthesia instead of general anesthesia, thereby mitigating the increased anesthetic risks associated with general anesthesia in pregnant women. However, as the use of neuraxial anesthesia for cesarean delivery has increased so has the risk of patients experiencing pain during surgery. As a result, pain during cesarean delivery has now become the most common reason for negligence claims relating to regional anesthesia against obstetric anesthesiologists in the UK. This article examined common themes (relating to consent, checking the block, managing intraoperative pain, and professionalism) that emerged from an analysis of these claims and highlighted the lessons to be learned for practicing anesthesiologists.
The Need for an Epidural “Window of Opportunity” in Pregnant Women With a Lumbar Tattoo
Authors: Zipori Y. , Jakobi P. , Solt I. , Abecassis P.
Published: November 2018

(Int J Obstet Anesth. 2018;33:53–56)

Anesthesiologists face a dilemma when pregnant women with lower back tattoos request epidural analgesia during labor, as clear guidelines have not been established regarding the performance of epidural procedures through a tattoo on the lower back. In the United States ∼25% of people between the ages of 18 and 50 report having a tattoo. The opinions of anesthesiologists vary widely as to how to approach this scenario. In surveys performed addressing the issue, 40% of survey respondents indicated they would not perform an epidural technique through a lumbar tattoo and 70% reported the lack of a departmental policy for how to manage these patients.
Vitamin D Supplementation During Pregnancy: State of the Evidence From a Systematic Review of Randomized Trials
Authors: Hollis B.W. , Johnson D. , Thomas C. , Hulsey T.C. , Wagner C.L.
Published: November 2018

(BMJ. 2017;359:j5237)

Vitamin D affects bone growth and calcium homeostasis but more far reaching effects have been proposed, including effects on pregnancy and birth outcomes. Dietary and supplementation recommendations for vitamin D vary across medical and professional organizations in spite of growing concern regarding the high prevalence of vitamin D deficiency in pregnant women and newborns. This study was a systematic review and meta-analysis of randomized controlled trials of prenatal vitamin D supplementation that was undertaken with the goal of estimating the effects of vitamin D supplementation during pregnancy on maternal, neonatal, and infant outcomes.
Very Tight Versus Tight Control: What Should be the Criteria for Pharmacologic Therapy Dose Adjustment in Diabetes in Pregnancy? Evidence From Randomized Controlled Trials
Authors: Caissutti C. , Saccone G. , Ciardulli A. , Berghella V.
Published: November 2018

(Acta Obstet Gynecol Scand. 2018;97:235–247)

Management for women with gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (DM), includes diet, physical activity, and oral hypoglycemic agents or insulin as needed. However, the optimal schedule, frequency, and timing of glucose monitoring as well as the ideal therapeutic glucose level remain inconclusive. Results from randomized controlled trials (RCTs) have not been able to define any specific criteria for pharmacologic therapy dose adjustment. Therefore, these investigators undertook a systematic review of RCTs in order to analyze the criteria being used for pharmacologic therapy dose adjustment.
A Survey of International Antisepsis Procedures for Neuraxial Catheterization in Labor
Authors: Fayman K. , Allan A. , Hudson C. , Logarta M.
Published: November 2018

(Int J Obstet Anesth. 2018;33:8–16)

Neuraxial analgesia during labor is commonly performed, but serious complications may arise due to infection of the neuraxial space. Although adherence to antisepsis precautions is mandatory, what appropriate antisepsis practice entails varies widely among countries and even hospitals within the same country. In view of this, the current study was undertaken with the primary aim of clarifying international antisepsis practices for neuraxial analgesia during labor.
Eroding Access and Quality of Childbirth Care in Rural US Counties
Authors: Shah N.T.
Published: November 2018

(JAMA. 2018;319(12):1203–1204)

Compared with other high-income nations, the United States is lagging in birth outcomes. Hospitals often lose money on maternity care as obstetric services have high fixed costs and low reimbursements. As a result, many hospital obstetric units with small volumes and large shares of Medicaid recipients have closed. This has particularly impacted hospitals in rural counties.
Prediction of Outliers in Pain, Analgesia Requirement, and Recovery of Function After Childbirth: A Prospective Observational Cohort Study
Authors: Komatsu R. , Carvalho B. , Flood P.
Published: November 2018

(Br J Anaesth. 2018;121:417–426)

Most women report opioid-free functional recovery ∼3 to 4 weeks after childbirth. However, a minority of women report severe pain and remain on opioids for a prolonged period after childbirth, which has potential for long-term harm. There is limited information available to predict which women will have poor recovery or require opioids for a protracted period. Consequently, the authors of the present study identified demographic, obstetrical, and psychological factors associated with parturients who are likely to have a difficult postpartum recovery with respect to pain, opioid use, and recovery of function.
Perinatal and Maternal Morbidity and Mortality Among Term Singletons Following Midcavity Operative Vaginal Delivery Versus Cesarean Delivery
Authors: Muraca G.M. , Skoll A. , Lisonkova S. , Sabr Y. , Brant R. , Cundiff G.W. , Joseph K.S.
Published: November 2018

(BJOG. 2018;125:693–702)

Recently, to reduce the cesarean delivery rate, the use of operative vaginal delivery has been advocated by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. There is uncertainty, however, in the balance of risks and benefits between cesarean delivery and operative vaginal delivery. Previous research has lacked information on pelvic station, a measure of the descent of the fetal head with respect to the maternal ischial spines. Operating at the midcavity station requires the greatest skill compared with outlet or lowcavity forceps procedures. This study aimed to quantify the effect of operative vaginal delivery at midcavity station on maternal and perinatal mortality and morbidity compared with cesarean delivery.
Gastric Ultrasound in the Third Trimester of Pregnancy: A Randomized Controlled Trial to Develop a Predictive Model of Volume Assessment
Authors: Arzola C. , Perlas A. , Siddiqui N.T. , Downey K. , Ye X.Y. , Carvalho J.C.A.
Published: November 2018

(Anaesthesia. 2018;73:295–303)

Bedside gastric ultrasound is used in diverse patient groups for the assessment of gastric content and volume. Using qualitative assessment, a distinction can be made between an empty stomach and one containing solid/thick fluid contents or clear fluids. In addition, quantitative assessment of gastric volume can be estimated using the cross-sectional area of the gastric antrum when clear fluid contents are present in the stomach. Small volumes ≤1.5 mL/kg1 are consistent with baseline gastric secretions, whereas higher volumes suggest patient ingestion that may increase aspiration risk. The primary objective of this study was to evaluate the relationship between gastric antral cross-sectional area as measured by ultrasound and the volume of clear fluids ingested by pregnant women.
A Prospective Cohort Study of Fetal Heart Rate Monitoring: Deceleration Area is Predictive of Fetal Acidemia
Authors: Cahill A.G. , Tuuli M.G. , Stout M.J. , López J.D. , Macones G.A.
Published: November 2018

(Am J Obstet Gynecol. 2018;218:523.e1–523.e12)

While intrapartum electronic fetal monitoring (EFM) is commonly used and promises to reduce adverse neonatal outcomes by predicting acidemia, there is a lack of data regarding an association between EFM patterns and acidemia. This study aimed to assess EFM patterns and their association with acidemia and neonatal morbidity and determine which visually interpreted EFM patterns were associated with acidemia and neonatal morbidity.
Birth Plans—Impact on Mode of Delivery, Obstetrical Interventions, and Birth Experience Satisfaction: A Prospective Cohort Study
Authors: Afshar Y. , Mei J.Y. , Gregory K.D. , Kilpatrick S.J. , Esakoff T.F.
Published: November 2018

(Birth. 2018;45:43–49)

Birth plans are intended to serve as a communication tool between women and their providers. Patient involvement in decision-making during childbirth has been positively associated with patient satisfaction with birth. However, one study found more than half of medical personnel believed the presence of a birth plan predicted worse outcomes, while only 2% of pregnant women believed birth plans were associated with worse outcomes. There is a lack of research on birth outcomes in the presence of birth plans. The authors of this study hypothesized women with birth plans would have fewer obstetrical interventions, fewer cesarean deliveries, and greater satisfaction with their birth experience.
Lumbar Spine Anatomy in Women Sustaining Unintentional Dural Puncture During Labor Epidural Placement: A Descriptive Study Using Magnetic Resonance Imaging and Ultrasound
Authors: Barrett N.M. , Arzola C. , Krings T. , Downey K. , Carvalho J.C.A.
Published: November 2018

(Reg Anesth Pain Med. 2018;43:92–96)

Unintentional puncture of the dura mater is one of the most common complications of epidural catheter placement and can result in a postdural puncture headache. The incidence of this complication has remained unchanged and efforts to identify patient risk factors have been unsuccessful. There has not been success in identifying risk factors for this complication. A retrospective study showed there was a higher risk of atypical sonoanatomy of the ligamentum flavum/dura mater unit among women who experienced unintentional dural puncture during epidural placement compared with a control group. It was not clear whether this was a limitation of ultrasound imaging or a representation of abnormal anatomy. The objectives of this study were to assess for abnormal lumbar anatomy in women sustaining unintentional dural punctures during labor epidural placement utilizing magnetic resonance imaging (MRI) and ultrasound.
A Randomized Trial of Phenylephrine Infusion Versus Bolus Dosing for Nausea and Vomiting During Cesarean Delivery in Obese Women
Authors: George R.B. , McKeen D.M. , Dominguez J.E. , Allen T.K. , Doyle P.A. , Habib A.S.
Published: November 2018

(Can J Anesth. 2018;65(3):254–262)

Hypotension is a common complication of cesarean delivery with spinal anesthesia and can cause intraoperative nausea and/or vomiting (IONV). Bolus dosing of phenylephrine has been shown to be an effective treatment for hypotension, but it does not treat or prevent IONV. Prophylactic phenylephrine infusion, however, has been shown to reduce the incidence of hypotension as well as maternal nausea and vomiting. However, previous studies excluded obese women. This multicenter, randomized, double-blinded study compared phenylephrine infusion to phenylephrine boluses, hypothesizing that IONV incidence would be lower with prophylactic phenylephrine infusion.
IV. POSTOPERATIVE ANALGESIA Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review
Authors: Gamez B.H. , Habib A.S.
Published: November 2018

(Anesth Analg. 2018;126(5):1606–1614)

Severe acute pain after cesarean delivery (CD) triples a women’s risk of developing postpartum depression. Consequently, preoperative identification of women at greater risk for severe postoperative pain may be helpful in identifying more effective and intensive analgesic interventions for this population. In this narrative review, the authors evaluated the utility of various existing tools to predict severe pain and/or opioid consumption in the first 48 hours after CD.
Prophylactic Use of an Intra-Aortic Balloon Pump in a High-risk Patient With Peripartum Cardiomyopathy Requiring Cesarean Delivery
Authors: Samalavicius R.S. , Puodziukaite L. , Radaviciute I. , Norkiene I. , Urbonas K. , Misiuriene I. , Janusauskas V. , Zorinas A. , Rucinskas K. , Serpytis P.
Published: November 2018

(Int J Obstet Anesth. 2018;33:67–71)

The most commonly used mechanical-assist device for the management of heart failure is the intra-aortic balloon pump (IABP). The balance between myocardial oxygen supply and demand is improved via the device’s counter-pulsation. Although some case reports have mentioned the use of IABP counter-pulsation for circulatory support in pregnant women with cardiac failure, few publications have discussed its use during delivery. This case report described the successful management of a patient with peripartum cardiomyopathy who underwent cesarean delivery using preemptive IABP counter-pulsation.
The Multimodal Assessment Model of Pain
Authors: Wideman Timothy H. , Edwards Robert R. , Walton David M. , Martel Marc O. , Hudon Anne , Seminowicz David A.
Published: November 2018

Objectives:

Pain assessment is enigmatic. Although clinicians and researchers must rely upon observations to evaluate pain, the personal experience of pain is fundamentally unobservable. This raises the question of how the inherent subjectivity of pain can and should be integrated within assessment. Current models fail to tackle key facets of this problem, such as what essential aspects of pain are overlooked when we only rely on numeric forms of assessment, and what types of assessment need to be prioritized to ensure alignment with our conceptualization of pain as a subjective experience. We present the multimodal assessment model of pain (MAP) as offering practical frameworks for navigating these challenges.

Methods:

This is a narrative review.

Results:

MAP delineates qualitative (words, behaviors) and quantitative (self-reported measures, non–self-reported measures) assessment and regards the qualitative pain narrative as the best available root proxy for inferring pain in others. MAP offers frameworks to better address pain subjectivity by: (1) delineating separate criteria for identifying versus assessing pain. Pain is identified through narrative reports, while comprehensive assessment is used to infer why pain is reported; (2) integrating compassion-based and mechanism-based management by both validating pain reports and assessing underlying processes; (3) conceptualizing comprehensive pain assessment as both multidimensional and multimodal (listening/observing and measuring); and (4) describing how qualitative data help validate and contextualize quantitative pain measures.

Discussion:

MAP is expected to help clinicians validate pain reports as important and legitimate, regardless of other findings, and help our field develop more comprehensive, valid, and compassionate approaches to assessing pain.
Subfibular impingement: current concepts, imaging findings and management strategies
Authors: Kaplan Jonathan R.M. , Aiyer Amiethab , Nguyen Duc M. , Vulcano Ettore , Buller Leonard T. , Sheth Pooja , Jose Jean
Published: November 2018

Subfibular impingement is one cause of extraarticular ankle impingement characterized by pain in the lateral aspect of the hindfoot. Associated with severe hindfoot deformity, subfibular impingement can be secondary to posterior tibial tendon dysfunction, calcaneal fracture malunion, or neuropathic or inflammatory arthritidies. MRI often is necessary to rule out other causes of ankle pain. Advanced imaging findings are related to abutment between the fibula and calcaneus and include subcortical marrow edema, cystic changes, sclerosis, and the presence of soft-tissue entrapment or extensive soft-tissue thickening between the fibula and the calcaneus. A trial of nonoperative management should be exhausted prior to open or arthroscopic procedures being considered. However, in recalcitrant cases unresponsive to conservative treatment, there are several surgical procedures described for the management of these deforming forces.

Level of Evidence: Level V.
Patient attitudes towards electronics usage in a hospital-based orthopaedic clinic: a survey study
Authors: McDaniel Claire , Davis Meghan , Kessler Michael
Published: November 2018

Background:

Patients and physicians are increasingly using technology to deliver healthcare for both preserving information and communication methods. However, little research has been done into patient attitudes towards technology use in the outpatient orthopaedic clinic.

Methods:

A paper survey was conducted of 1000 patients in a mixed-specialty hospital-based orthopaedic surgery clinic to determine patient attitudes towards common technologies. Data analysis was performed using chi-squared and Fisher exact tests. Continuous variables were examined using Kruskal-Wallis tests.

Results:

Most patients reported approving of desktops (98.0%, 95% CI 96.9%-98.8%) or tablets (97.4%, 95% CI 96.2-98.3%) to access medical files, as well as communication methods such as cellular phones set to silent (92.1%, 95% CI 90.3%-93.7%) and pagers set to silent (94.3%, 95% CI 92.7%-95.6%). However, most patients disapproved of cellular phones set to ring (32.3%, 95% CI 29.4%-35.3%), and approved less of pagers that are set to beep mode (70.2%, 95% CI 67.3%-73.0%), indicating that patients dislike intrusions into the clinical encounter.

Conclusions:

The majority of patients approve of certain technology use in the outpatient orthopaedic clinic, specifically means to access medical records and nonintrusive communication methods. As patients rank the orthopaedic surgeons’ bedside manner as a highly important aspect of outpatient clinical care, technology integration must be carefully done to preserve bedside manner.
Recovery of Bone Mineral Mass After Upper Limb Fractures in Children and Teenagers
Authors: Maggio Albane B.R. , Martin Xavier , Tabard-Fougère Anne , Steiger Christina , Dayer Romain , Delhumeau Cécile , Ceroni Dimitri
Published: November 2018

Background:

Loss of bone mineral mass and muscle atrophy are predictable consequences of cast-mediated immobilization following wrist and forearm fractures. This study aimed to prospectively determine whether previously reported lower bone mineral mass following immobilization for wrist and forearm fractures in children and teenagers had recovered at 6- and 18-month follow-up.

Methods:

We recruited 50 children and teenagers who underwent a cast-mediated immobilization for a forearm or wrist fracture. Dual-energy x-ray absorptiometry scans of different skeletal sites were performed at the time of fracture, at cast removal, at 6 and at 18-month follow-up. Injured patients were paired with healthy controls according to sex and age. Dual-energy x-ray absorptiometry values were compared between groups and the injured and uninjured forearms of the patients.

Results:

At the time of fracture, injured and healthy subjects showed no differences between their bone mineral density (BMD) and bone mineral content (BMC) z-scores at the lumbar spine, or between their BMDs at the peripheral wrist. At cast removal, upper limb bone mineral variables were significantly lower in the injured group (except for the ultradistal radius) than in the uninjured group, with differences ranging from 3.8% to 10.2%. No residual decrease in bone mineral variables was observed at any upper limb site at 6- and 18-month follow-up (28 injured patients). Significant residual increases in the BMDs and BMCs were observed for the injured group’s ultradistal radius and whole wrists (+4.8% to +5.2%).

Conclusions:

A rapid bone mass reversal occurs by resumption of mobilization, with full bone recovery 6 months after a forearm or wrist fracture. Finally, healing bone callus could introduce a bias into the interpretation of BMD and BMC data at the fracture site, not only at cast removal but also 18 months after the fracture.
Radiological Evaluation Does Not Reflect the Clinical Outcome After Surgery in Unstable Thoracolumbar and Lumbar Type A Fractures Without Neurological Symptoms
Authors: Lorente Rafael , Lorente Alejandro , Palacios Pablo , Barrios Carlos , Rosa Bárbara , Vaccaro Alexander
Published: November 2018

Study design:

This is a prospective study of 2 cohorts.

Objective:

Compare the clinical and radiologic outcome of 2 cohorts of unstable thoracolumbar and lumbar fractures treated by open posterior fixation (OPF) with bone graft or by percutaneous fixation (PCF) without grafting.

Summary of Background Data:

In recent years, PCF is the most common treatment of thoracolumbar fractures. To date, no studies have analyzed clinical outcomes in terms of return to work.

Material and Methods:

Two cohorts of patients with unstable thoracolumbar and lumbar fractures fractures (type A2, A3, and A4) without neurological symptoms underwent OPF (n=91) or PCF (n=54) between 2010 and 2015. A conventional radiologic study was performed in the preoperative, immediate postoperative period, 1-year, and 2-year follow-up. Clinical outcomes were evaluated by Visual Analog Scale and Oswestry Disability Index scores at 1-year and 2-year follow-up. The period to return to work and the type of work were also recorded.

Results:

The percentages of correction were significantly higher in cases operated by OPF: fracture angle (P<0.001), kyphotic deformity (P<0.001), vertebral compression (P<0.001), and displacement (P<0.001). Cases operated by PCF experienced greater loss of correction at 2-year follow-up, especially in fracture displacement (P<0.001), deformity angle (P<0.001), kyphotic deformity (P<0.001), and in the sagittal index (P<0.001). Besides this greater loss of correction, PCF cases showed better Visual Analog Scale (P<0.001) and Oswestry Disability Index scores (P<0.001) at final follow-up. The percentage of patients returning to the same heavy work position was higher in the PCF group (P<0.001) and in a shorter period of time (P<0.001).

Conclusions:

The greater loss of correction of patients undergoing PCF does not reflect the clinical outcomes that were significantly better as compared to patients undergoing open fixation with grafting. It would be useful to further evaluate if the radiological changes could have a long-term clinical significance.
Epidermal growth factor receptor tyrosine kinase inhibitors in advanced nonsmall cell lung cancer: what is the preferred first-line therapy?
Authors: Roeper Julia , Griesinger Frank
Published: November 2018

Purpose of review

Epidermal growth factor receptor (EGFR) mt+ nonsmall cell lung cancer (NSCLC) were the first molecularly described NSCLC with an established ‘targeted’ therapy inhibiting mutated EGFR [EGFR tyrosine kinase inhibitor (TKI)]. EGFR TKI of first and second generation have led to an unprecedented improvement in objective response rate, progression-free survival (PFS) and overall survival (OS) compared with chemotherapy with a significantly reduced toxicity and improved quality of life. Fast elucidation of the most frequent resistance mechanism against first and second-generation TKI, T790M, led to the approval of the third-generation TKI osimertinib in second line.

Recent findings

Recently, the FLAURA study showed an impressive PFS benefit and immature OS data for osimertinib against solely first-generation TKI's. Also, the ARCHER study comparing dacomitinib against first-generation TKI showed a PFS and also OS benefit. Two studies combining EGFR TKI and antiangiogenesis showed PFS but no OS benefit. Lately, the combination of TKI and chemotherapy has seen a revival with the NEJ009 study, resulting in an impressive median OS of 55 months.

Therefore, potentially four different therapeutic options are available in first-line therapy of EGFR mt+ NSCLC, first, second, third generation, TKI + antiangiogenic agent and TKI + chemotherapy. The purpose of the review is to help to guide physicians to decide in their treatment choice and discuss potential directions of research.
C-Reactive Protein Values After Colorectal Resection: Can We Discharge a Patient With a C-Reactive Protein Value >100? A Retrospective Cohort Study
Authors: Benoit Olivier , Faron Mathieu , Margot Nicolas , Creavin Ben , Debove Clotilde , Tiret Emmanuel , Parc Yann , Lefevre Jérémie H.
Published: November 2018

BACKGROUND:

C-reactive protein is a useful negative predictive test for the development of anastomotic leakage following colorectal surgery. Evolution of procedures (laparoscopy, enhanced recovery program, early discharge, complex redo surgery) may influence C-reactive protein values; however, this is poorly studied to date.

OBJECTIVE:

The aim of this study is to evaluate C-reactive protein as an indicator of postoperative complication and as a predictor for discharge.

DESIGN:

This is retrospective study of a consecutive monocentric cohort.

SETTINGS:

All patients undergoing a colorectal resection with anastomosis (2014–2015) were included.

MAIN OUTCOMES MEASURES:

C-reactive protein, leukocytosis, type of resection, and postoperative course were the primary outcomes measured.

RESULTS:

A total of 522 patients were included. The majority had either a colorectal (n = 159, 31%) or coloanal anastomosis (n = 150, 29%). Overall morbidity was 29.3%. C-reactive protein was significantly higher among patient having intra-abdominal complications at an early stage (day 1–2) (164.6 vs 136.2;p= 0.0028) and late stage (day 3–4) (209.4 vs 132.1;p< 0.0001). In multivariate analysis, early C-reactive protein was associated with BMI (coefficient, 4.9; 95% CI, 3.2–6.5;p< 0.0001) and open surgical procedures (coefficient, 43.1; 95% CI, 27–59.1;p< 0.0001), while late C-reactive protein value was influenced by BMI (coefficient, 4.8; 95% CI, 2.5–7.0;p= 0.0024) and associated extracolonic procedures (coefficient, 34.2; 95% CI, 2.7–65.6;p= 0.033). Sensitivity, specificity, negative predictive values, and positive predictive values for intra-abdominal complication were 85.9%, 33.6%, 89.3%, and 27.1% for an early C-reactive protein <100 mg/L and 72.7%, 75.4%, 89.4%, and 49.2% for a late C-reactive protein <100 mg/L. Four hundred seven patients with an uneventful postoperative course were discharged at day 8 ± 6.4 with a mean discharge C-reactive protein of 83.5 ± 67.4. Thirty-eight patients (9.3%) were readmitted and had a significantly higher discharge C-reactive protein (138.6 ± 94.1 vs 77.8 ± 61.2,p= 0.0004). Readmission rate was 16.5% for patients with a discharge C-reactive protein >100 mg/L vs 6% with C-reactive protein <100 mg/L (p= 0.0008). For patients included in an enhanced recovery program (discharge at day 4 ± 2.4), the threshold should be higher because discharge is around day 3 or 4. With a C-reactive protein <140, readmission rate was 2% vs 19%, (p= 0.056).

LIMITATIONS:

This study includes retrospective data.

CONCLUSION:

C-reactive protein <100 mg/L is associated with a lower risk of intra-abdominal complication and readmission rates. SeeVideo Abstractat http://links.lww.com/DCR/A749.
Robotic Transanal Minimally Invasive Surgery for the Excision of Rectal Neoplasia: Clinical Experience With 58 Consecutive Patients
Authors: Tomassi Marco J. , Taller Janos , Yuhan Robert , Ruan Joseph H. , Klaristenfeld Daniel D.
Published: November 2018

BACKGROUND:

Given the significant perioperative risks and costs of total mesorectal excision, minimally invasive transanal surgical approaches have grown in popularity for early rectal cancer and rectal polyps. This article discusses a transanal robotic surgery technique to perform full-thickness resections of benign and malignant rectal neoplasms.

OBJECTIVE:

The purpose of this study was to describe an initial experience with robotic transanal minimally invasive surgery.

DESIGN:

This was a retrospective cohort study of consecutive patients who underwent robotic transanal minimally invasive surgery.

SETTINGS:

The study was conducted at a high-volume colorectal surgery practice with a large health maintenance organization.

PATIENTS:

Patients at Southern California Kaiser Permanente with early rectal cancer and rectal polyps amenable to transanal excision were included.

INTERVENTIONS:

Transanal resection of rectal tumors were removed using robotic transanal minimally invasive surgery.

MAIN OUTCOME MEASURES:

Local recurrence of rectal pathology was measured.

RESULTS:

A total of 58 patients underwent robotic transanal minimally invasive surgery with full-thickness rectal resection by 4 surgeons for the following indications: rectal cancer (n = 28), rectal polyp (n = 18), rectal carcinoid (n = 11), and rectal GI stromal tumor (n = 1). Mean operative time was 66.2 minutes (range, 17–180 min). The mean tumor height from the anal verge was 8.8 cm (range, 4–14 cm), and the mean specimen size was 3.3 cm (range, 1.3–8.2 cm). A total of 57 (98.3%) of 58 specimens were intact, and 55 (94.8%) of 58 specimens had negative surgical margins. At a mean follow-up of 11.5 months (range, 0.3–33.3 mo), 3 patients (5.5%) developed local recurrences, and all underwent successful salvage surgery.

LIMITATIONS:

The study was limited by being a retrospective, nonrandomized trial with short follow-up.

CONCLUSIONS:

Robotic transanal minimally invasive surgery is a safe, oncologically effective surgical approach for rectal polyps and early rectal cancers. It offers the oncologic benefits and perioperative complication profile of other transanal minimally invasive surgical approaches but also enhances surgeon ergonomics and provides an efficient transanal rectal platform. See Video Abstract at http://links.lww.com/DCR/A759.
Hemorrhoidal Disease Symptom Score and Short Health ScaleHD: New Tools to Evaluate Symptoms and Health-Related Quality of Life in Hemorrhoidal Disease
Authors: Rørvik Håvard D. , Styr Karl , Ilum Lars , McKinstry Grant L. , Dragesund Tove , Campos André H. , Brandstrup Birgitte , Olaison Gunnar
Published: November 2018

BACKGROUND:

There are no adequately validated tools to evaluate symptoms or disease-specific health-related quality of life in hemorrhoidal disease.

OBJECTIVE:

The purpose of this study was to assess validity, reliability, and responsiveness of a symptom score of patient-reported pain, itching, bleeding, soiling, and prolapse (Hemorrhoidal Disease Symptom Score). In addition, the study set out to assess reliability and responsiveness of an instrument to measure health-related quality of life in patients with hemorrhoids (Short Health ScaleHD), with 1 item in its 4 dimensions: symptom load, functional status, disease-specific worries, and general well-being.

DESIGN:

This was a cross-sectional (validity and reliability) and longitudinal (responsiveness) study.

SETTINGS:

The study was conducted at a single center.

PATIENTS:

Cohort 1 included 295 patients with hemorrhoids to study validity and 60 patients with test–retest scores to study reliability. Cohort 2 included 128 and 121 patients operated for hemorrhoids to study responsiveness of the Hemorrhoidal Disease Symptom Score and the Short Health ScaleHD.

MAIN OUTCOME MEASURES:

The study evaluated validity, reliability, and responsiveness. Patient-reported symptom load on a 7-point Likert scale was used as comparator, and receiver operating characteristics curve assessed discriminative validity. Interclass correlation assessed reliability. Receiver operating characteristics curve assessed responsiveness, meaning the ability to discriminate between patients with and without improvement after surgery.

RESULTS:

The Hemorrhoidal Disease Symptom Score demonstrated the ability to discriminate between patients reporting high or low symptom load (area under the curve = 0.786 (95% CI, 0.725–0.848)). The Hemorrhoidal Disease Symptom Score and the Short Health ScaleHD demonstrated adequate reliability and responsiveness, with interclass correlation of 0.822 (95% CI, 0.715–0.891) and 0.763 (95% CI, 0.634–0.851) and area under the curve of 0.843 (95% CI, 0.756–0.929) and 0.840 (95% CI, 0.752–0.929).

LIMITATIONS:

We had no gold standard comparator to assess validity and responsiveness.

CONCLUSIONS:

The findings suggest that the Hemorrhoidal Disease Symptom Score is valid, reliable, and responsive and that the Short Health ScaleHD is reliable and responsive. Used together, these tools provide a good overview of symptoms and their impact on patient well-being. See Video Abstract at http://links.lww.com/DCR/A770.
Ileal Pouch Excision: A Contemporary Observational Cohort
Authors: Worley Guy H.T. , Patsouras Dimitrios , Sahnan Kapil , O. Adegbola Samuel , Mahmood Humza , Faiz Omar D. , Clark Susan K.
Published: November 2018

BACKGROUND:

Pouch excision is required for many of those patients experiencing pouch failure in whom ileostomy alone is inadequate and revision surgery is not appropriate. The published rate of pouch failure is approximately 10% at 10 years, resulting in a growing cohort of patients requiring excision.

OBJECTIVE:

In this article, we aim to describe the indications for excision and postoperative outcomes at our center since 2004.

DESIGN:

This is a retrospective observational study.

SETTINGS:

This study was conducted at a tertiary referral center for ileal pouch dysfunction. Cases were documented from 2004 to 2017.

PATIENTS:

The cohort comprised 92 patients; 83% were diagnosed with ulcerative colitis, 15% with familial adenomatous polyposis, and 2% with indeterminate colitis.

INTERVENTIONS:

Patients underwent excision of pelvic ileal pouches.

MAIN OUTCOME MEASURES:

The primary outcomes measured were the time to perineal wound healing and healing at 6 months. Thirty- and 90-day morbidity and mortality were evaluated.

RESULTS:

Postoperative histology was consistent with Crohn’s disease in 1 patient. The median time from pouch creation to excision was 7 years. The rate of perineal wound healing at 6 months was 78%, and regression analysis demonstrated significantly improved chances of healing for noninfective indications for excision (p = 0.023; OR, 15.22; 95% CI, 1.45–160.27) and for more recent procedures (p = 0.032; OR, 12.00; 95% CI, 1.87–76.87).

LIMITATIONS:

This study was limited because it was retrospective in nature, and it was a single-center experience.

CONCLUSIONS:

This study represents the most contemporary cohort of patients undergoing pouch excision surgery. The procedure retains a relatively high postoperative morbidity, but this study demonstrates a learning curve with improving perineal healing over time associated with a high institutional volume. Defunctioning ileostomy may improve perineal wound healing in patients with infective indications for excision. Further investigation is required to establish the quality-of-life benefits of pouch excision in this modern cohort. See Video Abstract at http://links.lww.com/DCR/A804.