bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Outcomes and Central Pain Mechanisms are Improved After Upper Trapezius Eccentric Training in Female Computer Users With Chronic Neck/Shoulder Pain
Authors: Heredia-Rizo Alberto M. , Petersen Kristian K. , Madeleine Pascal , Arendt-Nielsen Lars
Published: September 2018

Objectives:

The effects of eccentric exercises on clinical outcomes and central pain mechanisms are unclear in neck/shoulder pain (NSP). The aims were to: (1) evaluate the clinical impact of unilateral eccentric training in female computer users with chronic NSP; (2) compare pressure pain sensitivity, temporal summation of pain (TSP); and conditioned pain modulation (CPM) in female office workers with and without NSP; and (3) assess sensitization and central pain responses after training.

Methods:

In part A, 20 females with NSP were compared with 20 controls. In part B, the NSP group underwent a 5-week upper trapezius eccentric training program. Participants reported their pain intensity and completed the Neck Disability Index, and the Disabilities of the Arm, Shoulder and Hand questionnaire. Pressure pain thresholds (PPTs) were assessed over the neck and forearm. Cuff algometry identified pain detection threshold (PDT) and pain tolerance thresholds (PTT). TSP was evaluated by visual analog scale pain scores during 10 repetitive cuff stimulations. CPM was calculated as the difference in PDT with and without a conditioning painful stimulus. Outcomes were measured at baseline and after intervention. Pain intensities were collected at 3- and 6-month follow-up.

Results:

Pain and disability decreased after intervention (P<0.05) and at follow-ups (P=0.002). The NSP group showed reduced PTT (P≤0.02), but no differences in TSP (P=0.947) or CPM (P=0.059) compared with controls. After training, participants with NSP had improved CPM, PPTs, and PTT at the nontreated side (P<0.05).

Discussion:

Eccentric training improved pain and disability, reduced sensitization, and enhanced CPM efficiency in female computer users with NSP.
Career Expectations of Obstetrics and Gynecology Residents and Future Residents
Authors: Alston Meredith J. , Ehrig Jessica , Autry Amy (Meg) , Wagner Sarah A. , Kohl-Thomas Belinda M. , Allshouse Amanda A. , Gottesfeld Marshall , Stephenson-Famy Alyssa
Published: September 2018

OBJECTIVE:

To understand contemporary fourth-year medical student and resident career expectations in obstetrics and gynecology.

METHODS:

Students invited for obstetrics and gynecology residency interviews and residents (postgraduate years 1–4) at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph's Hospital, and Texas A&M in 2016–2017 received a voluntary, electronic survey regarding career expectations. Questions were compared between students and residents using a χ2 test for category responses and for age a two-sample t test.

RESULTS:

Response rates were similar between students (68% [277/409]) and residents (63% [97/153]). Residents compared with students were more frequently planning to enter private practice (43% vs 19%) and less frequently planning an academic career (19.4% vs 30.4%) or subspecialties (38% vs 51%) (P<.001). Although most respondents planned to work full-time (96% vs 94.9%), 83% (vs 94%) of residents planned to work greater than 40 hours per week (P<.001). Respondents reported greater than $150,000 in educational debt (65%) and anticipated starting salary greater than $200,000 (89%). More residents planned to retire by age 60 years (23% vs 7%) (P<.001). Thirty-eight percent of residents reported having changed career plans during residency, citing work–life balance as the most important factor (89%).

DISCUSSION:

Trainees' career expectations appear to evolve over time moving toward a higher likelihood to pursue private practice, work fewer hours, and retire earlier despite large educational debt. It is critical that the specialty understand these trends when planning to address national workforce needs.
Eliminating Preventable Maternal Deaths in the United States
Authors: Metz Torri D.
Published: September 2018

The crisis of a rising maternal mortality ratio in the United States continues to receive attention in both the scientific literature and the lay press. To continue to make progress in preventing these deaths, we must celebrate our successes and clearly delineate the next steps. The Centers for Disease Control and Prevention program, Building U.S. Capacity to Review and Prevent Maternal Deaths, recently published a report from nine maternal mortality review committees, which accomplishes just that. The report is a collaborative effort from maternal mortality review committees demonstrating the capacity to do three important tasks: 1) collect data in a standardized fashion across maternal mortality review committees throughout the United States, 2) assess preventability of maternal deaths by consensus from experts on multidisciplinary state committees, and 3) create recommendations based on maternal death review with far-reaching effect. Next steps involve expansion of this standardized process to maternal mortality review committees in every state and translation of those recommendations into state-specific action through the use of local resources such as state perinatal quality care collaboratives. This commentary summarizes the content of the report from nine maternal mortality review committees.
Delayed Childbearing as a Growing, Previously Unrecognized Contributor to the National Plural Birth Excess
Authors: Adashi Eli Y. , Gutman Roee
Published: September 2018

OBJECTIVE:

To establish the annual and cumulative multiyear contribution of delayed childbearing to the national plural birth excess.

METHODS:

Using publicly available national birth data reported by the National Center for Health Statistics, we estimated the contribution of delayed childbearing to the national plural birth excess through 2016. To this end, the observed as well as the maternal age- and race-adjusted national plural birth rates were assessed before (1949–1966; n=71,570,717) and during (1971–2016; n=166,817,655) the assisted reproduction era. Comparable estimates through 2025 relied on simulated projections.

RESULTS:

The relative risk estimates of unassisted plural births by maternal age before the assisted reproduction era (1949–1966) proved unimodal and race-dependent. The risk of unassisted plural births in 35- to 39-year-old black women proved 2.75-fold higher than that of 15- to 19-year-old counterparts (39.81/1,000 to 14.48/1,000; 95% CI 2.67–2.83). A 2.47-fold risk increment was noted for comparably aged white women (28.76/1,000 to 11.63/1,000; 95% CI 2.43–2.52). Similar age-dependent risk increments were obtained for twin and higher order births. An increasingly prominent delayed childbearing trend during the assisted reproduction era (1971–2016) gave rise to 255,964 (95% CI 134,746–375,581) and 66,271 (95% CI 34,099–96,197) unassisted plural births by white and black women, respectively. In 2016 alone, delayed childbearing accounted for 24% (95% CI 15–32%) and 38% (95% CI 28–47%) of the national plural birth excess for white and black women, respectively. By 2025, delayed childbearing could account for as much as 46% (95% CI 32–60%) and 40% (95% CI 30–53%) of the national plural birth excess for white and black women, respectively.

CONCLUSION:

Delayed childbearing, a growing contributor to the national plural birth excess previously solely ascribed to assisted reproduction, warrants greater consideration in future clinical, analytic, and policy deliberations as well as in individual family planning decisions.
Team-Based Learning Sessions Compared With Traditional Lecture in the Obstetrics and Gynecology Clerkship
Authors: Krase Kelli , Pfeifer Emily , Swan Kimberly
Published: September 2018

OBJECTIVE:

To estimate the effects of team-based learning sessions as part of the curriculum for the obstetrics and gynecology clerkship.

METHODS:

This is a prospective cohort study of clinical clerkship curriculum undertaken in Kansas City and Wichita between 2013 and 2017. A team-based learning curriculum included the same topics as the traditional lecture-format lectures and was instituted in Kansas City. The primary outcome was the obstetrics and gynecology National Board of Medical Examiners examination given at the end of the clerkship, both before and after the implementation of the team-based learning curriculum in Kansas City. An online questionnaire issued by the University of Kansas School of Medicine assessed learner satisfaction. A voluntary multiple-choice examination taken by both Kansas City and Wichita students months after clerkship completion assessed knowledge retention.

RESULTS:

The post–team-based learning Kansas City cohort scored a mean of 78.6 (95% CI 77.8–79.4) on the National Board of Medical Examiners obstetrics and gynecology subject examination compared with the pre–team-based learning Kansas City cohort scoring a mean of 74.6 (95% CI 73.6–75.6, P<.001). Student surveys did not show significant differences in satisfaction between pre–team- and post–team-based learning cohorts in Kansas City. There was no significant difference in knowledge retention scores between Kansas City and Wichita cohorts.

DISCUSSION:

We found significant improvement in National Board of Medical Examiners subject examination scores, which is likely the result of multiple curriculum changes, including the shift from didactic sessions to the active learning strategy of team-based learning. Team-based learning has provided a beneficial and stimulating learning experience for students.
An Interactive Holographic Curriculum for Urogynecologic Surgery
Authors: Siff Lauren N. , Mehta Neil
Published: September 2018

BACKGROUND:

Urogynecologic surgery, transvaginal pelvic floor surgery in particular, requires learning by feel and high-volume pattern recognition. In the era of limited duty hours and case numbers, we sought to develop a curriculum, one that can be self-guided, to help trainees develop a spatial understanding of the relationships of pelvic floor musculature, ligamentous supports, and surrounding neurovasculature outside of the operating room.

INSTRUMENT:

We created and piloted an innovative interactive holographic using an augmented reality headset to teach surgical anatomy, procedural steps, recognition, and management of the uterosacral ligament suspension and sacrospinous ligament fixation, the two most common native tissue vaginal prolapse repairs.

EXPERIENCE:

Our curriculum was independently trialed by obstetrics and gynecology residents and subspecialty fellows and was widely accepted by trainees, postgraduate levels 1–6. As compared with usual self-study, 88% ranked the modules as “much” or “very much better” and 81% would be “likely” or “very likely” to use mixed reality smartglasses to prepare for surgery.

CONCLUSION:

This interactive holographic curriculum is a novel technique to teach complex pelvic floor anatomy, key steps, and management of complications of the uterosacral ligament suspension and sacrospinous ligament fixation. It is widely accepted by obstetrics and gynecology residents and gynecologic subspecialty fellows.
Pregnancy and Naltrexone Pharmacotherapy
Authors: Jones Cresta W. , Terplan Mishka
Published: September 2018

A 25-year-old woman, gravida 3 para 2 at 12 weeks of gestation, with two prior cesarean deliveries, presents for prenatal care. She is in treatment for opioid use disorder on extended-release naltrexone injection, with a history of opioid overdose, relapse, and poor treatment adherence on methadone and buprenorphine. She asks, “Is it safe for my baby if I continue on this medication? How will you manage my postoperative pain?”
Institutional Responses to Harassment and Discrimination in Obstetrics and Gynecology
Authors: Eichelberger Kacey Y. , Chescheir Nancy C. , Riley Laura E.
Published: September 2018

Institutional harassment and discrimination are prevalent in the field of medicine and are detrimental to the well-being of individuals, teams, and the work environment. The familiar framework of an obstetric safety bundle is used here to propose 11 practical steps a health care team or institution may take to prepare for and respond to workplace harassment and discrimination in a systematic fashion.
Bias in Obstetrician–Gynecologists' Workplaces
Authors: Chescheir Nancy C. , Benner Rebecca S.
Published: September 2018

Obstetrician–gynecologists (ob-gyns) face similar types of biases in the workplace as any people in society. In this first of three articles exploring this issue, we present the stories from ob-gyns who describe their experiences dealing with these biases. These stories serve to personalize the issue and to encourage us to personally face bias in the workplace to build our own resilience and strength, to support those who are personally attacked or diminished, and to develop workplace cultures that are inclusive, diverse, and strong.
Prenatal Treatment and Outcomes of Women With Opioid Use Disorder
Authors: Brogly Susan B. , Saia Kelley E. , Werler Martha M. , Regan Emily , Hernández-Díaz Sonia
Published: September 2018

OBJECTIVE:

To describe the characteristics, treatment, and outcomes of pregnant women with opioid use disorder.

METHODS:

Women attending an obstetric and addiction recovery clinic in Boston from 2015 to 2016 were enrolled in a prospective cohort study and followed through delivery (N=113). Buprenorphine or methadone was initiated clinically. The Addiction Severity Index was administered at enrollment. Prenatal and delivery data were systematically abstracted from medical charts.

RESULTS:

Most women in the cohort were non-Hispanic white (80.5%) with a mean age of 28 years. Few women were married (8.9%). More than half of the cohort had been incarcerated, 29.2% had current legal involvement, and 15.0% generally had unstable housing. A majority (70.8%) were infected with hepatitis C and histories of sexual (56.6%) and physical (65.5%) abuse were prevalent. Regular substance used included heroin (92.0%), injection heroin (83.2%), other opioids (69.0%), marijuana (73.5%), alcohol (56.6%), and cocaine (62.8%). Fifty-nine women (52.2%) were treated initially with prenatal buprenorphine and 54 (47.8%) with methadone; 49.6% also were taking concomitant psychotropic medications. Employment (0.766±0.289) and psychologic (0.375±0.187) Addiction Severity Index scores were the highest, indicating the most severe problems in these areas. Opioid use relapse did not differ by treatment (44.7% overall). Thirteen (22.5%) of 59 women treated with buprenorphine transitioned to methadone mainly because of positive opioid screens. Overall, 23.0% (n=26) of the cohort discontinued clinical care. The number of pregnancy losses was small (three therapeutic abortions, four miscarriages, one stillbirth), with an overall live birth rate of 90.8% (95% CI 82.7–95.9).

CONCLUSION:

These data on the social circumstances, substance use, treatment, and treatment outcomes of pregnant women with opioid use disorder may help clinicians to understand and treat this clinically complex population.
What Is New in Endometriosis?
Authors: Stovall Dale W.
Published: September 2018

This month we focus on current research in endometriosis. Dr. Stovall discusses four recent publications, which are concluded with a “bottom-line” that is the take-home message. A complete reference for each can be found in Box 1 on this page along with direct links to the abstracts.
Recent progress in systemic sclerosis-interstitial lung disease
Authors: Castelino Flavia V. , Dellaripa Paul F.
Published: September 2018

Purpose of review

Systemic sclerosis is a systemic autoimmune disorder wherein interstitial lung disease (ILD) is the major source or morbidity and mortality. Research into mechanisms of fibrosis and its intersection with autoimmunity, specifically lung fibrosis, has accelerated and been applied to autoimmune disorders such as scleroderma. This review highlights important emerging insights and treatment trials.

Recent findings

The important elements of this review focus on the challenges faced in identifying patients not only who develop lung disease but who are at a higher risk for progression given the heterogeneous natural history of ILD in scleroderma. Risk assessment scoring models using radiographic and physiologic parameters are highlighted and recent and ongoing clinical trials in scleroderma ILD are discussed.

The implications of much of this ongoing work is a potential paradigm shift in our ability to identify those patients at risk for progression, and to offer novel therapies that can limit the progression of inflammatory and fibrotic lung disease in this challenging group of patients.
Gastrointestinal involvement in systemic sclerosis: diagnosis and management
Authors: McMahan Zsuzsanna H. , Hummers Laura K.
Published: September 2018

Purpose of review

This review provides important updates in systemic sclerosis (SSc)-related gastrointestinal disease, with a particular focus on the diagnosis and management of dysmotility.

Recent findings

In the past 2 years, several studies were published that present interesting diagnostic insights into SSc and gastrointestinal dysmotility. Studies focusing on new therapies and the novel application of existing therapies, both in SSc and non-SSc-associated gastrointestinal dysmotility syndromes, demonstrate progress in the management of these challenging complications.

SSc gastrointestinal disease is heterogeneous in its clinical presentation, which presents a challenge in diagnosis and management. Objective studies may help to identify patterns of gastrointestinal dysmotility and more specifically target therapy. A variety of drugs are now available or are under study in the management of gastrointestinal dysmotility, such as prucalopride, intravenous immunoglobulin, pyridostigmine, linaclotide, relamorelin, and others. These drugs may improve symptoms and quality of life in SSc gastrointestinal patients. Combination therapies are also under study. Electroacupuncture, dietary intervention (e.g. medical nutrition therapy, low FODmap diet), and medical cannibus may also play a role in alleviating patient symptoms; however, more data are needed to define the role of these interventions in SSc.
Peculiar clinicopathological features of immune-mediated necrotizing myopathies
Authors: Allenbach Yves , Benveniste Olivier
Published: September 2018

Purpose of review

In the past decade, immune-mediated necrotizing myopathies have emerged as a separate entity in the heterogenous group of autoimmune myopathies. This group is characterized by clinical manifestations restricted to the muscle tissue, and until recently, the definition was based on muscular pathological features.

Recent findings

It was shown that they are the most severe autoimmune myopathies in term of muscle damages. They have been associated with two myositis-specific antibodies: either anti-signal recognition particle (anti-SRP) or anti-hydroxy-3-methylglutaryl-CoA reductase (anti-HMGCR) antibodies. These two antibodies are now considered as immune-mediated necrotizing myopathy (IMNM) diagnostic criteria. Each antibody delineates a homogenous subgroup of IMNM patients in terms of severity and IMNM without myositis-specific antibodies have a high risk of malignancy. In addition, pathological observations as well as in-vitro experiments suggest the pathogenic role of anti-SRP and anti-HMGCR antibodies.

IMNM are muscle-specific autoimmune diseases associated with a severe weakness and a risk poor muscle strength recovery. Anti-SRP and anti-HMGCR antibodies are specifically associated with this condition and are crucial for the diagnosis and the prognosis. The muscle biopsy remains necessary for IMNM diagnosis in absence of myositis-specific antibodies.
Pedicled Vascularized Bone Graft of the Distal Radius for Recalcitrant Nonunion of the Distal Humerus
Authors: Zaidenberg Ezequiel E. , Juarez Cesca Fernando , Pastrana Martin J. , Zaidenberg Carlos R.
Published: September 2018

Objectives:

To analyze the clinical and radiological outcomes of a series of patients treated with a pedicled vascularized bone graft (VBG) of the distal radius for the treatment of recalcitrant atrophic nonunions of the distal humerus.

Design:

Retrospective clinical study.

Setting:

University-affiliated teaching hospital.

Patients:

Fifteen patients with supracondylar humeral atrophic nonunions with at least 3 previous failed surgical interventions were included.

Intervention:

Debridement of the distal humerus nonunion through a posterior elbow approach with provisional fixation was performed. Then, a pedicled VBG was harvested from the distal radius and tunneled back into the humeral bone defect. Iliac crest was used as needed, both for the nonunion and to stabilize the radius. Finally, definitive fixation with 2 locked plates was performed.

Main Outcome Measurements:

Radiological results, complications, elbow range of motion, Mayo elbow performance score, and subjective pain were evaluated.

Results:

There were 4 male and 11 female patients, with a mean age of 51 (range, 28–73) years. The mean follow-up period was 46 (range, 37–72) months with a minimum of 3 years. Radiological consolidation was achieved in all patients. Elbow range of motion was >100 degrees in 11 patients and between 50 and 100 degrees in 4 patients. Preoperative Mayo scores were poor in all patients. At final follow-up, Mayo scores were excellent in 3, good in 9, and fair in 3 patients. The mean postoperative visual analog scale score was 1.2 (range 0–3).

Conclusions:

Pedicled VBG of the distal radius was shown to be a reliable and effective alternative for the treatment of recalcitrant atrophic nonunions of the distal humerus, when other methods have failed.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Osteonecrosis After Surgically Repaired Proximal Humerus Fractures Is a Predictor of Poor Outcomes
Authors: Belayneh Rebekah , Lott Ariana , Haglin Jack , Konda Sanjit , Zuckerman Joseph D. , Egol Kenneth A.
Published: September 2018

Objectives:

To determine the effect of osteonecrosis (ON) on the clinical and functional outcome after open reduction and internal fixation of proximal humerus fractures.

Design:

Prospective cohort study.

Setting:

Academic medical center.

Patients:

Over a 12-year period, patients were screened and identified on presentation to the emergency department or in the clinical office for inclusion in an institutional review board–approved registry. One hundred sixty-five patients with 166 proximal humerus fractures met inclusion criteria. Eight patients developed radiographic evidence of ON (4.8%).

Intervention:

Surgical repair of proximal humerus fractures.

Main Outcome Measure:

Patients were divided into 2 cohorts; 1 cohort being those diagnosed with ON and the other cohort being those who were not. All patients were prospectively followed and assessed for clinical and functional outcomes at the latest follow-up visit (mean = 22.9 months) using the Disabilities of Arm, Shoulder and Hand survey along with ranges of motion of the injured extremity.

Results:

Average postoperative forward elevation for patients with ON was worse than those without ON (P = 0.002). Additionally, there was a significant difference in Disabilities of Arm, Shoulder and Hand scores at the latest follow-up between the 2 groups (P = 0.026). There was no difference in external rotation or mean length of follow-up between the 2 groups (P > 0.05).

Conclusions:

This study demonstrates the negative effects of ON after open reduction and internal fixation of proximal humerus fractures. Those who develop ON have poorer functional and clinical outcomes as compared with patients without ON. Consequently, the development of ON can be used as a predictor of poor outcomes.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Biomechanical Evaluation of Osteoporotic Proximal Periprosthetic Femur Fractures With Proximal Bicortical Fixation and Allograft Struts
Authors: O'Connell Robert S. , Owen John R. , Hansen Erik J. , Bashir Azhar S. , Wayne Jennifer S. , Satpathy Jibanananda , Kates Stephen L.
Published: September 2018

Objectives:

To evaluate the strength of proximal bicortical fixation using a novel osteoporotic synthetic bone model of Vancouver B1 periprosthetic proximal periprosthetic femur fractures (PFFs) and to assess the influence of strut allograft augmentation with regard to allowing early assisted weight bearing. The secondary aim was to evaluate whether the strut position, either medial or anterior, influenced the strength of the construct.

Methods:

Thirty synthetic osteoporotic femurs were implanted with cemented stems. A segmental defect made distal to the stem simulated a fracture and was repaired with a stainless steel locking compression plate and 2 stainless steel proximal locking attachment plates. Specimens were then divided into 3 groups: no-strut, medial strut, and anterior strut. Cadaveric femoral struts were wired to the specimens. Cyclic axial compression simulated assisted weight bearing and was followed by loading to failure.

Results:

Medial struts required higher failure load than no-strut (P = 0.008) and more energy to failure than anterior (P = 0.018) or no-strut (P < 0.001). The higher load to failure, however, would not be advantageous in clinical practice because estimates for assisted weight bearing after fractures in average-weight patients are well below these failure loads. Furthermore, all specimens tolerated cyclical loading. All failures occurred distal to the plate originating at the last screw hole.

Conclusions:

Failure loads for all groups were above what would be expected for low-demand activities of assisted weight bearing. Therefore, proximal bicortical fixation should allow for early, assisted weight bearing without allograft strut augmentation even with lower density bone.
Developing Research to Change Policy: Design of a Multicenter Cost-Effectiveness Analysis Comparing Intramedullary Nailing to Skeletal Traction in Malawi
Authors: Lau Brian C. , Wu Hao-Hua , Mustafa Mohammed , Ibrahim John , Conway Devin , Agarwal-Harding Kiran , Shearer David W. , Chokotho Linda
Published: September 2018

Introduction:

The purpose of our study is to prospectively evaluate the cost effectiveness of intramedullary nailing compared with skeletal traction in a resource-limited setting where traction remains the most common definitive treatment.

Methods:

This multicenter, prospective multicenter investigation was conducted in Malawi at 2 central hospitals and 3 district hospitals. The project was divided into phases. In phase 1, the EuroQol-5D and SMFA were translated and validated in Chichewa. In phase 2, adult patents with OTA/AO 32 femur shaft fractures were prospectively enrolled, and a comparison of quality of life and functional status was made. In phase 3, a cost-effectiveness analysis was performed between those treated with intramedullary nail and those treated with skeletal traction.

Conclusion:

This study serves as an example of an economic study in orthopaedic surgery conducted in a resource-poor environment through academic collaboration.
Thoracic Lordosis, Especially in Males, Increases Blood Loss in Adolescent Idiopathic Scoliosis
Authors: Abousamra Oussama , Sponseller Paul D. , Lonner Baron S. , Shah Suken A. , Marks Michelle C. , Cahill Patrick J. , Pahys Joshua M. , Newton Peter O.
Published: September 2018

Background:

Intraoperative blood loss during posterior spinal fusion for adolescent idiopathic scoliosis (AIS) has been reportedly associated with multiple factors. This study aims to investigate the effect of thoracic kyphosis on blood loss in AIS spinal fusion.

Methods:

Patients with AIS who underwent posterior-only procedures for Lenke I and II type curves were identified. All included patients had intraoperative tranexamic acid. Difference in estimated blood loss per blood volume (EBL/BV) was identified between hypokyphotic curves (−), normal curves (N), and hyperkyphotic curves (+) classified based on Lenke sagittal modifier. Regression analysis was then performed with EBL/BV as dependent variable. Independent variables included radiographically measured T5-T12 kyphosis and calculated 3D T5-T12 kyphosis in addition to sex, body mass index (BMI), operative time, number of fused vertebrae, number of Ponte osteotomy levels, and main thoracic coronal curve.

Results:

In total, 837 patients were included. For female patients: EBL/BV was significantly higher for (−) (18%) compared with (N) (16%) and (+) (14%). A total of 29 female patients had T5-T12≤0 (−15 to 0 degree). EBL/BV was not significantly higher than patients with T5-T12>0 degree (18%±9% vs. 16%±11%; P=0.212). For male patients: EBL/BV was significantly higher in (−) (23%) compared with (+) (16%). In total, 14 male patients had T5-T12≤0 (−13 to 0) degree. EBL/BV was significantly higher than patients with T5-T12>0 degree (32%±18% vs. 18%±13%; P=0.015). Significant factors in predicting EBL/BV were sex, BMI, number of fused levels, and both 2D and 3D T5-T12 kyphosis. Male sex as well as every fused-level predicted an increase in EBL/BV~2%. Every 10-unit decrease in BMI predicted an increase in EBL/BV of 7%. Every 10-degree decrease in 2D or 3D T5-T12 kyphosis predicted an increase in EBL/BV~1%. The impact of the number of Ponte osteotomy levels was not significant.

Conclusions:

This study supports the role of sagittal thoracic alignment in affecting EBL/BV in AIS surgery. Male patients with severe thoracic lordosis (T5-T12≤0 degree) are the highest risk group for intraoperative bleeding. These findings are helpful in predicting the intraoperative blood loss for patients with AIS undergoing posterior spinal fusion. In addition to sex and number of fused levels, decreased thoracic kyphosis is associated with increased blood loss.

Level of Evidence:

Level III—prognostic study.
Electrophysiological Function of the Lumbar Multifidus and Erector Spinae Muscles in Elderly Patients With Chronic Low Back Pain
Authors: Sakai Yoshihito , Matsui Hiroki , Ito Sadayuki , Hida Tetsuro , Ito Kenyu , Koshimizu Hiroyuki , Harada Atsushi
Published: September 2018

Study Design:

This was a cross-sectional electrophysiological study.

Objective:

The main objective of this study was to evaluate electrophysiological activation of lumbar multifidus (LM) and erector spinae (ES) in elderly patients with chronic low back pain (CLBP) classified by LBP developmental mechanisms.

Summary of Background Data:

Local and global muscles that function independently for stabilization and moment production, respectively, are crucial for stability and mobility of the lumbar spine. There is little research conducted on the electrophysiological functions of the LM as a local muscle and the ES as a global muscle in the lumbar spine, and their interrelation in patients with CLBP.

Materials and Methods:

Elderly patients aged 65 years and above, with CLBP were assigned into motion-induced LBP (49 patients) or walking-induced LBP cohorts (57 patients), and compared with a control group (53 patients without LBP). Electrophysiological activation of the LM and ES was performed using surface electromyography (EMG) and mechanomyography (MMG) during lumbar extension and flexion. Electromechanical coupling efficiency (EMCE) was calculated using the ratio of MMG to EMG.

Results:

EMG and MMG amplitudes in the LM tended to be lower in patients with LBP than in the control group. EMG and MMG amplitudes in the ES tended to be higher in patients with LBP than in the control group. EMCE was significantly higher in both the LM and ES during lumbar extension and flexion in the motion-induced LBP cohort than in the walking-induced LBP cohort; however, ES dominance was seen in the motion-induced LBP cohort, both in lumbar extension and flexion, according to the EMCE ratio.

Conclusions:

ES dominance was seen in the motion-induced LBP cohort, both in lumbar extension and flexion, according to the EMCE ratio. Subgrouping of patients according to the induction of LBP seems to be important for CLBP treatment, and the electrophysiological assessment for the deep and superficial back muscles may be beneficial to elderly patients.
Microendoscopic Decompression for Lumbar Spinal Stenosis With Degenerative Spondylolisthesis
Authors: Minamide Akihito , Simpson Andrew K. , Okada Motohiro , Enyo Yoshio , Nakagawa Yukihiro , Iwasaki Hiroshi , Tsutsui Shunji , Takami Masanari , Nagata Keiji , Hashizume Hiroshi , Yukawa Yasutsugu , Yamada Hiroshi , Yoshida Munehito
Published: September 2018

Study Design:

This study was a retrospective subgroup analysis of prospective cohort data.

Objective:

The main objectives of this study were to develop a classification of degenerative spondylolisthesis (DS) and concurrent lumbar spinal stenosis (LSS) based on pathologic stage, and to determine how these subtypes of DS affect outcomes for minimally invasive (MIS) decompression

Summary of Background Data:

DS with LSS is a common clinical scenario, yet there is no consensus on optimal treatment. Natural history of DS is described as early degenerative damage, followed by instability, and eventual restabilization via spondylotic changes. MIS decompression surgery has become increasingly popular, but the effect of DS subtypes on clinical outcomes after MIS decompression is unknown.

Patients and Methods:

From 2008 to 2013, all patients who underwent microendoscopic laminotomy for single-level LSS with DS were included. In total, 218 patients (91 male, 127 female individuals) were reviewed. DS pathologic staging was defined as early, advanced, or end stage, based on percent slippage (10% slippage), degree of dynamic instability (3 mm), and disc height. The following variables were evaluated preoperatively and >2 years postoperatively and compared among groups: Japanese Orthopaedic Association (JOA) score, JOA recovery rate, and Visual Analog Scale low back pain.

Results:

In total, 173 patients were included in final analysis. Final follow-up period was 2.3 years. Average JOA recovery rate was 63.8%. There were no significant differences in JOA recovery and Visual Analog Scale among 3 DS stages (P>0.05). In total, 9.8% of patients required additional spine surgery, with 5% requiring subsequent fusion. All patients who required subsequent fusion were in the advanced stage DS group.

Conclusions:

Microendoscopic decompression is an effective treatment for patients with DS and concurrent LSS, with only 5% of patients requiring subsequent fusion at over 2-year follow-up, and another 5% requiring revision or adjacent segment decompression. The advanced stage DS group, indicating a >10% anterolisthesis and/or >3 mm of dynamic instability, was more likely to require additional surgery.
Wine consumption and colorectal cancer risk: a meta-analysis of observational studies
Authors: Xu Weisong , Fan Hui , Han Zhijuan , Liu Yufeng , Wang Yiping , Ge Zhenming
Published: September 2018

There were inconsistent results with respect to the correlation between consumption of wine and the development of colorectal cancer (CRC). We carried out a meta-analysis to investigate this issue. We included observational studies on the aforementioned relationship according to a literature search of Embase and Pubmed from inception till 28 February 2017. The summary relative risk (SRR) and 95% confidence intervals (CI) were calculated using a random-effects model. A total of eight case–control and nine cohort studies were identified, involving 12 110 CRC cases. The study showed that wine drinking was not associated with any greater risk for CRC (SRR=0.99, 95% CI: 0.89–1.10; P
heterogeneity<0.001) compared with nondrinkers. The subgroup analyses indicated that null associations were observed in men and women for colon and rectal cancer. Neither light to moderate (<2 drinks/day; SRR=0.93, 95% CI: 0.80–1.08, I
2
=69.2%) nor heavy (≥2 drinks/day; SRR=1.00, 95% CI: 0.86–1.16, I
2
=39.9%) consumption of wine was associated statistically with CRC risk. This meta-analysis suggests that any wine consumption was not associated with the risk of CRC. Null associations were shown in men and women for colon and rectal cancer.
Uptake of breast and cervical cancer screening in four Gulf Cooperation Council countries
Authors: So Vivian H.T. , Channon Andrew A. , Ali Mohamed M. , Merdad Leena , Al Sabahi Sultana , Al Suwaidi Huda , Al Ajeel Abdullah , Osman Nabil , Khoja Tawfik A.M.
Published: September 2018

In Gulf Cooperation Council States, there is limited information on national levels of mammography and Pap smear screening uptake. The aim of this study is to provide a baseline for national estimates for mammography and Pap smear screening and to explore associations between screening uptake and socioeconomic factors. The nationally representative World Health Survey Plus, implemented in 2008/2009 in Kuwait, Oman, Saudi Arabia and United Arab Emirates (UAE), was used. Uptake of mammography and Pap smear was estimated for each country, followed by the examination of associations between screening and a range of socioeconomic variables. Levels of breast and cervical cancer screening uptake within recommended intervals in all countries were low. The percentages of women aged 40–75 years who had a mammogram were 4.9% in Saudi Arabia, 8.9% in Oman, 13.9% in the UAE and 14.6% in Kuwait. The percentages of women aged 25–49 years who had a Pap smear test were 7.6% in Saudi Arabia, 10.6% in Oman, 17.7% in Kuwait and 28.0% in the UAE. Marital status, wealth, education, nationality and place of residence are associated with screening uptake, with the lower educated, poor and unmarried having the lowest percentages of uptake. The four Gulf Cooperation Council countries need to set clear targets and increase the proportion of women who have regular breast and cervical cancer screening examinations. Health education campaigns and awareness programmes that are fully integrated into the health system are required to ensure women use services that are available to prevent breast and cervical cancers.
Use of gene expression profile testing as a prognostic tool in early-stage cutaneous melanoma – compelling but not ready for primetime
Authors: Christensen Luisa , Scott Jeffrey , Bordeaux Jeremy
Published: September 2018

Advances in the field of molecular genetics have led to the development of multiple tests capable of identifying genetic changes within cutaneous melanoma. Although the majority of these tests are currently used for diagnostic purposes, their potential use as prognostic tools is rapidly emerging. A new 31-gene expression profile test has been developed that promises to accurately predict metastatic risk in patients with early-stage cutaneous melanoma. Although current data are promising, many questions remain in terms of its potential effects in patient care. Thus, before this test is used routinely in clinical practice, we recommend that it first be performed as part of current adjuvant treatment trials as a potential predictive marker or other high-quality studies investigating relevant outcomes resulting from changes in the clinical management of patients on the basis of the gene expression profile test results.
Nuclear Medicine Therapy With 223Radium-dichloride for Osseous Metastases in Prostate Carcinoma
Authors: Wale Daniel J. , Viglianti Benjamin L. , Gross Milton D. , Ferretti Alice , Rubello Domenico , Wong Ka Kit
Published: September 2018

Painful osseous metastasis resulting from castration-resistant prostate carcinoma is a common clinical problem. Historically, nuclear medicine offered several palliative beta-emitting radiopharmaceuticals targeting the skeleton with the goal of decreasing pain. However, these have largely been replaced by the alpha-emitting agent 223radium (Ra). 223Ra received Food and Drug Administration approval in 2013 for the treatment of metastatic castration-resistant prostate cancer with symptomatic bone metastases without visceral metastases. 223Ra offers an improved therapeutic profile due to its alpha-particle emissions resulting in a relatively higher linear energy transfer and lower particle range compared with beta-emitters. 223Ra also has demonstrated to increase overall survival in patients and to delay adverse skeletal events. Running a successful clinical nuclear therapy program with 223Ra requires a multidisciplinary team approach and this article suggests an implementation strategy from the authors’ institution. Potential new nuclear radiopharmaceuticals still under investigation offering the future possibility of radioligand therapy are also discussed briefly.
Langerhans Cell Histiocytoma: A Benign Histiocytic Neoplasm of Diverse Lines of Terminal Differentiation
Authors: Dupeux Margot , Boccara Olivia , Frassati-Biaggi Annonciade , Hélias-Rodzewicz Zofia , Leclerc-Mercier Stéphanie , Bodemer Christine , Molina Thierry Jo , Emile Jean-François , Fraitag Sylvie
Published: September 2018

Langerhans cell (LC) histiocytoma is a neonatal tumor that often consists of a single, ulcerated nodule. Systemic involvement is rare, and LC histiocytoma is considered to be a variant of congenital, self-healing LC histiocytosis (also referred to as Hashimoto–Pritzker disease). In view of its low prevalence, LC histiocytoma is not always diagnosed in a clinical examination and requires histological confirmation. Furthermore, the histological and molecular features of LC histiocytoma have not been well characterized. Here, we report on 6 cases of this rare disease and review the corresponding literature. LC histiocytoma differs from classical self-healing LC histiocytosis with regard to the pathological features; we found that LC histiocytoma was associated with massive infiltration by histiocytes of various sizes and shapes (although often large) throughout the dermis and the superficial subcutis. Epidermotropism was rare, mitotic figures were not inconspicuous, and necrotic or calcified areas were often present. Immunohistochemical assessment revealed a mixture of different types of histiocytes (with CD1a+ CD207+, CD1a+ CD207−, and CD1a− CD207− CD163+ cells). Genetic testing was performed in 5 cases; it revealed a BRAF mutation (p.V600E and p.485_490delinsF) in 2 cases, a HRAS mutation (p.T58I) in 1 case, a combination of 2 PTEN mutations in another case (p.I224M and p. R234W), and no mutations in the fifth case. All the lesions regressed spontaneously, and none recurred during follow-up.
Utility of TERT Promoter Mutations for Cutaneous Primary Melanoma Diagnosis
Authors: Thomas Nancy E. , Edmiston Sharon N. , Tsai Yihsuan S. , Parker Joel S. , Googe Paul B. , Busam Klaus J. , Scott Glynis A. , Zedek Daniel C. , Parrish Eloise A. , Hao Honglin , Slater Nathaniel A. , Pearlstein Michelle V. , Frank Jill S. , Kuan Pei Fen , Ollila David W. , Conway Kathleen
Published: September 2018

Telomerase reverse transcriptase (TERT) promoter mutations are commonly found in malignant melanomas but rare in melanocytic nevi. To assess its potential diagnostic utility for the distinction of melanoma from nevus, we determined the TERT promoter mutation status of 86 primary melanomas, 72 melanocytic nevi, and 40 diagnostically problematic melanocytic proliferations. Of the 86 melanomas, 67 (77.9%) were TERT-positive, defined as harboring a hotspot TERT promoter mutation at positions -124C>T, -124_125CC>TT, -138_139CC>TT, or -146C>T. Of the 72 nevi, only 1 (1.4%) was TERT-positive. Of the 40 diagnostically uncertain melanocytic proliferations, 2 (5.0%) were TERT-positive. TERT positivity as a test for melanoma versus nevus had an accuracy of 87.3% [95% confidence interval (CI), 81.1–92.1], a sensitivity of 77.9% (95% CI, 68.9–85.4), a specificity of 98.6% (95% CI, 95.8–100), a positive predictive value of 98.5% (95% CI, 95.6–100), and a negative predictive value of 78.9% (95% CI, 72.6–85.4). Our results indicate that hotspot TERT promoter mutation status may be a useful ancillary parameter for the diagnosis of melanoma. In particular, the high specificity of these mutations for melanoma indicates the presence of a TERT promoter mutation in a melanocytic neoplasm associated with diagnostic controversy, or uncertainty should increase concern for a melanoma.
Randomized Controlled Trial of Preoperative Topical Decolonization to Reduce Surgical Site Infection for Staphylococcus aureus Nasal Swab–Negative Mohs Micrographic Surgery Patients
Authors: Smith Harvey , Borchard Kate , Cherian Paul , Tai Yee , Vinciullo Carl
Published: September 2018

BACKGROUND

Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus).

OBJECTIVE

The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus.

METHODS AND MATERIALS

The authors performed a randomized controlled trial of S. aureus nasal swab–negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention.

RESULTS

In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29).

CONCLUSION

Topical decolonization reduces SSI in nasal swab–negative Mohs surgery patients.
Nuclear and Radiological Source Security Culture Assessment of Radioactive Material Users at a University
Authors: Rane Shraddha , Harris Jason T. , Foss Eric K. , Sheffield Courtney
Published: September 2018

Securing radioactive sources has become increasingly important given the rising threat of radiological terrorism. While radiation safety has long been established in most applicable industries, the importance of nuclear and radiological source security has lagged behind in nonnuclear material specific industries, such as academic institutions and medical facilities. To evaluate the attitudes and behaviors regarding nuclear security culture, an assessment of nuclear and radiological material practices was developed and conducted on 73 radioactive material users at a university. The survey portion of the assessment was comprised of a series of questions segregated into four categories: policy, enforcement, leadership, and behavior. Nuclear security awareness questions formed a subset of the questionnaire. Users were classified by their radioactive material experience and work classification: student, faculty, or other staff. Of the users surveyed, 9% were also interviewed face-to-face to further expand on their views of nuclear security culture. Results of the assessment showed that students from the work classification group as well as the cohort of radioactive material users with 2–5 y of experience possessed a greater degree of awareness towards nuclear security compared to faculty and other more experienced radioactive material users. Relative to students and faculty, other staff from the work classification group faced some difficulty judging the enforcement of policies, adequacy of inspection, and job performance review related to nuclear security. The response from all three groups emphasized the need to enhance threat-response preparedness and greater communication among stakeholders.
The Impact of Military Women in Health Physics
Authors: VanHorne-Sealy Jama
Published: September 2018

Some of the finest women in the U.S. military serve with distinction in the health physics field. These talented women consistently rise above the norm and lead the way in science and in military service. There are over 200 military health or medical physicists, 35 (17%) of whom are female, supporting over one million Department of Defense personnel. They serve in the U.S. Air Force, Army, and Navy. Health physics and medical physics career fields in the military provide a unique opportunity for women to excel, and they have made monumental contributions to the medical community, to the military, and to the nation. This paper highlights just some of the impressive accomplishments of female military health and medical physicists in the service of their nation.