bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Appropriate Venous Thromboembolism Prophylaxis in Patients With Orthopaedic Trauma With Symptom-Driven Vascular and Radiographic Studies
Authors: Domes Christopher M. , Schleyer Anneliese M. , McQueen James M. , Pergamit Ronald F. , Beingessner Daphne M.
Published: July 2017

Objective:

To evaluate venous thromboembolism (VTE) prophylaxis adherence and effectiveness in orthopaedic trauma patients who had vascular or radiographic studies showing deep vein thromboses or pulmonary emboli.

Design:

Retrospective review.

Setting:

A level I trauma center that independently services a 5-state region.

Patients:

Four hundred seventy-six patients with orthopaedic trauma who underwent operative treatments for orthopaedic injuries and had symptom-driven diagnostic VTE studies.

Intervention:

The medical records of patients treated surgically between July 2010 and March 2013 were interrogated using a technical tool that electronically captures thrombotic event data from vascular and radiologic imaging studies by natural language processing.

Main Outcome Measurements:

Patients were evaluated for hospital guideline–directed VTE prophylaxis adherence with mechanical or chemical prophylaxis. Patient demographics, associated injuries, mechanism of injury, and symptoms that led to imaging for a VTE were also assessed.

Results:

Of the 476 orthopaedic patients who met inclusion criteria, 100 (mean age 52.3 median 52, SD 18.3, 70% men) had positive VTE studies. Three hundred seventy-six (age 47.3, SD 17.3, 69% men) had negative VTE studies. Of the 100 patients with VTE, 63 deep vein thromboses, and 49 pulmonary emboli were found. Eight-five percent of all patients met hospital guideline–VTE prophylaxis standards.

Conclusion:

The study population had better than previously reported VTE prophylaxis adherence, however, patients still developed VTEs.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Delayed treatment of a posterior cruciate ligament tibial insertion avulsion fracture in a child with open physis: a case report with a 4-year follow-up
Authors: Guimarães Tales M. , Helito Paulo V.P. , Angelini Fabio J. , Demange Marco K. , Pécora José R. , Helito Camilo P.
Published: July 2017

Posterior cruciate ligament avulsion fracture from its tibial insertion is a rare pathology in children. It is usually caused by high-energy traumas and its diagnosis is not always easy. Late diagnosis leads to late treatment, which can result in suboptimal results. We present a case of a 13-year-old boy hit by a car, who had a delay in diagnosis and treatment because of severe head trauma. The patient was treated 4 months after the trauma with open reduction and internal fixation of the avulsion fracture. After 4 years of follow-up, he has no complaints and has achieved good functional outcome.
Lengthening With Monolateral External Fixation Versus Magnetically Motorized Intramedullary Nail in Congenital Femoral Deficiency
Authors: Szymczuk Vivian L. , Hammouda Ahmed I. , Gesheff Martin G. , Standard Shawn C. , Herzenberg John E.
Published: July 2017

Background:

Limb lengthening for congenital femoral deficiency (CFD) with or without fibular hemimelia can be performed with both external and internal devices. The purpose of this study is to compare clinical outcomes of femoral lengthening utilizing monolateral external fixation versus a magnetically motorized intramedullary nail in patients with CFD with or without fibular hemimelia.

Methods:

This retrospective review included 62 patients with femoral lengthening, 32 patients had monolateral external fixation (group A), 30 patients had internal lengthening nail (group B). Mean age in years was 9.4±3.8 and 15.4±4.9 for groups A and B, respectively. Mean follow-up in years was 4.47±2.7 and 1.86±0.7 years for groups A and B, respectively.

Results:

Mean lengthening achieved was 5.6±1.7 and 4.8±1.4 cm for group A and group B, respectively (P=0.052). Mean distraction index was 0.7±0.2 mm/d for group A and 0.7±0.2 mm/d for the group B (P=0.99). Mean consolidation index for group A was 29.3±12.7 and 34.8±11.2 d/cm for group B (P=0.08). Mean arc of motion before surgery and at final follow-up were similar between groups (P=0.35). Group A had significantly less range of motion at the end of distraction (P=0.0007) and at consolidation (P<0.0001). Both groups had similar rates of obstacles and complications. A significant difference between groups was found in the total problems (P<0.001) specifically with pin site/superficial infection (P<0.0001).

Conclusions:

The intramedullary nail had superior range of motion during the lengthening phase and at consolidation and an overall lower problem complication rate, while maintaining similar distraction and healing indices to monolateral external fixation. Internal lengthening nails represent a significant advance in technology for CFD lengthening.

Level of Evidence:

Level IV—therapeutic.
The Lumbar Pelvic Angle, the Lumbar Component of the T1 Pelvic Angle, Correlates With HRQOL, PI-LL Mismatch, and it Predicts Global Alignment
Authors: Protopsaltis Themistocles S. , Lafage Renaud , Smith Justin S. , Passias Peter G. , Shaffrey Christopher I. , Kim Han Jo , Mundis Gregory M. , Ames Christopher P. , Burton Douglas C. , Bess Shay , Klineberg Eric , Hart Robert A. , Schwab Frank J. , Lafage Virginie
Published: July 2017

Study Design.

Prospective multicenter analysis of adult spinal deformity (ASD) patients.

Objective.

The aim of this study was to introduce the lumbar pelvic angle (LPA), a novel parameter of spinopelvic alignment.

Summary of Background Data.

The T1 pelvic angle (TPA), a measure of global spinopelvic alignment, correlates with health-related quality of life (HRQOL), but it may not be measureable on all intraoperative x-rays. In patients with previous interbody fusion at L5-S1, the plane of the S1 endplate can be blurred, creating error in pelvic incidence and lumbar lordosis (PI-LL) measure. The LPA is more readily measured on intraoperative imaging than the TPA.

Methods.

ASD patients were included with either coronal Cobb angle >20°, sagittal vertical axis (SVA) >5 cm, thoracic kyphosis >60°, or pelvic tilt (PT) >25°. Measures of disability included Oswestry Disability Index (ODI), Scoliosis Research Society (SRS), and Short Form (SF)-36. Baseline and 2-year follow-up radiographic and HRQOL outcomes were evaluated. Linear regressions compared LPA with radiographic parameters and HRQOL.

Results.

A total of 852 ASD patients (407 operative) were enrolled (mean age 53.7). Baseline LPA correlated with PI-LL (r = 0.79), PT (r = 0.78), TPA (r = 0.82), and SVA (r = 0.61) (all P < 0.001). PI-LL, LPA, and TPA correlated with ODI (r = 0.42/0.29/0.45), SF-36 physical component score (−0.43/−0.28/−0.45) SRS (−0.354/−0.23/−0.37) with all P < 0.001. At 2 years’ follow-up, LPA correlated with PI-LL (r = 0.77), PT (r = 0.78), TPA (r = 0.83), and SVA (r = 0.57) (all P < 0.001). Categorizing patients by increasing LPA (<7°; 7°–15°; >15°) revealed progressive increases in all HRQOL, PI-LL (−3.2°/12.7°/32.4°), and TPA (9.7°/20.1°/34.6°) with all P < 0.001. Moderate disability (ODI = 40) corresponded to LPA 10.1°, PI-LL 12.6°, and TPA 20.6°. Mild disability (ODI = 20) corresponded to LPA 7.2°, PI-LL 4.2°, and TPA 14.7°.

Conclusion.

LPA correlates with TPA, PI-LL, and HRQOL in ASD patients. LPA can be used as an intraoperative tool to gauge correction with a target LPA of <7.2°. LPA predicts global alignment, as it correlates with baseline and 2-year TPA and SVA. Along with the cervical-thoracic pelvic angle and TPA, LPA completes the fan of spinopelvic alignment.

Level of Evidence: 3
Management of Bronchopleural Fistula Complicated by Skin Wound Necrosis after Thoracomyoplasty
Authors: Divisi Duilio , Barone Mirko , Zaccagna Gino , Di Francescantonio William , Crisci Roberto
Published: July 2017

Skin necrosis is a rare complication after thoracomyoplasty and usually needs conservative treatment. We described positive findings with surgical approach. A 54-year-old man showed bronchopleural fistula after undergoing right pneumonectomy for lung cancer, treated with thoracomyoplasty. On the 20th postoperative day, a skin wound lesion was noted, whose deterioration required a skin flap transposition. Patient was discharged from hospital on the 7th postoperative day and did not show relapse at the 7th year follow-up. Surgery can be the most viable alternative to medical treatments in the management of a chest wall cutaneous complication even in high-risk patients.
Comparison of Patient-reported Outcomes after Implant Versus Autologous Tissue Breast Reconstruction Using the BREAST-Q
Authors: Pirro Ortensia , Mestak Ondrej , Vindigni Vincenzo , Sukop Andrej , Hromadkova Veronika , Nguyenova Alena , Vitova Lenka , Bassetto Franco
Published: July 2017

Background:

The demand for reconstructive breast procedures of various types has accelerated in recent years. Coupled with increased patient expectations, it has fostered the development of oncoplastic and reconstructive techniques in breast surgery. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life are the most significant outcome variables when evaluating surgical success. The aim of this study was to evaluate the quality of life after implant breast reconstruction compared with autologous breast reconstruction.

Materials and Methods:

A cross-sectional study design was used. A total of 65 women who had completed postmastectomy implant-based or autologous reconstruction in the participating center were asked to complete the BREAST-Q (Reconstruction Module).

Results:

Data analysis demonstrated that women with autologous breast reconstruction were significantly more satisfied with their breasts (P = 0.0003) and with the overall outcome (P = 0.0001) compared with women with implant breast reconstruction. All other BREAST-Q parameters that were considered and observed were not significantly different between the 2 patient groups.

Conclusions:

Through statistical analysis, our results showed that patients who underwent autologous tissue reconstruction had better satisfaction with the reconstructed breast and the outcome, while both techniques appear to equally improve psychosocial well-being, sexual well-being, and chest satisfaction.
Development of a Universal Nutritional Screening Platform for Plastic Surgery Patients
Authors: Roy Melissa , Hunter Paul , Perry Julie A. , Cross Karen M.
Published: July 2017

Background:

Plastic surgeons routinely see patients with complex or chronic wounds of all etiology. In a previous study, we found that up to 1 in 4 of these patients is at risk for malnutrition, which may be influencing their ability to heal. The goal of this study was to develop and validate a universal screening protocol that would be fast and accurate and allow for effective intervention and optimization of nutrition before plastic surgery.

Methods:

To accomplish these goals, we adopted a 2-part screening algorithm using the Canadian Nutritional Screening Tool (CNST) to triage patients in our outpatient clinics and then further screened those identified as being at risk using the Subjective Global Assessment (SGA) tool and blood work.

Results:

We screened 111 patients with diagnoses related to breast cancer (n = 10; 9.01%), elective surgery (n = 38; 34.23%), emergency surgery (n = 8; 7.21%), fractures (n = 15; 13.51%), and wounds (n = 40; 36.04%). Of the screened subjects, 15.32% (n = 17) were found to be at nutritional risk using the CNST, and 13 were confirmed to be moderately or severely malnourished using the SGA. Importantly, there were no positive correlations between nutritional status and smoking, diabetes, body mass index, or age, indicating that a universal screening protocol is needed to effectively screen a diverse plastic surgery population for malnutrition.

Conclusions:

Screening patients with both the CNST and the SGA is an effective way to identify patients before surgery to improve outcomes.
Patient-Reported Outcomes Are Better after Oncoplastic Breast Conservation than after Mastectomy and Autologous Reconstruction
Authors: Chand Natalie D. , Browne Victoria , Paramanathan Nirmala , Peiris Lashan J. , Laws Siobhan A. , Rainsbury Richard M.
Published: July 2017

Background:

Oncoplastic breast-conserving surgery (OBCS) avoids mastectomy for larger tumors, but patient-reported outcomes are unknown.

Methods:

The BREAST-Q questionnaire was distributed to 333 women following therapeutic mammaplasty or latissimus dorsi (LD) miniflap since 1991 [tumor diameter, 32.5 (5–100) mm). QScore software generated scores/100 for breast appearance, physical, emotional, and sexual wellbeing. Outcomes following therapeutic mammaplasty and LD miniflap were compared and qualitative data analyzed to identify common themes relating to satisfaction.

Results:

One hundred fifty (45%) women responded [mammaplasty versus LD miniflap, 52% versus 42%; age, 52 (30–83) years; follow-up, 84 (4–281) months). Eighty-nine percent rated OBCS better than mastectomy, > 80% recommending it to others. Mean outcome scores for breast appearance, physical, and emotional wellbeing were high and persisted beyond 15 years. Therapeutic mammaplasty patients were significantly more satisfied than those undergoing LD miniflap with the shape (P < 0.05), the size (P < 0.005), and the natural feel of the treated breast (P = 0.01). They demonstrated similar scores for physical and emotional wellbeing and a lower score for sexual wellbeing than LD miniflap patients. More LD miniflap patients reported back/shoulder symptoms and were more likely to report upper back pain (P < 0.05), but very few (< 5%) were concerned about donor-site appearance. Overall satisfaction with surgical outcomes was high in both OBCS groups (82% “excellent/very good”) but greatest after therapeutic mammaplasty (P < 0.005).

Conclusions:

Patients report long-lasting satisfaction after OBCS and outcomes that compare very favorably with those reported following mastectomy and immediate autologous reconstruction.
Fetal Anatomic Imaging Between 11 and 14 Weeks Gestation
Authors: LIFF INGRID , BROMLEY BRYANN
Published: July 2017

Fetal imaging between 11 and 14 weeks is a standard component of prenatal risk assessment for aneuploidy. Evaluating the fetus during this gestational age window provides the opportunity to reliably examine anatomic structures. Using a defined imaging protocol, approximately 50% of major abnormalities can be detected. Some abnormalities should almost always be detected, some may be detected on occasion and others are not currently detectable. Imagers must be familiar with embryologic patterns of development and natural history of anomalies. Patients must be informed of the limitations of early anatomic evaluation. Currently, early anatomic evaluation does not replace the standard second trimester evaluation.
Management of Chronic Pelvic Pain
Authors: BISHOP LAUREN A.
Published: July 2017

The management of chronic pelvic pain poses a significant challenge to both physicians and patients. Patients should be evaluated for both gynecologic and nongynecologic conditions, and >1 source may be identified. Treatment involves medical as well as surgical options, and it is important to set realistic goals with patients. Treatment may not be curative, but should improve the patient’s quality of life.
Summary of Future Developments
Authors: ZOLTON JESSICA R. , DECHERNEY ALAN
Published: July 2017

Endometriosis is a chronic disease with the potential to cause devastating clinical manifestations such as infertility and chronic pelvic disease. Current treatment is limited to surgical intervention and pharmacologic therapy targeting estrogen and progesterone to suppress ectopic endometrial tissue proliferation. Undesired side effects and contraindications to the use of hormonal medications may reduce treatment options. As the pathogenesis of endometriosis continues to be investigated, new therapies will emerge. The identification of genes involved in the development of endometriosis may allow targeted therapy to prevent or cure disease. In addition, increasing knowledge of the inflammatory pathways that promote ectopic endometrial growth will permit the development of pharmacologic agents to manipulate these signaling pathways. Utilization of selective progesterone receptor modulators, aromatase inhibitors, and modern gonadotropin-releasing hormone antagonists provide more options to manage disease when traditional treatment fails. Individualized therapeutic strategies will soon be a reality as a greater understanding of endometriosis is obtained through the investigation of genomic studies, molecular pathways, and environmental influences.
Endometriosis and Fertility Preservation
Authors: BARNETT REBECCA , BANKS NICOLE , DECHERNEY ALAN H.
Published: July 2017

Endometriosis is common, affecting 5% to 10% of reproductive age women. Nearly half of women with surgical evidence of endometriosis fail to achieve spontaneous pregnancy. Surgical treatment of endometriosis can be detrimental to ovarian reserve. In the absence of surgical intervention, ovarian reserve may still be negatively impacted over time. Fertility preservation was developed for women requiring gonadotoxic treatments. Improved methods have led to greater consideration of offering these services to women with other disease processes that threaten ovarian reserve. This chapter will present the debate regarding use of fertility preservation in management of endometriosis, and outline the need for further studies.
Update on SGLT2 Inhibitors—New Data Released at the American Diabetes Association
Authors: Lee Sara
Published: July 2017

Sodium–glucose cotransporter 2 (SGLT2) inhibitors are one of the newer classes of antiglycemic agents approved for the management of patients with type 2 diabetes mellitus. Due to their unique mechanism of action, SGLT2 inhibitors have shown to be beneficial beyond glucose control. The improvement in cardiovascular (CV) outcomes was first observed in the landmark EMPA-REG OUTCOMES study. Following these results, numerous CV outcome trials were designed to identify whether the beneficial CV and renal effects observed with empagliflozin are unique or a drug class effect. The benefit of SGLT2 inhibition was confirmed by the CANagliflozin cardioVascular Assessment Study (CANVAS) Program, presented at the American Diabetes Association 77th Scientific Sessions. With over 10,000 patients, the CANVAS Program integrated data from two large CV outcome studies. Canagliflozin achieved a 14% reduction in the composite endpoint of CV mortality, nonfatal myocardial infarction (MI), or nonfatal stroke, and a 33% reduction in the risk of hospitalization for heart failure (HF) compared with placebo. Potential renal protective effects were also observed with canagliflozin; however, an increased risk of amputation with canagliflozin was seen in both CANVAS studies. The class effect of SGLT2 inhibitors was also confirmed in new analyses of the The Comparative Effectiveness of Cardiovascular Outcomes (CVD-REAL) study, which aimed to evaluate SGLT2 inhibitors (dapagliflozin, canagliflozin, and empagliflozin) in broader patient populations with type 2 diabetes mellitus. In patients who were new to SGLT2 inhibitors, significant reductions in rates of CV death and hospitalization for HF were observed compared with any other glucose-lowering agents. SGLT2 inhibitors were also associated with lower rates in hospitalization for HF in patients with and without CV disease. In addition, substudies of the EMPA-REG OUTCOME trial further provided insight on the efficacy of empagliflozin across categories of adjusted control of blood pressure, low-density lipoprotein cholesterol, and hemoglobin A1c (HbA1c) over time.
Treatment Outcomes of Children With HIV Infection and Drug-resistant TB in Three Provinces in South Africa, 2005–2008
Authors: Hall Eric W. , Morris Sapna B. , Moore Brittany K. , Erasmus Linda , Odendaal Ronel , Menzies Heather , van der Walt Martie , Smith Sarah E.
Published: July 2017

Objective:

To describe outcomes of HIV-infected pediatric patients with drug-resistant tuberculosis (DR TB).

Methods:

Demographic, clinical and laboratory data from charts of pediatric patients treated for DR TB during 2005–2008 were collected retrospectively from 5 multi-DR TB hospitals in South Africa. Data were summarized, and Pearson χ2 test or Fisher exact test was used to assess differences in variables of interest by HIV status. A time-to-event analysis was conducted using days from start of treatment to death. Variables of interest were first assessed using the Kaplan-Meier method. Cox proportional hazard models were fit to estimate crude and adjusted hazard ratios.

Results:

Of 423 eligible participants, 398 (95%) had culture-confirmed DR TB and 238 (56%) were HIV infected. A total of 54% were underweight, 42% were male and median age was 10.7 years (interquartile range: 5.5–15.3). Of the 423 participants, 245 (58%) were successfully treated, 69 (16%) died, treatment failed in 3 (1%), 36 (9%) were lost to follow-up and 70 (17%) were still on treatment, transferred or had unknown outcomes. Time to death differed by HIV status (P = 0.008), sex (P < 0.001), year of tuberculosis diagnosis (P = 0.05) and weight status (P = 0.002). Over the 2-year risk period, the adjusted rate of death was 2-fold higher among participants with HIV compared with HIV-negative participants (adjusted hazard ratio = 2.28; 95% confidence interval: 1.11–4.68).

Conclusions:

Male, underweight and HIV-infected children with DR TB were more likely to experience death when compared with other children with DR TB within this study population.
Prevalence of Rubella Antibodies Among Children in the Democratic Republic of the Congo
Authors: Alfonso Vivian H. , Doshi Reena H. , Mukadi Patrick , Higgins Stephen G. , Hoff Nicole A. , Bwaka Ado , Mwamba Guillaume Ngoie , Okitolonda Emile , Muyembe Jean-Jacques , Gerber Sue , Rimoin Anne W.
Published: July 2017

Background:

While generally mild in children, rubella infection in early pregnancy can lead to miscarriage, fetal death or congenital rubella syndrome. Rubella vaccination is not yet available as a part of routine immunization in the Democratic Republic of the Congo (DRC), and the burden of infection is unknown.

Methods:

In collaboration with the 2013–2014 DRC Demographic and Health Survey, a serosurvey was carried out to assess population immunity to vaccine-preventable diseases. Dry blood spot samples collected from children 6–59 months of age were processed using the Dynex Technologies Multiplier FLEX chemiluminescent immunoassay platform (Dynex Technologies, Chantilly, VA).

Results:

Among the 7195 6- to 59-month-old children, 33% were positive and <1% indeterminate for rubella antibodies in weighted analyses. Seroprevalence was positively associated with age of the child and province, with seropositivity highest in Bandundu (53%) and lowest in Kasai-Oriental (20%). In multivariate analyses, serologic evidence of infection was associated with age of the mother and child, socioeconomic status and geographic location.

Conclusions:

Rubella infection is prevalent among children in the DRC, and while most seroconversion occurs in young children, a significant proportion of children remain at risk and may enter reproductive age susceptible to rubella infection. While not currently in place, implementation of a surveillance program will provide improved estimates of both rubella virus circulation and the burden of congenital rubella syndrome. Such information will play an important role in future policy decisions, vaccine delivery strategies and may provide a basis upon which the effectiveness of rubella antigen introduction may be assessed.
Predictors of the Biomechanical Effects of Customized Foot Orthoses in Adults With Flat-Arched Feet
Authors: Arnold John B. , May Thomas , Bishop Christopher
Published: July 2017

Objective:

To determine the potential presence and characteristics of biomechanical responders to customized foot orthoses during walking in adults with flat-arched feet.

Design:

Experimental, repeated-measures.

Setting:

University clinic and laboratory.

Participants:

Eighteen symptom-free adults with flat-arched feet.

Interventions:

Customized foot orthoses.

Main Outcome Measures:

In-shoe foot biomechanics were measured during walking with and without customized foot orthoses using 3D analysis. Selected kinematic and kinetic variables during baseline walking were compared between subgroups who displayed reductions in calcaneal eversion with foot orthoses to those with no change or increases.

Results:

Biomechanical responders displayed significantly greater peak calcaneal eversion (+2.2 degrees, P = 0.009). Time to peak calcaneal eversion (−11%, P = 0.006), peak dorsiflexion of the hallux (−6 degrees, P = 0.001), and medial–lateral excursion of the center of pressure during loading response were all reduced in the responder subgroup (−2 mm, P ≤ 0.001). Variables significantly different between subgroups were moderately associated with the response to foot orthoses (canonical correlation = 0.687, effect size = 0.47, P = 0.063).

Conclusions:

Individuals with increased dynamic foot pronation were more likely to show a favorable biomechanical response to customized foot orthoses, providing preliminary evidence to support the stratified use of foot orthoses to optimize their effectiveness.
Supraglottic Atomization of Surfactant in Spontaneously Breathing Lambs Receiving Continuous Positive Airway Pressure
Authors: Milesi Ilaria , Tingay David G. , Lavizzari Anna , Bianco Federico , Zannin Emanuela , Tagliabue Paolo , Mosca Fabio , Ventura Maria Luisa , Rajapaksa Anushi , Perkins Elizabeth J. , Black Don , Di Castri Marco , Sourial Magdy , Pohlmann Gerhard , Dellaca’ Raffaele L.
Published: July 2017

Objectives:

To determine the short-term tolerance, efficacy, and lung deposition of supraglottic atomized surfactant in spontaneously breathing lambs receiving continuous positive airway pressure.

Design:

Prospective, randomized animal study.

Setting:

Animal research laboratory.

Subjects:

Twenty-two preterm lambs on continuous positive airway pressure (132 ± 1 d gestational age).

Interventions:

Animals receiving continuous positive airway pressure via binasal prongs at 8 cm H2O were randomized to receive atomized surfactant at approximately 60-minute of life (atom; n = 15) or not (control; n = 7). The atom group received 200 mg/kg of poractant alfa (Curosurf; Chiesi Farmaceutici SpA, Parma, Italy) over 45 minutes via a novel atomizer located in the upper pharynx that synchronized surfactant delivery with the inspiratory phase.

Measurements and Main Results:

Arterial blood gas, regional distribution of tidal ventilation (electrical impedance tomography), and carotid blood flow were recorded every 15 minutes until 90 minutes after stabilizing on continuous positive airway pressure. Gas exchange, respiratory rate, and hemodynamic variables, including carotid blood flow, remained stable during surfactant treatment. There was a significant improvement in arterial alveolar ratio after surfactant delivery in the atom group (p < 0.05; Sidak posttests), while there was no difference in Paco
2. Electrical impedance tomography data showed a more uniform pattern of ventilation in the atom group. In the atom group, the median (interquartile range) deposition of surfactant in the lung was 32% (22–43%) of the delivered dose, with an even distribution between the right and the left lungs.

Conclusions:

In our model of spontaneously breathing lambs receiving CPAP, supraglottic atomization of Curosurf via a novel device was safe, improved oxygenation and ventilation homogeneity compared with CPAP only, and provided a relatively large lung deposition suggesting clinical utility.
Epidemiology of Noninvasive Ventilation in Pediatric Cardiac ICUs*
Authors: Romans Ryan A. , Schwartz Steven M. , Costello John M. , Chanani Nikhil K. , Prodhan Parthak , Gazit Avihu Z. , Smith Andrew H. , Cooper David S. , Alten Jeffrey , Mistry Kshitij P. , Zhang Wenying , Donohue Janet E. , Gaies Michael
Published: July 2017

Objective:

To describe the epidemiology of noninvasive ventilation therapy for patients admitted to pediatric cardiac ICUs and to assess practice variation across hospitals.

Design:

Retrospective cohort study using prospectively collected clinical registry data.

Setting:

Pediatric Cardiac Critical Care Consortium clinical registry.

Patients:

Patients admitted to cardiac ICUs at PC4 hospitals.

Interventions:

None.

Measurements and Main Results:

We analyzed all cardiac ICU encounters that included any respiratory support from October 2013 to December 2015. Noninvasive ventilation therapy included high flow nasal cannula and positive airway pressure support. We compared patient and, when relevant, perioperative characteristics of those receiving noninvasive ventilation to all others. Subgroup analysis was performed on neonates and infants undergoing major cardiovascular surgery. To examine duration of respiratory support, we created a casemix-adjustment model and calculated adjusted mean durations of total respiratory support (mechanical ventilation + noninvasive ventilation), mechanical ventilation, and noninvasive ventilation. We compared adjusted duration of support across hospitals. The cohort included 8,940 encounters from 15 hospitals: 3,950 (44%) received noninvasive ventilation and 72% were neonates and infants. Medical encounters were more likely to include noninvasive ventilation than surgical. In surgical neonates and infants, 2,032 (55%) received postoperative noninvasive ventilation. Neonates, extracardiac anomalies, single ventricle, procedure complexity, preoperative respiratory support, mechanical ventilation duration, and postoperative disease severity were associated with noninvasive ventilation therapy (p < 0.001 for all). Across hospitals, noninvasive ventilation use ranged from 32% to 65%, and adjusted mean noninvasive ventilation duration ranged from 1 to 4 days (3-d observed mean). Duration of total adjusted respiratory support was more strongly correlated with duration of mechanical ventilation compared with noninvasive ventilation (Pearson r = 0.93 vs 0.71, respectively).

Conclusions:

Noninvasive ventilation use is common in cardiac ICUs, especially in patients admitted for medical conditions, infants, and those undergoing high complexity surgery. We observed wide variation in noninvasive ventilation use across hospitals, though the primary driver of total respiratory support time seems to be duration of mechanical ventilation.
Is Intussusception a Middle-of-the-Night Emergency?
Authors: Lampl Brooke S. , Glaab Jonathan , Ayyala Rama S. , Kanchi Rania , Ruzal-Shapiro Carrie B.
Published: July 2017

Objectives

Intussusception is the most common abdominal emergency in pediatric patients aged 6 months to 3 years. There is often a delay in diagnosis, as the presentation can be confused for viral gastroenteritis. Given this scenario, we questioned the practice of performing emergency reductions in children during the night when minimal support staff are available. Pneumatic reduction is not a benign procedure, with the most significant risk being bowel perforation. We performed this analysis to determine whether it would be safe to delay reduction in these patients until normal working hours when more support staff are available.

Methods

We performed a retrospective review of intussusceptions occurring between January 2010 and May 2015 at 2 tertiary care institutions. The medical record for each patient was evaluated for age at presentation, sex, time of presentation to clinician or the emergency department, and time to reduction. The outcomes of attempted reduction were documented, as well as time to surgery and surgical findings in applicable cases. A Wilcoxon rank test was used to compare the median time with nonsurgical intervention among those who did not undergo surgery to the median time to nonsurgical intervention among those who ultimately underwent surgery for reduction. Multivariable logistic regression was used to test the association between surgical intervention and time to nonsurgical reduction, adjusting for the age of patients.

Results

The median time to nonsurgical intervention was higher among patients who ultimately underwent surgery than among those who did not require surgery (17.9 vs 7.0 hours; P < 0.0001). The time to nonsurgical intervention was positively associated with a higher probability of surgical intervention (P = 0.002).

Conclusions

Intussusception should continue to be considered an emergency, with nonsurgical reduction attempted promptly as standard of care.
Impact of Extracapsular Lymph Node Involvement After Neoadjuvant Chemoradiation Therapy Followed by Surgery in Carcinoma of the Esophagus
Authors: Depypere Lieven P. , Moons Johnny , Mariette Christophe , D’Journo Xavier B. , Thomas Pascal A. , Hölscher Arnulf H. , Bollschweiler Elfriede , van Berge-Henegouwen Mark I. , Van Lanschot Jan J. B. , Lerut Toni E. M. R. , Nafteux Philippe R.
Published: July 2017

Objectives:

The current study aims to examine the impact of extracapsular lymph node involvement (EC-LNI) on survival for both esophageal adenocarcinoma (AC) and squamous cell carcinoma (SCC) treated with neoadjuvant chemoradiation therapy (nCRT) followed by surgery.

Background:

Studies have demonstrated the negative prognostic value of EC-LNI in primary surgery, but its impact after nCRT remains unclear.

Methods:

From the databases of 6 European high-volume centers 1505 patients with R0 resections were withheld. Oncologic variables, including ypT, ypN, number of positive lymph nodes, and lymph node capsular status: EC-LNI and intracapsular lymph node involvement (IC-LNI), were examined. Statistical analysis was performed by Cox proportional hazards modeling.

Results:

In SCC 182 patients (31.6%) had positive lymph nodes, of whom 60 (33.0%) showed EC-LNI. In AC 391 patients (42.1%) had positive lymph nodes, of whom 147 (37.6%) showed EC-LNI. Overall 5-year survival (O5YS) in SCC was 42.0%. Presence of EC-LNI meant a significantly worse O5YS than IC-LNI or pN0 (10.6%, 39.5%, and 47.4%, respectively; P < 0.05). O5YS in AC was 41.2%. No significant difference was observed between EC-LNI and IC-LNI (P = 0.322). In the multivariate analysis, among the examined possible prognosticators, presence of EC-LNI showed the highest hazard ratio (2.29, confidence interval: 1.52–3.47) as an independent prognosticator for overall survival in SCC, but it was not in AC.

Conclusions:

Based on this international multicenter study, the presence of EC-LNI after nCRT is at least as important as N-stage for survival and EC-LNI is the strongest prognosticator for overall survival in SCC but not in AC.
Do Surgeons React?
Authors: Gostlow Hannah , Vega Camila Vega , Marlow Nicholas , Babidge Wendy , Maddern Guy
Published: July 2017

Objective:

To assess and report on surgeons’ ability to identify and manage incidences of harassment.

Background:

The Royal Australasian College of Surgeons is committed to driving out discrimination, bullying, harassment, and sexual harassment from surgical training and practice, through changing the culture of the workplace. To eradicate these behaviors, it is first critical to understand how the current workforce responds to these actions.

Methods:

A retrospective analysis of video data of an operating theatre simulation was conducted to identify how surgeons, from a range of experience levels, react to instances of harassment. Thematic analysis was used to categorize types of harassment and participant response characteristics. The frequency of these responses was assessed and reported.

Results:

The type of participant response depended on the nature of harassment being perpetuated and the seniority of the participant. In the 50 instances of scripted harassment, active responses were enacted 52% of the time, acknowledgment responses 16%, and no response enacted in 30%. One senior surgeon also perpetuated the harassment (2%). Trainees were more likely to respond actively compared with consultants.

Conclusion:

It is apparent that trainees are more aware of instances of harassment, and were more likely to intervene during the simulated scenario. However, a large proportion of harassment was unchallenged. The hierarchical nature of surgical education and the surgical workforce in general needs to enable a culture in which the responsibility to intervene is allowed and respected. Simulation-based education programs could be developed to train in the recognition and intervention of discrimination, bullying, harassment and sexual harassment.
Trends on Axillary Surgery in Nondistant Metastatic Breast Cancer Patients Treated Between 2011 and 2015
Authors: Poodt Ingrid G. M. , Spronk Pauline E. R. , Vugts Guusje , van Dalen Thijs , Peeters M. T. F. D. Vrancken , Rots Marjolijn L. , Kuijer Anne , Nieuwenhuijzen Grard A. P. , Schipper Robert-Jan
Published: July 2017

Objectives:

To evaluate patterns of care in axillary surgery for Dutch clinical T1-4N0M0 (cT1-4N0M0) breast cancer patients and to assess the effect of the American College for Surgeons Oncology Group (ACOSOG)-Z0011 and After Mapping of the Axilla: Radiotherapy Or Surgery (AMAROS) trial on axillary surgery patterns in Dutch cT1-2N0M0 sentinel node positive breast cancer patients.

Background:

Since publication of the ACOSOG-Z0011 and AMAROS trial, omitting a completion axillary lymph node dissection (cALND) in sentinel node positive breast cancer patients is proposed in selected patients.

Methods:

Data were obtained from the nationwide Nationaal Borstkanker Overleg Nederland breast cancer audit. Descriptive analyses were used to demonstrate trends in axillary surgery. Multivariable logistic regression analyses were used to identify factors associated with the omission of cALND in cT1-2N0M0 sentinel node-positive breast cancer patients.

Results:

Between 2011 and 2015 in cT1-4N0M0 breast cancer patients, the use of sentinel lymph node biopsy as definitive axillary staging increased from 72% to 93%, and (c)ALND as definitive axillary staging decreased from 24% to 6% (P < 0.001). The use of cALND decreased from 75% to 17% in cT1-2N0 sentinel node-positive patients (P < 0.001). Earlier year of diagnosis, lower age, primary mastectomy, invasive lobular subtype, increasing tumor grade, and treatment in a nonteaching hospital were associated with a lower probability of omitting cALND (P < 0.001).

Conclusions:

This study shows a trend towards less extensive axillary surgery in Dutch cT1-T4N0M0 breast cancer patients; illustrated by an overall increase of sentinel lymph node biopsy and decrease in cALND. Despite this trend, particularly noticed in cT1-2N0 sentinel node-positive patients after publication of the ACOSOG-Z0011 and AMAROS trial, variations in patterns of care in axillary surgery are still present.
Does Surgeon Sex Matter?
Authors: Sharoky Catherine E. , Sellers Morgan M. , Keele Luke J. , Wirtalla Christopher J. , Karakousis Giorgos C. , Morris Jon B. , Kelz Rachel R.
Published: July 2017

Objective:

We sought to compare postoperative outcomes of female surgeons (FS) and male surgeons (MS) within general surgery.

Summary of Background Data:

FS in the workforce are increasing in number. Female physicians provide exceptional care in other specialties. Differences in surgical outcomes of FS and MS have not been examined.

Methods:

We linked the AMA Physician Masterfile to discharge claims from New York, Florida, and Pennsylvania (2012 to 2013) to examine practice patterns and to compare surgical outcomes of FS and MS. We paired FS and MS operating at the same hospital using cardinality matching with refined balance and compared inpatient mortality, any postoperative complication, and prolonged length of stay (pLOS) in FS and MS.

Results:

Overall practice patterns differed between the 663 FS and 3219 MS. We identified 2462 surgeons (19% FS, 81% MS) at 429 hospitals who met inclusion criteria for outcomes analysis. FS were younger (mean age ± SD FS: 48.5 ± 8.4 years, MS: 54.3 ± 9.4y; P < 0.001) with less clinical experience (mean years ± SD FS: 11.6 ± 8.3 y, MS: 17.6 ± 10.0 years; P < 0.001) than MS before matching. FS had lower rates of inpatient mortality (FS: 1.51%, MS: 2.30%; P < 0.001), any postoperative complication (FS: 12.6%, MS: 16.1%; P < 0.001), and pLOS (FS: 18.4%, MS: 20.7%; P < 0.001) before matching. After matching, FS and MS outcomes were equivalent.

Conclusion:

Surgeon practice patterns vary by sex and experience. FS and MS with similar characteristics who treat similar patients at the same hospital have equivalent rates of inpatient morality, postoperative complications, and prolonged length of hospital stay. Patients should select the surgeon who is the best fit for them regardless of sex.
Renal Autotransplantation and Extracorporeal Nephron-Sparing Surgery for De Novo Renal Cell Carcinoma in a Kidney Allograft
Authors: Ono Shinichiro , Kenmochi Takashi , Ito Taihei , Aida Naohiro , Otsuki Kazunori , Akutsu Naotake , Maruyama Michihiro , Kusaka Mamoru , Shiroki Ryoichi , Hoshinaga Kiyotaka
Published: July 2017

De novo renal cell carcinoma (RCC) rarely occurs in kidney allografts; however, the risk of RCC in these patients is 100-fold that of the general healthy population. Although total nephrectomy has been the standard treatment for kidney allograft RCC, several authors have reported that early-stage RCC in kidney allografts was successfully treated with nephron-sparing surgery. We herein describe a new procedure involving renal autotransplantation and extracorporeal nephron-sparing surgery, which was performed to treat de novo RCC near the hilum of a transplanted kidney. In the 22 months since transplantation, the patient's renal function has been favorable, and no recurrence has been observed. In conclusion, renal autotransplantation is a feasible technique for the treatment of RCC in kidney allografts, especially RCC located near the hilum.
Temporal expression divergence of network modules
Authors: Park Yongjin , Kang Tae-Hyuk , Friedmann Theodore , Bader Joel S.
Published: July 2017

Here we propose new module-based approaches to identify differentially regulated network sub-modules combining temporal trajectories of expression profiles with static network skeletons. Starting from modules identified by network clustering of static networks, our analysis refines pre-defined genesets by partitioning them into smaller homogeneous sets by non-paramettric Bayesian methods. Especially for case-control time series data we developed multi-time point discriminative models and identified each network module as a mixture or admixture of dynamic discriminative functions. Our results shows that our proposed approach outperformed existing geneset enrichment methods in simulation studies. Moreover we applied the methods to neural stem cell differentiation data, and discovered novel modules differentially perturbed in different developmental stages.
Tau Internalization is Regulated by 6-O Sulfation on Heparan Sulfate Proteoglycans (HSPGs)
Authors: Rauch Jennifer N. , Chen John J. , Sorum Alexander W. , Miller Gregory M. , Sharf Tal , See Stephanie K. , Hsieh-Wilson Linda C. , Kampmann Martin , Kosik Kenneth S.
Published: July 2017

The misfolding and accumulation of tau protein into intracellular aggregates known as neurofibrillary tangles is a pathological hallmark of neurodegenerative diseases such as Alzheimer’s disease. However, while tau propagation is a known marker for disease progression, exactly how tau propagates from one cell to another and what mechanisms govern this spread are still unclear. Here, we report that cellular internalization of tau is regulated by quaternary structure and have developed a cellular assay to screen for genetic modulators of tau uptake. Using CRISPRi technology we have tested 3200 genes for their ability to regulate tau entry and identified enzymes in the heparan sulfate proteoglycan biosynthetic pathway as key regulators. We show that 6-O-sulfation is critical for tauheparan sulfate interactions and that this modification regulates uptake in human central nervous system cell lines, iPS-derived neurons, and mouse organotypic brain slice culture. Together, these results suggest novel strategies to halt tau transmission.
A temperature-dependent phase transformation of (E)-2-[(4-chlorophenyl)imino]acenaphthylen-1-one
Authors: Bao Lipiao , Olmstead Marilyn M.
Published: July 2017

The crystal structure determination based on 90 K data of the title imine ligand, C18H10ClNO, revealed non-merohedral twinning with three twin domains. In our experience, this is an indication of an ordering phase transition. Consequently, the structure was redetermined with higher temperature data, and a reversible phase transition was discovered. The higher temperature phase is indeed an ordered structure. At the higher temperature, the 4-chlorophenyl group has rotated by ca 7° into a crystallographic mirror plane. Warming the crystal from 90 K to 250 K changes the space group from triclinic P-1, to monoclinic P21/m. Diverse non-classical interactions are present in the crystal packing, and these are described for the phase change reported in this work. The crystal structure of the title imine ligand, measured at 100 K, has been reported on previously [Kovach et al. (2011). J. Mol. Struct.
992, 33–38].
The information of story: the genre and information activities of ultrarunning race reports
Authors: Gorichanaz Tim
Published: July 2017

Purpose

The purpose of this paper is to explore the “race report” as a document genre in the serious-leisure pursuit of ultrarunning. Despite the sport’s largely non-documental nature, race reports stand as an anomaly in their importance. This exploration serves as a springboard to investigate the informativeness of story in human life generally.

Design/methodology/approach

A qualitative survey of the information behavior of ultrarunners was conducted. The 46 participants were runners in a 100-mile footrace in 2016. Responses were first analyzed through phenomenological theme analysis and then were subjected to a deductive audit using a framework of information activities validated for use in serious-leisure pursuits.

Findings

Race reports are bound up in information activities across the information-communication chain. Race reports help athletes choose races, prepare for races, pre-experience races, communicate their race experiences, gather new ideas, extend their training and, finally, find entertainment.

Research limitations/implications

This discussion of genre is synchronic, largely limited to one moment in time, and its findings were limited in depth by the survey method. Further research should investigate race reports historically (diachronically) and infrastructurally.

Originality/value

This work points to symbiosis between genre theory and information behavior theory. It also legitimizes narrative reasoning as a way of knowing, which has been largely unrecognized in information behavior. Some implications of this for information science and technology are discussed.