bluuebunny/crossref_metadata_2025 huggingface dataset:
Sagittal Imbalance Does Not Influence Cup Anteversion in Total Hip Arthroplasty Dislocations
Authors: Haws Brittany E. , Khechen Benjamin , Patel Dil V. , Louie Philip K. , Iyer Sravisht , Cardinal Kaitlyn L. , Guntin Jordan A. , Singh Kern
Published: September 2018

Study Design:

Retrospective Cohort.

Summary of Background Data:

Studies have shown that lumbar fusion procedures are associated with an increased risk of total hip arthroplasty (THA) dislocation. Some have speculated that the increased risk of dislocation is caused by mispositioning of the acetabular component because of spinal sagittal imbalance. Unfortunately, the exact relationship between spinal sagittal balance and cup orientation is unknown.

Objective:

The objective of this study was to investigate the effect of spinal sagittal alignment on cup anteversion in THA dislocation.

Methods:

Patients that suffered a THA dislocation were retrospectively identified. Cross-table lateral hip radiographs were used to measure cup anteversion with normal acetabular anteversion defined as 15±10 degrees. Lateral lumbar spine radiographs were used to measure lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt, and sacral slope. Normal sagittal balance was defined as a PI-LL difference of <10 degrees. The association between sagittal balance and THA characteristics was assessed using Pearson correlation coefficient, χ2 analysis, and independent t tests.

Results:

A total of 29 patients had full radiographic imaging. Among these patients, 62.1% dislocated following a primary THA and 37.9% following a revision THA. Abnormal spinal sagittal balance was identified in 20 patients (69.0%). Eight (27.6%) patients had undergone spinal fusion prior to THA. Abnormal cup anteversion was demonstrated in 51.7% of all patients. Presence of a spinal fusion was not associated with cup anteversion, sagittal balance, or time to dislocation. Sagittal balance was not associated with direction of dislocation, time to dislocation, or cup anteversion.

Conclusions:

A majority of patients with a THA dislocation demonstrated abnormal sagittal balance. However, sagittal balance was not associated with acetabular cup anteversion. As such, the relationship between spinal deformity and dislocation rates after THA may not be because of inaccurate cup orientation.
How to Write an Effective Introduction
Authors: Fried Tristan , Foltz Carol , Lendner Mayan , Vaccaro Alexander R.
Published: September 2018

Ideally, the Introduction is an essential attention grabbing section of a research paper. If written correctly, the Introduction peaks the reader’s interest as well as serves as a roadmap for the rest of the paper. An effective Introduction builds off related empirical research and demonstrates a gap in which the current study fills. Finally, the Introduction proposes the research question(s) which will be answered in subsequent sections of the paper. A strong Introduction also requires the use of a simple and well-organized format as well as the avoidance of common pitfalls.
Effect of Cervical Decompression Surgery on Gait in Adult Cervical Spondylotic Myelopathy Patients
Authors: Haddas Ram , Lieberman Isador , Arakal Raj , Boah Akwasi , Belanger Theodore , Ju Kevin
Published: September 2018

Study Design:

This is a prospective cohort study.

Objective:

To evaluate the effect of cervical decompression surgery on the biomechanics of the spine and lower extremities in cervical spondylotic myelopathy (CSM) patients and compare with asymptomatic controls.

Summary of Background Data:

Difficulties with balance and gait are one of the most common manifestations of CSM. Patients with CSM have a slower gait speed, prolonged double support duration, and reduced cadence compared with healthy controls. Surgical decompression was found to improve clinical outcomes, but conflicting results are noted when examining function.

Materials and Methods:

In total, 25 subjects with symptomatic CSM underwent clinical gait analysis performed a week before (pre) and 3 months after the surgery (post). Clinical gait analysis was performed on 30 matched asymptomatic controls as well. Spine and lower extremity kinematics, spatiotemporal parameters, and clinical outcome were measured.

Results:

CSM patients demonstrated slower walking speed (P=0.006), reduced cadence (P=0.001), longer step time (P=0.013) wider step width (P=0.001), greater ankle range of motion (ROM) (P=0.019), less hip ROM (P=0.050), increased pelvis (P=0.001), and lumbar spine (P=0.049) ROM compared with controls. Postoperatively CSM patients demonstrated a faster walking speed (P=0.002), increased cadence (P=0.029), longer step length (P=0.015), narrower step width (P=0.004), greater knee (P=0.043), and hip ROM (P=0.007), less pelvis (P=0.002), lumbar spine (P=0.035), and cervical spine (P=0.044) ROM, and improved clinical outcomes (neck pain disability index questionnaire, oswestry disability index, and visual analog scale; P=0.001) compared with their preoperative values. Postsurgical CSM patients did not present with any differences compared with controls, beside pelvis ROM (P=0.019).

Conclusions:

Preoperatively, CSM patients clearly showed altered gait parameters compared with controls. However, after cervical decompression surgery, CSM patients exhibited improved gait pattern, spatiotemporal parameters, spine and lower extremity ROM, as well as patient-reported outcomes. Postoperatively, CSM patients did not show major differences in gait when compared with matched asymptomatic controls.
Patient-specific Rods for Surgical Correction of Sagittal Imbalance in Adults
Authors: Solla Federico , Barrey Cédric Y. , Burger Evalina , Kleck Christopher J. , Fière Vincent
Published: September 2018

Study Design:

This was an innovative concept and a preliminary prospective series.

Objective:

The aim of this study was to present the concept and the technical aspects of patient-specific rods (PSR), and compare preoperative and postoperative sagittal parameters (after PSR implantation), with a special focus on the difference pelvic incidence (PI)—lumbar lordosis (LL).

Background:

Despite established techniques for planning and proven correlations between quality of life and sagittal alignment, some patients do not achieve optimal radiologic outcomes after surgery and are still hypolordotic and imbalanced. We hypothesize that the use of PSR could improve the correspondence between planning and surgical realization.

Methods:

The planning was based on spinopelvic parameters evaluated on a full-spine x‐ray. The surgical procedure including osteotomies was simulated using a dedicated program to reach the following objectives: PI-LL<10 degrees, a pelvic tilt <20 degrees, and sagittal vertical axis <50 mm. From the virtually corrected spine, the rod curvature and length were defined. Two PSRs were thus precisely manufactured and bent to this specification. Adults with degenerative spinal disorders requiring a construct ≥5 levels were implanted with PSR and prospectively included. We compared ratios through the χ2 test.

Results:

A total of 60 patients (mean age of 64.4 years old; range, 34–83) were included. Follow-up was carried out over a period of 1 year. Average pedicle screws construct was of 6.4 levels (range, 5–9). Eight patients underwent a pedicle subtraction osteotomy. PI-LL was <10 degrees at baseline in 29/60 patients, and at follow-up in 50/60 (odds ratio=5, P=E-5).

Conclusions:

The ratio of patients with optimal PI-LL improved significantly from PSR implantation. In comparison with published data for conventional surgery, patients implanted with PSR were 2.6 times more likely to be optimally corrected. The expected benefits of PSR include the optimal execution of the plan, decreased mechanical complications, and reduced operating time, no longer requiring the bending of rods during surgery. A randomized trial on sagittal correction using PSR is ongoing.
Tether Creation Between the Second and Third Extensor Digitorum Communis for Third Extensor Tendon Subluxation at the Metacarpophalangeal Joint
Authors: Shiode Ryoya , Moritomo Hisao
Published: September 2018

We developed a substitution technique for a sagittal band reconstruction for subluxation of the third extensor tendon at the metacarpophalangeal joint. Through this procedure, we attempted to supply a tether between the second and third extensor digitorum communis (EDC) tendons. A half-slip of the second EDC was interlaced to the third EDC tendon at the level of the third metacarpal head with the metacarpophalangeal joint in full flexion position; this ensured that the interlace of the graft serves as a direct stabilizer against ulnar subluxation. A key advantage of our procedure is the strong and reliable interlace of the graft that does not require postoperative immobilization and allows unprotected motion protocol.
Patterns of treatment and BRAF testing with immune checkpoint inhibitors and targeted therapy in patients with metastatic melanoma presumed to be BRAF positive
Authors: Ghate Sameer , Ionescu-Ittu Raluca , Burne Rebecca , Ndife Briana , Laliberté François , Nakasato Antonio , Duh Mei Sheng
Published: September 2018

Patients with BRAF V600 (BRAF) mutated metastatic melanoma are eligible for therapy with both immune checkpoint inhibitors and targeted therapies, making treatment choice a complex decision. The present study aimed to describe patterns of treatment with immunotherapy and targeted therapy and BRAF testing in patients with metastatic melanoma presumed to have BRAF mutations (BRAF+) in the years following the approval of the newer generation of immune checkpoint inhibitors and targeted therapies (2014–2016). Two large US commercial claims databases [Truven Health Analytics MarketScan and IQVIA Real-World Data Adjudicated Claims – USA (IQVIA RWD Adjudicated Claims – USA)] were used. Patients were presumed BRAF+ if they received at least 2 lines of therapy of which at least 1 included targeted therapy. Sequence of lines of therapy and regimens used in first (1L), second (2L), and third (3L), as well as timing of BRAF testing by sequence of therapy were described. In the Truven sample (n=162), targeted therapy was used by 66% in 1L and by 54% in 2L, and 62% had a BRAF test; in the IQVIA RWD Adjudicated Claims – USA sample (n=247), targeted therapy was used by 62% in 1L and by 50% in 2L, and 68% had a BRAF test. Among those with a claim for a BRAF test prior to 1L, over two-thirds were initiated on targeted therapy. These findings suggest that the rate of BRAF testing remained low in the years following the approval of BRAF-targeted regimens for metastatic disease. Given the recently approved adjuvant treatment options for stage III melanoma, improving the rates of BRAF testing becomes increasingly important.
Results from phase II trial of HSP90 inhibitor, STA-9090 (ganetespib), in metastatic uveal melanoma
Authors: Shah Shalin , Luke Jason J. , Jacene Heather A. , Chen Tianqi , Giobbie-Hurder Anita , Ibrahim Nageatte , Buchbinder Elizabeth L. , McDermott David F. , Flaherty Keith T. , Sullivan Ryan J. , Lawrence Donald P. , Ott Patrick A. , Hodi F. Stephen
Published: September 2018

Uveal melanoma (UM) is a rare form of melanoma without effective therapy. The biology of UM relies on several heat-shock protein 90 (Hsp90)-dependent molecules such as MET, MEK and AKT, making Hsp90 inhibition a rational approach. Patients with stage IV UM, measurable disease, and no previous chemotherapy were eligible. Patients received either ganetespib 200 mg weekly (cohort A) or 150 mg twice a week (cohort B). Primary endpoint response rate (RR) was assessed by RECIST. A total of 17 patients were accrued for this study, with seven in cohort A and 10 in cohort B. Liver metastases were present in 59%. Response outcomes included one partial response, four stable disease, 11 progressive disease, and one withdrawal for ORR: 5.9% and disease control rate of 29.4%. Progression-free survival was 1.6 months (cohort A) and 1.8 months (cohort B). Overall survival was 8.5 months (cohort A) and 4.9 months (cohort B). An overall 31% of adverse events were grade 3–4 and were mostly related to gastrointestinal toxicities. Early on-treatment (1 months) positron emission tomography showed reduction in metabolic activity in 24% of patients, suggesting a pharmacodynamic effect of Hsp90 inhibition. These early metabolic changes did not seem to be durable and/or clinically significant in relation to the 2-month response assessment. Hsp90 inhibition with ganetespib resulted in modest clinical benefit on two dosing schedules and was associated with significant, although manageable, gastrointestinal toxicity. Evidence of pharmacodynamic activity for Hsp90 inhibition was observed via positron emission tomography, which did not translate into clinical benefit, suggesting rapid development of resistance.
Melanoma signature in Brazil: epidemiology, incidence, mortality, and trend lessons from a continental mixed population country in the past 15 years
Authors: de Melo Andréia C. , Wainstein Alberto J.A. , Buzaid Antonio C. , Thuler Luiz C.S.
Published: September 2018

The current research aimed to understand melanoma epidemiology in Brazil and to evaluate temporal trends in incidence and mortality. The data came from Brazilian Hospital Cancer Registries, Population Based Cancer Registries, and the National Mortality Information System from 2000 to 2014. Descriptive statistics were used for epidemiological and clinical characteristics. To describe trends in change in incidence and mortality rates, the Average Annual Percentage Change (AAPC) was calculated. Between 2000 and 2013, in men, the median incidence rate rose from 2.52 to 4.84, with an AAPC of +21.5% [95% confidence interval (CI): 15.4–28] and in women from 1.93 to 3.22 per 100 000, with an AAPC of +13.9% (95% CI: 8.1–20). Regarding mortality, between 2000 and 2014, the rates went from 0.85 to 0.9 per 100 000 for men (AAPC=+0.8, 95% CI: 0.4–1.1) and from 0.56 for 0.53 per 100 000 for women (AAPC=−0.1, 95% CI: −0.2 to 0). From the database, a total of 28 624 patients with melanoma were included. Most of the patients were females (51.9%), White (75%) and with stage I or II (53.2%). Sex, ethnicity, education level, geographical area of the cancer center, topography, histology, time between diagnosis and treatment, and early death were significantly associated with distant metastases. Brazil is a large country with a very young population and a low rate of melanoma incidence and prevalence that should increase over the years. Understanding the trends attributed to melanoma is important for behavioral counseling interventions that focus on promoting skin cancer prevention.
Safety and Efficacy of Cabozantinib for Metastatic Nonclear Renal Cell Carcinoma
Authors: Prisciandaro Michele , Ratta Raffaele , Massari Francesco , Fornarini Giuseppe , Caponnetto Salvatore , Iacovelli Roberto , De Giorgi Ugo , Facchini Gaetano , Scagliarini Sarah , Sabbatini Roberto , Caserta Claudia , Peverelli Giorgia , Mennitto Alessia , Verzoni Elena , Procopio Giuseppe
Published: September 2018

Objective:

The activity of cabozantinib in nonclear cell histologies has not been evaluated.

Materials and Methods:

Data were collected across 24 Italian hospitals. Patients were aged 18 years and older with advanced nonclear cell renal cell carcinoma (RCC), with an Eastern Cooperative Oncology Group Performance Status 0 to 2, who had relapsed after previous systemic treatments for metastatic disease. Cabozantinib was administered orally at 60 mg once a day in 28 days cycles. Dose reductions to 40 or 20 mg were made due to toxicity. Adverse events (AEs) were monitored using CTCAE version 4.0.

Results:

Seventeen patients were enrolled. Three (18%) patients were diagnosed type I papillary RCC, 9 (53%) type II papillary, 3 (18%) chromophobe, and 2 (11%) with Bellini duct carcinoma. In total, 11 patients started with 60 mg. Six patients started a lower dose of 40 mg. Median progression-free survival was 7.83 months (0.4 to 13.4 mo), while median overall survival was not reached but 1-year overall survival was about 60%. Six patients (35%) experienced a partial response to treatment and 6 patients (35%) showed a stable disease. In the remaining 5 (30%), we observed a progressive disease. Grade 3 and 4 AEs were observed in 41% of patients. Among 20 patients, only 1 (6%) discontinued treatment due to AEs. Asthenia (41%), diarrhea (35%), aminotransferase increasing (35%), mucosal inflammation (35%), hand and foot syndrome (24%), and hypothyroidism (24%) were the most frequently AEs.

Conclusions:

Our data showed that, cabozantinib is a active and feasible treatment in patient with nonclear cell RCC.
Differential Outcomes Among Immunosuppressed Patients With Merkel Cell Carcinoma
Authors: Cook Maclean , Baker Kelsey , Redman Mary , Lachance Kristina , Nguyen Macklin H. , Parvathaneni Upendra , Bhatia Shailender , Nghiem Paul , Tseng Yolanda D.
Published: September 2018

Objectives:

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin cancer with higher incidence among whites, elderly, and immunosuppressed patients. Although immunosuppressed MCC patients are at higher risk of recurrence and MCC-related death, it is unknown whether immunosuppression type is associated with differential outcomes.

Materials and Methods:

We retrospectively evaluated 89 nonmetastatic MCC patients with a diagnosis of chronic immunosuppression. Immunosuppression was categorized as chronic lymphocytic leukemia (31% of cohort), other hematologic malignancies (18%), solid organ transplant (21%), autoimmune disease (21%), and human immunodeficiency virus acquired deficiency syndrome (8%). Progression-free survival (PFS) and MCC-specific survival (MSS) were estimated with the cumulative incidence function. Overall survival (OS) was estimated by the Kaplan-Meier method.

Results:

With a median follow-up of 52 months, 53 deaths occurred (42 from MCC, 7 unknown, and 4 non-MCC). Two-year PFS, MSS, and OS were 30%, 55%, and 52%, respectively. Human immunodeficiency virus/acquired deficiency syndrome and solid organ transplant patients were diagnosed with MCC at a younger age (median 55 and 59 y, respectively) and with more advanced stage disease compared with other immunosuppressed subgroups. PFS did not significantly differ among the 5 immunosuppression subgroups (P=0.30), but significant differences were observed in MSS and OS (both P=0.01). Controlling for potential confounders for OS, including age and stage, immunosuppression type was still significantly associated with risk of death (P=0.01).

Conclusions:

Among immunosuppressed MCC patients, recurrent MCC is the major cause of mortality. The risk of death from MCC differs among immunosuppression types, suggesting important biological differences in host-tumor immune interactions.
A Simplified Risk Stratification Method for Women With Stage I Endometrial Carcinoma
Authors: Elshaikh Mohamed A. , Modh Ankit , Sakr Sharif , Shrestha Resha , Burmeister Charlotte , Ali-Fehmi Rouba , Hanna Rabbie K.
Published: September 2018

Objectives:

Available risk stratification methods for women with endometrial carcinoma are controversially defined. We sought to develop a simplified and an individualized prognostic index for cancer recurrence in women with International Federation of Gynecology and Obstetrics (FIGO) stage I endometrial carcinoma, solely of endometrioid histology.

Materials and Methods:

We identified 976 women who underwent a hysterectomy and did not receive any adjuvant therapy. Cox proportional hazards model was used to identify independent predictors of recurrence. Prognostic groups were created based on the number of independent predictors of recurrence (0, 1, or 2 or 3 risk factors). These groups were then validated using a separate cohort of 611 women treated at another academic institution. The model’s performance for predicting cancer recurrence was measured by the concordance probability estimate along with a 95% confidence interval.

Results:

Median follow-up was 65 months. The final recurrence model included 3 risk groups based on 3 independent predictors of recurrence (tumor grade 2 or 3, the presence of lymphovascular space invasion and stage IB). Five-year recurrence rates were 4%, 16%, and 44% for groups 0, 1, and 2 or 3, respectively. The performance of the model was very good with a concordance probability estimate of 0.72 and 0.80 for the development and validation cohorts, respectively.

Conclusions:

On the basis of 3 well-known prognostic factors, we have developed and externally validated a simplified prognostic model that accurately predicts cancer recurrence in women with stage I endometrial carcinoma. This simplified predictive tool may be helpful in estimating individualized risk of recurrence and guide counseling with regard to adjuvant treatment.
Histopathology of Hand–Foot–Mouth Disease in Adults and Criteria for Differentiation From Erythema Multiforme
Authors: Böer-Auer Almut , Metze Dieter
Published: September 2018

Background:

Hand–foot–mouth disease (HFMD) is a common contagious viral infection usually affecting infants and children. Recently, literature on HFMD in adults is increasing. It has been reported that adults often present with unusual exanthems with similarities to erythema multiforme (EM). No study has so far compared the histologic features of HFMD with those of EM.

Methods:

Histopathologic features in 7 biopsies of 6 adult patients with HFMD are compared with biopsies from 9 patients with EM to identify the best criteria for differentiation.

Results:

HFMD and EM both have a perivascular lymphocytic infiltrate together with epidermal necrosis, spongiosis, ballooning, and reticular alteration. However, large numbers of neutrophils in parakeratosis (P < 0.05), in the viable epidermis (P < 001), or neutrophils forming intraepidermal collections (P < 0.05) are significantly more common in HFMD. In HFMD, necrotic keratinocytes are emphasized in the upper third of the epidermis (P < 0.05), whereas the lower third is typically involved more in EM. Neutrophils are significantly more common and more numerous in the dermal infiltrate of HFMD compared with EM (P < 0.01) Extravasated erythrocytes in the epidermis are more common and more numerous in HFMD (P < 0.05).

Conclusions:

Lesions of EM and HFMD can be differentiated based on the amount of neutrophils in the epidermis and in the dermal infiltrate, which are significantly more numerous in HFMD. In addition, necrosis is emphasized in the upper part of the epidermis in HFMD and in the lower part of it in EM.
Follicle and Sebaceous Gland Multinucleated Cells in Measles
Authors: Magdaleno-Tapial Jorge , Valenzuela-Oñate Cristian , Giacaman-von der Weth Macarena , Ferrer-Guillén Blanca , García-Legaz Martínez Marta , Martínez-Domenech Álvaro , Hernández-Bel Pablo , Alegre-de Miquel Víctor
Published: September 2018

We report the case of a 32-year-old man with measles in which skin biopsy helped to establish a definitive diagnosis. Follicular involvement is a common histopathologic feature of measles. Multinucleated epidermal and follicular cells are distinctive findings.
Mixing of Injectable Fillers: A National Survey
Authors: Libby Tiffany J. , Williams Ramone F. , El Habr Constantin , Tinklepaugh Adam , Ciocon David
Published: September 2018

BACKGROUND

The mixing of hyaluronic acid or calcium hydroxylapatite fillers with normal saline, plain lidocaine, or lidocaine with epinephrine before injection is a familiar practice among dermatologists. However, the frequency of this practice and rationale behind it has not been well studied.

OBJECTIVE

To better elucidate the clinical practice of mixing fillers with other solutions before injecting among dermatologists.

METHODS

A survey was electronically distributed to members of the American Society for Dermatologic Surgery.

RESULTS

Four hundred seventy-five dermatologists responded to the survey. Thirty-five percent of respondents mix fillers before injection. Solutions used were as follows: plain lidocaine (44%), lidocaine with epinephrine (36%), normal saline (30%), and sterile water (7%). Respondents mix filler for the following reasons: to decrease viscosity (40%), increase anesthesia (30%), decrease swelling (17%), and increase volume (13%).

CONCLUSION

Despite the lack of evidence, more than one-third of dermatologists surveyed mix fillers with other solutions before injection. Plain lidocaine is most commonly used. The top reason for mixing fillers is to decrease viscosity and facilitate ease of injection. More scientific data are needed to support this practice and better understand the biophysical changes that occur when mixing fillers with other solutions.
Hidradenitis Suppurativa After Radical Surgery—Long-Term Follow-up for Recurrences and Associated Factors
Authors: Walter Anne-Christine , Meissner Markus , Kaufmann Roland , Valesky Eva , Pinter Andreas
Published: September 2018

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic debilitating skin disease in inverse body areas. Wide excision is recommended in Hurley Stages II to III, but the rate and symptoms of recurrences in long-term follow-up remain unclear.

OBJECTIVE

To analyze the allocation of recurrences regarding the operative field, the onset and quality of HS symptoms as well as factors associated with recurrences in long-term follow-up.

MATERIAL AND METHODS

Forty-eight patients with Hurley Stage III disease who had undergone 91 wide excisions from 2010 to 2015 were clinically examined regarding postoperative complications and allocation and quality of recurrences. To determine the risk of recurrence, possible surgery, and lifestyle-related associated factors were investigated.

RESULTS

Postoperative recurrences of HS were seen in 54.2%. Most recurrences (inflamed nodules) were detected in a <1-cm margin around the operative field (18.7%). Surgery under tumescence local anesthesia showed symptoms in 40.6% compared with 28.6% under general anesthesia. Increased alcohol consumption (p = .027) but not body mass index (p = .11) or smoking behavior (p = .45) had significant effect on relapse of HS.

CONCLUSION

Caution must be given especially in surgery with local anesthesia only. Half of patients with HS showed long-term follow-up signs of recurrence after wide excision, most frequently nearby the operation field.
Effect of Vitamin D Deficiency on Hypertrophic Scarring
Authors: Ince Bilsev , Uyar Ilker , Dadaci Mehmet
Published: September 2018

BACKGROUND

Although many different diseases have been reported with vitamin D deficiency, the authors failed to find any studies on the association of hypertrophic scarring (HS) in the literature.

OBJECTIVE

The authors aimed to determine the relationship between vitamin D deficiency and HS and investigate the effect of replacement therapy on HS development in patients with vitamin D deficiency.

PATIENTS AND METHODS

Patients who presented to the authors' outpatient clinic with HS between 2013 and 2016 were included in the study. In the first stage, all the patients with HS complaints were assessed for vitamin D levels. In the second stage, 50 patients with a vitamin D level less than 25 ng/mL and a linear scar after at least 1 year of trauma were randomly divided into 3 groups. Group 1: patients who did not accept any medical or surgical treatment; Group 2: patients who were subjected to vitamin D replacement only; Group 3: patients who underwent surgical excision and suturation after vitamin D replacement.

RESULTS

A statistically significant correlation was found between HS and vitamin D levels (p < .05). A statistically significant decrease in scar width was observed in Group 3 (p < .05).

CONCLUSION

Increasing vitamin D levels to above 25 ng/mL before scar revision and vitamin D deficiency in patients with HS may help reduce scar width.
Copaiba Oil Attenuates Right Ventricular Remodeling by Decreasing Myocardial Apoptotic Signaling in Monocrotaline-Induced Rats
Authors: Campos-Carraro Cristina , Turck Patrick , de Lima-Seolin Bruna Gazzi , Tavares Angela Maria Vicente , dos Santos Lacerda Denise , Corssac Giana Blume , Teixeira Rayane Brinck , Hickmann Alexandre , Llesuy Susana , da Rosa Araujo Alex Sander , Belló-Klein Adriane
Published: September 2018

There is an increase in oxidative stress and apoptosis signaling during the transition from hypertrophy to right ventricular (RV) failure caused by pulmonary arterial hypertension (PAH) induced by monocrotaline (MCT). In this study, it was evaluated the action of copaiba oil on the modulation of proteins involved in RV apoptosis signaling in rats with PAH. Male Wistar rats (±170 g, n = 7/group) were divided into 4 groups: control, MCT, copaiba oil, and MCT + copaiba oil. PAH was induced by MCT (60 mg/kg intraperitoneally) and, 7 days later, treatment with copaiba oil (400 mg/kg by gavage) was given for 14 days. Echocardiographic and hemodynamic measurements were performed, and the RV was collected for morphometric evaluations, oxidative stress, apoptosis, and cell survival signaling, and eNOS protein expression. Copaiba oil reduced RV hypertrophy (24%), improved RV systolic function, and reduced RV end-diastolic pressure, increased total sulfhydryl levels and eNOS protein expression, reduced lipid and protein oxidation, and the expression of proteins involved in apoptosis signaling in the RV of MCT + copaiba oil as compared to MCT group. In conclusion, copaiba oil reduced oxidative stress, and apoptosis signaling in RV of rats with PAH, which may be associated with an improvement in cardiac function caused by this compound.
Conservative Management of Placenta Accreta Spectrum
Authors: SENTILHES LOÏC , KAYEM GILLES , SILVER ROBERT M.
Published: September 2018

The purpose of this review was to assist obstetricians and gynecologists in considering the most appropriate conservative treatment option to manage women with placenta accreta spectrum according to their individual need and local expertise of the heath care team. The issue is challenging, as the quality of evidence with regard to efficacy is poor, and is mainly based on retrospective studies with limited sample size.
A Brief Review—EPR Dosimetry and the Use of Animal Teeth as Dosimeters
Authors: Harshman Amber , Johnson Thomas
Published: September 2018

The technique of electron paramagnetic resonance dosimetry using tooth enamel was established in the late 1960s, and considerable research has been conducted to learn more about the benefits of using human teeth as dosimeters for the purpose of retrospective dose reconstruction. Comparatively few studies have been done which have investigated animal teeth for the same purpose. The potential exists for utilizing animal teeth as dosimeters to reconstruct doses received by a species, as well as by humans. Animals investigated in electron paramagnetic resonance studies included cows, rats, mice, dogs, pigs, rhesus monkeys, goats, reindeer, walruses, bison, polar foxes, moose, and polar bears. Much has been determined regarding the characteristics of animal teeth, and overall the use of animal teeth for electron paramagnetic resonance dosimetry appears to be a viable means of estimating external dose. Although much has been learned from animal studies, there remain unanswered questions related to electron paramagnetic resonance dosimetry and the use of animal teeth as electron paramagnetic resonance dosimeters. This article summarizes the findings of animal electron paramagnetic resonance studies and outlines what is still unknown.
Reflections on Basic Science Studies Involving Low Doses of Ionizing Radiation
Authors: Paunesku Tatjana , Woloschak Gayle
Published: September 2018

Investigation of health effects of low doses of radiation as a field of study has been riddled with difficulties since its inception. In this document we will use 100 mGy as the cutoff upper limit for low-dose radiation, borrowing this definition from the U.S. Department of Energy, although other agencies and researchers sometimes include up to five‐fold higher doses under the same title. Difficulties in this area of research are most often ascribed to the fact that effects of low doses of radiation are subtle and difficult to distinguish from the plethora of other low-grade stresses. Thus, for example, most epidemiological studies include hundreds of thousands of samples and generate risk estimates that are statistically meaningful only when they are considered on a scale of hundreds or thousands of people. A logical approach to remedy the situation for low-dose research was to conduct well-controlled animal studies with hundreds of animals; nevertheless, even after many such studies were completed, our understanding of the biological basis for risk from low-dose radiation exposure is still not conclusive. In this paper we argue that the problem lies in the fact that our approach to animal studies is not comprehensive but conceptually binary. While some researchers apply epidemiological models to animal data, others look into molecular and cellular biology only. Very few studies are conducted to bridge this gap and consider how a realistic model of DNA damage could be integrated into a realistic model of radiation carcinogenesis.
The Evolving Role of the Medical Radiation Safety Officer
Authors: Berry Kendall , Elder Deirdre , Kroger Linda
Published: September 2018

The field of medicine has been rapidly changing recently for providers and patients. This article considers how such changes have impacted the roles and responsibilities of the medical facility radiation safety officer. To supplement the personal experiences of the authors, a questionnaire soliciting voluntary feedback was submitted to a group of medical radiation safety officers. Several common themes emerged in the responses received, confirming that the role of the medical radiation safety officer has indeed changed concurrent with the changes occurring in medicine, frequently due to changing regulations and accreditation requirements in response to new and novel imaging and treatment modalities. Today’s medical radiation safety officer faces some daunting challenges, including limited staffing, incorporation of numerous accreditation standards, and maintenance of effective communication with administrators and other personnel. Nonetheless, respondents indicate that they have tremendous job satisfaction and embrace the changing landscape. Shared challenges and changes are discussed herein to provide readers with a perspective on the life of a medical center radiation safety officer.
A Radiation Weather Station: Development of a Continuous Monitoring System for the Collection, Analysis, and Display of Environmental Radiation Data
Authors: Lynch Rebecca A. , Smith Travis , Jacobs Mitchell C. , Frank Samuel J. , Kearfott Kimberlee J.
Published: September 2018

Due to heightened fear surrounding the possibility of future terrorism involving nuclear weapons and radiological dispersive devices, compounded by nonroutine nuclear power plant releases such as from emergencies or accidents, interest in contamination levels of environmental radiation has spiked. This project sought to develop a continuously operational radiation-monitoring system, with graphically visualized data easily accessible to the public. Because this continuing project is housed at a university facility, it bears no connection to perceived political or commercial interests, generally increasing the credibility of the endeavor. Outdoor weather and radiation parameters were gathered by sensors installed on the rooftop of a two-story building. A display and cloud service website was used to project the live data in an understandable format. A correlation was observed between weather and visibly heightened levels of gamma radiation. The goal of this paper is to share and highlight the overall hardware selection and the unique software challenges encountered when developing a robust collection and analysis system, along with the challenges of displaying meteorological and radiological data in a clear and concise fashion.
A 15-Year Review of Corneal Transplant in Brazil
Authors: Almeida Hirlana Gomes , Kara-José Newton , Hida Richard Yudi , Kara-Junior Newton
Published: September 2018

Purpose:

To analyze 15-year of corneal transplant in Brazil.

Methods:

Cross-sectional, retrospective, observational, and analytical study, between available data from the Brazilian Transplant Registry (January 2002–December 2016), collected by the Brazilian Association of Organ Transplantation was performed. The variables analyzed per year were number of corneal transplants, corneal transplants per million people (pmp), corneal transplant teams, and individuals on the waiting list for corneal transplants. Quantitative variables were expressed by their respective values. To verify the relationship of time with the variables, the Spearman correlation test was applied, adopting P<0.05 for rejection of the null hypothesis.

Results:

Evaluation of the data from 2002 to 2016 revealed an increase in number of (1) corneal transplants (4,976–14,534—approximately 292% in 15 years; P<0.0001); (2) corneal transplants pmp (29.4–71.1 pmp; P<0.0001); (3) productivity of corneal transplants teams (40.1–79 transplants by each team per year; P=0.067); (4) effectiveness in meeting the Brazilian population demand for corneal transplants per year (18.2%–57.0%; P<0.0001); (5) potential donors (P<0.0001), effective donors (P<0.0001), and nondonors (P<0.0001). There was a reduction in the number of patients on the waiting list (19,189–10,923; P=0.056).

Conclusion:

Despite the progress in the last decade, the number of corneal transplants in Brazil cannot meet the growing population demand. Thus, this study suggests the implementation of more effective public policies of corneal transplants in Brazil, to minimize disparities in national territory, adequately meet the population demand, and reduce the time in waiting lists for corneal transplants.
Diurnal Variation of Choroidal Thickness in Primary Open-angle Glaucoma
Authors: Baek Sung Uk , Kim Jin-Soo , Kim Young Kook , Jeoung Jin Wook , Park Ki Ho
Published: September 2018

Purpose:

To investigate, in primary open-angle glaucoma (POAG) and healthy subjects, the pattern and magnitude of diurnal variation in macular choroidal thickness (mCT).

Methods:

A prospective study was conducted on Koreans comprising 21 patients with POAG and 17 healthy subjects. All underwent mCT, systemic blood pressure (BP), and intraocular pressure measurements during the daytime at 5 time points (8 am, 11 am, 2 pm, 5 pm, and 8 pm). The mCT was determined at 5 sites using swept-source optical coherence tomography.

Results:

In the healthy subjects, the mean mCT was 233.63±50.98 μm at 8 am, which then decreased gradually to 2 pm (206.02±45.91, P=0.015) and increased again in the evening (8 pm; 228.12±51.69, P=0.030). The mean mCT in the POAG patients at 8 am, 246.50±48.94 μm, also decreased to 226.77±51.48 at 2 pm (P=0.027) but did not increase in the evening (229.07±50.87; P=0.566). However, the overall diurnal variation of mean mCT was not statistically significant in either group (P=0.179 and 0.164, respectively). The systolic BP, diastolic BP, and mean ocular perfusion pressure of the POAG had the peak value at 8 am and the trough value at 8 pm (P=0.001, 0.002, and <0.001).

Conclusions:

The mCT in the POAG patients did not increase in the evening relative to the healthy subjects’ pattern. However, the diurnal mCT values measured in the healthy subjects and POAG patients were not statistically significant.
Choroidal Detachment and Increased Intraocular Pressure in a Case of Secondary Pulmonary Hypertension
Authors: Lei Xunwen , Zhang Jinzhi , Li Qiang , Liu Yang , Pu Donghui , Jin Xin , Yang Kehu
Published: September 2018

Purpose:

To report a case of secondary pulmonary hypertension, choroidal detachment, and increased intraocular pressure (IOP) in a patient with a congenital ventricular septal defect.

Methods:

This is a case report.

Patient:

A 36-year-old man with congenital ventricular septal defect developed dilated and congested conjunctival and episcleral veins, high IOP, and choroidal detachment.

Results:

The right eye had secondary glaucoma, myopia, and choroidal detachment. He had severe pulmonary hypertension and decreased heart function. After successful treatment for heart failure, IOP was reduced, the refractive state returned to normal, choroidal detachment was reversed, and visual acuity improved.

Conclusions:

Secondary pulmonary hypertension resulting from a congenital ventricular septal defect caused serious optic abnormalities that resolved substantially with appropriate treatment of the pulmonary hypertension.
Acute Secondary Optic Neuropathy as a Complication of a Single Episode of Acutely Raised Intraocular Pressure: A Case Series
Authors: Garala Pavitra , Bansal Atul
Published: September 2018

Purpose:

The purpose of this case series is to report development of acute secondary optic neuropathy due to optic nerve injury associated with single episode of acutely raised intraocular pressure (IOP) of varying etiologies.

Patients and Methods:

Retrospective review of a series of 3 consecutive cases diagnosed at University hospitals of Coventry and Warwickshire and review of published literature.

Results:

Three cases, respectively, with Posner Schlossman syndrome, acute idiopathic hypertensive anterior uveitis, and primary acute angle-closure initially presented with raised IOPs of 38 to 68 mm Hg. All cases were treated initially with medical management and the primary acute angle-closure case had subsequent Nd:YAG laser peripheral iridotomy. All 3 cases developed acute optic nerve injury with reduced vision, an afferent pupillary defect and optic disc swelling which subsequently persisted as optic neuropathy with sectoral optic atrophy and disc pallor.

Conclusions:

This rare cases series highlights the importance of increased awareness of the possibility of developing acute secondary optic neuropathy in patients with acutely raised IOP. On the basis of the acute clinical features, including disc edema with disc hemorrhages and an afferent pupillary defect the most likely pathophysiology of the resultant optic nerve injury is the acute impact of high IOP on optic nerve head perfusion. This appears similar to nonarteritic anterior oschemic optic neuropathy. Other systemic and local risk factors may also contribute. Appropriate timely management to reduce the acutely raised IOP are essential but may not be sufficient in preventing optic neuropathy due to changes at presentation.
Taurolidine–Citrate Line Locks Prevent Recurrent Central Line–Associated Bloodstream Infection in Pediatric Patients
Authors: Clark Julia E. , Graham Nicolette , Kleidon Tricia , Ullman Amanda
Published: September 2018

This study describes a successful, targeted intervention in central venous access device routine care to decrease central line–associated bloodstream infection. Taurolidine–citrate locks significantly reduced the rate of central line–associated bloodstream infection, particularly Gram-negative organisms without adverse events.
Delayed Seroreversion in HIV-exposed Uninfected Infants
Authors: Chatpornvorarux Sunsanee , Maleesatharn Alan , Rungmaitree Supattra , Wittawatmongkol Orasri , Phongsamart Wanatpreeya , Lapphra Keswadee , Kongstan Nantaka , Khumcha Benjawan , Chokephaibulkit Kulkanya
Published: September 2018

Background:

Recent studies report delayed anti-HIV antibody clearance (seroreversion) among HIV-exposed uninfected infants that may affect diagnostic practices. We evaluated the age-specific seroreversion rates in Thailand.

Methods:

The medical records of HIV-exposed uninfected infants born in January 2000–December 2014 were reviewed. Anti-HIV seroreversion rates at 12, 18 and 24 months were analyzed in 3 periods according to the Thai National Guidelines of prevention of mother-to-child transmission of HIV: zidovudine with or without single dose nevirapine to all women (2000–2006), adding lamivudine plus nevirapine to zidovudine in women with CD4 count <200 cells/mm3 (2007–2009) and zidovudine plus lamivudine plus boosted lopinavir to all women (2010–2014). In 2013, the serologic test kit was changed from third- to fourth-generation (4G) assay. All the infants were formula fed.

Results:

Among 736 infants, the overall seroreversion rates at 12, 18 and 24 months of age were 59.38%, 94.57% and 100%, respectively. The seroreversion rates at 12 months of age declined from 68% in 2000–2006 and 65.9% in 2007–2009, to 42.9% in 2010–2014 (P = 0.001). Seroreversion rates at 18 months of age were more than 96.5% before 2013 and decreased to 79.1% in 2013–2014 (P = 0.001) with use of 4G. Multivariate analysis identified antepartum protease inhibitors treatment and the use of 4G testing as independent factors associated with delayed seroreversion.

Conclusions:

Anti-HIV seroreversion delay in HIV-exposed uninfected infants was associated with use of protease inhibitors and 4G HIV testing, complicating the interpretation to exclude perinatal HIV infection.
Term Elective Cesarean Delivery and Offspring Infectious Morbidity
Authors: Wainstock Tamar , Walfisch Asnat , Shoham-Vardi Ilana , Segal Idit , Sergienko Ruslan , Landau Daniella , Sheiner Eyal
Published: September 2018

Background:

Studies have found associations between delivery mode and offspring long-term health. We aimed to study the possible association between delivery mode and the risk for long-term infectious diseases of the offspring during a follow-up period of up of 18 years.

Methods:

A population-based cohort analysis was performed comparing different subtypes of infectious morbidity leading to hospitalization among children, based on delivery mode (vaginal vs. elective cesarean). Data on pregnancy course and outcome, delivery mode and later offspring hospitalizations were available from a single tertiary center. All singleton uncomplicated deliveries and pregnancies between the years 1991 and 2014 were included in the analysis. Kaplan–Meier and multivariable Weibull survival models were applied to adjust for differences in follow-up time between the study groups and confounders.

Results:

During the study period, 138,910 newborns met the inclusion criteria: 13,206 (9.5%) were delivered by elective cesarean delivery, and 125,704 (91.5%) were delivered vaginally. During the follow-up period (median: 10.22 years), 13,054 (9.4%) were hospitalized (at least once) with infectious morbidity: 12.0% and 9.1% among the cesarean and vaginally delivered children, respectively (Relative Risk: 1.36; 95% confidence interval: 1.28–1.43; incidence density rates for first hospitalization were 15.22/1000 person-years and 9.06/1000 person-years among cesarean and vaginally delivered children, respectively; Kaplan–Meier log rank P < 0.001). The association between cesarean delivery and long-term pediatric infectious morbidity remained significant in the multivariable model, controlling for confounding variables (adjusted hazard ratio: 1.18; 95% confidence interval: 1.11–1.25; P < 0.001).

Conclusions:

Children delivered by elective cesarean section are at an increased risk for hospitalization with pediatric infectious morbidity when compared with vaginally delivered children.
Diarrhea-Associated Mortality in Children Less Than 5 Years of Age in the United States, 2005–2016
Authors: Aliabadi Negar , Pham Huong , Curns Aaron T. , Rha Brian , Tate Jacqueline E. , Parashar Umesh D.
Published: September 2018

Diarrheal disease morbidity decreased after the 2006 US introduction of rotavirus vaccine. We calculated diarrheal death rates for children who were <5 years of age during 2005–2016. Death rates declined from 2.3/100,000 (2005–2006) to 1.7/100,000 (2014–2016). Declines were seen among 1- to 23-month olds, white and black children. Further exploration of the role of rotavirus vaccine in decreasing deaths among children is warranted.