bluuebunny/crossref_metadata_2025 huggingface dataset:
Scleral Pneumatonometry in Penetrating Keratoplasty: A Clinical Study
Authors: Magalhaes Otavio A. , Aldave Anthony J.
Published: August 2017

Purpose:

To evaluate the reliability between pneumatonometry intraocular pressure (IOP) measurement in different scleral locations and corneal IOP in a penetrating keratoplasty (PK) setting. Our aim is to validate a method that can potentially be used for patients with keratoprostheses.

Methods:

This is a prospective observational study of 40 patients who underwent monocular PK by a single surgeon and had no significant anterior segment condition in the contralateral eye. Participants were recruited during routine visits to the Cornea Clinic at the Stein Eye Institute, between November 2016 and February 2017. Goldmann applanation tonometry, central corneal pachymetry, and inferior, inferotemporal, and temporal scleral pneumatonometry of both eyes were collected.

Results:

The correlation coefficient between corneal Goldmann applanation tonometry IOP and inferior, inferotemporal, and temporal scleral pneumatonometry IOP in the transplanted eye found that all locations were significantly and strongly correlated (r = 0.76, r = 0.80, and r = 0.75, respectively; P < 0.001). The correlation coefficient was higher for inferior and inferotemporal scleral measurements when the contralateral eye was used to predict the PK corneal IOP (r = 0.85 and r = 0.79, respectively; P < 0.001) and weaker for temporal measurement (r = 0.72; P < 0.001). Central corneal thickness correction formulas did not improve the correlation between scleral and corneal IOPs. All linear regression analyses were statistically significant (P < 0.001).

Conclusions:

The inferotemporal sclera was the optimal location for pneumatonometry IOP measurement. The contralateral eye could be used to more accurately predict the IOP in the eye of interest. Scleral pneumatonometry is an intuitive and reliable method to monitor IOP when corneal measurement is not available.
Ocular Gossypiboma: Ultrasound B-Scan Assessment of Retained Surgical Sponge After Ahmed Valve Surgery: A Case Report
Authors: Babic Kelly , Siguan-Bell Christine , Hee Michael , Lin Shan C.
Published: August 2017

Purpose of the Study:

To present the first documented case of an ocular gossypiboma (retained foreign body) of a mitomycin-C-soaked sponge confirmed echographically using diagnostic ultrasound B-scan after Ahmed valve surgery.

Patients and Methods:

A patient who underwent phacoemulsification with Ahmed valve implantation surgery had a retained Weck-Cels sponge soaked with mitomycin-C. With the use of ocular ultrasound B-scan, the retained sponge was localized and a second procedure was performed to explant it.

Conclusion:

In cases of ocular gossypiboma the use of ultrasound modalities can be a valuable tool especially because B-scan access is common and can be cost-effective.
Optic Disc Drusen and Family History of Glaucoma—Results of a Patient-directed Survey
Authors: Gramer Gwendolyn , Gramer Eugen , Weisschuh Nicole
Published: August 2017

Purpose:

Prospective evaluation of family history (FH) of glaucoma and FH of optic disc drusen (ODD) in patients with sonographically confirmed ODD.

Patients and Methods:

A total of 87 patients with ODD interviewed all their first-degree and second-degree relatives using a detailed questionnaire on whether an ophthalmologist had diagnosed or excluded glaucoma or ocular hypertension (OH). Using a second questionnaire, 62 of these patients also provided information about ODD in their FH. Control groups for FH of glaucoma consisted of 2170 patients with glaucoma or OH evaluated with the same methods and identical questions for FH of glaucoma in a previous study, and of 176 healthy individuals without glaucoma or ODD who were interviewed on family history of glaucoma.

Results:

Glaucoma in FH was significantly more frequent in patients with ODD with an incidence of 20.7% compared with healthy controls with an incidence of 2.8%, and half as frequent as in glaucoma patients with an incidence of 40%. ODD in FH were found in 9.7% of patients with ODD.

Conclusions:

As there is a high frequency of family history of glaucoma in patients with ODD, evaluation of FH of ODD and FH of glaucoma is essential in patients with ODD. Glaucoma in FH of ODD patients requires intraocular pressure monitoring and whenever deemed beneficial timely initiation of intraocular pressure–lowering therapy.
Electromagnetic Navigational Bronchoscopy Reduces the Time Required for Localization and Resection of Lung Nodules
Authors: David Bolton William , Cochran Thomas , Ben-Or Sharon , Stephenson James E. , Ellis William , Hale Allyson L. , Binks Andrew P.
Published: August 2017

Objective

The aims of the study were to evaluate electromagnetic navigational bronchoscopy (ENB) and computed tomography–guided placement as localization techniques for minimally invasive resection of small pulmonary nodules and determine whether electromagnetic navigational bronchoscopy is a safer and more effective method than computed tomography–guided localization.

Methods

We performed a retrospective review of our thoracic surgery database to identify patients who underwent minimally invasive resection for a pulmonary mass and used either electromagnetic navigational bronchoscopy or computed tomography–guided localization techniques between July 2011 and May 2015.

Results

Three hundred eighty-three patients had a minimally invasive resection during our study period, 117 of whom underwent electromagnetic navigational bronchoscopy or computed tomography localization (electromagnetic navigational bronchoscopy = 81; computed tomography = 36). There was no significant difference between computed tomography and electromagnetic navigational bronchoscopy patient groups with regard to age, sex, race, pathology, nodule size, or location. Both computed tomography and electromagnetic navigational bronchoscopy were 100% successful at localizing the mass, and there was no difference in the type of definitive surgical resection (wedge, segmentectomy, or lobectomy) ( P = 0.320). Postoperative complications occurred in 36% of all patients, but there were no complications related to the localization procedures. In terms of localization time and surgical time, there was no difference between groups. However, the down/wait time between localization and resection was significant (computed tomography = 189 minutes; electromagnetic navigational bronchoscopy = 27 minutes); this explains why the difference in total time (sum of localization, down, and surgery) was significant ( P < 0.001).

Conclusions

We found electromagnetic navigational bronchoscopy to be as safe and effective as computed tomography–guided wire placement and to provide a significantly decreased down time between localization and surgical resection.
Robotic versus Conventional Coronary Artery Bypass Grafting
Authors: Kofler Markus , Stastny Lukas , Johannes Reinstadler Sebastian , Dumfarth Julia , Kilo Juliane , Friedrich Guy , Schachner Thomas , Grimm Michael , Bonatti Johannes , Bonaros Nikolaos
Published: August 2017

Objective

Robotic coronary artery bypass grafting (CABG) was shown to be a safe and feasible method for the treatment of coronary artery disease in highly selected patients. However, long-term outcome data comparing robotic CABG with conventional CABG are still missing. Therefore, we aimed to compare robotic with conventional CABG in terms of perioperative and long-term outcomes.

Methods

Of 2947 consecutive elective patients with coronary artery disease operated at a single center between 2001 and 2013, 280 underwent robotic CABG. After propensity score matching, 134 pairs of robotic versus conventional CABG (age = 62 ± 10 years, log EuroScore = 2.4 ± 2.4% vs. mean ± SD age = 63 ± 10 years, log EuroScore 2.5 ± 1.7%, respectively; all P > 0.05) were formed. The mean ± SD follow-up was 6.6 ± 3.2 years.

Results

There was no difference in perioperative mortality (robotic = 0% vs. conventional = 1.5%, P = 0.154), myocardial infarction (robotic = 0% vs. conventional = 2.2%, P = 0.08), and stroke rate (robotic = 0% vs. conventional = 0.7%, P = 0.318) between the groups. Longer cardiopulmonary bypass (robotic = 112 ± 100 minutes vs. conventional = 67 ± 48 minutes, P < 0.0001) and cross-clamp times (robotic = 68 ± 54 minutes vs. conventional = 38 ± 27 minutes, P <0.0001) were observed in robotic patients. Long-term follow-up yielded equivalent results in terms of survival (1, 5, and 10 years: robotic = 99.3%, 96.9%, and 81.3% vs. conventional = 96.3%, 92.2%, and 82.6%, respectively; log-rank P = 0.187) and freedom from major adverse cardiac and cerebral events at 1, 5, and 10 years after procedure (robotic = 90.6%, 77.7%, 70.1% vs. conventional = 94.1%, 82.2%, 66.6%; log-rank P = 0.790).

Conclusions

Long-term outcomes of robotic CABG are comparable with conventional CABG for selected patients. Longer operative times of robotic CABG do not influence the excellent long-term outcomes.
Glenohumeral Instability Related to Special Conditions: SLAP Tears, Pan-labral Tears, and Multidirectional Instability
Authors: Van Blarcum Gregory S. , Svoboda Steven J.
Published: August 2017

Glenohumeral instability is one of the more common conditions seen by sports medicine physicians, especially in young, active athletes. The associated anatomy of the glenohumeral joint (the shallow nature of the glenoid and the increased motion it allows) make the shoulder more prone to instability events as compared with other joints. Although traumatic dislocations or instability events associated with acute labral tears (ie, Bankart lesions) are well described in the literature, there exists other special shoulder conditions that are also associated with shoulder instability: superior labrum anterior/posterior (SLAP) tears, pan-labral tears, and multidirectional instability. SLAP tears can be difficult to diagnose and arthroscopic diagnosis remains the gold standard. Surgical treatment as ranged from repair to biceps tenodesis with varying reports of success. Along the spectrum of SLAP tears, pan-labral tears consist of 360-degree injuries to the labrum. Patients can present complaining of either anterior or posterior instability alone, making the physical examination and advanced imaging a crucial component of the work up of the patients. Arthroscopic labral repair remains a good initial option for surgical treatment of these conditions. Multidirectional instability remains one of the more difficult conditions for the sports medicine physician to diagnose and treat. Symptoms may only be reported as vague pain versus frank instability making the diagnoses particularly challenging, especially in a patient with overall joint laxity. Conservative management to include physical therapy is the mainstay initial treatment in patients without an identifiable structural abnormality. Surgical management of this condition has evolved from open to arthroscopic capsular shifts with comparable results.
Anterior Glenohumeral Instability
Authors: Pickett Adam , Svoboda Steven
Published: August 2017

Anterior shoulder dislocations, subluxations, and recurrent instability of the shoulder joint are common problems usually affecting a young active population. However, it can be a problem for patients up to the late decades in life and can lead to major shoulder arthropathy if left untreated or improperly treated. This article discusses the natural history, pathologic morphologic changes of the shoulder joint associated with anterior instability along with normal anatomic variants. We will also discuss current treatment recommendations and possible causes of the patient with recurrent instability despite prior stabilization procedures.
Rehabilitation Following Surgery for Glenohumeral Instability
Authors: Johnson Michael
Published: August 2017

Shoulder dislocation and subsequent instability is a common problem in young athletes. Though it is not uncommon to attempt nonoperative rehabilitation in the early going, reinjury rates are high, particularly with contact sport athletes. As a result, many athletes will undergo a primary repair of one, or multiple, glenohumeral ligaments that make up the anterior shoulder capsule. This paper presents phases of rehabilitation from the preoperative stage up to returning to play. Criteria for phase progression are included, along with examples of common exercises and themes for each phase that allow the physical therapist to consider when working with patients who have had this type of shoulder surgery, allowing them to return to full function with low risk of reinjury.
Recurrent Shoulder Instability After Primary Bankart Repair
Authors: Donohue Michael A. , Mauntel Timothy C. , Dickens Jonathan F.
Published: August 2017

The glenohumeral joint is one of the most frequently dislocated joints and occurs with increasing frequency in collision and contact athletes, especially those in sports that repeatedly place the glenohumeral joint in a position of vulnerability. Nonoperative management of shoulder instability especially in young contact athletes results in unacceptably high recurrence rates; thus, early surgical stabilization has become commonplace. Surgical stabilization typically yields acceptable outcomes. However, recurrent anterior instability may occur following a previous stabilization procedure at rates of 7% to 12%. Recurrent glenohumeral instability represents a treatment challenge for orthopedic surgeons as it not only has the potential to result in subsequent surgery, therapy, and missed activity time, but also has been associated with long-term degenerative joint changes. Thus, recurrent instability requires close examination to determine underlying pathology leading to failure. Evaluation of underlying pathology requires consideration of patient activity-related factors, hyperlaxity and multidirectional instability, glenoid bone loss, glenoid track lesions, and other pathologic lesions. Revision surgical stabilization approaches include arthroscopic and open stabilization, as well as glenoid osseous augmentation procedures. Postoperative rehabilitation and release to sports and activity must be tailored to protect the shoulder from continued instability. Understanding that risk of recurrent glenohumeral instability and the risk factors associated with it are essential so that these factors may be mitigated and recurrent instability prevented.
High Serum Bilirubin Levels, NT-pro-BNP, and Lactate Predict Mortality in Long-Term, Severely Ill Respiratory ECMO Patients
Authors: Kaestner Franziska , Rapp Daniel , Trudzinski Franziska C. , Olewczynska Nicole , Wagenpfeil Stefan , Langer Frank , Flaig Monika , Wilkens Heinrike , Bals Robert , Klingele Matthias , Lensch Christian , Fähndrich Sebastian , Lepper Philipp M.
Published: August 2017

Mortality in patients treated with extracorporeal membrane oxygenation (ECMO) is high. Therefore, it is crucial to better understand conditions that are associated with mortality in ECMO patients. In this retrospective analysis, we observed 51 patients treated with high-flow ECMO in 2013 and 2014 at our center. We recorded laboratory values and intensive care procedures. The hypothesis of bilirubin being a predictor of mortality during ECMO treatment was initially addressed. Therefore, laboratory values were obtained before initiation and at the time of highest bilirubin throughout the procedure. Receiver operating characteristic (ROC) curves and survival analysis were conducted. Our cohort consisted of patients with advanced age (median: 55 years; range: 22–76) and high mortality (26/51; 51%). Lactate, bilirubin, and NT-pro-BNP were significantly (p < 0.05) associated with mortality in univariable analyses. The cut-off values with highest Youden’s index were bilirubin ≥10 mg/dl, lactate ≥2.25 mmol/L, and NT-pro-BNP ≥11,500 pg/ml. A multivariable analysis, revealed an area under the curve (AUC) of 0.85 (95% confidence interval [CI]: 0.74–0.97), sensitivity of 0.79, and specificity of 0.91. Bilirubin, lactate, and NT-pro-BNP were associated with mortality during ECMO treatment. However, laboratory values were only evaluated at the time of peak bilirubin.
Incidence and Impact of On-Cardiopulmonary Bypass Vasoplegia During Heart Transplantation
Authors: Truby Lauren K. , Takeda Koji , Farr Maryjane , Beck James , Yuzefpolskaya Melana , Colombo Paolo C. , Topkara Veli K. , Mancini Donna , Naka Yoshifumi , Takayama Hiroo
Published: August 2017

Despite significant advances in the medical management of heart transplant (HT) recipients, perioperative complications, including vasoplegia, remain a significant contributor to morbidity and mortality. This is a retrospective review of patients who received HT at our institution between 2012 and 2015. Mean systemic vascular resistance (SVR) was calculated during the bypass run. Vasoplegia was defined as a mean SVR <800 dynes s/cm5 despite a high pressor requirement (>1,500 μg neosynephrine bolused). The primary outcome of interest was 30 day post-transplant survival. There were 138 patients included in the current study. A total of 16% (n = 22) patients were identified as having developed on-cardiopulmonary bypass vasoplegia. Vasoplegic patients had a significantly higher body mass index (BMI) (30.1 ± 5.0 vs. 26.5 ± 4.7; p = 0.005) and were more likely to be male (95.5% vs. 66.4%; p = 0.004). Use of continuous-flow left ventricular assist device (CF-LVAD) as bridge-to-transplant (BTT) was prevalent among vasoplegic patients (81.8% vs. 57.8%; p = 0.033). These patients had significantly decreased survival at 30 and 60 days (86.4% vs. 99.1% at 30 days; 77.3% vs. 92.8% at 60 days). Bridge-to-transplant with CF-LVAD was an independent predictor of on-cardiopulmonary bypass (CPB) vasoplegia. On-CPB vasoplegia complicated 16% of HTs in the current study and was associated with increased mortality. Bridge-to-transplant with CF-LVAD was an independent predictor of this phenomenon.
Hematologic Disorders in Children with Continuous Renal Replacement Therapies
Authors: Fabra Celia , Infante Sara , Miras Isabel , Pretus Susana , Santiago María José , Fernández Sarah N. , López-Herce Jesús
Published: August 2017

The objective of this study was to analyze hematologic disorders, coagulation disorders, and transfusion requirements in children with continuous renal replacement therapies (CRRT). This is a retrospective analysis of a prospectively collected database of children receiving CRRT between 2010 and 2015. Patient characteristics, CRRT parameters, hematologic and coagulation parameters, and need for transfusions were recorded and analyzed. We compared patients after heart surgery and noncardiac patients, those requiring extracorporeal membrane oxygenation (ECMO) and those without ECMO, and patients with different anticoagulation therapies: heparin and citrate. Eighty-seven patients were included (69% after heart surgery). Thirty-four percentage of patients required ECMO. Hematologic alterations throughout the therapy included a descent in hematocrit from 33.6% to 30.3% (p = 0.002) and in platelet count from 159.291 to 101.163 (p < 0.001). Coagulation parameters improved as international normalized ratio decreased from 1.5 to 1.2 (p < 0.001), fibrinogen increased from 328 to 437 mg/dl (p = 0.04), and activated partial thromboplastin time (APTT) was normalized. There were no significant differences in hematologic parameters or need for blood products between patients after heart surgery and the rest of patients, or between patients receiving heparin or citrate for anticoagulation. Ninety percentage of patients received blood products, but patients on ECMO and those who deceased required more transfusions than the rest of the patients (p < 0.01). We conclude that children undergoing CRRT show a descent in hematocrit and platelet count and require large amounts of blood products, especially those ECMO and patients who died.
Pneumonia with bacterial and viral coinfection
Authors: Cawcutt Kelly , Kalil Andre C.
Published: August 2017

Purpose of review

We aim to review the epidemiology of pneumonia with bacterial and viral coinfection, the pathogenesis and clinical impact of coinfection along with the current state of treatment and outcomes.

Recent findings

Emphasis is given to the pathogenesis of bacterial and viral co-infection including specific highlighting on influenza, rhinovirus, respiratory syncytial virus and cytomegalovirus. Updates on the current state of diagnosis and management are included, as well as on areas where future research can be directed to improve patient clinical outcomes regarding viral and bacterial coinfection.

Bacterial and viral coinfection is increasingly recognized as an underlying etiology for community- and hospital-acquired infections. Coinfections may be a risk factor for ICU admission, severity of disease, and mortality. Clinicians must be aware of these coinfections for appropriate management and prognostication, as well as for the prevention of nosocomial spread of viral illness.
ICU admission after surgery: who benefits?
Authors: Ghaffar Sadia , Pearse Rupert M. , Gillies Michael A.
Published: August 2017

Purpose of review

Death following surgery remains a major cause of death worldwide, and ICU admission following major surgery is considered a standard of care in many healthcare systems. However, ICU resources are finite and expensive, thus identifying those most likely to benefit is of great importance.

Recent findings

Advances in surgical and perioperative management have moved the focus of postoperative care to preventing complications and reducing duration of hospitalisation. Recent health services research has failed to find association between ICU admission and improved outcome in many types of elective major noncardiac surgery. Use of alternatives to ICU such as post anaesthesia care units (PACUs), high dependency units (HDUs) or specialist wards with enhanced nursing care are able to perform some elements of ICU monitoring in a less intensive environment, and may provide a better alternative to the traditional model of ICU admission for many patients having major surgery. ICU admission should still be considered for very high-risk patients and those having complex or emergency surgery. Improved triage tools are required to identify those at the highest risk of death or complications.

Identifying those most at risk of death and complications following surgery and preventing them is the major challenge of perioperative care in the coming decades. Future research should focus on how postoperative care can best be structured to provide optimum care to patients within available resources. Incidence of complications or failure to rescue (FtR) may provide useful metrics in future research.
Time to ditch HDL-C as a measure of HDL function?
Authors: Ronsein Graziella E. , Heinecke Jay W.
Published: August 2017

Purpose of review

Epidemiological and clinical studies link low levels of HDL cholesterol (HDL-C) with increased risk of atherosclerotic cardiovascular disease (CVD). However, genetic polymorphisms linked to HDL-C do not associate consistently with CVD risk, and randomized clinical studies of drugs that elevate HDL-C via different mechanisms failed to reduce CVD risk in statin-treated patients with established CVD. New metrics that capture HDL's proposed cardioprotective effects are therefore urgently needed.

Recent findings

Recent studies demonstrate cholesterol efflux capacity (CEC) of serum HDL (serum depleted of cholesterol-rich atherogenic lipoproteins) is an independent and better predictor of incident and prevalent CVD risk than HDL-C. However, it remains unclear whether therapies that increase CEC are cardioprotective. Other key issues are the impact of HDL-targeted therapies on HDL particle size and concentration and the relationship of those changes to CEC and cardioprotection.

It is time to end the clinical focus on HDL-C and to understand how HDL's function, protein composition and size contribute to CVD risk. It will also be important to link variations in function and size to HDL-targeted therapies. Developing new metrics for quantifying HDL function, based on better understanding HDL metabolism and macrophage CEC, is critical for achieving these goals.
TTF-1-positive Metastatic Endometrioid Carcinoma: A Case Report and Review of Literature of a Potential Diagnostic Pitfall
Authors: Casteillo François , Fournel Pierre , Da Cruz Vanessa , Karpathiou Georgia , Boutet Claire , Jacquin Jean-Philippe , Tissot Claire , Meyer-Bisch Vincent , Péoc’h Michel , Forest Fabien
Published: August 2017

A 75-year-old female patient, nonsmoker was addressed to our institution for a fracture of C5 vertebra with spinal cord compression by a tumor mass invading surrounding soft tissue. She had a previous history of breast ductal carcinoma and endometrioid carcinoma. Biopsy of the tumor mass showed a TTF-1-positive carcinoma. Molecular study showed a E545K mutation of PIK3CA. Lung imaging showed multiple nodules evocative of metastasis rather than a primitive tumor. Reviewing of slides of endometrioid carcinoma showed areas positive for TTF1, and the same E545K mutation was found in endometrial tumor. The final diagnosis was endometrioid metastatic carcinoma with aberrant TTF-1 expression. A subset of endometrial neoplasm expresses TTF-1, this situation might be confusing especially in case of metastatic disease.
Does Strong and Diffuse PAX-8 Positivity Occur in Primary Lung Carcinoma? An Immunohistochemical Study of 418 Cases and Review of the Literature
Authors: McHugh Kelsey E. , Arrossi Andrea V. , Farver Carol F. , Mukhopadhyay Sanjay
Published: August 2017

Although rare cases of PAX-8–positive primary lung carcinoma have been reported, details of staining distribution and intensity in such cases are limited. The aim of this study was to determine whether strong and diffuse PAX-8 staining can occur in primary lung carcinoma. Immunohistochemical staining for PAX-8 (Rabbit polyclonal, 10336-1-AP; Proteintech) was performed on whole-tissue sections from 418 resected primary lung carcinomas. PAX-8 was positive in 5/418 (1.2%) cases, all of which were large cell neuroendocrine carcinomas. Staining was weak to moderate in all 5 cases, and was seen in 5% to 30% of tumor cells. All other primary lung carcinomas (413/418) were negative for PAX-8. This study—the largest series of PAX-8-stained whole-tissue sections of primary lung carcinoma to date—shows that strong and diffuse staining for PAX-8 does not occur in primary lung carcinoma of any type. This staining pattern in a carcinoma in a lung specimen provides strong evidence of nonpulmonary origin.
Automated RNA In Situ Hybridization for 18 High Risk Human Papilloma Viruses in Squamous Cell Carcinoma of the Head and Neck: Comparison With p16 Immunohistochemistry
Authors: Drumheller Bradley , Cohen Cynthia , Lawson Diane , Siddiqui Momin T.
Published: August 2017

Detection of human papilloma virus (HPV)–related head and neck squamous cell carcinoma (HNSCC) is important, as HPV-associated HNSCCs respond better to therapy. The RNAscope HPV-test is a novel RNA in situ hybridization (ISH) technique which strongly stains transcripts of E6 and E7 mRNA in formalin-fixed, paraffin-embedded tissue, with the potential to replace the indirect immunohistochemical (IHC) marker for p16 protein. A direct clinical comparison between p16 IHC and an automated RNA ISH using 18 probes has not been established. Samples from 27 formalin-fixed, paraffin-embedded HNSCC cases from the Emory University Hospital archives were stained using 18 individual RNA ISH probes for high-risk HPV (RNAscope 2.5 LS Probe ) on a Leica autostainer (Buffalo Grove, IL) and were compared with p16 IHC. Two pathologists reviewed and reached a consensus on all interpretations. The RNAscope technique was positive in 89% (24/27) and the p16 IHC was positive in 78% (21/27). The RNAscope was negative in 11.1% of samples (3/27) and the p16 IHC–negative in 22.2% (6/27). The RNA ISH detected 100% of the p16-positive IHC-stained slides and had a concordance of 88.9% (24/27). This easy to interpret automated staining method for 18 high-risk HPV genotypes is a feasible replacement for the indirect p16 IHC method.
Variation in Bariatric Surgery Episode Costs in the Commercially Insured
Authors: Kelsall Alexander C. , Cassidy Ruth , Ghaferi Amir A.
Published: August 2017

Objective:

To describe hospital-level variation in roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Michigan.

Background:

Bariatric surgery is an increasingly prevalent elective surgical procedure that will likely be considered for future bundled payment programs, both public and private. Past research in the Medicare population found that the index hospitalization is responsible for the majority of payment variation among hospitals. However, this research largely excluded SG, now the most commonly performed bariatric surgery procedure nationally.

Methods:

We used data from a state-wide quality collaborative to calculate the average risk and price-adjusted 30-day episode payment for patients undergoing RYGB and SG procedures at Michigan hospitals between January 2009 and October 2014. We organized hospitals into quintiles and compared the variation in payments between highest and lowest-cost quintiles, and also the payment categories that drove this variation.

Results:

We identified 9035 patients undergoing RYGB (n = 4194) or SG (n = 4841) procedures at 31 hospitals. The average price and risk-adjusted episode payment ranged from $11,874 in the lowest hospital quintile to $13,394 in the highest quintile, representing a difference of $1519 (12.8%). Payments for the index hospitalization accounted for the largest share of total episode costs for both procedure types. Despite representing 2.7% to 6.0% of payments across quintiles, postdischarge payments explained 22.6% of hospital variation in SG. Similarly, readmissions explained 24.5% of payment variation for SG episodes, despite representing between 1.2% and 4.4% of payments.

Conclusions:

Collectively, our findings suggest that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. SG may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and postdischarge payments, components of episode payment more likely to be influenced by provider discretion.
The role of splenic angioembolization as an adjunct to nonoperative management of blunt splenic injuries: A systematic review and meta-analysis
Authors: Crichton James Charles Ian , Naidoo Kamil , Yet Barbaros , Brundage Susan I. , Perkins Zane
Published: August 2017

BACKGROUND

Nonoperative management (NOM) of hemodynamically normal patients with blunt splenic injury (BSI) is the standard of care. Guidelines recommend additional splenic angioembolization (SAE) in patients with American Association for the Surgery of Trauma (AAST) Grade IV and Grade V BSI, but the role of SAE in Grade III injuries is unclear and controversial. The aim of this systematic review was to compare the safety and effectiveness of SAE as an adjunct to NOM versus NOM alone in adults with BSI.

METHODS

A systematic literature search (Medline, Embase, and CINAHL) was performed to identify original studies that compared outcomes in adult BSI patients treated with SAE or NOM alone. Primary outcome was failure of NOM. Secondary outcomes included morbidity, mortality, hospital length of stay, and transfusion requirements. Bayesian meta-analyses were used to calculate an absolute (risk difference) and relative (risk ratio [RR]) measure of treatment effect for each outcome.

RESULTS

Twenty-three studies (6,684 patients) were included. For Grades I to V combined, there was no difference in NOM failure rate (SAE, 8.6% vs NOM, 7.7%; RR, 1.09 [0.80–1.51]; p = 0.28), mortality (SAE, 4.8% vs NOM, 5.8%; RR, 0.82 [0.45–1.31]; p = 0.81), hospital length of stay (11.3 vs 9.5 days; p = 0.06), or blood transfusion requirements (1.8 vs 1.7 units; p = 0.47) between patients treated with SAE and those treated with NOM alone. However, morbidity was significantly higher in patients treated with SAE (SAE, 38.1% vs NOM, 18.6%; RR, 1.83 [1.20–2.66]; p < 0.01). When stratified by grade of splenic injury, SAE significantly reduced the failure rate of NOM in patients with Grade IV and Grade V splenic injuries but had minimal effect in those with Grade I to Grade III injuries.

CONCLUSION

Splenic angioembolization should be strongly considered as an adjunct to NOM in patients with AAST Grade IV and Grade V BSI but should not be routinely recommended in patients with AAST Grade I to Grade III injuries.

LEVEL OF EVIDENCE

Systematic review and meta-analysis, level III.
Time to aortic occlusion: It’s all about access
Authors: Romagnoli Anna , Teeter William , Pasley Jason , Hu Peter , Hoehn Melanie , Stein Deborah , Scalea Thomas , Brenner Megan
Published: August 2017

INTRODUCTION

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less invasive method of proximal aortic occlusion compared with resuscitative thoracotomy with aortic cross-clamping (RTACC). This study compared time to aortic occlusion with REBOA and RTACC, both including and excluding time required for common femoral artery (CFA) cannulation.

METHODS

This was a retrospective, single-institution review of REBOA or RTACC performed between February 2013 and January 2016. Time of skin incision to aortic cross-clamp for RTACC, time required for CFA cannulation by percutaneous and open methods, and time from guide-wire insertion to balloon inflation at Zone 1 for REBOA, were obtained from videographic recordings.

RESULTS

Eighteen RTACC and 21 REBOAs were performed. Median (Q1, Q3) time from skin incision to aortic cross-clamping was 317 seconds (227, 551 seconds). Median (Q1, Q3) time from start of arterial access to Zone 1 balloon occlusion was 474 seconds (431, 572 seconds) (vs. RTACC, p = 0.01). All REBOA procedures were performed with the same device. The median time to complete CFA cannulation was 247 seconds (range, 164–343 seconds), with no difference between percutaneous or open procedures (p = 0.07). The median (Q1, Q3) time to aortic occlusion in REBOA once arterial access had been established was 245 seconds (179, 295.5 seconds), which was significantly shorter than RTACC (p = 0.003).

CONCLUSIONS

Once CFA access is achieved, time to aortic occlusion is faster with REBOA. Time to aortic occlusion is less than the time required to cannulate the CFA either by percutaneous or open approaches, emphasizing the importance of accurate and expedient CFA access. Resuscitative endovascular balloon occlusion of the aorta may represent a feasible alternative to thoracotomy for aortic occlusion. Time to aortic occlusion will likely decrease with the advent of newer REBOA technology. The rate-limiting portion of REBOA continues to be obtaining CFA access.

LEVEL OF EVIDENCE

Therapeutic, level V.
The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock
Authors: Scerbo Michelle H. , Holcomb John B. , Taub Ethan , Gates Keith , Love Joseph D. , Wade Charles E. , Cotton Bryan A.
Published: August 2017

BACKGROUND

To date, no civilian studies have demonstrated that pre-hospital (PH) tourniquets improve survival. We hypothesized that late, trauma center (TC) tourniquet use would increase death from hemorrhagic shock compared to early (PH) placement.

METHODS

All patients arriving to a Level 1, urban TC between October 2008 and January 2016 with a tourniquet placed before (T-PH) or after arrival to the TC (T-TC) were evaluated. Cases were assigned the following designations: indicated (absolute indication [vascular injury requiring repair/ligation, operation within 2 hours for extremity injury, or traumatic amputation] or relative indication [major musculoskeletal/soft tissue injury requiring operation 2–8 hours after arrival, documented large blood loss]) or non-indicated. Outcomes were death from hemorrhagic shock, physiology upon arrival to the TC, and massive transfusion requirements. After univariate analysis, logistic regression was carried out to assess independent predictors of death from hemorrhagic shock.

RESULTS

A total of 306 patients received 326 tourniquets for injuries to 157 upper and 147 lower extremities. Two hundred eighty-one (92%) had an indication for placement. Seventy percent of patients had a blunt mechanism of injury. T-TC patients arrived with a lower systolic blood pressure (SBP, 101 [86, 123] vs. 125 [100, 145] mm Hg, p < 0.001), received more transfusions in the first hour of arrival (55% vs. 34%, p = 0.02), and had a greater mortality from hemorrhagic shock (14% vs. 3.0%, p = 0.01). When controlling for year of admission, mechanism of injury and shock upon arrival (SBP ≤90 mm Hg or HR ≥120 bpm or base deficit ≤ 4) indicated T-TC had a 4.5-fold increased odds of death compared to T-PH (OR 4.5, 95% CI 1.23–16.4, p = 0.02).

CONCLUSIONS

Waiting until TC arrival to control hemorrhage with a tourniquet was associated with worsened blood pressure and increased transfusion within the first hour of arrival. In routine civilian trauma patients, delaying to T-TC was associated with 4.5-fold increased odds of mortality from hemorrhagic shock.

LEVEL OF EVIDENCE

Level IV.
Disabling Central Paroxysmal Positioning Upbeat Nystagmus and Vertigo Associated With the Presence of Anti–Glutamic Acid Decarboxylase Antibodies
Authors: Martins Ana I. , Carvalho João N. , Amorim Ana M. , Geraldo Argemiro , Eggenberger Eric , Lemos João
Published: August 2017

An immune attack by anti–glutamic acid decarboxylase (GAD) antibodies is believed to cause a deficiency in gamma-aminobutyric acid–mediated neurotransmission in the cerebellum. This, in turn, leads to several eye movement disorders, including spontaneous downbeat (DBN) and periodic alternating nystagmus. We describe a 68-year-old diabetic woman with disabling paroxysmal positioning upbeat nystagmus (UBN) exclusively in the supine position, associated with asymptomatic spontaneous DBN, alternating skew deviation and hyperactive vestibulo-ocular reflex responses on head impulse testing, in whom high titers of anti-GAD antibodies were detected. After treatment with intravenous immunoglobulin, a complete resolution of positioning UBN and spontaneous DBN occurred, along with a decrease in anti-GAD antibody titers. Positioning UBN in this case may reflect a transient disinhibition of the central vestibular pathways carrying posterior semicircular canal signals, due to lack of normal inhibitory input from the cerebellar nodulus/uvula. Immunoglobulin restored cerebellar inhibitory output, possibly by improving gamma-aminobutyric acid neurotransmission.
Hyaluronan supplementation as a mechanical regulator of cartilage tissue development under joint-kinematic-mimicking loading
Authors: Wu Yabin , Stoddart Martin J. , Wuertz-Kozak Karin , Grad Sibylle , Alini Mauro , Ferguson Stephen J.
Published: August 2017

Articular cartilage plays an essential role in joint lubrication and impact absorption. Through this, the mechanical signals are coupled to the tissue's physiological response. Healthy synovial fluid has been shown to reduce and homogenize the shear stress acting on the cartilage surfaces due to its unique shear-thinning viscosity. As cartilage tissues are sensitive to mechanical changes in articulation, it was hypothesized that replacing the traditional culture medium with a healthy non-Newtonian lubricant could enhance tissue development in a cartilage engineering model, where joint-kinematic-mimicking mechanical loading is applied. Different amounts of hyaluronic acid were added to the culture medium to replicate the viscosities of synovial fluid at different health states. Hyaluronic acid supplementation, especially at a physiologically healthy concentration (2.0 mg ml
−1
), promoted a better preservation of chondrocyte phenotype. The ratio of collagen II to collagen I mRNA was 4.5 times that of the control group, implying better tissue development (however, with no significant difference of measured collagen II content), with a good retention of collagen II and proteoglycan in the mechanically active region. Simulating synovial fluid properties by hyaluronic acid supplementation created a favourable mechanical environment for mechanically loaded constructs. These findings may help in understanding the influence of joint articulation on tissue homeostasis, and moreover, improve methods for functional cartilage tissue engineering.
Hydrodynamic advantages of swimming by salp chains
Authors: Sutherland Kelly R. , Weihs Daniel
Published: August 2017

Salps are marine invertebrates comprising multiple jet-propelled swimming units during a colonial life-cycle stage. Using theory, we show that asynchronous swimming with multiple pulsed jets yields substantial hydrodynamic benefit due to the production of steady swimming velocities, which limit drag. Laboratory comparisons of swimming kinematics of aggregate salps (Salpa fusiformisandWeelia cylindrica) using high-speed video supported that asynchronous swimming by aggregates results in a smoother velocity profile and showed that this smoother velocity profile is the result of uncoordinated, asynchronous swimming by individual zooids.In situflow visualizations ofW. cylindricaswimming wakes revealed that another consequence of asynchronous swimming is that fluid interactions between jet wakes are minimized. Although the advantages of multi-jet propulsion have been mentioned elsewhere, this is the first time that the theory has been quantified and the role of asynchronous swimming verified using experimental data from the laboratory and the field.
Connexin membrane materials as potent inhibitors of breast cancer cell migration
Authors: Ferrati Silvia , Gadok Avinash K. , Brunaugh Ashlee D. , Zhao Chi , Heersema Lara A. , Smyth Hugh D. C. , Stachowiak Jeanne C.
Published: August 2017

Gap junction (GJ) channels facilitate cell–cell communication through the exchange of chemical and mechanical signals, ensuring proper tissue development and homeostasis. The complex, disease stage-dependent role of connexins in breast cancer progression has been extensively studied over the past two decades. In the early stages of breast cancer, substantial evidence supports the role of GJ channels, formed by connexins at the interfaces between neighbouring cells, as suppressors of cell migration and proliferation. These findings suggest that materials that reintroduce connexins into the tumour cell environment have the potential to inhibit cell migration. Here, we report that exposure of highly metastatic MDA-MB-231 breast tumour cells to connexin-rich biovesicle materials potently suppresses cell migration. Specifically, these biovesicles, which can form GJ interfaces with cells, were extracted from the plasma membrane of donor cells engineered to express a high concentration of functional connexin 43 channels. These connexin-rich membrane materials dramatically reduced cell migration in both a transwell migration assay and a scratch closure assay. Collectively, these results suggest that using membrane materials to reintroduce connexins into the tumour cell environment provides a novel approach for combating cell migration and invasion.
Whitham modulation theory for the Kadomtsev– Petviashvili equation
Authors: Ablowitz Mark J. , Biondini Gino , Wang Qiao
Published: August 2017

The genus-1 Kadomtsev–Petviashvili (KP)-Whitham system is derived for both variants of the KP equation; namely the KPI and KPII equations. The basic properties of the KP-Whitham system, including symmetries, exact reductions and its possible complete integrability, together with the appropriate generalization of the one-dimensional Riemann problem for the Korteweg–de Vries equation are discussed. Finally, the KP-Whitham system is used to study the linear stability properties of the genus-1 solutions of the KPI and KPII equations; it is shown that all genus-1 solutions of KPI are linearly unstable, while all genus-1 solutions of KPII are linearly stable within the context of Whitham theory.
Mittag-Leffler synchronization of delayed fractional-order bidirectional associative memory neural networks with discontinuous activations: state feedback control and impulsive control schemes
Authors: Ding Xiaoshuai , Cao Jinde , Zhao Xuan , Alsaadi Fuad E.
Published: August 2017

This paper is concerned with the drive–response synchronization for a class of fractional-order bidirectional associative memory neural networks with time delays, as well as in the presence of discontinuous activation functions. The global existence of solution under the framework of Filippov for such networks is firstly obtained based on the fixed-point theorem for condensing map. Then the state feedback and impulsive controllers are, respectively, designed to ensure the Mittag-Leffler synchronization of these neural networks and two new synchronization criteria are obtained, which are expressed in terms of a fractional comparison principle and Razumikhin techniques. Numerical simulations are presented to validate the proposed methodologies.
Some applications of mathematics in golf
Authors: Otto S. R.
Published: August 2017

At its core, like many other sports, golf is a game of integers. The minimization of the number of strokes played is generally what determines the winner, whether each of these are associated with the shortest of putts or the longest of drives. The outcomes of these shots are influenced by very slight changes, but hopefully in a deterministic sense. Understanding the mechanics of golf necessitates the development of models and this is coupled more often than not to the use of statistics. In essence, the individual aspects of the sport can be modelled adequately via fairly simplistic models, but the presence of a human at one end of the kinematic chain has a significant impact on the variability of the entire process. In this paper, we will review some of the ways that mathematics has been used to develop the understanding of the physical processes involved in the sport, including some of the analysis which is exploited within the Equipment Rules. We will also discuss some of the future challenges.
Satellite telemetry reveals higher fishing mortality rates than previously estimated, suggesting overfishing of an apex marine predator
Authors: Byrne Michael E. , Cortés Enric , Vaudo Jeremy J. , Harvey Guy C. McN. , Sampson Mark , Wetherbee Bradley M. , Shivji Mahmood
Published: August 2017

Overfishing is a primary cause of population declines for many shark species of conservation concern. However, means of obtaining information on fishery interactions and mortality, necessary for the development of successful conservation strategies, are often fisheries-dependent and of questionable quality for many species of commercially exploited pelagic sharks. We used satellite telemetry as a fisheries-independent tool to document fisheries interactions, and quantify fishing mortality of the highly migratory shortfin mako shark (Isurus oxyrinchus) in the western North Atlantic Ocean. Forty satellite-tagged shortfin mako sharks tracked over 3 years entered the Exclusive Economic Zones of 19 countries and were harvested in fisheries of five countries, with 30% of tagged sharks harvested. Our tagging-derived estimates of instantaneous fishing mortality rates (F= 0.19–0.56) were 10-fold higher than previous estimates from fisheries-dependent data (approx. 0.015–0.024), suggesting data used in stock assessments may considerably underestimate fishing mortality. Additionally, our estimates ofFwere greater than those associated with maximum sustainable yield, suggesting a state of overfishing. This information has direct application to evaluations of stock status and for effective management of populations, and thus satellite tagging studies have potential to provide more accurate estimates of fishing mortality and survival than traditional fisheries-dependent methodology.