bluuebunny/crossref_metadata_2025 huggingface dataset:
Femoral nerve injury after transfemoral catheterization and total hip arthroplasty
Authors: Pritchett James W.
Published: March 2018

Background:

Nerve injury after total hip arthroplasty (THA) is a recognized complication and is included in informed consent. Ninety-five percent of femoral artery catheterizations (FACs) utilize a right-side approach, and scar can develop around the femoral nerve. The effect of prior FAC on femoral nerve injury during THA has not been investigated previously.

Methods:

The Medicare database was searched for patients who had primary THA after FAC between 2005 - 2015 (study group). Patients who underwent bilateral THA without prior FAC served as the control group. Proprietary software was used to query the database according to the International Classification of Diseases procedural and diagnostic codes and Common Procedural Technology Codes for primary THA and FAC. Chi-square testing was used to determine significance (P<0.05).

Results:

There were 62,016 patients in the study group and 441,013 patients in the control group. The left femoral nerve injury rate in the control group was 0.55% and 0.51% in the study group. The right femoral nerve injury rate in the control group was 0.53% and 1.55% in the study group (P<0.0001). This complication was not coded in the hospital record of 54% of patients. Greater and more complex secondary procedures were performed to treat the nerve injury in the study group (P<0.001), indicating a more severe injury.

Conclusions:

Patients with prior right FAC have significantly more severe right femoral nerve injuries during THA. Awareness of this risk may improve dialogue with and treatment of patients.
Safety of dorsolateral talonavicular joint fixation in modified double arthrodesis: an anatomic study
Authors: Atwater Lara C. , Aynardi Michael C. , Melvani Roshan , Schon Lew C. , Miller Stuart D.
Published: March 2018

Background:

Augmentation of talonavicular fusion with a retrograde percutaneous naviculocalcaneal screw has been shown to increase fixation stiffness of double (subtalar and talonavicular joint) arthrodesis. However, previous authors have speculated that neurovascular structures could be at risk in a percutaneous procedure. We investigated the safety of this procedure. We hypothesized that a high risk of neurovascular injury would be found.

Methods:

Dorsolateral talonaviculocalcaneal screw fixation was performed in 17 fresh-frozen cadaver limbs. A 1.5-cm incision was created over the lateral third of the navicular. Using percutaneous technique, a 4.5-mm cannulated screw was inserted using a guide wire. Blunt dissection and careful soft-tissue retraction were performed. The incision was extended, and a caliper was used to measure the distance from the guide wire to the superficial peroneal nerve (SPN), extensor hallucis longus, extensor digitorum longus, deep peroneal nerve (DPN), and deep peroneal artery (DPA). All injuries were recorded.

Results:

Injury to the deep neurovascular bundle occurred in five of 17 specimens. These injuries involved four insults to the DPN, two to the DPA, and one to branches of the SPN.

Conclusions:

Use of a retrograde naviculocalcaneal screw to augment talonavicular fusion in the setting of double arthrodesis was associated with high risk of injury to anatomic structures, including the deep neurovascular bundle.

Clinical Relevance:

An open procedure with careful dissection along the neurovascular bundle should be considered with use of a retrograde naviculocalcaneal screw to augment talonavicular fusion to avoid risk to nearby anatomic structures.
Autoimmune manifestations of infections
Authors: Jara Luis J. , Medina Gabriela , Saavedra Miguel A.
Published: March 2018

Purpose of review

To provide an update about the interactions between infections and autoimmune diseases (AIDs), from the molecular perspective to the clinical spectrum and the differentiation between infection and disease activity.

Recent findings

Any kind of infection may modify the innate and adaptive immune response through the following mechanisms: molecular mimicry, superantigens, epitope spreading and B-cell activation. The consequence is the overproduction of antibodies shared with those found in AIDs. Viral infections, especially HIV and hepatitis C virus, can stimulate the production of antiphospholipid antibodies and confer an increased risk to develop antiphospholipid syndrome.

The identification of risk factors to develop infections in patients with AIDs is remarkable to prevent them. These factors are the use of steroids and immunosuppressants, the involvement of a major organ (lungs, brain and kidney) and severe activity. Biomarkers to differentiate infection from disease activity are scarce, but the combination of procalcitonine and C-reactive protein seems to have higher specificity and sensibility to identify infections in patients with AIDs. Finally, the clinical judgment is the hallmark to differentiate between infections and disease activity.
The Omaha System as a Structured Instrument for Bridging Nursing Informatics With Public Health Nursing Education
Authors: Eardley Debra L. , Krumwiede Kelly A. , Secginli Selda , Garner Linda , DeBlieck Conni , Cosansu Gulhan , Nahcivan Nursen O.
Published: March 2018

Advancements in healthcare systems include adoption of health information technology to ensure healthcare quality. Educators are challenged to determine strategies to integrate health information technology into nursing curricula for building a nursing workforce competent with electronic health records, standardized terminology, evidence-based practice, and evaluation. Nursing informatics, a growing specialty field, comprises health information technology relative to the profession of nursing. It is essential to integrate nursing informatics across nursing curricula to effectively position competent graduates in technology-laden healthcare environments. Nurse scholars developed and evaluated a nursing informatics case study assignment used in undergraduate level public health nursing courses. The assignment included an unfolding scenario followed by electronic health record charting using standardized terminology to guide the nursing process. The assignment was delivered either online or in class. Seventy-two undergraduate students completed the assignment and a posttest. Fifty-one students completed a satisfaction survey. Results indicated that students who completed the assignment online demonstrated a higher level of content mastery than those who completed the assignment in class. Content mastery was based on posttest results, which evaluated students' electronic health record charting for the nursing assessment, evidence-based interventions, and evaluations. This innovative approach may be valuable to educators in response to the National Academy of Sciences recommendations for healthcare education reform.
Stifled Learning
Authors: Thomas Constance Ann
Published: March 2018

Incivility is of great concern in nursing, yet little is known about nursing students' encounters with incivility during clinical education. The lived experience of nursing students who encountered uncivil acts (n = 12) was explored through narrative interviews. Themes describing incivility emerged, including covert criticism and open shaming. Students experienced emotional and physical turmoil, and mixed messages that created a paradox. Further research is needed to understand components of incivility and the negative remnants left by uncivil encounters on nursing students.
An Innovative Role for Faith Community Nursing
Authors: Lentz Judy C.
Published: March 2018

Although the specialty of palliative nursing and palliative care continues to grow in hospital and outpatient settings, a paucity of home-based palliative services remains. This article discusses a new paradigm of faith-based palliative care ministry using faith community nurses (FCNs). Under the leadership of a palliative care doula (a nurse expert in palliative care), nurses in the faith community can offer critical support to those with serious illness. Models such as this provide stimulating content for FCN practice and opportunity to broaden health ministry within faith communities.
Estradiol suppresses ingestive response evoked by activation of 5-HT1A receptors in the lateral hypothalamus of ovariectomized rats
Authors: Taschetto Ana P.D. , Levone Brunno R. , Kochenborger Larissa , da Silva Eduardo S. , Flores Rafael A. , Faria Moacir S. , Paschoalini Marta A.
Published: March 2018

The present study investigated the effects of estradiol (E2) on ingestive behavior after activation of 5-HT1A receptors in the lateral hypothalamus (LH) of female rats habituated to eat a wet mash diet. Ovariectomized rats treated with corn oil (OVX) or estradiol cypionate (OVX+E) received local injections into the LH of vehicle or an agonist of 5-HT1A receptors, 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OH-DPAT; at a dose of 6 nmol). To determine the involvement of these receptors in food intake, some animals were pretreated with N-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-N-(2-pyridinyl) cyclohexane carboxamide maleate (WAY-100635, a 5-HT1A receptor full antagonist, at a dose of 0.37 nmol), followed by the injection of the agonist 8-OH-DPAT or its vehicle. The results showed that the injection of 8-OH-DPAT into the LH of OVX rats significantly increased food intake, and the duration and frequency of this behavior. The pretreatment with E2 suppressed the hyperphagic response induced by 8-OH-DPAT in OVX animals. The inhibition of 5-HT1A receptors after pretreatment with WAY-100635 blocked the hyperphagic effects evoked by 8-OH-DPAT in OVX. These results indicate that the activity of LH 5-HT1A receptors could be affected by blood E2 levels.
THE THICKNESSES OF CHOROID, MACULAR SEGMENTS, PERIPAPILLARY RETINAL NERVE FIBER LAYER, AND RETINAL VASCULAR CALIBER IN HIV-1–INFECTED PATIENTS WITHOUT INFECTIOUS RETINITIS
Authors: Cetin Ebru N. , Sayin KUTLU Selda , Parca Osman , Kutlu Murat , Pekel Gökhan
Published: March 2018

Purpose:

To evaluate choroidal, macular, peripapillary retinal nerve fiber layer (RNFL) thicknesses and retinal vascular caliber alterations in HIV-1–infected patients without opportunistic infections.

Methods:

This cross-sectional study included 45 HIV-1–infected patients and 47 healthy subjects. Spectral domain optical coherence tomography was used for assessment of choroidal, macular, peripapillary RNFL thicknesses and retinal vascular caliber alterations.

Results:

The mean CD4 count was 426 ± 226 cells per milliliter and the mean HIV-1 RNA level was 1.8 × 105 ± 3.6 × 105 copies/mL in HIV-infected group. Central inner plexiform, superior photoreceptor, superior and nasal retinal pigment epithelium layers were thinner in HIV-infected patients compared with control subjects (P < 0.05). The differences in sectoral retinal thicknesses lost their significance after Bonferroni correction (P < 0.01). The average thickness of pericentral retina within 3 mm was thinner in the photoreceptor layer in HIV-infected patients compared with control subjects (P = 0.033). The differences in peripapillary RNFL thickness, choroidal thickness, and retinal vascular caliber were not significant between the groups. Choroidal thickness and pericentral outer plexiform were thinner, whereas peripapillary RNFL was thicker in newly diagnosed cases (16 patients) compared with patients having treatment for at least 4 months or longer (27 patients, P < 0.05, Mann–Whitney U test). HIV-1 RNA showed negative correlation with choroidal thickness (r = −0.435, P = 0.003) and positive correlation with peripapillary RNFL in central (r = 0.323, P = 0.032) and superonasal (r = 0.369, P = 0.014) sectors.

Conclusion:

Choroidal thickness was thinner in newly diagnosed patients compared with patients on treatment. Viral load showed negative correlation with choroidal thickness. Retinal segmental alterations occurred in HIV-infected patients compared with control subjects.
ACUTE RETINAL NECROSIS AND CONTRALATERAL CUTANEOUS ERUPTION AFTER THE SHINGLES VACCINE
Authors: Ali Amro , Kirschenbaum Malka Davina , Sharma Sansar , Wandel Thaddeus L.
Published: March 2018

Purpose:

To the best of our knowledge, we present a rare case report describing an occurrence of acute retinal necrosis in an otherwise healthy individual who received the shingles vaccine.

Methods:

Observational case report.

Patient:

A 63-year-old healthy and immunocompetent white man presented with change of vision in the left eye after blunt trauma. A diagnosis of corneal abrasion was made. During follow-up, a detailed history discovered a progressive deterioration in vision over the past few weeks. Three months before presentation, he had received the shingles vaccine (Zostavax); 1 month before presentation, he reported an episode of varicella skin eruption on the face.

Results:

On examination, the patient was found to have acute retinal necrosis with white satellite lesions in the fundus of the left eye. An anterior chamber paracentesis and polymerase chain reaction confirmed the diagnosis of varicella-zoster virus.

Conclusion:

Varicella-zoster virus reactivation after shingles vaccination may predispose both immunocompetent and immunocompromised individuals to herpes-zoster ophthalmicus, leading to acute retinal necrosis.
LOCALIZATION OF MACULAR CRYSTALS ASSOCIATED WITH CHRONIC RETINAL DETACHMENT TO THE POSTERIOR HYALOID USING SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY
Authors: Atchison Elizabeth A. , Flood Timothy P.
Published: March 2018

Purpose:

To present a case of crystalline retinopathy associated with chronic retinal detachment and localize the macular crystals using spectral domain optical coherence tomography.

Methods:

Case Report.

Results:

A 37-year-old man with previously treated chronic retinal detachment presented with normal vision and crystalline maculopathy. Spectral domain optical coherence tomography localized the macular crystals to the posterior hyaloid membrane and on the internal limiting membrane, but not within the retina.

Conclusion:

The macular crystals in crystalline retinopathy associated with chronic retinal detachment most likely originate in the subretinal space beneath the detached retina, migrate through the retinal break into the vitreous cavity, and lodge on the surface of the internal limiting membrane. When the posterior hyaloid membrane separates, the crystals, which are attached to the posterior hyaloid membrane, elevate from the retina.
Effectiveness of a healthy lifestyle intervention for chronic low back pain: a randomised controlled trial
Authors: Williams Amanda , Wiggers John , O'Brien Kate M. , Wolfenden Luke , Yoong Sze Lin , Hodder Rebecca K. , Lee Hopin , Robson Emma K. , McAuley James H. , Haskins Robin , Kamper Steven J. , Rissel Chris , Williams Christopher M.
Published: March 2018

We assessed the effectiveness of a 6-month healthy lifestyle intervention, on pain intensity in patients with chronic low back pain who were overweight or obese. We conducted a pragmatic randomised controlled trial, embedded within a cohort multiple randomised controlled trial of patients on a waiting list for outpatient orthopaedic consultation at a tertiary hospital in NSW, Australia. Eligible patients with chronic low back pain (>3 months in duration) and body mass index ≥27 kg/m2 and <40 kg/m2 were randomly allocated, using a central concealed random allocation process, to receive advice and education and referral to a 6-month telephone-based healthy lifestyle coaching service, or usual care. The primary outcome was pain intensity measured using an 11-point numerical rating scale, at baseline, 2 weeks, and monthly for 6 months. Data analysis was by intention-to-treat according to a prepublished analysis plan. Between May 13, 2015, and October 27, 2015, 160 patients were randomly assigned in a 1:1 ratio to the intervention or usual care. We found no difference between groups for pain intensity over 6 months (area under the curve, mean difference = 6.5, 95% confidence interval −8.0 to 21.0; P = 0.38) or any secondary outcome. In the intervention group, 41% (n = 32) of participants reported an adverse event compared with 56% (n = 45) in the control group. Our findings show that providing education and advice and telephone-based healthy lifestyle coaching did not benefit patients with low back pain who were overweight or obese, compared with usual care. The intervention did not influence the targeted healthy lifestyle behaviours proposed to improve pain in this patient group.
Repeated touch and needle-prick stimulation in the neonatal period increases the baseline mechanical sensitivity and postinjury hypersensitivity of adult spinal sensory neurons
Authors: van den Hoogen Nynke J. , Patijn Jacob , Tibboel Dick , Joosten Bert A. , Fitzgerald Maria , Kwok Charlie H.T.
Published: March 2018

Noxious stimulation at critical stages of development has long-term consequences on somatosensory processing in later life, but it is not known whether this developmental plasticity is restricted to nociceptive pathways. Here, we investigate the effect of repeated neonatal noxious or innocuous hind paw stimulation on adult spinal dorsal horn cutaneous mechanical sensitivity. Neonatal Sprague-Dawley rats of both sexes received 4 unilateral left hind paw needle pricks (NPs, n = 13) or 4 tactile (cotton swab touch) stimuli, per day (TC, n = 11) for the first 7 days of life. Control pups were left undisturbed (n = 17). When adult (6-8 weeks), lumbar wide-dynamic-range neuron activity in laminae III-V was recorded using in vivo extracellular single-unit electrophysiology. Spike activity evoked by cutaneous dynamic tactile (brush), pinch and punctate (von Frey hair) stimulation, and plantar receptive field areas were recorded, at baseline and 2 and 5 days after left plantar hind paw incision. Baseline brush receptive fields, von Frey hair, and pinch sensitivity were significantly enhanced in adult NP and TC animals compared with undisturbed controls, although effects were greatest in NP rats. After incision, injury sensitivity of adult wide-dynamic-range neurons to both noxious and dynamic tactile hypersensitivity was significantly greater in NP animals compared with TC and undisturbed controls. We conclude that both repeated touch and needle-prick stimulation in the neonatal period can alter adult spinal sensory neuron sensitivity to both innocuous and noxious mechanical stimulation. Thus, spinal sensory circuits underlying touch and pain processing are shaped by a range of early-life somatosensory experiences.
An Emergent Large Vessel Occlusion Screening Protocol for Acute Stroke: A Quality Improvement Initiative
Authors: Ver Hage Anna , Teleb Mohamed , Smith Evelyn
Published: March 2018

Background: Nurses play an integral role in triaging stroke patients. The purpose of this quality improvement initiative was to determine the efficacy of using an emergent large vessel occlusion (ELVO) screening protocol in the emergency department by nursing staff to improve identification of eligible patients as compared with current practice, improving time to endovascular treatment. Methods: Retrospective chart review was used to identify 76 patients admitted to a large urban stroke center. Of these, 36 presented during a 4-month period before the implementation of the Stroke Vision, Aphasia, Neglect (Stroke VAN) tool for assessing ELVO risk; 40 patients were admitted during the 4 months after implementation of Stroke VAN. Results: The mean door-to-computed tomography angiography scan times were reduced from 119 to 49 minutes (P < .0001) for all patients and reduced from 77 to 27 minutes in a subset of VAN-positive patients. Conclusion: Implementation of the VAN screening tool to assess for ELVO was associated with decreased door-to-computed tomography angiography times and more rapid identification of endovascular eligible patients with ischemic stroke.
Aneurysmal Subarachnoid Hemorrhage Mortality After Implementation of Nocturnist Advanced Practice Provider Coverage
Authors: McLaughlin Diane C. , Margretta Margaret M. , Freeman William D.
Published: March 2018

Introduction: We hypothesized that a nocturnist advanced practice provider (APP) model compared with overnight neurocritical care coverage with general critical care physicians and neurology residents would provide similar patient outcomes, as measured by patient mortality. Methods: This study is a retrospective review of healthcare outcomes of aneurysmal subarachnoid hemorrhage (aSAH) patients from 2013 and 2016, after implementation of specialty-trained neurocritical care nocturnist APPs. In 2013, overnight hours were covered by the general intensive care unit team and a junior neurology resident. In 2016, these patients were cared for by APPs overnight. The primary outcome measured was comparison of mortality before and after this change of overnight coverage because the daytime coverage remained similar between years. Results: In 2013, 58 patients were admitted to the neurocritical care unit with aSAH. In 2016, 19 aSAH patients were admitted to the neurocritical care unit. The mean modified Fisher grade was 3.36 in 2013, with 14 of 58 deaths (mortality rate, 24%). In 2016, the mean modified Fisher grade was 3.4. Three patients died (mortality rate, 15.7%). Conclusion: The active nocturnist APP model was associated with an approximately 10% reduction in SAH mortality (P = .54). This supports the hypothesis that APPs can provide noninferior care as the previous model. Further studies are needed to demonstrate the effects of both nocturnist and APP-driven models.
Diltiazem-Associated Cardiogenic Shock in Thyrotoxic Crisis
Authors: Subahi Ahmed , Ibrahim Walid , Abugroun Ashraf
Published: March 2018

Clinical Features:

The patient we present is a 39-year-old woman with a history of hyperthyroidism who developed fast atrial fibrillation secondary to thyrotoxic storm. After the initiation of intravenous diltiazem drip, she developed hypotension, bradycardia, then asystole cardiac arrest.

Therapeutic Challenge:

It is well known that calcium channel blockers and beta blockers should be used with extreme caution if the patient with thyroid storm has decompensated heart failure with reduced ejection fraction. Despite this, it is recognized that guidelines for the management of thyroid storm do not include an algorithm of action in this situation. Thus, dealing with low-output failure during thyroid storm may pose a critical challenge.

Solution:

A significant portion of patients with thyrotoxic storm have an underlying low-output cardiac failure. Early identification, proper hemodynamic monitoring, and administration of the agents with appropriate pharmacodynamic profile and therapeutic potentials are essential to avoid treatment-induced cardiogenic shock.
Complicated pneumonia: current concepts and state of the art
Authors: Tracy Michael C. , Mathew Roshni
Published: March 2018

Purpose of review

This review aims to provide clinicians engaged in the care of infants and children an update on the current understanding of the epidemiology, etiology, diagnostic evaluation, and clinical management of complicated pneumonia. The review provides timely information surrounding areas of consensus and ongoing research.

Recent findings

The epidemiology and etiologies of complicated pneumonia continue to evolve over the past several decades in context of the introduction of new vaccines. We review uncommon and emerging pathogens. Immunocompromised patients are particularly at risk for complications. The 2011 clinical practice guidelines for pediatric community-acquired pneumonia from The Pediatric Infectious Diseases Society/Infectious Diseases Society of America and the British Thoracic Society are changing approaches to evaluation and management. The efficacy of new diagnostic laboratory studies, and imaging techniques, continues to be studied. Antibiotics are the mainstay of treatment, with several new options to consider. Techniques for the drainage of parapneumonic effusions continue to optimize.

Although much is known about complicated pneumonia, it remains a significant burden. New diagnostic and therapeutic interventions hold much promise. This review seeks to provide clinicians with evidence that motivates a reasoned approach to the evaluation and management of complicated pneumonia.
New directions in point-of-care ultrasound at the crossroads of paediatric emergency and critical care
Authors: Bortcosh William , Shaahinfar Ashkon , Sojar Sakina , Klig Jean E.
Published: March 2018

Purpose of review

The diagnostic capability, efficiency and versatility of point-of-care ultrasound (POCUS) have enabled its use in paediatric emergency medicine (PEM) and paediatric critical care (PICU). This review highlights the current applications of POCUS for the critically ill child across PEM and PICU to identify areas of progress and standardized practice and to elucidate areas for future research.

Recent findings

POCUS technology continues to evolve and advance bedside clinical care for critically ill children, with ongoing research extending its use for an array of clinical scenarios, including respiratory distress, trauma and dehydration. Rapidly evolving and upcoming applications include diagnosis of pneumonia and acute chest syndrome, identification of intra-abdominal injury via contrast-enhancement, guidance of resuscitation, monitoring of increased intracranial pressure and procedural guidance.

POCUS is an effective and burgeoning method for both rapid diagnostics and guidance for interventions and procedures. It has clinical application for a variety of conditions that span PEM and PICU settings. Formal POCUS training is needed to standardize and expand use of this valuable technology by PICU and PEM providers alike.
Understanding the Pathophysiology of Psychological Distress and Pancreatic Cancer
Authors: Bettison Travis M. , Nahm Christopher B. , Gill Anthony J. , Mittal Anubhav , Malhi Gin S. , Samra Jaswinder S.
Published: March 2018

Background

Psychological distress is highly prevalent in patients with pancreatic cancer (PC), yet little is known about the pathophysiology underlying the relationship between these 2 diseases. Our aim was to systematically review the evidence examining the pathophysiological mechanisms of the association between PC and psychological distress.

Methods

A systematic review of the literature was conducted using MEDLINE, Embase, PsychINFO, and CINAHL databases and reported according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies examining the pathophysiological mechanisms between PC and psychological distress were included for analysis.

Results

Eight studies were identified that fulfilled inclusion criteria. Four mechanisms were identified accounting for the possible relationship between psychological distress and PC, including (1) stress-induced β-adrenergic signaling, (2) interleukin-6–mediated effects, (3) kynurenine pathway upregulation, and (4) altered cerebral glucose metabolism.

Conclusions

The relationship between psychological distress and PC is complex, and our understanding of these mechanisms may have implications for holistic clinical management and oncological outcome. The evidence exploring the pathophysiology of this interaction is sparse, but most well established with regard to the stress-induced β-adrenergic signaling mechanism. Further studies in larger cohorts are required to elucidate the relationship between PC and psychological distress to be able to identify therapeutic targets for both conditions.
International Society of Gynecological Pathologists (ISGyP) Endometrial Cancer Project: Guidelines From the Special Techniques and Ancillary Studies Group
Authors: Cho Kathleen R. , Cooper Kumarasen , Croce Sabrina , Djordevic Bojana , Herrington Simon , Howitt Brooke , Hui Pei , Ip Philip , Koebel Martin , Lax Sigurd , Quade Bradley J. , Shaw Patricia , Vidal August , Yemelyanova Anna , Clarke Blaise , Hedrick Ellenson Lora , Longacre Teri A. , Shih Ie-Ming , McCluggage W. Glenn , Malpica Anais , Oliva Esther , Parkash Vinita , Matias-Guiu Xavier
Published: March 2018

The aim of this article is to propose guidelines and recommendations in problematic areas in pathologic reporting of endometrial carcinoma (EC) regarding special techniques and ancillary studies. An organizing committee designed a comprehensive survey with different questions related to pathologic features, diagnosis, and prognosis of EC that was sent to all members of the International Society of Gynecological Pathologists. The special techniques/ancillary studies group received 4 different questions to be addressed. Five members of the group reviewed the literature and came up with recommendations and an accompanying text which were discussed and agreed upon by all members of the group. Twelve different recommendations are made. They address the value of immunohistochemistry, ploidy, and molecular analysis for assessing prognosis in EC, the value of steroid hormone receptor analysis to predict response to hormone therapy, and parameters regarding applying immunohistochemistry and molecular tests for assessing mismatch deficiency in EC.
Opportunities and challenges for junior investigators conducting pain clinical trials
Authors: Adams Meredith C.B. , Bicket Mark C. , Murphy Jamie D. , Wu Christopher L. , Hurley Robert W.
Published: March 2018

Introduction:

Clinical investigation serves a vital role to advance treatment and management strategies for patients with pain. For those new to clinical investigation, key advice for both the novice clinical investigator and the experienced researcher expanding to translational work may accelerate research efforts.

Objective:

To review foundational material relevant to junior investigators focusing on pain clinical trials, with an emphasis on randomized controlled trials.

Methods:

We reviewed recent publications and resources relevant to clinical investigators, with a particular emphasis on pain research.

Results:

Understanding the approaches and barriers to clinical pain research is a first step to building a successful investigative portfolio. Key components of professional development include motivation, mentorship, and collaborative approaches to research. Many junior clinical investigators face challenges in pursing research careers and sparking iterative progress toward success in clinical trials. Pain-specific research metrics and goals—including hypothesis development, study design considerations, and regulatory concerns—are also important considerations to junior investigators who pursue clinical trails. Approaches to build toward collaborative and independent funding are essential for investigators.

Conclusion:

This work provides a foundation for understanding the clinical research process and helps inform the goals and plans of clinical investigators.
Stigma Reduction Among African American Women With HIV: UNITY Health Study
Authors: Rao Deepa , Kemp Christopher G. , Huh David , Nevin Paul E. , Turan Janet , Cohn Susan E. , Simoni Jane M. , Andrasik Michele , Molina Yamile , Mugavero Michael J. , French Audrey L.
Published: March 2018

Introduction:

African American women encounter disproportionately high rates of HIV-related morbidity and mortality, which is partially mediated through stigma and its effect on HIV treatment adherence.

Objective:

To assess the effect of the UNITY peer support workshop on HIV-related stigma among African American women living with HIV, compared with a time and attention control group.

Methods:

African American women living with HIV were randomized to the UNITY workshop or a breast cancer education control group. Interventions took place in HIV clinics in Chicago, IL and Birmingham, AL. Participants self-reported HIV-related stigma and social support at baseline, after workshop, and at 4 follow-up visits over 12 months.

Results:

Two hundred thirty-nine participants (UNITY n = 124; breast cancer education n = 115) were assessed over 1 year. Both arms experienced decreases in mean stigma scores over time. Our model estimated that allocation to UNITY was not associated with a significant difference in stigma points over time. Post hoc analysis suggested that preceding increases in perceived social support are associated with decreased HIV-related stigma in this population.

Conclusions:

Although UNITY did not significantly reduce HIV-related stigma in this population, our findings suggest that social support may be key to HIV-related stigma reduction.
Impact of HLA Allele-KIR Pairs on Disease Outcome in HIV-Infected Thai Population
Authors: Mori Masahiko , Wichukchinda Nuanjun , Miyahara Reiko , Rojanawiwat Archawin , Pathipvanich Panita , Miura Toshiyuki , Yasunami Michio , Ariyoshi Koya , Sawanpanyalert Pathom
Published: March 2018

Background:

Class I human leukocyte antigen (HLA) molecules contribute to HIV control through antigen presentation to both cytotoxic T lymphocytes and natural killer cells. Contribution of cytotoxic T lymphocytes to HIV clinical outcome by HLA alleles has been well studied. However, reports about the role of natural killer cells in HIV clinical outcome, particularly, about the effect of HLA-killer immunoglobulin-like receptor (KIR) pairs, remain incomplete.

Methods:

The effects of HLA allele-KIR pairs on HIV clinical outcome were statistically analyzed in a Thai cohort of treatment-naive chronically infected population (n = 209).

Results:

Five HLA allele-KIR pairs scored significantly in viral load (VL) differences. Among them, opposing effects on VL were identified among subjects expressing KIR2DL2 ligands within the HLA-C1 group: higher VL in individuals expressing HLA-B*46:01+KIR2DL2+ compared with individuals without KIR (HLA-B*46:01+KIR2DL2−) (5.0 vs 4.6 log10 copies/mL, P = 0.02), in HLA-C*01:02+KIR2DL2+ (5.0 vs 4.6 log10 copies/mL; P = 0.02), and lower VL in HLA-C*12:03+KIR2DL2+ (4.3 vs 5.6 log10 copies/mL; P = 0.01). In the longitudinal analysis of a ten-year follow-up, HLA-B*46:01+KIR2DL2+ve subjects also had a higher mortality rate compared with the subjects without that pair, independent of variables including antiretroviral treatment, as well as CD4+ T-cell count, sex, and age (adjusted hazard ratio 5.9, P = 0.02).

Conclusion:

We identified several HLA allele-KIR pairs associated with clinical outcome differences including opposing effects on VL within 1 HLA group with the same KIR. Among them, HLA-B*46:01 emerged in Southeast Asia about 50,000 years ago and is now the most prevalent HLA-B allele in that area. These findings highlight that each endemic area has unique features of anti-HIV innate immunity that impact clinical outcome.
Longitudinal Follow-up of Individuals With Cleft Lip Using Three-Dimensional Stereophotogrammetry
Authors: Morioka Daichi , Mandrano Nirina , Fujimoto Hiroki , Koga Yasushi , Sato Nobuhiro , Tosa Yasuyoshi , Ohkubo Fumio , Yoshimoto Shinya
Published: March 2018

The usefulness of three-dimensional (3D) stereophotogrammetry for treating cleft lip (CL) has been well documented. However, there are only a few reliable anthropometric analyses in infants with CL because at this age they cannot assume a resting facial position. Since 2014, we have used a handheld 3D imaging system in the operating room to obtain optimal images of infants with CL and palate under general anesthesia. Currently, 168 infants with a unilateral cleft, 50 infants with bilateral clefts, and 47 infants with an isolated cleft palate are being followed up in this way for a maximum of 30 months. Most patients ≥3 years of age are cooperative and allow staff to obtain 3D images without sedation. We plan to follow them until adulthood, obtaining 3D images at every intervention. Each year, >150 infants can be added to this ongoing longitudinal study. Using an archive of these digital images, various retrospective studies can be attempted in the future, which include comparisons of the long-term outcomes of various surgical techniques and interventions at different time intervals. This is the first 2-year preliminary report of a 20-year longitudinal study.
Localization of the Maxillary Ostium in Relation to the Reduction of Depressed Nasomaxillary Fractures
Authors: Hwang Kun , Wu XiaJing , Kim Hun , Kang Young Hye
Published: March 2018

The aim of this study was to elucidate the precise location of the maxillary ostium using computed tomography for the reduction of depressed nasomaxillary fractures.

Computed tomography images (61 males, 42 females; age range, 3–97 years) were analyzed. Coronal sections were cut every 3 mm.

The primary maxillary ostium (PMO) was located 24.7% ± 3.9% of bizygomatic distance (BZD) lateral to septum. The horizontal distance of the PMO significantly increased with age (P = 0.032). The PMO was located 53.3% ± 8.0% of nasal length (NL) above superior surface of the palatal bone (SP). The vertical-to-horizontal ratio of the PMO decreased with age (P = 0.013). The PMO was located 30.3 ± 4.3 mm posterior to the tip of nasal bone. The PMO was located 24.6 ± 4.8 mm posterior to the anterior nasal spine (ANS). The ANS-PMO distance significantly increased with age (P = 0.027). The hiatus semilunaris (HS) was located 11.9% ± 3.2% of BZD lateral to septum. The HS was located 62.4% ± 10.3% of NL above SP. The vertical distance of the HS significantly decreased with age (P = 0.019). The accessory maxillary ostium (AMO) was located 14.9% ± 2.8% of BZD lateral to septum. The horizontal distance of the AMO significantly increased with age (P = 0.027). The AMO was located 44.8% ± 6.9% of NL above SP. The vertical distance of the AMO significantly decreased with age (P < 0.001). The vertical-to-horizontal ratio of the AMO decreased with age (P < 0.001).

The distances of the ostium from surgical landmarks measured in this study might be helpful when inserting a small curved elevator into the maxillary ostium in the reduction of medial maxillary fractures.
Facial Defect Reconstruction Using the True Scarless Pre-Expanded Forehead Flap
Authors: Zhu Shan , Liu Yuanbo , Zang Mengqing , Chen Bo , Li Shanshan , Xue Bingjian , Han Tinglu
Published: March 2018

Objective:

This clinical study describes a reconstructive method for facial soft-tissue defects that uses the pre-expanded forehead flap and minimizes donor site morbidities.

Methods:

The surgery was subdivided into 3 stages. First stage, an appropriately sized expander was buried underneath the forehead. Second stage, after adequate inflation of the expander, a forehead flap based on the frontal branches of the superficial temporal artery was raised, and the distal portion of the flap was used to reconstruct the facial defect. The cutaneous pedicle of the flap was designed near the frontal hairline. Third stage, 3 weeks later, the flap pedicle was divided, and the forehead incisional scar was melted into the neoreconstructed hairline.

Results:

Between July 2010 and December 2016, 16 patients underwent facial defect reconstruction. Etiologies included postburn scar (31%), melanocytic nevus (56%), and hemangioma (13%). The mean size of the defects was 8.78 × 5.06 cm (range, 3 × 2.5 to 15 × 7 cm). The average dimension of the forehead flap was 21.63 × 7.38 cm (range, 12 × 4 to 28 × 10 cm). Fifteen flaps survived without any perfusion-related complications. Venous congestion occurred in 1 flap and gradually subsided without any flap loss. Patients were followed after surgery, ranging from 4 to 48 months. Patients and/or their family members were satisfied with the final aesthetic outcomes.

Conclusion:

Facial defect reconstruction using a pre-expanded forehead flap, with the donor-site incisional scar designed along the hairline, can not only provide sufficient tissue for defect reconstruction, but also maximally reduce donor-site morbidities.
Unilateral Hard Palate Necrosis After Ascending Palatine Artery Embolization
Authors: Alalawi Waleed Abdulhadi , Almajed Emtenan
Published: March 2018

Embolization is a common treatment modality for refractory epistaxis. Here, the authors reported that the first patient with unilateral necrosis of the mucosa overlying the hard palate developed after embolization of ascending palatine artery. A 46-year-old man with a history of maxillofacial trauma complicated by 2 episodes of significant unilateral epistaxis. Although he did not experience any epistaxis after embolization, unilateral necrosis of the mucosa overlying the hard palate developed gradually 2 weeks after embolization. The necrotic tissue of hard palate was treated by surgical debridement and followed by antibiotic and analgesic.
Office-Based Three-Dimensional Printing Workflow for Craniomaxillofacial Fracture Repair
Authors: Elegbede Adekunle , Diaconu Silviu C. , McNichols Colton H.L. , Seu Michelle , Rasko Yvonne M. , Grant Michael P. , Nam Arthur J.
Published: March 2018

Three-dimensional printing of patient-specific models is being used in various aspects of craniomaxillofacial reconstruction. Printing is typically outsourced to off-site vendors, with the main disadvantages being increased costs and time for production. Office-based 3-dimensional printing has been proposed as a means to reduce costs and delays, but remains largely underused because of the perception among surgeons that it is futuristic, highly technical, and prohibitively expensive. The goal of this report is to demonstrate the feasibility and ease of incorporating in-office 3-dimensional printing into the standard workflow for facial fracture repair.

Patients with complex mandible fractures requiring open repair were identified. Open-source software was used to create virtual 3-dimensional skeletal models of the, initial injury pattern, and then the ideally reduced fractures based on preoperative computed tomography (CT) scan images. The virtual 3-dimensional skeletal models were then printed in our office using a commercially available 3-dimensional printer and bioplastic filament. The 3-dimensional skeletal models were used as templates to bend and shape titanium plates that were subsequently used for intraoperative fixation.

Average print time was 6 hours. Excluding the 1-time cost of the 3-dimensional printer of $2500, roughly the cost of a single commercially produced model, the average material cost to print 1 model mandible was $4.30. Postoperative CT imaging demonstrated precise, predicted reduction in all patients.

Office-based 3-dimensional printing of skeletal models can be routinely used in repair of facial fractures in an efficient and cost-effective manner.
Suture Fixation of Globe to the Orbital Wall for Complicated Strabismus
Authors: Yan Jianhua , Wen Yun , Wang Zhonghao
Published: March 2018

Purpose:

The aim of this study was to observe the surgical outcomes of suture globe fixation to the orbital wall for patients with complicated strabismus.

Materials and Methods:

The medical records of patients with complicated strabismus who were treated at the Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, China, from January 2010 to June 2015 were retrospectively reviewed. Routine strabismus surgery was not possible in these cases. Eyes were anchored to the orbital wall by simple strong anastomosis of the extraocular muscle and orbital wall tissues using silk suture, which resulted in slight overcorrection of the ultimate ocular position after anchoring.

Results:

Eight patients with complicated strabismus received suture globe fixation to the orbital wall in our hospital, including 4 cases of strabismus that occurred after severe orbital injury and/or fracture repair, 2 cases of medial rectus rupture after endoscopic sinus surgery, 1 case of complete third nerve palsy, and 1 case of complete sixth nerve palsy. Five patients were male and 3 female, with age ranging from 20.0 to 57.0 years (mean = 38.1 years). The right eyes were involved in 7 cases and the left in 1 case. Five cases underwent globe fixation to the medial orbital wall, 2 cases to the lateral orbital wall, and 1 case to the inferior orbital wall. After at least 6 months follow-up, preoperative horizontal deviation of 60.625 ± 27.443 prism diopter (PD) (mean ± standard deviation) was reduced to 16.250 ± 12.464 PD. The vertical deviation was reduced from 15.000 ± 12.313 PD to 7.5 ± 5.244 PD. Two patients achieved orthophoria, and although the remaining 6 patients showed some residual strabismus (undercorrection), their appearance was significantly improved. No other surgical complications occurred in these cases.

Conclusion:

Suture fixation of the globe to the orbital wall by flesh-to-flesh anastomosis of the extraocular muscle and orbital wall tissues achieved a desirable surgical result for complicated strabismus.
Prehospital airway procedures performed in trauma patients by ground forces in Afghanistan
Authors: Blackburn Megan B. , April Michael D. , Brown Derek J. , DeLorenzo Robert A. , Ryan Kathy L. , Blackburn August N. , Schauer Steven G.
Published: March 2018

BACKGROUND

Airway management is of critical importance in combat trauma patients. Airway compromise is the second leading cause of potentially survivable death on the battlefield and accounts for approximately 1 in 10 preventable deaths. Reports from the Iraq and Afghanistan wars indicate 4% to 7% incidence of airway interventions on casualties transported to combat hospitals. The goal of this study was to describe airway management in the prehospital combat setting and document airway devices used on the battlefield.

METHODS

This study is a retrospective review of casualties that required a prehospital lifesaving airway intervention during combat operations in Afghanistan. We obtained data from the Prehospital Trauma Registry that was linked to the Department of Defense Trauma Registry for outcome data for the time period between January 2013 and September 2014.

RESULTS

Seven hundred five total trauma patients were included, 16.9% required a prehospital airway management procedure. There were 132 total airway procedures performed, including 83 (63.4%) endotracheal intubations and 26 (19.8%) nasopharyngeal airway placements. Combat medics were involved in 48 (36.4%) of airway cases and medical officers in 73 (55.3%). Most (94.2%) patients underwent airway procedures due to battle injuries caused by explosion or gunshot wounds. Casualties requiring airway management were more severely injured and less likely to survive as indicated by Injury Severity Score, responsiveness level, Glascow Coma Scale, and outcome.

CONCLUSION

Percentages of airway interventions more than tripled from previous reports from the wars in Afghanistan and Iraq. These changes are significant, and further study is needed to determine the causes. Casualties requiring airway interventions sustained more severe injuries and experienced lower survival than patients who did not undergo an airway procedure, findings suggested in previous reports.

LEVEL OF EVIDENCE

Prognostic and epidemiological study, level III.