bluuebunny/crossref_metadata_2025 huggingface dataset:
Modulation of brainstem activity and connectivity by respiratory-gated auricular vagal afferent nerve stimulation in migraine patients
Authors: Garcia Ronald G. , Lin Richard L. , Lee Jeungchan , Kim Jieun , Barbieri Riccardo , Sclocco Roberta , Wasan Ajay D. , Edwards Robert R. , Rosen Bruce R. , Hadjikhani Nouchine , Napadow Vitaly
Published: April 2017

Migraine pathophysiology includes altered brainstem excitability, and recent neuromodulatory approaches aimed at controlling migraine episodes have targeted key brainstem relay and modulatory nuclei. In this study, we evaluated the impact of respiratory-gated auricular vagal afferent nerve stimulation (RAVANS), a novel neuromodulatory intervention based on an existing transcutaneous vagus nerve stimulation approach, in the modulation of brainstem activity and connectivity in migraine patients. We applied 3T–functional magnetic resonance imaging with improved in-plane spatial resolution (2.62 × 2.62 mm) in episodic migraine (interictal) and age- and sex-matched healthy controls to evaluate brain response to RAVANS (gated to either inhalation or exhalation) and sham stimulation. We further investigated RAVANS modulation of tactile trigeminal sensory afference response in the brainstem using air-puff stimulation directed to the forehead during functional magnetic resonance imaging. Compared with sham and inhalatory-gated RAVANS (iRAVANS), exhalatory-gated RAVANS (eRAVANS) activated an ipsilateral pontomedullary region consistent with nucleus tractus solitarii (NTS). During eRAVANS, NTS connectivity was increased to anterior insula and anterior midcingulate cortex, compared with both sham and iRAVANS, in migraine patients. Increased connectivity was inversely correlated with relative time to the next migraine attack, suggesting clinical relevance to this change in connectivity. Poststimulation effects were also noted immediately after eRAVANS, as we found increased activation in putative pontine serotonergic (ie, nucleus raphe centralis) and noradrenergic (ie, locus coeruleus) nuclei in response to trigeminal sensory afference. Regulation of activity and connectivity of brainstem and cortical regions involved in serotonergic and noradrenergic regulation and pain modulation may constitute an underlying mechanism supporting beneficial clinical outcomes for eRAVANS applied for episodic migraine.
Nociceptor interleukin 10 receptor 1 is critical for muscle analgesia induced by repeated bouts of eccentric exercise in the rat
Authors: Alvarez Pedro , Bogen Oliver , Green Paul G. , Levine Jon D.
Published: April 2017

Delayed-onset muscle soreness is typically observed after strenuous or unaccustomed eccentric exercise. Soon after recovery, blunted muscle soreness is observed on repeated eccentric exercise, a phenomenon known as repeated bout effect (RBE). Although regular physical activity decreases muscle hyperalgesia, likely because of increased production of the anti-inflammatory cytokine interleukin-10 (IL-10) in the skeletal muscle, whether IL-10 also contributes to the antinociceptive effect of RBE is unknown. Furthermore, whether IL-10 attenuates muscle hyperalgesia by acting on muscle nociceptors remains to be established. Here, we explored the hypothesis that blunted muscle nociception observed in RBE depends on a local effect of IL-10, acting on IL-10 receptor 1 (IL-10R1) expressed by muscle nociceptors. Results show that after a second bout of eccentric exercise, rats exhibited decreased muscle hyperalgesia, indicative of RBE, and increased expression of IL-10 in the exercised gastrocnemius muscle. Although knockdown of IL-10R1 protein in nociceptors innervating the gastrocnemius muscle by intrathecal antisense oligodeoxynucleotide did not change nociceptive threshold in naive rats, it unveiled latent muscle hyperalgesia in rats submitted to eccentric exercise 12 days ago. Furthermore, antisense also prevented the reduction of muscle hyperalgesia observed after a second bout of eccentric exercise. These data indicate that recovery of nociceptive threshold after eccentric exercise and RBE-induced analgesia depend on a local effect of IL-10, acting on its canonical receptor in muscle nociceptors.
An Assessment of the Continuing Education Needs of Nurse Practitioners Who Manage Patients With Psoriasis
Authors: Barnes Justin A. , Hwang Sharon , Scalici Samantha , Merwin Patti , Kramerman Inessa , Weinberg Jeffrey M. , Cerenzia Wendy
Published: April 2017

Introduction

Psoriasis affects 2%–3% of the U.S. population and can have a profound impact on patient quality of life. Nurse practitioners (NPs) have a key role in managing psoriasis, and they need to stay current in this rapidly evolving area. Continuing education programs can increase the capabilities of NPs; however, these programs must target the areas of greatest educational need. This study was conducted to identify and quantify educational needs among NPs related to psoriasis.

Methods

Practice patterns of NPs were assessed using a case vignette survey, a validated method of assessing clinician practice patterns. The survey instrument presented two patient cases followed by questions presenting choices for severity assessment, treatment approach, and assessment of comorbidity risks.

Results

Several important educational gaps were identified by this study. NPs generally treat patients appropriately based on the perceived level of disease severity; however, approximately half of NPs underestimated disease severity in both patient cases, setting up the possibility of undertreatment. Additional gaps were identified in assessing risks of common psoriasis comorbidities.

Conclusions

The results of this study will allow for the design of optimally targeted continuing education programs, which in turn will enhance the capabilities of NPs who manage patients with psoriasis.
Collegiate Student Athletes With History of ADHD or Academic Difficulties Are More Likely to Produce an Invalid Protocol on Baseline ImPACT Testing
Authors: Manderino Lisa , Gunstad John
Published: April 2017

Objective:

Attention deficit hyperactivity disorder (ADHD) and other academically-relevant diagnoses have been suggested as modifiers of neurocognitive testing in sport-related concussion, such as Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). These preexisting conditions may suppress ImPACT scores to the extent that they are indistinguishable from low scores because of poor effort. The present study hypothesized that student athletes with history of ADHD or academic difficulties produce lower ImPACT composite scores and are more likely to produce invalid protocols than those without such conditions.

Design:

Cross-sectional study.

Setting:

Midsized public university.

Participants:

Nine hundred forty-nine National College Athletic Association athletes (average age = 19.2 years; 6.8% ADHD, 5.6% Academic Difficulties, 2.0% comorbid ADHD/Academic Difficulties).

Independent Variables:

Three seasons of baseline ImPACT protocols were analyzed. Student athletes were grouped using self-reported histories of ADHD or academic difficulties taken from ImPACT demographic questions.

Dependent Variables:

ImPACT composite scores and protocol validity.

Results:

Student athletes in the academic difficulties and comorbid groups performed worse on ImPACT composite scores (Pillai's Trace = 0.05), though this pattern did not emerge for those with ADHD. Student athletes with comorbid history were more likely to produce an invalid baseline (10.5% invalid) (χ2 (2) = 11.08, P = 0.004). Those with ADHD were also more likely to produce an invalid protocol (7.7% invalid, compared with 2.6% in student athletes with no history) (χ2 (2) = 10.70, P = 0.005).

Conclusions:

These findings suggest that student athletes reporting comorbid histories or histories of academic difficulties alone produce lower ImPACT composite scores, and that those with comorbid histories or histories of ADHD alone produce invalid protocol warnings more frequently than student athletes without such histories. Future studies should further examine invalid score thresholds on the ImPACT, especially in student athletes with conditions that may influence test performance.

Clinical Relevance:

Student athletes with history of ADHD or academic difficulties may more frequently fall below validity score thresholds, suggesting caution in interpreting test performance.
Rapid Infliximab Infusion in Children
Authors: Lev‐Tzion Raffi , Assa Amit , Yerushalmi Baruch , Lahad Avishay , Friedman Mira , Ledder Oren , Turner Dan
Published: April 2017

Pediatric data on rapid infliximab infusion are scarce. We report our experience with a 1‐hour rapid infusion protocol, prescribed in 3 pediatric inflammatory bowel disease units during 18 to 26 months. Children treated with infliximab for inflammatory bowel disease using a standard 2‐ to 3‐hour infusion protocol were switched to a 1‐hour protocol if they had received at least 4 standard duration infusions with no infusion reactions, there was no recent dose increase and no more than 10 weeks had elapsed since the previous infusion. A total of 102 children received infliximab infusions during the study period (85 Crohn disease; mean age 14.6 ± 2.6 years) of whom 63 were switched to the rapid infusions. Seven patients on the rapid protocol (11%) and 6 patients on the standard protocol (15%) had infusion reactions (P = 0.55). Consistent with adult data, our study indicates that a 1‐hour infliximab protocol in selected patients offers a safe alternative to the traditional 2‐ to 3‐hour infusions.
Impact of Interruptions, Distractions, and Cognitive Load on Procedure Failures and Medication Administration Errors
Authors: Thomas Lily , Donohue-Porter Patricia , Stein Fishbein Joanna
Published: April 2017

Medication administration errors are difficult to intercept since they occur at the end of the process. The study describes interruptions, distractions, and cognitive load experienced by registered nurses during medication administration and explores their impact on procedure failures and medication administration errors. The focus of this study was unique as it investigated how known individual and environmental factors interacted and culminated in errors.
Assessment of the Quality of Nursing Care From Perspectives of Nurses Who Experienced Hospitalization as Patients
Authors: Elayan Rana M. , Ahmad Muayyad M.
Published: April 2017

Nurses as patients or caregivers evaluated their care differently than nonnurses. A qualitative design with content analysis was used to provide an assessment of the quality of nursing care by examining nurses' perceptions as recipients of care. The 231 participants were registered nurses recruited from 8 hospitals in Amman, Jordan. Participants evaluated the quality of nursing care as either high (29.5%) or low (70.5%). Four improvement themes emerged: improving competency, serve with caring, professionalism, and administrative factors.
QSEN Institute RN-BSN Task Force
Authors: Stalter Ann M. , Phillips Janet M. , Dolansky Mary A.
Published: April 2017

The Quality and Safety Education for Nurses (QSEN) Institute RN-BSN Task Force presents a white paper on Recommendation for a Systems-based Practice Competency. The task force proposes a seventh QSEN competency, systems-based practice, to improve patient quality and safety. Recommendations to integrate systems-based practice into both education and practice settings, consistent with job descriptions and promotion criteria, involve a comprehensive continuing education program for nurses upon interview, orientation, residency programming, performance evaluation, and license renewal.
Shaped versus Round Implants in Breast Reconstruction: A Multi-Institutional Comparison of Surgical and Patient-Reported Outcomes
Authors: Khavanin Nima , Clemens Mark W. , Pusic Andrea L. , Fine Neil A. , Hamill Jennifer B. , Kim H. Myra , Qi Ji , Wilkins Edwin G. , Kim John Y. S.
Published: April 2017

Background:

Since the 2012 approval of shaped implants, their use in breast reconstruction has increased in the United States. However, large-scale comparisons of complications and patient-reported outcomes are lacking. The authors endeavored to compare surgical and patient-reported outcomes across implant types.

Methods:

The Mastectomy Reconstruction Outcomes Consortium database was queried for expander/implant reconstructions with at least 1-year postexchange follow-up (mean, 18.5 months). Outcomes of interest included postoperative complications, 1-year revisions, and patient-reported outcomes. Bivariate and mixed-effects regression analyses evaluated the effect of implant type on patient outcomes.

Results:

Overall, 822 patients (73.5 percent) received round and 297 patients (26.5 percent) received shaped implants. Patients undergoing unilateral reconstructions with round implants underwent more contralateral symmetry procedures, including augmentations (round, 18.7 percent; shaped, 6.8 percent; p = 0.003) and reductions (round, 32.2 percent; shaped, 20.5 percent; p = 0.019). Shaped implants were associated with higher rates of infection (shaped, 6.1 percent; round, 2.3 percent; p = 0.002), that remained significant after multivariable adjustment. Other complication rates did not differ significantly between cohorts. Round and shaped implants experienced similar 2-year patient-reported outcome scores.

Conclusions:

This prospective, multicenter study is the largest evaluating outcomes of shaped versus round implants in breast reconstruction. Although recipients of round implants demonstrated lower infection rates compared with shaped implants, these patients were more likely to undergo contralateral symmetry procedures. Both implant types yielded comparable patient-reported outcome scores. With appropriate patient selection, both shaped and round implants can provide acceptable outcomes in breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
A Prospective Randomized Trial Comparing the Effects of Lidocaine in Breast Reduction Surgery
Authors: Christie Brian M. , Kapur Sahil , Kempton Steve J. , Hanson Summer E. , Ma Yue , Rao Venkat K.
Published: April 2017

Background:

Use of dilute epinephrine tumescent solution in breast reduction surgery has been shown to significantly decrease operative blood loss without increasing perioperative complications. Lidocaine is commonly added to epinephrine to decrease postoperative pain. Evidence supporting this practice, however, is limited, and lidocaine toxicity has been reported.

Methods:

With institutional review board approval, patients undergoing bilateral breast reduction surgery were assigned to receive either tumescent saline solution with epinephrine (1:1 million) (group 1), or tumescent saline solution with epinephrine (1:1 million) and lidocaine (0.05%) (group 2). Tumescent solution (500 ml) was infiltrated just before skin incision. Wise pattern reduction with an inferior pedicle was used in all cases. A nurse in the postanesthesia care unit documented immediate postoperative pain and intravenous narcotic use. Patients used a survey to record postoperative pain, nausea/vomiting, and narcotic use for the first 24 hours. Results were analyzed using analysis of variance and logistic regression models.

Results:

Forty consecutive patients were enrolled (20 in each group). There was no statistical difference between groups 1 and 2 in total intravenous narcotic use (0.89 versus 0.55; p = 0.10), 24-hour narcotic use (32.19 versus 29.47; p = 0.71), peak pain scores both in the postanesthesia care unit (5.47 versus 4.47; p = 0.24) and 24 hours postoperatively surgery (6.44 versus 6.68; p = 0.78), and 24-hour nausea/vomiting counts [group 1, OR, 1.11 (p = 0.87); group 2, OR, 1.87 (p = 0.51)]. There were no hospital admissions in either group.

Conclusions:

The addition of lidocaine to tumescent solution does not significantly affect postoperative pain following breast reduction surgery. Considering potential risks and added costs, this practice may not be of benefit.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.
Indomethacin Enhances Fat Graft Retention by Up-Regulating Adipogenic Genes and Reducing Inflammation
Authors: Zhan Weiqing , Tan Shaun S. , Han Xiaolian , Palmer Jason A. , Mitchell Geraldine M. , Morrison Wayne A.
Published: April 2017

Background:

Cell-assisted lipotransfer has been promisingly applied to restore soft-tissue defects in plastic surgery; however, the harvesting of stromal vascular fraction increases morbidity and poses potential safety hazards. The authors investigated whether adding indomethacin, an antiinflammatory proadipogenic drug, to the fat graft at the time of transplantation would enhance the final graft volume compared with cell-assisted lipotransfer.

Methods:

In vitro, human adipose-derived stem cells were cultured in conditioned growth media supplemented with various doses of indomethacin to investigate adipogenesis and the expression of the adipogenic genes. In vivo, lipoaspirate mixed with stromal vascular fractions or indomethacin was injected into the dorsum of mice. Tissues were harvested at weeks 2, 4, and 12 to evaluate histologic changes.

Results:

In vitro, polymerase chain reaction analysis revealed that increased up-regulation of adipogenic genes and activation of the peroxisome proliferator-activated receptor-γ pathway. In vivo, the percentage volume of adipocytes in the indomethacin-assisted groups was higher than that in the lipoaspirate-alone (control) group at 12 weeks (p = 0.016), and was equivalent to the volume in the cell-assisted groups (p = 1.000). Indomethacin improved adipose volumes but had no effect on vascularity. A larger number of small adipocytes appeared in the treatment samples than in the controls at 2 weeks (p = 0.044) and 4 weeks (p = 0.021).

Conclusions:

Pretreating lipoaspirate with indomethacin enhances the final volume retention of engrafted fat. This result is explained in part by increased adipogenesis and possibly by the inhibition of inflammatory responses.
N-Acetylcysteine Prevents Retrograde Motor Neuron Death after Neonatal Peripheral Nerve Injury
Authors: Catapano Joseph , Zhang Jennifer , Scholl David , Chiang Cameron , Gordon Tessa , Borschel Gregory H.
Published: April 2017

Background:

Neuronal death may be an overlooked and unaddressed component of disability following neonatal nerve injuries, such as obstetric brachial plexus injury.N-acetylcysteine and acetyl-l-carnitine improve survival of neurons after adult nerve injury, but it is unknown whether they improve survival after neonatal injury, when neurons are most susceptible to retrograde neuronal death. The authors’ objective was to examine whetherN-acetylcysteine or acetyl-l-carnitine treatment improves survival of neonatal motor or sensory neurons in a rat model of neonatal nerve injury.

Methods:

Rat pups received either a sciatic nerve crush or transection injury at postnatal day 3 and were then randomized to receive either intraperitoneal vehicle (5% dextrose),N-acetylcysteine (750 mg/kg), or acetyl-l-carnitine (300 mg/kg) once or twice daily. Four weeks after injury, surviving neurons were retrograde-labeled with 4% Fluoro-Gold. The lumbar spinal cord and L4/L5 dorsal root ganglia were then harvested and sectioned to count surviving motor and sensory neurons.

Results:

Transection and crush injuries resulted in significant motor and sensory neuron loss, with transection injury resulting in significantly less neuron survival. High-doseN-acetylcysteine (750 mg/kg twice daily) significantly increased motor neuron survival after neonatal sciatic nerve crush and transection injury. NeitherN-acetylcysteine nor acetyl-l-carnitine treatment improved sensory neuron survival.

Conclusions:

Proximal neonatal nerve injuries, such as obstetric brachial plexus injury, produce significant retrograde neuronal death after injury. High-doseN-acetylcysteine significantly increases motor neuron survival, which may improve functional outcomes after obstetrical brachial plexus injury.
Improvement of Flap Necrosis in a Rat Random Skin Flap Model by In Vivo Electroporation-Mediated HGF Gene Transfer
Authors: Seyed Jafari S. Morteza , Shafighi Maziar , Beltraminelli Helmut , Geiser Thomas , Hunger Robert E. , Gazdhar Amiq
Published: April 2017

Background:

Despite great understanding of underlying mechanisms for flap necrosis and advances in surgical techniques, flap necrosis remains a critical issue. In the present study, the authors investigated the efficacy of electroporation-mediated hepatocyte growth factor (HGF) gene delivery to random dorsal skin flaps (McFarlane) to accelerate wound healing and reduce flap necrosis.

Methods:

Fifteen male Wistar rats (290 to 320 g) were divided randomly into three groups. Group a, the control group (n= 5), underwent surgery and received no gene transfer. Group b received electroporation-mediatedHGFgene delivery 24 hours after surgery as a treatment. Group c received electroporation-mediatedHGFgene delivery 24 hours before surgery as prophylaxis (n= 5). Planimetry, laser Doppler imaging, and immunohistochemistry were used to assess the efficacy ofHGFgene therapy among the groups.

Results:

Electroporation-mediatedHGFgene delivery significantly decreased flap necrosis percentage compared with the control group in prophylactic and treatment groups (p= 0.0317 andp= 0.0079, respectively) and significantly increased cutaneous perfusion compared with the control group (p= 0.0317 andp= 0.0159, respectively). Moreover, Spearman rank correlation showed a significant negative correlation between flap necrosis percentage and laser index (p= 0.0213 andr= −0.5964, respectively). Furthermore, significantly higher mean CD31+vessel density was detected in treatment and prophylactic groups (p= 0.0079 andp= 0.0159, respectively). In addition, quantitative image analysis revealed significantly higher HGF protein expression in groups b and c (p= 0.0079 andp= 0.0079, respectively).

Conclusion:

These findings suggested in vivo electroporation-mediatedHGFgene delivery enhanced viability and vascularity of the ischemic skin flap.
A Systematic Review of Different Implants and Approaches for Proximal Interphalangeal Joint Arthroplasty
Authors: Yamamoto Michiro , Malay Sunitha , Fujihara Yuki , Zhong Lin , Chung Kevin C.
Published: April 2017

Background:

Outcomes after implant arthroplasty for primary degenerative and posttraumatic osteoarthritis of the proximal interphalangeal joint were different according to the implant design and surgical approach. The purpose of this systematic review was to evaluate outcomes of various types of implant arthroplasty for proximal interphalangeal joint osteoarthritis, with an emphasis on different surgical approaches.

Methods:

The authors searched all available literature in the PubMed and EMBASE databases for articles reporting on outcomes of implant arthroplasty for proximal interphalangeal joint osteoarthritis. Data collection included active arc of motion, extension lag, and complications. The authors combined the data of various types of surface replacement arthroplasty into one group for comparison with silicone arthroplasty.

Results:

A total of 849 articles were screened, yielding 40 studies for final review. The mean postoperative arc of motion and the mean gain in arc of motion of silicone implant with the volar approach were 58 and 17 degrees, respectively, which was greater than surface replacement implant with the dorsal approach at 51 and 8 degrees, respectively. The mean postoperative extension lag of silicone implant with the volar approach and surface replacement with the dorsal approach was 5 and 14 degrees, respectively. The revision rate of silicone implant with the volar approach and surface replacement with the dorsal approach was 6 percent and 18 percent at a mean follow-up of 41.2 and 51 months, respectively.

Conclusion:

Silicone implant with the volar approach showed the best arc of motion, with less extension lag and fewer complications after surgery among all the implant designs and surgical approaches.
Preventing Early-Stage Graft Bone Resorption by Simultaneous Innervation: Innervated Iliac Bone Flap for Mandibular Reconstruction
Authors: Wang Lei , Wei Jian-Hua , Yang Xi , Yang Zi-Hui , Sun Mo-Yi , Cheng Xiao-Bing , Xu Li-Qun , Lei De-Lin , Zhang Chen-Ping
Published: April 2017

Background:

Postoperative resorption of vascularized bone grafts jeopardizes the success of dental implant(s) and functional rehabilitation of the jaw. Recent evidence supports the crucial role of innervation in bone regeneration and turnover.

Methods:

This study reports a new technique for simultaneous innervation of vascularized iliac flaps in mandibular reconstruction, through neurorrhaphy between ilioinguinal nerves, which innervate iliac bone, and inferior alveolar nerves or great auricular nerves. Twenty-two patients (aged 50 to 69 years) with postoncologic continuity defects of the mandible underwent mandibular reconstruction (10 innervated flaps and 12 control flaps). Graft bone resorption was analyzed by computed tomographic scans at 6 and 12 months postoperatively, and bone quality was evaluated for dental implantation, with histologic and histomorphometric analyses for graft samples.

Results:

At 12-month follow-up, graft bone density loss in the control group was significantly higher than in the innervated group (p < 0.05). Bone quality evaluation indicated a suitable condition for dental implantation in all patients in the innervated group but in 41.7 percent of patients in the control group. Histologic and histomorphometric analyses showed successful innervation in the innervated group but not in the control group. Osteoclast activity was significantly higher in the control group than in the innervated group (p < 0.05).

Conclusions:

Innervated iliac flaps may effectively prevent bone resorption of grafts in mandible reconstruction that otherwise jeopardize the success of dental implants. This new strategy of innervation of bone flaps appears clinically valuable and provides insights into the homeostasis of grafts for functional reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Adipose Tissue Drives Response to Ischemia-Reperfusion Injury in a Murine Pressure Sore Model
Authors: Gust Madeleine J. , Hong Seok Jong , Fang Robert C. , Lanier Steven T. , Buck Donald W. , Nuñez Jennifer M. , Jia Shengxian , Park Eugene D. , Galiano Robert D. , Mustoe Thomas A.
Published: April 2017

Background:

Ischemia-reperfusion injury contributes significantly to the pathogenesis of chronic wounds such as pressure sores and diabetic foot ulcers. The authors’ laboratory has previously developed a cyclical murine ischemia-reperfusion injury model. The authors here use this model to determine factors underlying tissue response to ischemia-reperfusion injury.

Methods:

C57BL/6 mice were subjected to cycles of ischemia-reperfusion that varied in number (one to four cycles) and duration of ischemia (1 to 2 hours). For each ischemia-reperfusion condition, the following variables were analyzed: (1) digital photographs for area of necrosis; (2) hematoxylin and eosin staining and immunohistochemistry for inflammatory infiltrate; and (3) expression of inflammatory markers by quantitative polymerase chain reaction. In addition, human adipocytes and fibroblasts were cultured in vitro under conditions of hypoxia and reoxygenation, and expression of inflammatory markers was analyzed by quantitative polymerase chain reaction.

Results:

Increases in both ischemia-reperfusion cycle number and ischemia duration correlated with increased areas of epithelial necrosis both grossly and histologically, and with an increase in cellularity and neutrophil density. This increased inflammatory infiltrate and a significant increase in the expression of proinflammatory markers (Hmox1, interleukin-6, interleukin-1, and monocyte chemoattractant protein-1) was observed in adipose tissue subjected to ischemia-reperfusion injury, but not in dermis. These results were mirrored in human adipose tissue.

Conclusions:

The authors further characterize a novel, reproducible murine model of ischemia-reperfusion injury. The results of their study indicate that adipose tissue is less tolerant of ischemia-reperfusion than dermal tissue. Rather than being an “innocent bystander,” adipose tissue plays an active role in driving the inflammatory response to ischemia-reperfusion injury.
The Challenges of Augmentation Mastopexy in the Massive Weight Loss Patient: Technical Considerations
Authors: Coombs Demetrius M. , Srivastava Udayan , Amar Dalit , Rubin J. Peter , Gusenoff Jeffrey A.
Published: April 2017

Background:

Augmentation mastopexy in the massive weight loss population is challenging because of poor skin elasticity and lack of inframammary support. Despite several large studies of augmentation mastopexy in the literature, few data exist regarding this unique patient population. The authors examine early postoperative ptosis, implant malposition, and strategies to optimize outcomes.

Methods:

A retrospective review of massive weight loss patients who underwent augmentation mastopexy from 2003 to 2011 was performed to record age, body mass index, implant characteristics, postoperative ptosis, and implant malposition.

Results:

Thirty patients were identified with a mean age of 44.8 ± 8.5 years, mean current body mass index of 26.1 ± 3.9 kg/m2, and mean follow-up time of 283.5 days (range, 7 to 1095 days). Preoperatively, patients mostly presented with grade 3 ptosis (63.3 percent). Five patients (16.7 percent) developed postoperative ptosis within the first 3 months after surgery, with no increase after this time. Implant malposition increased significantly with time: 61.9 percent by 12 months (p = 0.006), with a median time for implant malposition of 160 days. Postoperative ptosis was significantly related to age (p = 0.039) and a larger left-side implant (p = 0.022). Implant malposition was significantly related to higher current body mass index (p = 0.047), but not to implant size. Two patients (6.6 percent) underwent revision procedures.

Conclusion:

Massive weight loss patients have an increased risk of early postoperative ptosis or implant malposition, reinforcing the need for appropriate preoperative counseling to manage patient expectations.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Clinical Significance of Incidentally Detected Torus Tubarius Calcification
Authors: Buch Karen , Nadgir Rohini N. , Qureshi Muhammad Mustafa , Ozonoff Al , Sakai Osamu
Published: April 2017

Objectives

Calcification of the torus tubarius has been rarely reported in the literature. Histopathologic studies have previously described cases of Eustachian tube calcification and cite an association with increasing patient age. The purpose of this study was to examine the prevalence of torus tubarius calcification and potential clinical significance on an unrestricted patient population using thin-section computed tomography (CT), which has not been previously reported.

Methods

After the institutional review board approval, 1571 consecutive patients who underwent noncontrast head CT between January 2011 and July 2011 were retrospectively reviewed for torus tubarius calcification. Images were acquired at 1.25-mm slice thickness using a 64-detector row CT. Medical records were reviewed for chronic medical conditions including chronic kidney disease, alcoholism, autoimmune conditions, endocrine disorders, elevated alkaline phosphatase levels, history of otitis media, purified protein derivative positivity, history of head and neck surgery and radiation, and human immunodeficiency virus infection. Motion-limited studies and patients with limited clinical data were excluded. Statistical analyses were performed using the independent samplettest and Fisher exact test.

Results

Ten (0.6%) of 1571 patients had torus tubarius calcification, of which 7 (70%) were unilateral, and 3 (30%) were bilateral calcification. There was no significant association between torus tubarius calcification and common medical disorders including endocrine disorders, human immunodeficiency virus, chronic kidney disease, alcoholism, purified protein derivative positivity, history of head and neck surgery or radiation, and autoimmune diseases.

Conclusions

Based on the largest series to date on an unrestricted population using thin-section CT imaging, calcification of the torus tubarius is a rare entity with an overall prevalence of 0.6%. Although the clinical significance remains uncertain, there is no significant association between torus tubarius calcification and common medical conditions.
Gastric Heterotopic Pancreas: Computed Tomography With Clinicopathologic Correlation
Authors: Lee Nam Ju , Hruban Ralph H. , Fishman Elliot K.
Published: April 2017

Asymptomatic heterotopic pancreas (HP) is benign and can be monitored long term without further intervention. Heterotopic pancreas is sometimes surgically resected because it can be difficult to distinguish HP from neoplastic submucosal masses such as gastrointestinal stromal tumors. Although it is not very common, HP should be considered in the differential diagnosis when diagnosing extramucosal gastric masses to avoid unnecessary intervention. We review gastric HP with pathologic correlation to help with diagnosing HP on computed tomography.
Contained Rupture of an Abdominal Aortic Aneurysm With Extensive Vertebral Body and Retroperitoneal Space Destruction
Authors: Walker Sean T. , Pipinos Iraklis I. , Johanning Jason M. , Vargo Christopher J.
Published: April 2017

Chronic contained rupture of an abdominal aortic aneurysm with vertebral body erosion most commonly presents with symptoms of low back pain. Although not well known, vertebral body erosion or destruction may be seen in up to 25% of patients with sealed or contained rupture of an abdominal aortic aneurysm. This appearance on cross-sectional imaging may mimic a malignant or infectious process. Although these cases can present a diagnostic challenge, published cases of chronic contained rupture of an abdominal aortic aneurysm with vertebral body erosion demonstrate clinical and imaging similarities that, when recognized, can assist in diagnosis.
Lung Cancer in Patients With Tuberculous Fibrothorax and Empyema: Computed Tomography and 18F-Fluorodeoxyglucose Positron Emission Tomography Findings
Authors: Xu Hai , Koo Hyun Jung , Lee Han Na , Lim Soyeoun , Lee Jae Wook , Choi Chang-Min , Kim Mi Young
Published: April 2017

Objective

The aim of this study was to describe the characteristics of lung cancers in patients with tuberculous fibrothorax or empyema.

Methods

We retrospectively evaluated 138 consecutive patients with a diagnosis of lung cancer combined with fibrothorax (n = 127) or empyema (n = 11) from January 2005 to May 2015. All patients underwent computed tomography, and 105 underwent 18F-fluorodeoxyglucose positron emission tomography. Clinical, pathologic, and computed tomography characteristics and maximum standardized uptake values on positron emission tomography of 76 cancers ipsilateral to the fibrothorax or empyema (group 1) were compared with those of 62 contralateral cancers (group 2).

Results

The median age at diagnosis of patients was 70 years, with a male-to-female ratio of 8.9:1. The most common type was squamous cell carcinoma (41.3%) followed by adenocarcinoma (39.1%). Most were in the peripheral lung (70.3%), and half abutted the pleura. The median maximum standardized uptake value was 8.9. Tumors in group 1 were larger (median, 48.5 vs 42.8 mm, P = 0.036) and more advanced (T3 or T4) (P = 0.014) than those in group 2.

Conclusions

Lung cancers ipsilateral to tuberculous fibrothorax or empyema presented larger and advanced T stages, and the diagnosis could be delayed. The most common type cancer was squamous cell carcinoma.
Assessing Synovitis and Bone Erosion With Apparent Diffusion Coefficient in Early Stage of Rheumatoid Arthritis
Authors: Qu Jin , Lei Xinwei , Zhan Ying , Li Huixia , Zhang Yu
Published: April 2017

Purpose

The aim of this study was to assess the value of apparent diffusion coefficient (ADC) in distinguishing synovitis from joint fluid and bone erosion from cysts.

Methods

Twenty-eight patients with suspected rheumatoid arthritis underwent diffusion-weighted imaging and pre– and post–contrast-enhanced magnetic resonance imaging. The mean ADC values were compared between synovitis and joint effusion and between bone erosion and cyst.

Results

Mean ADC value of synovitis was significantly lower than that of the joint effusion (2.6 ± 0.37 × 10−3 vs 1.63 ± 0.37 × 10−3 mm2/s, P < 0.001; cutoff value 2.10 × 10−3 mm2/s). Mean ADC value of bone erosion was significantly lower than that of the cysts (1.61 ± 0.39 × 10−3 vs 2.39 ± 0.34 × 10−3 mm2/s, P < 0.001; cutoff value 2.04 × 10−3 mm2/s).

Conclusion

Apparent diffusion coefficient can be used in differentiating between synovitis and joint effusion and between bone erosion and cysts.
Investigation on Computed Tomography Features of Primary Thymic Atypical Carcinoid Tumors
Authors: Kan Xiaojing , Wang Pengming , Gong Zhiquan , Gao Feifei , Zhang Yuxia , Ge Yinghui
Published: April 2017

Objectives

The thymic atypical carcinoid tumors (aTCs) are rare. The computed tomography (CT) features of aTC were poorly studied, and researches under this topic with large samples are in a small quantity in the literature. Our aim was to investigate the CT features of aTC.

Methods

Eleven cases of aTC (7 men and 4 women; mean age, 56 ± 16 years) proved by pathology were retrospectively analyzed. All the patients underwent contrast-enhanced CT scans with dual phase (25–30 and 60–70 seconds) after contrast agent injection. Two experienced radiologists analyzed the imaging findings. The observing indexes of CT features were based on standard CT reporting terms of mediastinal masses suspicious for thymic malignancy, particularly on the findings of marginal cystic/necrotic component (MCC) sign and hypervascular sign in tumors.

Results

All the tumors were located in the anterior and/or middle mediastinum and heterogeneous parenchyma, with moderate to marked enhancement, and had multiple cystic/necrotic components. The maximum diameter of lesions ranged from 5 to 24 cm. Among the 11 patients involved in this study, 6 patients had distant metastases, all of which were identified as skeletal metastases; 9 cases showed MCC sign only at the margin (3 cases) or at both marginal and central margins (6 cases), and 5 cases showed hypervascular sign.

Conclusions

Our results suggested that the MCC and hypervascular signs should be included as characterization in addition to the standard features for the diagnosis of aTC.
Computed Tomography Features of Benign and Malignant Calcified Thyroid Nodules: A Single-Center Study
Authors: Kim Donghyun , Kim Dong Wook , Heo Young Jin , Baek Jin Wook , Lee Yoo Jin , Park Young Mi , Baek Hye Jin , Jung Soo Jin
Published: April 2017

Objective

No previous studies have investigated thyroid calcification on computed tomography (CT) quantitatively by using Hounsfield unit (HU) values. This study aimed to analyze quantitative HU values of thyroid calcification on preoperative neck CT and to assess the characteristics of benign and malignant calcified thyroid nodules (CTNs).

Materials and Methods

Two hundred twenty patients who underwent neck CT before thyroid surgery from January 2015 to June 2016 were included. On soft-tissue window CT images, CTNs with calcified components of 3 mm or larger in minimum diameter were included in this study. The HU values and types of CTNs were determined and analyzed.

Results

Of 61 CTNs in 49 patients, there were 42 malignant nodules and 19 benign nodules. The mean largest diameter of the calcified component was 5.3 (2.5) mm (range, 3.1–17.1 mm). A statistically significant difference was observed in the HU values of calcified portions between benign and malignant CTNs, whereas there was no significant difference in patient age or sex or in the size, location, or type of each CTN. Of the 8 CTNs with pure calcification, 3 exhibited a honeycomb pattern on bone window CT images, and these 3 CTNs were all diagnosed as papillary thyroid carcinoma on histopathological examination.

Conclusions

Hounsfield unit values of CTNs may be helpful for differentiating malignancy from benignity.
Venous Sinus Thrombosis in Blunt Trauma: Incidence and Risk Factors
Authors: Slasky Shira E. , Rivaud Yayone , Suberlak Matthew , Tairu Oluwole , Fox Adam D. , Ohman-Strickland Pamela , Bilinisky Esther
Published: April 2017

Purpose

The aim of our study was to determine the incidence and risk factors of dural venous sinus thrombosis and epidural hemorrhage in the setting of a blunt trauma causing a calvarial fracture crossing a dural venous sinus.

Methods

A retrospective review of 472 blunt trauma patients with calvarial fracture crossing a dural venous sinus was performed. Two hundred ten patients who underwent computed tomography venography were identified and evaluated for the presence of dural venous sinus thrombosis and/or epidural hemorrhage. Site and displacement of fractures, as well as age, sex, Glasgow Coma Scale (GCS) score, and mechanism of injury, were considered for potential predictive value of thrombosis and/or epidural hemorrhage.

Results

We found a 23% incidence of dural venous sinus thrombosis in patients with a fracture traversing a dural venous sinus. Significant predictors of thrombosis included temporal fracture (38% incidence) and skull base fracture (31% incidence). Occipital fracture not involving the skull base was associated with a significantly decreased risk of thrombosis, with an incidence of 9%. Decreased GCS score and fall from height greater than 10 feet additionally predicted dural venous sinus thrombosis. Significant predictors of epidural hemorrhage included parietal fractures and displaced fractures, although a large percentage of nondisplaced fractures in other bones demonstrated epidural hemorrhage as well.

Conclusions

Dural venous sinus thrombosis in the setting of blunt trauma with a calvarial fracture crossing a dural venous sinus has an incidence of 23%. Increased suspicion for thrombosis is warranted in patients with temporal or skull base fractures, low GCS score, and recent fall from great height.
Multislice Computed Tomography Assessment of Tracheobronchial Patterns in Partial Anomalous Left Pulmonary Artery
Authors: Wang Shi-Yu , Gao Wei , Zhong Yu-Min , Sun Ai-Min , Wang Qian , Hu Li-Wei , Qiu Hai-Sheng , Li Jian-Ying , Jaffe Richard B.
Published: April 2017

Objective

The aim of this study was to present relationship between partial anomalous left pulmonary artery (PALPA) and the tracheobronchial tree and patterns of the tracheobronchial tree assessed by multislice computed tomography (MSCT).

Methods

Nine patients were assessed by MSCT. The relationships between the tracheobronchial tree and PALPA and different tracheobronchial patterns, location of tracheobronchial stenosis, severity of stenosis, and associated cardiac defects were evaluated. The results of MSCT for these patients were compared with the operative findings.

Results

The anatomy of PALPA was clearly identified by MSCT in all 9 patients. Three relationships between PALPA and the tracheobronchial tree were noted. In addition, 3 patterns of tracheobronchial tree anatomy were also demonstrated. The PALPA arose from the right pulmonary artery, forming a pulmonary sling (n = 2). The PALPA, which arose from the proximal right pulmonary artery, went below the tracheal bifurcation and passed anterior (n = 1) or inferior-anterior (n = 6) to the proximal left main bronchus. Three patterns of the tracheobronchial tree were presented with normal (n = 5), normal pattern with right tracheal bronchus (n = 3), and bridging bronchus (n = 1). The rate of tracheobronchial stenosis was 56% (5/9).

Five patients underwent operation, and at that time, the relationship between PALPA and the tracheobronchial tree defined on MSCT was confirmed.

Conclusions

The PALPA can be associated with tracheobronchial anomalies and airway compression depending on its orientation to the airway. Noninvasive imaging modalities such as MSCT will be helpful for making further management decisions.
Long-term Results After Oncoplastic Surgery for Breast Cancer
Authors: Clough Krishna B. , van la Parra Raquel F. D. , Thygesen Helene H. , Levy Eric , Russ Elisabeth , Halabi Najeeb M. , Sarfati Isabelle , Nos Claude
Published: April 2017

Objective:

The aim of this study was to evaluate the long-term oncologic outcome after oncoplastic surgery (OPS).

Background:

OPS combines wide tumor excision with reduction mammoplasty techniques thus extending breast conserving surgery to large tumors that might else be proposed a mastectomy. Little data are available about the oncologic results for breast conserving surgery of these larger tumors.

Methods:

From January 2004 until March 2016, a total of 350 oncoplastic breast reductions were prospectively entered into a database. Patients were included if their breast reshaping included a reduction mammoplasty with skin excision (Level 2 oncoplastic techniques).

Results:

Histologic subtypes were: invasive ductal carcinoma in 219 cases (62.6%), ductal carcinoma in situ (DCIS) in 88 cases (25.1%), and invasive lobular carcinoma in 43 (12.3%) cases. Seventy-three of the invasive cancers (27.9%) received neoadjuvant chemotherapy. The mean resection weight was 177 grams. The mean pathological tumor size was 26 mm (range 0–180 mm) and varied from 23 mm (4–180 mm) for invasive cancers to 32 mm (0–100 mm) for DCIS. Specimen margins were involved in 12.6% of the cases; 10.5% of invasive ductal, 14.7% of DCIS, and 20.9% of invasive lobular. The overall breast conservation rate was 92% and varied from 87.4% for DCIS to 93.5% for the invasive cancers. Thirty-one patients (8.9%) developed one or more postoperative complications, inducing a delay in postoperative treatments in 4.6% of patients. The median follow up was 55 months. The cumulative 5-year incidences for local, regional, and distant recurrences were 2.2%, 1.1%, and 12.4%, respectively.

Conclusions:

Oncoplastic breast reductions allow wide resections with free margins and can be used for large cancers as an alternative to mastectomy.
The GroinPain Trial: A Randomized Controlled Trial of Injection Therapy Versus Neurectomy for Postherniorraphy Inguinal Neuralgia
Authors: Verhagen Tim , Loos Maarten J. A. , Scheltinga Marc R. M. , Roumen Rudi M. H.
Published: April 2017

Objective:

This study compares tender point infiltration (TPI) and a tailored neurectomy as the preferred treatment for chronic inguinodynia after inguinal herniorraphy.

Background:

Some 11% of patients develop chronic discomfort after open inguinal herniorraphy. Both TPI and neurectomy have been suggested as treatment options, but evidence is conflicting.

Methods:

Patients with chronic neuropathic pain after primary Lichtenstein repair and >50% pain reduction after a diagnostic TPI were randomized for repeated TPI (combined Lidocaine/corticosteroids /hyaluronic acid injection) or for a neurectomy. Primary outcome was success (>50% pain reduction using Visual Analog Scale, VAS) after 6 months. Cross-over to neurectomy was offered if TPI was unsuccessful.

Results:

A total of 54 patients were randomized in a single center between January 2006 and October 2013. Baseline VAS was similar (TPI: 55, range 10–98 vs neurectomy: 53, range 18–82, P = 0.86). TPI was successful in 22% (n = 6), but a neurectomy was successful in 71% (n = 17, P = 0.001). After unsuccessful TPI, 19 patients crossed over to neurectomy and their median VAS score dropped from 60 to 14 (P = 0.001). No major complications after surgery were reported. Two-thirds of patients on worker's compensation returned to work.

Conclusion:

A tailored neurectomy is 3 times more effective than tender point infiltration in chronic inguinodynia after anterior inguinal hernia mesh repair. A step up treatment stratagem starting with tender point infiltration followed by a tailored neurectomy is advised.