bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Uterine Tamponade and Interventional Radiology Procedures During Delivery Hospitalizations
Authors: Merriam Audrey A. , Huang Yongmei , Wright Jason D. , Goffman Dena , D'Alton Mary E. , Friedman Alexander M.
Published: February 2020

OBJECTIVE:

To characterize use of uterine tamponade and interventional radiology procedures.

METHODS:

This retrospective study analyzed uterine tamponade and interventional radiology procedures in a large administrative database. The primary outcomes were temporal trends in these procedures 1) during deliveries, 2) by hospital volume, and 3) before hysterectomy for uterine atony or delayed postpartum hemorrhage. Three 3-year periods were analyzed: 2006–2008, 2009–2011, and 2012–2014. Risk of morbidity in the setting of hysterectomy with uterine tamponade and interventional radiology procedures as the primary exposures was additionally analyzed in adjusted models.

RESULTS:

The study included 5,383,486 deliveries, which involved 6,675 uterine tamponade procedures, 1,199 interventional radiology procedures, and 1,937 hysterectomies. Interventional radiology procedures increased from 16.4 to 25.7 per 100,000 delivery hospitalizations from 2006–2008 to 2012–2014 (P<.01), and uterine tamponade increased from 86.3 to 158.1 (P<.01). Interventional radiology procedures use was highest (45.0/100,000 deliveries, 95% CI 41.0–48.9) in the highest and lowest (8.9/100,000, 95% CI 7.1–10.7) in the lowest volume quintile. Uterine tamponade procedures were most common in the fourth (209.8/100,000, 95% CI 201.1–218.5) and lowest in the third quintile (59.8/100,000, 95% CI 55.1–64.4). Interventional radiology procedures occurred before 3.3% of hysterectomies from 2006 to 2008 compared with 6.3% from 2012 to 2014 (P<.05), and uterine tamponade procedures increased from 3.6% to 20.1% (P<.01). Adjusted risks for morbidity in the setting of uterine tamponade and interventional radiology before hysterectomy were significantly higher (adjusted risk ratio [aRR] 1.63, 95% CI 1.47–1.81 and aRR 1.75 95% CI 1.51–2.03, respectively) compared with when these procedures were not performed.

CONCLUSION:

This analysis found that uterine tamponade and interventional radiology procedures became increasingly common over the study period, are used across obstetric volume settings, and in the setting of hysterectomy may be associated with increased risk of morbidity, although this relationship is not necessarily causal.
Long-term Outcomes Following Vickers Ligament Release and Growth Modulation for the Treatment of Madelung Deformity
Authors: Del Core Michael , Beckwith Terri , Phillips Lee , Ezaki Marybeth , Stutz Chris , Oishi Scott N.
Published: February 2020

Background:

Madelung deformity arises from a partial distal radial growth disturbance in combination with an abnormal hypertrophic ligament spanning the volar radius and carpus, termed, the Vickers ligament. The purpose of this study is to report long-term clinical and radiographic outcomes following Vickers ligament release and distal radial physiolysis in a population of skeletally immature patients with symptomatic Madelung deformity.

Methods:

Medical records were retrospectively reviewed of patients with Madelung deformity surgically treated between 1994 and 2005. All eligible patients who underwent a Vickers ligament release and distal radial physiolysis were contacted and invited to return to the clinic for follow-up.

Results:

Six patients (8 wrists) with Madelung deformity underwent Vickers ligament release and distal radial physiolysis. All were white females with a mean age at initial presentation of 11.4 years (10 to 12.8 y). Mean age at the time of initial surgery was 12.0 years (10.0 to 14.5 y). The median follow-up time was 10.6 years (5.8 to 21.9 y) and the average age at last follow-up was 23.1 years (17.5 to 32.2 y). Pain alone or in combination with concerns for deformity was the chief complaint in 6 of 8 of the wrists. At 1 year of clinical follow-up, 7 of 8 wrists were reported to be pain-free, and 6 of the 8 were noted to be completely pain-free at last follow-up. Motion in flexion, extension, pronation, supination, radial, or ulnar deviation was similar between the preoperative status and long-term follow-up. The average preoperative ulnar tilt was 35.1 degrees (SD: 8.5 degrees), average preoperative lunate subsidence was 1.9 degrees (SD: 1.8 degrees), and average preoperative palmar carpal displacement was 21.9 degrees (SD: 2.9 degrees). At the final follow-up, there was a large progression in lunate subsidence, but minimal change in ulnar tilt and palmar carpal displacement. At last clinical follow-up, 2 of the 6 patients had undergone a subsequent procedure including 1 radial dome osteotomy and 1 ulnar shortening osteotomy.

Conclusion:

In the skeletally immature patient population with Madelung deformity with growth potential remaining, distal radial physiolysis and Vickers ligament release is associated with relief of pain, preservation of motion, and, a reasonable rate of reoperation.

Type of Study:

This was a therapeutic study.

Level of Evidence:

Level II.
Pediatric Ganglion Cyst Recurrence: Location Isn’t the Only Risk Factor
Authors: Mooney Megan L. , Jacobs Cale A. , Prusick Vincent W. , Riley Scott A.
Published: February 2020

Introduction:

Ganglion cysts represent the most common benign soft-tissue masses of the hand and wrist, most are treated nonoperatively, with relatively few local recurrences. Few studies have identified risk factors for recurrence in the pediatric population. The aim of this study is to identify risks of cyst recurrence and to establish if ultrasonographic imaging aids in the prediction of recurrence.

Methods:

A single-center retrospective chart review was performed, identifying patients diagnosed with a ganglion cyst of the hand or wrist. Demographic information, cyst characteristics, and ultrasound examination reports were documented. Standard statistical and logistic regression analyses were performed.

Results:

A total of 132 cysts were identified in 126 patients and the average age was 8.5 years old. The most common location was the dorsal wrist (57/132, 43.2%). There were 14 recurrences [11/14, (79%) dorsal wrist, 3/14 (21%) volar wrist, 0/14 (0%) in nonwrist locations]. The risk of recurrence was significantly greater for dorsal wrist cysts than nonwrist locations (odds ratio=18.1; 95% confidence interval: 1.02, 316.65; P=0.048); there was no statistical difference in recurrence rates between dorsal and volar cysts (P=0.15). Recurrence was noted in older patients (12.2 vs. 8.1 y, P<0.001) and those patients with painful masses (P=0.02). Patients undergoing surgical excision had a higher risk of recurrence than those who did not undergo surgical excision (P<0.001). Cyst volume as measured by ultrasound was performed in 37 cysts, with repeat ultrasounds in 12 cases demonstrating a decreased volume of 0.85 cm3 at baseline to 0.35 cm3 with repeat examination (P=0.40). In patients that received at least 1 ultrasound, there were no differences in cyst volume between those that recurred and those that did not (P=0.40).

Conclusions:

Risk factors for recurrence in pediatric patients with a ganglion cyst include older age, symptomatic masses, cysts located around the wrist, and those requiring surgical excision. Ultrasound examination of cyst volume did not predict recurrence.

Level of Evidence:

Level III—therapeutic.
Open Reduction of Neglected Supracondylar Humeral Fractures With Callus Formation in Children
Authors: Guo Meizhen , Xie Yan , Su Yuxi
Published: February 2020

Background:

The standard treatment for supracondylar humeral fractures (SHFs) in children is closed reduction and percutaneous Kirschner (K)-wire fixation. In patients who present >14 days after injury and show callus formation, this procedure cannot be performed. There are 2 options in these cases: functional exercises with osteotomy performed at a later stage if cubitus varus is present, or immediate open reduction and percutaneous K-wire fixation. This study aimed to evaluate the outcomes of K-wire fixation through an anterior approach in children with neglected SHF and identify factors predicting the outcomes.

Methods:

This retrospective study assessed the files of 32 children treated for neglected SHF at our hospital between June 2015 and May 2018. An incision was made along the anterior transverse groove of the elbow. The callus was removed, the fracture was reduced, and K-wire fixation was performed. The outcome evaluation included the radiological Baumann angle, pin fixation construct, carrying angles, and the functional outcome was Mayo Elbow Performance Score and Flynn criteria. Binary regression analysis compared the functional outcome as the dependent variable with age, time from injury to operation, operation time, and the amount of callus.

Results:

The interval between injury and operation was 14 to 40 days (average, 22.4 d). Patients were followed for 12 to 36 months (average, 21.5 mo). Fracture healing took 5 to 8 weeks (average, 6.6 wk). No patient had a vascular injury or compartment syndrome. Twelve patients were intraoperatively assessed for radial and median nerve injury. No nerve repair was required. All nerve injuries recovered within 3 months. No iatrogenic ulnar nerve injury occurred. One patient had an infected incision. Binary regression analysis showed that the time elapsed between injury and operation (P=0.033) and Gartland type (P=0.008) were inversely correlated with outcomes; the longer the duration, the poorer the outcomes.

Conclusions:

The functional outcomes after open reduction and K-wire fixation through an anterior approach were poorer with longer time to surgery and Gartland type.

Level of Evidence:

Level III.
Long-term Outcomes Following Multilevel Surgery in Cerebral Palsy
Authors: Jones Mark D. , Gardner Richard , Pyman Jane , Gargan Martin F. , Witherow Peter , Monsell Fergal
Published: February 2020

Background:

This long-term consecutive, retrospective single-center cohort study evaluates long-term outcomes of single-event multilevel surgery in diplegic cerebral palsy with respect to functional status, gait, and patient satisfaction.

Methods:

All patients with diplegic cerebral palsy who underwent single-event multilevel surgery >10 years previously were included. Retrospective gait assessment was performed using the Edinburgh Visual Gait Score (EVGS) and Gillette Functional Assessment Questionnaire Walking Scale (FAQWS) preoperatively and at midterm postoperative follow-up (median 2.6 y) and prospectively at most recent review [median 18 y, interquartile (IQ) range: 14.4 to 20.5 y]. The Short Form-36 (SF-36) was used prospectively to evaluate outcome compared with population norms for adults from the UK.

Results:

The complete assessment was possible in 26 of 39 patients who met the inclusion criteria. There was a statistically significant improvement at most recent follow-up compared with the preoperative assessment for EVGS and FAQWS [Wilcoxon Matched Pairs Signed Rank test −4.42 (P<0.0001) and 3.98 (P=0.0001), respectively]. The median Physical Health and Mental Health Component Summary scores for the SF-36 were 43.0 (IQ range: 32.8 to 46.8) and 55.3 (IQ range: 46.1 to 61.1), respectively.

Conclusions:

This study demonstrates significant long-term improvements in function, independence and patient satisfaction that continue into adulthood. This will inform discussions with patients and families considering this treatment option.

Level of Evidence:

Level IV—Retrospective cohort study.
Wrist Joint Skeletal Changes in Children With Transfusion-dependent Thalassemia
Authors: Dhawan Pawan , Kanojia Rajesh. K. , Chandra Jagdish , Kumar Ajay , Anand Rama , Gupta Sumit
Published: February 2020

Background:

Arthropathies and bone deformities are well known to occur in patients with thalassemia major and have been attributed to the disease or to its therapy. Before the advent of chelation therapy, these children developed widened diploic space and “hair-on-end” pattern in skull, “cobweb” pattern in the pelvis, and the lack of the normal concave outline in the long bones because of extensive marrow proliferation. After the introduction of iron-chelation therapy, these patients were noted to develop metaphyseal abnormalities and vertebral changes resembling spondylo-metaphyseal dysplasia. Only one study has shown some association of deferiprone (chelating agent) use with distal ulnar changes in these children. Our study was done to describe the skeletal changes and deformities in wrist joints of children with transfusion-dependent thalassemia and correlate them with age, mean pretransfusion hemoglobin level, mean serum ferritin level, and type and duration of chelation therapy in these children.

Methods:

A total of 60 children with transfusion-dependent thalassemia from the thalassemia daycare center were examined. These children were divided into 3 groups on the basis of their age (group A: 2 to 6 y, group B: 6 to 10 y, and group C: 10 to 14 y). Detailed history, including treatment history, number of blood transfusions received over the last 1 year, clinical examination, and radiologic assessment of both forearm with wrists were done.

Results:

The clinical and radiologic differences in radial and ulnar lengths increased significantly with the increasing age of these patients, the ulna being short. There was some correlation between increasing negative ulnar variance and distal radial articular angle with deferiprone consumption.

Conclusion:

Chelation therapy, particularly with deferiprone, may cause distal ulnar growth arrest causing ulnar shortening and progressive radial bowing in these children.

Level of Evidence:

Level IV—case series.
Preoperative Mental Health Component Scoring Is Related to Patient Reported Outcomes Following Lumbar Fusion
Authors: Stull Justin D. , Divi Srikanth N. , Goyal Dhruv K.C. , Bowles Daniel R. , Reyes Ariana A. , Bechay Joseph , Sonnier John Hayden , Nachwalter Ryan N. , Zarowin Joseph J. , Galetta Matthew S. , Kaye Ian David , Woods Barrett I. , Kurd Mark F. , Radcliff Kris E. , Rihn Jeffrey A. , Anderson David Greg , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: February 2020

Study Design.

Retrospective cohort review.

Objective.

The objective of this study was to identify depression using the Mental Component Score (MCS-12) of the Short Form-12 (SF-12) survey and to correlate with patient outcomes.

Summary of Background Data.

The impact of preexisting depressive symptoms on health-care related quality of life (HRQOL) outcomes following lumbar spine fusion is not well understood.

Methods.

Patients undergoing lumbar fusion between one to three levels at a single center, academic hospital were retrospectively identified. Patients under the age of 18 years and those undergoing surgery for infection, trauma, tumor, or revision, and less than 1-year follow-up were excluded. Patients with depressive symptoms were identified using an existing clinical diagnosis or a score of MCS-12 less than or equal to 45.6 on the preoperative SF-12 survey. Absolute HRQOL scores, the recovery ratio (RR) and the percent of patients achieving minimum clinically important difference (MCID) between groups were compared, and a multiple linear regression analysis was performed.

Results.

A total of 391 patients were included in the total cohort, with 123 (31.5%) patients reporting symptoms of depression based on MCS-12 and 268 (68.5%) without these symptoms. The low MCS-12 group was found to have significantly worse preoperative Oswestry disability index (ODI), visual analogue scale back pain (VAS Back) and visual analogue scale leg pain (VAS Leg) scores, and postoperative SF-12 physical component score (PCS-12), ODI, VAS Back, and VAS Leg pain scores (P < 0.05) than the non-depressed group. Finally, multiple linear regression analysis revealed preoperative depression to be a significant predictor of worse outcomes after lumbar fusion.

Conclusion.

Patients with depressive symptoms, identified with an MCS-12 cutoff below 45.6, were found to have significantly greater disability in a variety of HRQOL domains at baseline and postoperative measurement, and demonstrated less improvement in all outcome domains included in the analysis compared with patients without depression. However, while the improvement was less, even the low MCS-12 cohort demonstrated statistically significant improvement in all HRQOL outcome measures after surgery.

Level of Evidence: 3
Cholesterol-lowering drug pitavastatin targets lung cancer and angiogenesis via suppressing prenylation-dependent Ras/Raf/MEK and PI3K/Akt/mTOR signaling
Authors: Hu Tianjun , Shen Haibo , Huang Hongbo , Yang Zhenhua , Zhou Yinjie , Zhao Guofang
Published: February 2020

Therapeutic agents that target both tumor cell and vascular endothelial cell may achieve additional anti-tumor efficacy, particularly in lung cancer due to the critical roles of angiogenesis during lung cancer progression and metastasis. In this work, we showed that pitavastatin, a novel cholesterol-lowering drug, potently inhibited lung cancer cells and angiogenesis. This was achieved by the induction of apoptosis and inhibition of proliferation of lung cancer cells and human lung tumor-associated endothelial cell. Pitavastatin was not only effective to chemo-sensitive but also chemo-resistant lung cancer cells. This was also consistent with the finding that pitavastatin significantly enhanced cisplatin’s efficacy in lung cancer xenograft model without causing toxicity in mice. We further showed that pitavastatin inhibited lung tumor angiogenesis in vitro and in vivo through suppressing human lung tumor-associated endothelial cell migration and morphogenesis without affecting adhesion. Mechanistically, we showed that pitavastatin acted on lung cancer cells and human lung tumor-associated endothelial cell through suppressing prenylation-dependent Ras/Raf/MEK and PI3K/Akt/mTOR signaling. Our work is the first to demonstrate the inhibitory effects of pitavastatin on Ras-mediated signaling. Our findings provide pre-clinical evidence to repurpose pitavastatin for the treatment of lung cancer.
Myositis and myasthenia during nivolumab administration for advanced lung cancer: a case report and review of the literature
Authors: Veccia Antonello , Kinspergher Stefania , Grego Elisabetta , Peterlana Dimitri , Berti Alvise , Tranquillini Enzo , Caffo Orazio
Published: February 2020

The immunotherapy significantly improved survival of non-small cell lung cancer patients, but it may cause immune-related adverse events, which are severe in less than 10% of cases. We report the case of one patient who developed myositis and myasthenia during nivolumab treatment for metastatic lung squamous carcinoma. Moreover, we reviewed literature data in order to identify similar cases in cancer patients treated with immune-checkpoints inhibitors. A 65-year-old patient, who had previously received a first-line platinum-based therapy, developed diplopia and ptosis 4 weeks after the start of nivolumab. Although antibodies associated with myositis, myasthenia gravis and paraneoplastic syndromes were absent, immune-related myositis and myasthenia were diagnosed. Corticosteroids, immunoglobulin and pyridostigmine showed poor efficacy and the patient died 7 weeks after the appearance of the first symptoms. Fifteen similar cases were found in the literature. A close collaboration between different specialists is essential to rapidly identify and treat severe immune-related adverse events.
Cyclin-dependent kinase inhibitors plus aromatase inhibitor in first-line treatment hormone-receptor–positive/HER2-negative advanced breast cancer women with or without visceral disease: time to turn page?
Authors: Nigro Olga , Marrazzo Cristina , Gallerani Elisa , Bascialla Linda , Gueli Rossana , Grigioni Elena , De Giorgi Annamaria , Giaquinto Alice , Vallini Ilaria , Pinotti Graziella
Published: February 2020

Breast cancer is the most common female tumour type and accounts for the leading cancer mortality in women worldwide. Up to 75% of breast cancers express the oestrogen receptor or progesterone receptor (hormone-receptor–positive). Aromatase inhibitors were the preferred first-line treatment option. New and acquired resistance to hormonal blockade has led to the development of targeted treatments. Cyclin-dependent kinases (CDKs) are a large family of serine–threonine kinases that play an important role in regulating cell cycle progression: palbociclib, ribociclib, and abemaciclib. We conducted a study to evaluate the efficacy of CDK inhibitors (CDKi) plus aromatase inhibitor in hormone-receptor–positive/HER2-negative ABC patients with visceral disease, postponing the use of chemotherapeutic agents and strengthening the power of endocrine agents. We enrolled 22 patients treated with CDKi (palbocilib) plus aromatase inhibitor (group A) and 38 patients treated with chemotherapy (group B). Our small study confirms the effectiveness of treatment with CDKi plus aromatase inhibitor, even in patients with visceral metastases, when compared with chemotherapy.
Extensive vitiligo associated to response to c-kit inhibitor in metastatic mucosal melanoma
Authors: Pala Laura , Conforti Fabio , Cocorocchio Emilia , Ferrucci Pier Francesco
Published: February 2020

Mucosal melanoma is rare and accounts for 1.3–1.4% of all melanomas. Kit mutations are found in approximately 15–20% of mucosal melanomas. Immunotherapy with anti cytotoxic T-lymphocyte associated protein 4 and antiprogrammed cell death protein 1 have reported low clinical efficacy in this melanoma subtype. Studies with Kit inhibitor Imatinib showed response rates ranging from 20 to 30%. We present the case of a patient with a c-kit mutated metastatic melanoma who developed autoimmune vitiligo during treatment with oral tyrosine kinase inhibitor Masitinib.
First-Line Treatment With Atezolizumab Plus Nab-Paclitaxel for Advanced Triple-Negative Breast Cancer
Authors: Weng Xiuhua , Huang Xiaoting , Li Hongchao , Lin Shen , Rao Xin , Guo Xianzhong , Huang Pinfang
Published: February 2020

Objective:

The authors conducted a cost-effectiveness analysis incorporating recent phase III clinical trial (IMpassion130) data to evaluate the cost-effectiveness of atezolizumab in combination with nab-paclitaxel (AnP) against nab-paclitaxel alone as the first-line treatment for advanced triple-negative breast cancer in developed and developing countries.

Materials and Methods:

A decision-analytic Markov model was developed using IMpassion130 data to evaluate the cost-effectiveness of AnP over a lifetime from the US health care payer and Chinese health care system perspective. Model inputs were derived from IMpassion130 and published literature. The primary outcomes of the model were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed using univariate and probabilistic sensitivity analyses.

Results:

For the intention-to-treat (ITT) population, the projected mean outcome was better with AnP (1.41 QALYs) than with nab-paclitaxel alone (0.99 QALYs). Similar results were obtained for the programmed death ligand 1 (PD-L1)-positive population, with the obtained mean outcomes of 1.66 and 0.88 QALYs, respectively. For the Unites States, the ICER values comparing AnP with nab-paclitaxel were US$331,996.89 and US$229,359.88 per QALY gained for the ITT and PD-L1-positive populations, respectively. For China, the ICER values were US$106,339.26 and US$72,971.88 per QALY gained for the ITT and PD-L1-positive populations, respectively. The univariate sensitivity analysis indicated that the price of atezolizumab was the most influential factor in our study. AnP had 0% cost-effectiveness at the willingness-to-pay thresholds of US$150,000/QALY in the United States and US$29,383/QALY in China.

Conclusion:

AnP is not a cost-effective choice as the first-line treatment for advanced triple-negative breast cancer in the United States and China.
Determining Optimal Follow-up for Patients With Anal Cancer Following Chemoradiation
Authors: Frazer Marissa L. , Yang George , Felder Seth , McDonald Jordan , Sanchez Julian , Dessureault Sophie , Imanirad Iman , Carballido Estrella , Kim Richard D. , Hoffe Sarah E. , Frakes Jessica M.
Published: February 2020

Background:

US health care is increasingly defined by over expenditure and inefficiency. Optimizing patient follow-up is critical, especially in cancers treated with high control rates. To optimize patient care, this study assessed time to disease recurrence or toxicity in patients with anal carcinoma.

Materials and Methods:

In total, 140 patients with biopsy-proven, nonmetastatic anal carcinoma, treated with chemoradiation utilizing intensity-modulated radiation therapy, were identified from our institutional database. This retrospective study evaluated local recurrence (LR), distant metastasis (DM), overall survival (OS), and late ≥grade 3 toxicity (LG3T). Patients were followed posttreatment every 3 months for 2 years, every 6 months in years 3 to 5, then yearly thereafter per NCCN recommendations.

Results:

The median age and follow-up was 58 years and 27 months, respectively. Patients were categorized into high (n=61; 44%) and low (n=77; 55%) risk groups based on stage. The 2-year LC, DMFS, and OS were 93%, 94%, and 89% and 5-year LC, DMFS, OS were 92%, 87%, and 85%, respectively. Overall, there were 29 events (9 LR, 11 DM, and 9 LG3T), with 62% of events occurring within year 1 and 79% within 2 years. Stratified by event type, at 2 years 89% of LR, 64% of DM, and 89% LG3T were identified. At the remaining follow-up points, the event incidence rate was 1.3%.

Conclusion:

With the majority of recurrences/toxicities occurring within the first 2 years, a reduction in follow-up during years 3 to 5 may provide adequate surveillance. Revisions of the current recommendations could maximize resources while improving patient quality of life.
Treatment Timing in Small Cell Lung Cancer, a National Cancer Database Analysis
Authors: Bhandari Shruti , Kumar Rohit , Pham Danh , Gaskins Jeremy , Kloecker Goetz
Published: February 2020

Objectives:

Small cell lung cancer (SCLC) is an aggressive disease treated as soon as possible given its rapid doubling time. Evidence for the appropriate time to chemotherapy initiation (TCI) for SCLC is lacking. This study evaluated TCI in SCLC on a national level.

Materials and Methods:

The National Cancer Database identified 64,491 SCLC patients treated with chemotherapy from 2010 to 2014. Factors associated with TCI were identified with multiple linear regression analyses. TCI was categorized into 4 groups using cutoff points of 7, 14, and 28 days. Using these categories, median overall survival and log-rank test was used for univariate analysis of the survival outcome and the Cox model was used for multivariate analysis.

Results:

Median TCI was 18 days with 21% treated ≤7 days, 21% in 8 to 14 days, 30% 15 to 28 days, and 28% >28 days from diagnosis. Younger age, white race, no insurance, more comorbidities, and higher stage were associated with shorter TCI. Median overall survival for TCI within 7 days was 8.2 months, 8 to 14 days was 9.2 months, 15 to 28 days was 10.3 months, and > 28 days was 10.8 months (P<0.001). In the multivariate analysis, increased TCI was associated with improved survival across all stages. Among stage IV patients, compared with TCI≤7 days, the hazard ratio (HR) is 0.92 (P<0.001) for 8 to 14 days, HR 0.82 (P<0.001) for 15 to 28 days, and HR 0.77 (P<0.001) for >28 days of TCI. Results were similar for stage III and for stages I+II.

Conclusions:

Our results show worse survival with shorter TCI. This provides evidence to inform a discussion regarding appropriate treatment timing and individualizing treatment.
A New Hydrocellular Wound Dressing Used After Dermatologic Surgery: Dermatologic Surgeons' and Patients' Perceptions
Authors: Orlandini Vincent , Peyrot Itzia , Magis Quentin , Lebas Damien , Tranchant Philippe , Bailly Jean-Yves , Wiart Thierry , Amici Jean-Michel
Published: February 2020

BACKGROUND

Optimum postsurgical healing requires appropriate dressing use.

OBJECTIVE

This study assessed effectiveness and tolerance of a novel, hydrocellular dressing in dermatologic surgery using validated tools, describing its use in clinical practice, and comparing surgeons' and patients' perceptions of scar evolution.

METHODS

This study examined direct suture closures of surgical excisions of small- to medium-sized skin lesions on the extremities or trunk. Dressings were changed 3 times/week. The Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scales (POSAS) were used to assess outcomes. Data were collected at Day 0 (D0, FLC application), Day 15 to 21 (D15–21, suture removal), and Day 45 (D45) postprocedure by the surgeon and the patient.

RESULTS

There were 128 patients (mean age: 55.1 years, 56.1% women). Mean length and width of the excisions were 3.5 × 1.65 cm and the most common FLC applied was 8 × 8 cm (67.7%). Most scars had normal pigmentation, pliability, and height at D15 to 21 and D45, as reported by patients and surgeons using VSS. Patient scores on visual analog scale (VAS) were high (>8/10) and global satisfaction measured by POSAS was generally high (>7/10 at D15–21; >8/10 at D45).

CONCLUSION

These dressings were effective in managing surgical excisions, as assessed by VSS, VAS, and POSAS. Further controlled studies investigating various dressings in wound repair are needed.
Estrogen Plus Progestin Hormone Therapy and Ovarian Cancer
Authors: Lee Alice W. , Wu Anna H. , Wiensch Ashley , Mukherjee Bhramar , Terry Kathryn L. , Harris Holly R. , Carney Michael E. , Jensen Allan , Cramer Daniel W. , Berchuck Andrew , Doherty Jennifer Anne , Modugno Francesmary , Goodman Marc T. , Alimujiang Aliya , Rossing Mary Anne , Cushing-Haugen Kara L. , Bandera Elisa V. , Thompson Pamela J. , Kjaer Susanne K. , Hogdall Estrid , Webb Penelope M. , Huntsman David G. , Moysich Kirstin B. , Lurie Galina , Ness Roberta B. , Stram Daniel O. , Roman Lynda , Pike Malcolm C. , Pearce Celeste Leigh ,   for the Ovarian Cancer Association Consortium
Published: February 2020

Background:

Menopausal estrogen-alone therapy is a risk factor for endometrial and ovarian cancers. When a progestin is included with the estrogen daily (continuous estrogen–progestin combined therapy), there is no increased risk of endometrial cancer. However, the effect of continuous estrogen–progestin combined therapy on risk of ovarian cancer is less clear.

Methods:

We pooled primary data from five population-based case–control studies in the Ovarian Cancer Association Consortium, including 1509 postmenopausal ovarian cancer cases and 2295 postmenopausal controls. Information on previous menopausal hormonal therapy use, as well as ovarian cancer risk factors, was collected using in-person interviews. Logistic regression was used to assess the association between use of continuous estrogen–progestin combined therapy and risk of ovarian cancer by duration and recency of use and disease histotype.

Results:

Ever postmenopausal use of continuous estrogen–progestin combined therapy was not associated with increased risk of ovarian cancer overall (OR = 0.85, 95% CI = 0.72, 1.0). A decreased risk was observed for mucinous ovarian cancer (OR = 0.40, 95% CI = 0.18, 0.91). The other main ovarian cancer histotypes did not show an association (endometrioid: OR = 0.86, 95% CI = 0.57, 1.3, clear cell: OR = 0.68, 95% CI = 0.40, 1.2; serous: OR = 0.98, 95% CI = 0.80, 1.2).

Conclusions:

Given that estrogen-alone therapy has been shown to be associated with increased risk of ovarian cancer, these findings are consistent with the hypothesis that adding a progestin each day ameliorates the carcinogenic effects of estrogen on the cells of origin for all histotypes of ovarian cancer.
Fetal surgery and stem cell therapy for meningomyelocele
Authors: Hii Ling-Yien , Sung Chen-Ai , Shaw Steven W.
Published: February 2020

Purpose of review

To review the advance of maternal--fetal surgery, the research of stem cell transplantation and tissue engineering in prenatal management of fetal meningomyelocele (fMMC).

Recent findings

Advance in the imaging study provides more accurate assessment of fMMC in utero. Prenatal maternal--fetal surgery in fMMC demonstrates favourable postnatal outcome. Minimally invasive fetal surgery minimizes uterine wall disruption. Endoscopic fetal surgery is performed via laparotomy-assisted or entirely percutaneous approach. The postnatal outcome for open and endoscopic fetal surgery shares no difference. Single layer closure during repair of fMMC is preferred to reduce postnatal surgical intervention. All maternal--fetal surgeries impose anesthetic and obstetric risk to pregnant woman. Ruptured of membrane and preterm delivery are common complications. Trans-amniotic stem cell therapy (TRASCET) showed potential tissue regeneration in animal models. Fetal tissue engineering with growth factors and dura substitutes with biosynthetic materials promote spinal cord regeneration. This will overcome the challenge of closure in large fMMC. Planning of the maternal--fetal surgery should adhere to ethical framework to minimize morbidity to both fetus and mother.

Combination of endoscopic fetal surgery with TRASCET or tissue engineering will be a new vision to achieve to improve the outcome of prenatal intervention in fMMC.
Classification of Mouth Corners in Asian Women
Authors: Jeong Tae Kwang , Kim Young Min , Min Kyung Hee
Published: February 2020

Background:

There is increasing interest in mouth corner lift (MCL), as well as lip augmentation. Procedures for lip corner lifting to create smiling lips include botulinum toxin, injectable filler, and surgery. However, there is no proper system to classify mouth corners, thereby causing difficulties in patient counseling, treatment planning, and communicating with medical staff. We developed a new classification system to analyze the shape of mouth corners in Asian women.

Methods:

Lip shapes were classified as types I (arched upper lip) and II (flat upper lip), each of which was further classified as subtypes a (upturned mouth corner) and b (flat or downturned mouth corner). Atypical cases were classified as type III. The anterior–posterior view of facial photographs were taken of female patients aged 20–40 years who visited HB Plastic Surgery Clinic between January 2017 and December 2018. Patients who visited for surgery other than lip plastic surgery (group A) and those who visited for MCL (group B) were compared. Changes in mouth corner type across age were examined.

Results:

The most common type was IIb in group A and Ib in group B. IIa and IIb were more common in group A, whereas Ib was more common in group B, at a statistically significant level. With increasing age, the proportions of IIb and III tended to increase, and Ia and IIa tended to decrease.

Conclusion:

This relatively simple classification system for mouth corners might be helpful in patient counseling and communication with medical staff during plastic surgery.
Excision and Primary Anastomosis for Isolated, Short, Anastomotic Strictures in Transmen
Authors: Verla Wesley , Hoebeke Piet , Spinoit Anne-Françoise , Waterloos Marjan , Monstrey Stan , Lumen Nicolaas
Published: February 2020

Background:

Since the recommendation to perform excision and primary anastomosis (EPA) for isolated, short, anastomotic strictures in transmen, there have been no further reports about its results. This study aims to provide an updated and extended report about the results of EPA for the aforementioned indication.

Methods:

Since 2002, data of all transmen in whom an EPA urethroplasty has been performed at Ghent University Hospital were collected in a database. Exclusion criteria for this analysis were age <18 years old, nonanastomotic strictures, and stricture length >3.0 cm. Postoperative complications were analyzed with descriptive statistics. Failure-free survival (FFS) was analyzed with Kaplan–Meier statistics. Need for further urethral manipulation was used as definition for failure. Potential predictors for failure were entered in a univariate Cox regression analysis.

Results:

In total, 44 patients were included with a median (interquartile range) follow-up of 40 months (7–125 months). Complications after EPA urethroplasty were present in 12 (27%) of the patients and mainly involved low-grade complications (11/44, 25%). After 1, 2, and 5 years, the estimated FFS rate (SD) was 61% (7.8), 61% (7.8), and 47% (9.1). Stricture length (hazard ratio [HR], 2.11; P = 0.03), prior urethroplasty (HR, 3.53; P = 0.008), and extravasation at first voiding cystourethrography (HR, 3.00; P = 0.047) were identified as predictors for failure.

Conclusions:

EPA for an isolated, short, anastomotic stricture in transmen is associated with low complication rates, but high failure rates. After 5 years, the estimated FFS rate is 47%. Stricture length, prior urethroplasty, and extravasation at first voiding cystourethrography are predictors for failure.
Challenges and Solutions for the Implementation of Shared Decision-making in Breast Reconstruction
Authors: Myckatyn Terence M. , Parikh Rajiv P. , Lee Clara , Politi Mary C.
Published: February 2020

Background:

Patient-centered care is a hallmark of quality in healthcare. It is defined as care that is respectful of, and responsive to, individual patient preferences, needs, and values, while ensuring patients are informed and engaged in the treatment decision-making process.

Methods:

We reviewed the literature and drew upon our own experiences to study the implementation of tools intended to facilitate shared decision-making in breast reconstruction.

Results:

For women with breast cancer, decision-making about breast reconstruction is often a challenging and perplexing process. The variety of choices available regarding timing and type of reconstruction and the unique individual patient and clinical treatment variables to consider can further complicate decisions. Accordingly, strategies to facilitate the decision-making process and enable patients and clinicians to make high-quality decisions about breast reconstruction are an essential component of comprehensive breast cancer care. Shared decision making is one proposed model to support informed and preference-sensitive decision-making in line with the principles of patient-centered care. Despite an emerging level of interest in shared decision making, there remains a lack of clarity regarding what the process involves and how to effectively implement it into clinical practice.

Conclusions:

Thus, widespread adoption of shared decision making remains lacking in clinical practice for women considering postmastectomy breast reconstruction. To address these gaps, this article reviews the principles of shared decision making, explores ways shared decision making can be utilized for patients who are candidates for breast reconstruction, and provides a practical overview to facilitate implementation of shared decision making into clinical practice.
Do estimated 24-h pulse pressure components affect outcome? The Ohasama study
Authors: Bursztyn Michael , Kikuya Masahiro , Asayama Kei , Satoh Michihiro , Gavish Benjamin , Ohkubo Takayoshi
Published: February 2020

Objective:

Twenty-four-hour ambulatory pulse pressure (PP) is a powerful predictor of outcome. We attempted to apply the recently described PP components, an elastic (elPP), and systolic stiffening (stPP) components from 24-h ambulatory blood pressure (BP) monitoring (AMBP), and examine their influence on outcome in the Ohasama study population.

Design and methods:

Included were participants of the Ohasama study without history of cardiovascular disease (CVD), who were followed-up for total and CVD mortality, and for stroke morbidity. The PP components were derived from 24-h SBP and DBP using a model based on the nonlinear pressure--volume relationship in arteries expressing pressure stiffness relationship. Outcome predictive power was estimated by Cox regression models; hazard ratio with 95% confidence interval (CI), applied to elPP, and stPP, adjusted for age, sex, BMI, smoking, alcohol drinking, diabetes mellitus, total cholesterol, antihypertensive treatment, and mean arterial pressure (MAP), whenever appropriate.

Results:

Of 1745 participants (age 61.4 ± 11.6, 65% women), 580 died, 212 of CVD, and 290 experienced a stroke during 17 follow-up years. PP was strongly correlated with elPP (r = 0.89) and less so with stPP (r = 0.58), and the correlation between the two components was weak (r = 0.15). After the adjustment, hazard ratio of PP per 1 SD increment for total mortality, CVD mortality, and stroke morbidity were 1.095 (95% CI 0.973–1.232), 1.207 (1.000–1.456), and 0.983 (0.829–1.166), respectively. Corresponding hazard ratios and 95% CIs were nonsignificant for elPP, and stPP. However, among participants with median pulse rate 68.5 bpm or less (median, n = 872), total (327 deaths) and CVD (131 deaths) mortality were predicted by elPP (per 1 SD increment), hazard ratio 1.231 (95% CI, 1.082–1.401), and 1.294 (95% CI, 1.069–1.566), respectively. In the subgroup of treated participants with hypertension and pulse rate 68.5 or less bpm (n = 309), total (177 deaths) and CVD (77 deaths) mortality were predicted by elPP, hazard ratio of 1.357 (95% CI, 1.131–1.628), and 1.417 (95% CI, 1.092–1.839), respectively. Stroke morbidity was not predicted by either PP or the PP components.

Conclusion:

In a rural Japanese population, elPP but not stPP was predictive of total and CVD mortality even when adjusted for MAP and conventional risk factors in the subpopulation with slower pulse rate. This was mostly among the treated hypertensive patients.
PREVALENCE OF MISMATCH REPAIR GENE MUTATIONS IN UVEAL MELANOMA
Authors: Toomey Christopher B. , Protopsaltis Nicholas J. , Phou Samantha , Bakhoum Mathieu F. , Thorson John A. , Ediriwickrema Lilangi S. , Korn Bobby S. , Kikkawa Don O. , Goldbaum Michael H. , Lin Jonathan H.
Published: February 2020

Purpose:

Uveal melanomas are associated with characteristic genetic changes. Germline mutations in mismatch repair (MMR) genes and microsatellite instability have been implicated in the development of numerous malignant neoplasms such as colon and ovarian cancers. The frequency of MMR defects in uveal melanomas has yet to be determined.

Methods:

Here, we analyzed the frequency of MMR gene mutations in uveal melanoma specimens from the University of California, San Diego (UCSD), The Cancer Genome Atlas (TGCA), and the Catalogue of Somatic Mutations in Cancer (COSMIC).

Results:

We identified only two mutations in a MMR gene: one premature stop codon in the PMS gene within the UCSD cohort (0.5% frequency) and one in-frame deletion in MSH3 within the COSMIC database (0.8% frequency). We report copy number variation of MLH1 in monosomy 3 and show decreased mRNA expression of MLH1 in uveal melanoma specimens with monosomy 3. Expression levels of MLH1 were not found to correlate with the observed number of total mutations.

Conclusion:

Overall, we show that mutations in MMR genes in uveal melanoma specimens are exceedingly rare, and although one copy of MLH1 is lost in monosomy 3, it does not seem to have pathologic consequences in uveal melanoma pathogenesis.
MORTALITY OF PATIENTS WITH UVEAL MELANOMA DETECTED BY DIABETIC RETINOPATHY SCREENING
Authors: Hussain Rumana , Czanner Gabriela , Taktak Azzam , Damato Bertil , Praidou Anna , Heimann Heinrich
Published: February 2020

Purpose:

To investigate whether early detection and treatment of uveal melanoma by screening was associated with a lower mortality rate.

Methods:

Retrospective assessment of prospectively collected data comparing 132 patients with uveal melanoma referred by the National Diabetic Screening Service with 608 control patients referred through other means.

Results:

Mean tumor diameter was smaller in the diabetic screening group (11.1 mm vs. 12.5 mm) as was tumor thickness (3.4 mm vs. 5.4 mm). The prevalence of high-risk monosomy 3 was also lower (17/40, 43% vs. 62/110, 56%). Despite a higher rate of systemic comorbidities in the patients diagnosed through screening and despite older age at diagnosis, the 5-year all-cause mortality was similar in both groups (17% vs. 20%); however, the metastatic mortality was lower in the diabetic screening group (11/132, 8% vs. 95/608, 16%).

Conclusion:

Despite higher rates of comorbidities, the patients detected at diabetic screening had a lower 5-year mortality rate. The diabetic screening programme enabled detection and treatment of posterior uveal melanomas at an earlier stage. However, the confounding factors of lead and length time bias are not to be ignored.
VENOUS STASIS RETINOPATHY SECONDARY TO MYELIN OLIGODENDROCYTE GLYCOPROTEIN ANTIBODY-POSITIVE OPTIC NEURITIS
Authors: Lukewich Mark K. , Micieli Jonathan A.
Published: February 2020

Purpose:

To report a case of a 38-year-old woman with venous stasis retinopathy secondary to myelin oligodendrocyte glycoprotein-IgG optic neuritis.

Methods:

Observational case report.

Results:

We report a unique case of venous stasis retinopathy secondary to myelin oligodendrocyte glycoprotein-IgG optic neuritis with significant optic disc edema, tortuous and dilated retinal venules, and retinal hemorrhages, which resolved promptly with high-dose corticosteroids. The retinal changes were likely secondary to severe inflammation of the optic nerve and optic nerve sheath, which exhibited significant postcontrast enhancement on magnetic resonance imaging. Despite aggressive treatment with high-dose corticosteroids and plasmapheresis, the patient had a significant generalized visual field defect at 6 months.

Conclusion:

Venous stasis retinopathy may be secondary to myelin oligodendrocyte glycoprotein-IgG optic neuritis due to reduced venous outflow from significant optic nerve edema. This may be a poor prognostic factor and a marker for more severe optic nerve inflammation.
MULTIMODAL IMAGING IN ACUTE RETINAL NECROSIS PRESENTING WITH MACULAR INVOLVEMENT
Authors: Wang Jay C. , Lu Yifan , Sobrin Lucia , Husain Deeba
Published: February 2020

Purpose:

To report an unusual case of early macular necrosis in acute retinal necrosis and its features on multimodal imaging.

Methods:

Findings on fundus examination, laboratory workup, fluorescein angiography, autofluorescence, optical coherence tomography, and optical coherence tomography angiography.

Results:

A 31-year-old healthy woman presented with 1 week of photophobia and central scotoma of the right eye. Initial examination revealed vitritis, hyperemia of the optic disc, and a yellow-white macular lesion without any peripheral findings. Peripheral involvement was first noted only 4 days later. The patient was diagnosed with acute retinal necrosis secondary to varicella zoster virus and was successfully treated with intravitreal and oral antiviral medications. Optical coherence tomography imaging of the macular lesion showed involvement of both the inner and outer retina. Optical coherence tomography angiography revealed a large flow void in the choriocapillaris, which has not been previously demonstrated.

Conclusion:

Multimodal imaging offers valuable information in the evaluation of patients with acute retinal necrosis.