bluuebunny/crossref_metadata_2025_split huggingface dataset:
The management of locally advanced cervical cancer
Authors: Naga CH Pushpa , Gurram Lavanya , Chopra Supriya , Mahantshetty Umesh 
Published: July 2018

Purpose of review
Cervical cancer is still a major cause of morbidity and mortality among women worldwide. Surgery and chemoradiation are widely utilized treatments for cervical cancer. Despite the available standard treatment of choice, outcome is suboptimal among patients with LACC. It is vital to integrate the evidence generated from high-quality research work for effective management of these cases. This review intends to critically evaluate the latest evidence supporting the available treatment modalities and to provide a comprehensive overview of recent advances and ongoing research in the management of LACC.

Recent findings
Research advances in imaging and radiotherapy technologies, incorporating imaging into brachytherapy planning, use of newer targeted agents, chemotherapy intensification and immunotherapy are some of the new therapeutic options that have been in the forefront of research to improve the outcome of patients with LACC.

Summary
Advanced imaging modalities are increasingly being utilized to tailor treatments. Neoadjuvant chemotherapy followed by surgery does not improve outcomes in FIGO Stage IB2–IIB. Although cisplatin-based concurrent chemoradiation is the standard of care, more aggressive systemic therapies (neoadjuvant or adjuvant chemotherapy and chemoradiation) and use of newer agents, still remains investigational.
What Is the Survivorship of Revision Surgery Performed for the Chronically Dislocated THA?
Authors: Brown Timothy S. , McLaughlin Richard J. , Berry Daniel J. , Lewallen David G. , Trousdale Robert T. , Sierra Rafael J. 
Published: July 2018

Abstract

Background
Instability remains one of the most common indications for revision THA. However, little is known about the efficacy of surgery for and the complications associated with revision THA for patients with a chronically dislocated THA, which we define as a dislocation of more than 4 weeks.

Questions/purposes
For patients with a chronically dislocated THA undergoing revision THA, we asked (1) What is the survivorship free from additional revision for these procedures? (2) What complications are associated with revision THA in this setting? (3) What are the clinical outcomes as measured by the Harris hip score in these procedures?

Methods
From 1998 to 2014, 1084 patients who underwent revision THA for instability were reviewed and 33 patients (33 hips) were identified who had a hip that had been dislocated for more than 4 weeks. Median time dislocated was 4 months (range, 1–120 months), and the mean distance of the femoral head above hip center at presentation was 45 mm. Mean patient age was 67 ± 17 years, and 79% of patients (26 of 33) were women. During the period in question, we used four approaches: Treatment with acetabular component revision in 18 of 33 patients (55%), head and liner exchange in nine patients (27%), both-component revision in five patients (15%), and isolated femoral component revision in one patient (3%). A constrained liner was used in 17 patients (52%), including six of the patients treated with acetabular component revision, and three of those who had both-component revisions. During the period in question, our general indications were hip pain and/or unacceptable function with the chronically dislocated prosthesis. Our sample size was too small to evaluate the association of the procedure choice on survivorship or complication risk. We used Kaplan-Meier survivorship analysis to estimate survivorship free from complication, reoperation, or revision. Mean followup was 4.4 years (range, 2–10 years).

Results
Survivorship free from any revision, complication, or reoperation was 61% at 5 years (95% CI, 43–82). Survivorship free from revision was 83% at 5 years (95% CI, 67–98). Etiology for revision was aseptic loosening in three of 33 hips (9%), recurrent dislocation in two hips (6%), and deep periprosthetic joint infection in two hips (6%). Five complications (15%) did not result in a reoperation, including one dislocation and one incomplete peroneal nerve palsy in a patient after an anterolateral approach. The Harris hip score improved from mean 50 ± 17 preoperatively to mean 80 ± 11 at 5 years.

Conclusions
Chronically dislocated THAs can be successfully managed with revision THA. We recommend close evaluation of the components for aseptic loosening, performing revision surgery only on patients with pain and poor function, and thoroughly counseling patients that survivorship is modest and complications are common.

Level of Evidence
Level IV, therapeutic study.
The Obese Colorectal Surgery Patient: Surgical Site Infection and Outcomes
Authors: Wahl Tyler S. , Patel Fenil C. , Goss Lauren E. , Chu Daniel I. , Grams Jayleen , Morris Melanie S. 
Published: July 2018

BACKGROUND:
Obese patients undergoing colorectal surgery are at increased risk for adverse outcomes. It remains unclear whether these risks can be further defined with more discriminatory stratifications of obesity.

OBJECTIVE:
The purpose of this study was to understand the association between BMI and 30-day postoperative outcomes, including surgical site infection, among patients undergoing colorectal surgery.

DESIGN:
This was a retrospective cohort study.

SETTINGS:
The 2011–2013 American College of Surgeons National Surgical Quality Improvement Program database was used.

PATIENTS:
Patients included those undergoing elective colorectal surgery in 2011–2013 who were assessed by the American College of Surgeons National Surgical Quality Improvement Program.

MAIN OUTCOME MEASURES:
BMI was categorized into World Health Organization categories. Primary outcome was 30-day postoperative surgical site infection. Secondary outcomes included all American College of Surgeons National Surgical Quality Improvement Program–assessed 30-day postoperative complications.

RESULTS:
Our cohort included 74,891 patients with 4.4% underweight (BMI <18.5), 29.0% normal weight (BMI 18.5–24.9), 33.0% overweight (BMI 25.0–29.9), 19.8% obesity class I (BMI 30.0–34.9), 8.4% obesity class II (BMI 35.0–39.9), and 5.5% obesity class III (BMI ≥40.0). Compared with normal-weight patients, obese patients experienced incremental odds of surgical site infection from class I to class III (I: OR = 1.5 (95% CI, 1.4–1.6); II: OR = 1.9 (95% CI, 1.7–2.0); III: OR = 2.1 (95% CI, 1.9–2.3)). Obesity class III patients were most likely to experience wound disruption, sepsis, respiratory or renal complication, and urinary tract infection. Mortality was highest among underweight patients (OR = 1.3 (95% CI, 1.0–1.8)) and lowest among overweight (OR = 0.8 (95% CI, 0.6–0.9)) and obesity class I patients (OR = 0.8 (95% CI, 0.6–1.0)).

LIMITATIONS:
Retrospective analysis of American College of Surgeons National Surgical Quality Improvement Program hospitals may not represent patients outside of the American College of Surgeons National Surgical Quality Improvement Program and cannot assign causation or account for interventions to improve surgical outcomes.

CONCLUSIONS:
Patients with increasing BMI showed an incremental and independent risk for adverse 30-day postoperative outcomes, especially surgical site infections. Strategies to address obesity preoperatively should be considered to improve surgical outcomes among this population. See Video Abstract at http://links.lww.com/DCR/A607.
A prospective study of inflammatory biomarker levels and risk of early menopause
Authors: Bertone-Johnson Elizabeth R. , Manson JoAnn E. , Purdue-Smithe Alexandra C. , Hankinson Susan E. , Rosner Bernard A. , Whitcomb Brian W. 
Published: July 2018

Abstract

Objective:
Early menopause, the cessation of ovarian function before age 45, has consequences for fertility and cardiovascular health. Evidence from studies of women with autoimmune conditions and genetic studies supports a role for inflammation in early menopause, but the association of inflammatory markers and risk has not been directly evaluated.

Methods:
We assessed the relation of the soluble fraction of tumor necrosis factor alpha receptor 2 (sTNFR2), C-reactive protein, interleukin-6 (IL6) levels with incident early menopause among Nurses’ Health Study II participants who provided a premenopausal blood sample in 1996 to 1999. Cases (n = 328) were women reporting natural menopause between blood collection and age 45.
Controls (n = 492) included (1) 328 women with menopause after age 47, matched 1:1 with cases on age at blood collection and other factors; and (2) 164 additional women with menopause after age 45.

Results:
In multivariable models comparing cases and n = 492 controls, we observed a significant association of sTNFR2 levels and risk of early menopause (P = 0.002). Compared with women with the lowest sTNFR2 levels, odds ratios (95% CIs) for quartiles 2 to 4 were 0.60 (0.38-0.95), 0.93 (0.61-1.43), and 1.40 (0.93-2.11). Results further adjusting for antimüllerian hormone levels were similar in magnitude, as were results from sensitivity analyses of matched cases and controls (n = 328 pairs), nonsmokers, and leaner women. C-reactive protein and IL6 levels were unrelated to risk.

Conclusions:
The observation of lower risk of early menopause among women with moderate sTNFR2 levels compared with women with lower and higher levels warrants further prospective study.
Enhanced Drug Delivery to the Skin Using Liposomes
Authors: Blueschke Gert , Boico Alina , Negussie Ayele H. , Yarmolenko Pavel , Wood Bradford J. , Spasojevic Ivan , Fan Ping , Erdmann Detlev , Schroeder Thies , Sauerbier Michael , Klitzman Bruce 
Published: July 2018

Background:
Enhancing drug delivery to the skin has importance in many therapeutic strategies. In particular, the outcome in vascularized composite allotransplantation mainly depends on systemic immunosuppression to prevent and treat episodes of transplant rejection. However, the side effects of systemic immunosuppression may introduce substantial risk to the patient and are weighed against the expected benefits. Successful enhancement of delivery of immunosuppressive agents to the most immunogenic tissues would allow for a reduction in systemic doses, thereby minimizing side effects. Nanoparticle-assisted transport by low temperature–sensitive liposomes (LTSLs) has shown some benefit in anticancer therapy. Our goal was to test whether delivery of a marker agent to the skin could be selectively enhanced.

Methods:
In an in vivo model, LTSLs containing doxorubicin (dox) as a marker were administered intravenously to rats that were exposed locally to mild hyperthermia. Skin samples of the hyperthermia treated hind limb were compared with skin of the contralateral normothermia hind limb. Tissue content of dox was quantified both via high-performance liquid chromatography and via histology in skin and liver.

Results:
The concentration of dox in hyperthermia-treated skin was significantly elevated over both normothermic skin and liver. (P < 0.02).

Conclusions:
We show here that delivery of therapeutics to the skin can be targeted and enhanced using LTSLs. Targeting drug delivery with this method may reduce the systemic toxicity seen in a systemic free-drug administration. Development of more hydrophilic immunosuppressants in the future would increase the applicability of this system in the treatment of rejection reactions in vascularized composite allotransplantation. The treatment of other skin condition might be another potential application.
Dynamic pain connectome functional connectivity and oscillations reflect multiple sclerosis pain
Authors: Bosma Rachael L. , Kim Junseok A. , Cheng Joshua C. , Rogachov Anton , Hemington Kasey S. , Osborne Natalie R. , Oh Jiwon , Davis Karen D. 
Published: July 2018

AbstractPain is a prevalent and debilitating symptom of multiple sclerosis (MS); yet, the mechanisms underlying this pain are unknown. Previous studies have found that the functional relationships between the salience network (SN), specifically the right temporoparietal junction a SN node, and other components of the dynamic pain connectome (default mode network [DMN], ascending and descending pathways) are abnormal in many chronic pain conditions. Here, we use resting-state functional magnetic resonance imaging and measures of static and dynamic functional connectivity (sFC and dFC), and regional BOLD variability to test the hypothesis that patients with MS have abnormal DMN-SN cross-network sFC, dFC abnormalities in SN-ascending and SN-descending pathways, and disrupted BOLD variability in the dynamic pain connectome that relates to pain inference and neuropathic pain (NP). Thirty-one patients with MS and 31 controls completed questionnaires to characterize pain and pain interference, and underwent a resting-state functional magnetic resonance imaging scan from which measures of sFC, dFC, and BOLD variability were compared. We found that (1) ∼50% of our patients had NP features, (2) abnormalities in SN-DMN sFC were driven by the mixed-neuropathic subgroup, (3) in patients with mixed NP, dFC measures showed that there was a striking change in how the SN was engaged with the ascending nociceptive pathway and descending modulation pathway, (4) BOLD variability was increased in the DMN, and (5) the degrees of sFC and BOLD variability abnormalities were related to pain interference. We propose that abnormal SN-DMN cross-network FC and temporal dynamics within and between regions of the dynamic pain connectome reflect MS pain features.
Complex regional pain syndrome: intradermal injection of phenylephrine evokes pain and hyperalgesia in a subgroup of patients with upregulated α1-adrenoceptors on dermal nerves
Authors: Drummond Peter D. , Morellini Natalie , Finch Philip M. , Birklein Frank , Knudsen Lone F. 
Published: July 2018

Abstract
The aim of this study was to determine whether upregulated cutaneous expression of α1-adrenoceptors (α1-AR) is a source of pain in patients with complex regional pain syndrome (CRPS). Immunohistochemistry was used to identify α1-AR on nerve fibres and other targets in the affected and contralateral skin of 90 patients, and in skin samples from 38 pain-free controls. The distribution of α1-AR was compared between patients and controls, and among subgroups of patients defined by CRPS duration, limb temperature asymmetry, and diagnostic subtype (CRPS I vs CRPS II). In addition, α1-AR expression was investigated in relation to pain and pinprick hyperalgesia evoked by intradermal injection of the α1-AR agonist phenylephrine. Expression of α1-AR on nerve bundles in the CRPS-affected limb was greater in patients who reported prolonged pain and pinprick hyperalgesia around the phenylephrine injection site than in patients with transient pain after the injection. In addition, α1-AR expression in nerve bundles was greater in patients with CRPS II than CRPS I, and was greater in acute than more long-standing CRPS. Although less clearly associated with the nociceptive effects of phenylephrine, α1-AR expression was greater on dermal nerve fibres in the painful than contralateral limb. Together, these findings are consistent with nociceptive involvement of cutaneous α1-AR in CRPS. This involvement may be greater in acute than chronic CRPS, and in CRPS II than CRPS I.
International Service-Learning: Feedback From a Community Served
Authors: Haines Jamie , Lambaria Michele 
Published: July 2018

Introduction.
Mutual benefit to participants and recipients of international service-learning (ISL) is often assumed by academic institutions when bringing medical/health care and education to underserved countries. Research documenting feedback from host communities is needed in all disciplines, including physical therapy. Overall, host communities seem to appreciate collaborations with ISL visiting teams; however, these communities may endure hardships unbeknownst to visiting partners such as reinforcement of negative attitudes, disruption of community relations and dynamics, interactions with culturally insensitive visitors, and poor quality care. The purpose of this study was to collect and document feedback from a host community after a 2-week ISL experience with Doctor of Physical Therapy (DPT) students and faculty.

Methods.
Twelve community leaders who interacted daily with DPT students and faculty were interviewed. Individual interviews were completed and transcribed. The constant comparative method was used to generate themes.

Results.
Overall, the community felt that their the interactions with the ISL team 1) improved local cultural attitudes about disability, 2) improved awareness of the role of physical therapy, 3) fostered strong, respectful relationships between the community and team, and 4) strengthened the desire to sustain the partnership.

Discussion and Conclusion.
The host community was very satisfied with the partnership and wished to strengthen relationships for long-term sustainability. Recommendations for the ISL curriculum in physical therapist education were identified or reinforced from this study.
Minimally Invasive Ponto Surgery Versus the Linear Incision Technique With Soft Tissue Preservation for Bone Conduction Hearing Implants: A Multicenter Randomized Controlled Trial
Authors: Calon Tim G.A. , Johansson Martin L. , de Bruijn Arthur J.G. , van den Berge Herbert , Wagenaar Mariet , Eichhorn Edwin , Janssen Miranda M.L. , Hof Janny R. , Brunings Jan-Wouter , Joore Manuela A. , Jonhede Sofia , van Tongeren Joost , Holmberg Marcus , Stokroos Robert-Jan 
Published: July 2018

Objective:
To compare the surgical outcomes of the Minimally Invasive Ponto Surgery (MIPS) technique with those of the linear incision technique with soft-tissue preservation for bone-anchored hearing systems (BAHS).

Design:
Sponsor-initiated multicenter, open, randomized, controlled clinical trial.

Setting:
Maastricht University Medical Centre, Ziekenhuisgroep Twente and Medisch Centrum Leeuwarden, all situated in The Netherlands.

Participants:
Sixty-four adult patients eligible for unilateral BAHS surgery.
Interventions Single-stage BAHS surgery with 1:1 randomization to the linear incision technique with soft-tissue preservation (control) or the MIPS (test) group.

Primary and Secondary Outcome Measurements:
Primary objective: compare the incidence of inflammation (Holgers Index ≥ 2) during 12 weeks’ follow-up after surgery. Secondary objectives: skin dehiscence, pain scores, loss of sensibility around the implant, soft-tissue overgrowth, skin sagging, implant extrusion, cosmetic results, surgical time, wound healing and Implant Stability Quotient measurements.

Results:
Sixty-three subjects were analyzed in the intention-to-treat population. No significant difference was found for the incidence of inflammation between groups. Loss of skin sensibility, cosmetic outcomes, skin sagging, and surgical time were significantly better in the test group. No statistically significant differences were found for dehiscence, pain, and soft-tissue overgrowth. A nonsignificant difference in extrusion was found for the test group. The Implant Stability Quotient was statistically influenced by the surgical technique, abutment length, and time.

Conclusion:
No significant differences between the MIPS and the linear incision techniques were observed regarding skin inflammation. MIPS results in a statistically significant reduction in the loss of skin sensibility, less skin sagging, improved cosmetic results, and reduced surgical time. Although nonsignificant, the implant extrusion rate warrants further research.
Tablet-based Hearing Screening in Children Aged 5 to 17 in Rural Dominican Republic
Authors: Levy Dylan A. , Hill David R. , Bia Frank J. , Feinn Richard S. 
Published: July 2018

Objective:
The principal aim of this study was to examine the feasibility of hearing screening using tablet audiometry among a cohort of school-aged children in rural Dominican Republic. The authors hypothesized that the tablet audiometer would serve as an expeditious means for hearing loss screening in various remote locations.

Study Design:
Cross-sectional.

Setting:
Twenty-three remote locations in and around the city of La Romana, Dominican Republic. The quietest location available in each site was used for testing.

Patients:
Inclusion criteria comprised children aged 5 to 17 currently residing in the testing location. Children aged <5 years or >18 years were excluded.

Intervention:
Screening.

Main Outcome Measures:
For each subject, air conduction thresholds were obtained bilaterally at 500, 1000, 2000, and 4000 Hz; testing duration was also measured. Hearing loss was suspected if any threshold measured ≥30 dB.

Results:
In this cohort of 423 subjects, 44 (10.4%) failed the screening protocol. The mean thresholds for 500, 1000, 2000, and 4000 Hz frequencies were 26.05, 22.73, 17.57, and 17.15 dB, respectively. Of the 658 thresholds obtained at ≥30 dB, the majority were at 500 or 1000 Hz. The mean testing duration was 494 seconds.

Conclusions:
These results suggest that children living in remote communities can be screened quickly for hearing loss using a tablet audiometer. However, significant background noise during testing negatively impacted the low-frequency measurements, thus compromising test reliability. Despite extending the reach of existing audiological services, the value of tablet audiometry is not entirely clear in rural environments with uncontrollable background noise.
Evaluation of Intraoperative Testing During Cochlear Implantation From a Time and Cost Perspective: A Single-Center Experience in the United States
Authors: Page Joshua Cody , Al-Muhawas Fida , Allsopp Tristan , Cox Matthew D. , Karim Saleema , Dornhoffer John L. 
Published: July 2018

Objective:
To measure the time spent performing intraoperative testing during cochlear implantation (CI) and determine the impact on hospital charges.

Study Design:
Prospective study.

Setting:
Tertiary referral hospital.

Patients:
Twenty-two children (7 mo–18 yr) who underwent a total of 22 consecutive primary and/or revision CIs by a single surgeon from December 2016 to July 2017.

Intervention:
The time spent performing intraoperative testing, including evoked compound action potentials (ECAP) and electrical impedances (EI), was recorded for each case. The audiologist performing the testing was unaware of the time measurement and subsequent evaluations with regard to cost data. Billing information was used to determine if the testing contributed to increased operative charges to the patient.

Outcome Measures:
Whether intraoperative testing had an impact on operative charges to the patient.

Results:
The average time spent in testing (ECAPs/EIs in all cases) was 6.7 minutes (range, 2–26 min). No correlation was found between testing time and preoperative computed tomography findings, the audiologist performing testing, or the electrode type used (p > 0.05). Based on billing data, including time spent in the operating room (OR), 5/22 (23%) cases incurred greater charges than if intraoperative testing had not been performed.

Conclusion:
Our data suggest that intraoperative testing increases time in the OR and can contribute to increased hospital charges for CI patients. By using testing selectively, costs incurred by patients and hospitals may be reduced. This is of interest in a healthcare environment that is increasingly focused on cost, quality, and outcomes.