Medical Specialties Commons^™

Suppression Of Hmgb1 Released In The Glioblastoma Tumor Microenvironment Reduces Tumoral Edema., Bangxing Hong, Kamaldeen Muili, Chelsea Bolyard, Luke Russell, Tae Jin Lee, Yeshavanth Banasavadi-Siddegowda, Ji Young Yoo, Yuanqing Yan, Leomar Y Ballester, Kurt H Bockhorst, Balveen Kaur

Oncology Articles

HMGB1 is a ubiquitously expressed intracellular protein that binds DNA and transcription factors and regulates chromosomal structure and function. Under conditions of cell death or stress, it is actively or passively released by cells into the extracellular environment, where it functions as damage-associated molecular pattern (DAMP) that orchestrates pro-inflammatory cytokine release and inflammation. Our results demonstrate that HMGB1 is secreted in the tumor microenvironment after oncolytic HSV (oHSV) infection in vitro and in vivo. The impact of secreted HMGB1 on tumor growth and response to oncolytic viral therapy was evaluated by using HMGB1-blocking antibodies in vitro and in mice …

Air Of The Dog: Impending Respiratory Failure After A Dog Bite., Gregory Tanquary, Andrew Little, Juan A Morales-Torres

Trauma and Acute Care Articles

Animal and human bites represent a significant health issue worldwide. However, penetrating neck trauma secondary to animal bites is a rare presentation. We present the case of a 32-year-old female with neck pain and difficulty breathing after suffering a dog bite to the neck. Bedside ultrasound and subsequent computed tomography (CT) showed findings consistent with subcutaneous emphysema. Due to rapidly progressing neck swelling and stridor, she required advanced airway management followed by emergent exploratory surgery. We present a case report on impending respiratory failure after a dog bite and review the management of penetrating neck trauma.

Evaluating The Efficacy Of Seattle-Pap For The Respiratory Support Of Premature Neonates: Study Protocol For A Randomized Controlled Trial., Carl H Backes, Jennifer L Notestine, Jane M Lamp, Jeanne C Balough, Allison M Notestine, Crystal M Alfred, Juli M Kern, Michael R Stenger, Brian K Rivera, Mohannad Moallem, Randy R Miller, Apurwa Naik, Jennifer N Cooper, Christopher R Howard, Stephen E Welty, Noah H Hillman, John A F Zupancic, Larissa I Stanberry, Thomas N Hansen, Charles V Smith

OhioHealth Research Institute Articles

BACKGROUND: At birth, the majority of neonates born at < 30 weeks of gestation require respiratory support to facilitate transition and ensure adequate gas exchange. Although the optimal approach to the initial respiratory management is uncertain, the American Academy of Pediatrics endorses noninvasive respiratory support with nasal continuous positive airway pressure (nCPAP) for premature neonates with respiratory insufficiency. Despite evidence for its use, nCPAP failure, requiring intubation and mechanical ventilation, is common. Recently, investigators have described a novel method to deliver bubble nCPAP, termed Seattle-PAP. While preclinical and pilot studies are encouraging regarding the potential value of Seattle-PAP, a large trial is needed to compare Seattle-PAP directly with the current standard of care for bubble nCPAP (Fisher & Paykel CPAP or FP-CPAP).

METHODS/DESIGN: We designed a multicenter, non-blinded, randomized controlled trial that will enroll 230 premature infants (22

DISCUSSION: This trial will assess whether Seattle-PAP is more efficacious and cost-effective than FP-CPAP in real-world practice among premature neonates.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT03085329 . Registered on 21 March 2017.

Drug-Coated Balloon Treatment Of Femoropopliteal Lesions Typically Excluded From Clinical Trials: 12-Month Findings From The In.Pact Global Study., Gary M Ansel, Marianne Brodmann, Koen Keirse, Antonio Micari, Michael R Jaff, Krishna Rocha-Singh, Eric J Fernandez, Hong Wang, Thomas Zeller, In.Pact Global Study Investigators

Heart and Vascular Articles

PURPOSE: To report a post hoc analysis comparing outcomes between subjects who would have been included in the IN.PACT SFA randomized controlled trial vs those who would have been excluded.

METHODS: The 1406 subjects enrolled in the IN.PACT Global Study ( ClinicalTrials.gov identifier NCT01609296) were retrospectively assigned to a standard-use group (n=281) based on the inclusion and exclusion criteria from the randomized IN.PACT SFA trial; the remaining 1125 patients were assigned to the broader-use group. Freedom from clinically-driven target lesion revascularization (CD-TLR) was evaluated at 12 months. The composite primary safety endpoint was freedom from 30-day device- and procedure-related death …

Myiasis-Induced Sepsis: A Rare Case Report Of Wohlfahrtiimonas Chitiniclastica And Ignatzschineria Indica Bacteremia In The Continental United States., Travis B Lysaght, Meghan E Wooster, Peter C Jenkins, Leonidas G Koniaris

Trauma and Acute Care Articles

RATIONALE: The presentation of sepsis and bacteremia in cutaneous and cavitary myiasis is uncommon. We present a patient, residing in a temperate region of the United States, with myiasis and sepsis from the emerging human pathogens Wohlfahrtiimonas chitiniclastica and Ignatzschineria indica.

PATIENT CONCERNS: A 37-year-old male patient with an 8-month history of chronic lymphedema and ulcers of the lower left extremity presented with myiasis of the left foot and leg. The patient was initially seen by his family practitioner many times and was prescribed antibiotics which he could not afford. Debridement of the myiasis was not conducted by the family …

Foam Sclerotherapy Augmented Phlebectomy (Sap) Procedure For Varicose Veins: Report Of A Novel Technique., Raghu Kolluri, Katherine U Hays, Manjit S Gohel

Surgery Articles

INTRODUCTION: While traditional ambulatory phlebectomy (AP) is a safe and effective procedure, few adverse effects such as hematoma, bleeding, bruising and nerve injury have been reported. To improve AP and to reduce some of these adverse events, herein we report a novel technique - Foam Sclerotherapy Assisted Phlebectomy (SAP).

REPORT: The details of the above technique, along with the potential advantages and limitations will be discussed.

DISCUSSION: Foam sclerotherapy and DUS act as valuable adjuncts to traditional AP. SAP increases precision and creates additional venospasm leading to reduced bruising, reduced nerve injury and sclerosis of residual vein segments.

The Impact Of Depression On Patient Outcomes In Hip Arthroscopic Surgery., Robroy L Martin, John J Christoforetti, Ryan Mcgovern, Benjamin R Kivlan, Andrew B Wolff, Shane J Nho, John P Salvo, Thomas J Ellis, Geoff Van Thiel, Dean Matsuda, Dominic S Carreira

Surgery Articles

BACKGROUND: Mental health impairments have been shown to negatively affect preoperative self-reported function in patients with various musculoskeletal disorders, including those with femoroacetabular impingement.

HYPOTHESIS: Those with symptoms of depression will have lower self-reported function, more pain, and less satisfaction on initial assessment and at 2-year follow-up than those without symptoms of depression.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients who were enrolled in a multicenter hip arthroscopic surgery registry and had 2-year outcome data available were included in the study. Patients completed the 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and …

One-Year Analysis Of The Prospective Multicenter Sentry Clinical Trial: Safety And Effectiveness Of The Novate Sentry Bioconvertible Inferior Vena Cava Filter., Michael D Dake, Timothy P Murphy, Albrecht H Krämer, Michael D Darcy, Luke E Sewall, Michael A Curi, Matthew S Johnson, Frank Arena, James L Swischuk, Gary M Ansel, Mitchell J Silver, Souheil Saddekni, Jayson S Brower, Robert Mendes, Sentry Trial Investigators

Heart and Vascular Articles

PURPOSE: To prospectively assess the Sentry bioconvertible inferior vena cava (IVC) filter in patients requiring temporary protection against pulmonary embolism (PE).

MATERIALS AND METHODS: At 23 sites, 129 patients with documented deep vein thrombosis (DVT) or PE, or at temporary risk of developing DVT or PE, unable to use anticoagulation were enrolled. The primary end point was clinical success, including successful filter deployment, freedom from new symptomatic PE through 60 days before filter bioconversion, and 6-month freedom from filter-related complications. Patients were monitored by means of radiography, computerized tomography (CT), and CT venography to assess filtering configuration through 60 days, …

Twenty-Four Month Results From A Randomized Trial Of Cyanoacrylate Closure Versus Radiofrequency Ablation For The Treatment Of Incompetent Great Saphenous Veins., Kathleen Gibson, Nick Morrison, Raghu Kolluri, Michael Vasquez, Robert Weiss, Daniel Cher, Monte Madsen, Andrew Jones

Surgery Articles

OBJECTIVE: We previously reported 3-month and 12-month occlusion rates after treatment of clinically symptomatic saphenous vein reflux with either cyanoacrylate closure (CAC) using the VenaSeal Closure System (Medtronic, Dublin, Ireland) or radiofrequency ablation (RFA) in a randomized, multicenter, clinical trial, VenaSeal Sapheon Closure System vs Radiofrequency Ablation for Incompetent Great Saphenous Veins (VeClose). Herein we report the 24-month follow-up results of the VeClose trial.

METHODS: There were 222 patients with symptomatic great saphenous vein (GSV) incompetence who were randomly assigned to receive either CAC (n = 108) or RFA (n = 114). Patients were not allowed to receive adjunctive treatment …

Streamlined Surgical Draping Reduces Subcutaneous Implantable Cardioverter-Defibrillator Implant Procedure Preparation Time., Marcy Mcqueen, Lori A Woodford, Eric Holick, Kevin Wolfer, Anish K Amin

Heart and Vascular Articles

The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a proven alternative to transvenous implantable cardioverter-defibrillator systems. One critique of S-ICD use, however, has been the time required for implantation. Here, we discuss the use of an alternative surgical draping technique to reduce preparation time for device implantation.

Radio-Fluorogenic Gel Dosimetry With Coumarin., Peter A Sandwall, Brandt P Bastow, Henry B Spitz, Howard R Elson, Michael Lamba, William B Connick, Henry Fenichel

Oncology Articles

Gel dosimeters are attractive detectors for radiation therapy, with properties similar to biological tissue and the potential to visualize volumetric dose distributions. Radio-fluorogenesis is the yield of fluorescent chemical products in response to energy deposition from ionizing radiation. This report shares the development of a novel radio-fluorogenic gel (RFG) dosimeter, gelatin infused with coumarin-3-carboxlyic acid (C3CA), for the quantification of imparted energy. Aqueous solutions exposed to ionizing radiation result in the production of hydroxyl free radicals through water radiolysis. Interactions between hydroxyl free radicals and coumarin-3-carboxylic acid produce a fluorescent product. 7-hydroxy-coumarin-3-carboxylic acid has a blue (445 nm) emission following …

Cortical Trajectory Pedicle Screws For The Fixation Of Traumatic Thoracolumbar Fractures., Jacob C Wochna, Rudy Marciano, Irina Catanescu, Joel Katz, M Chance Spalding, Kailash Narayan

Trauma and Acute Care Articles

Objective Cortical bone trajectory pedicle screws (CBT) have a different trajectory compared to traditional pedicle screws (PS) and they may confer biomechanical advantages in some patient populations. We hypothesize that the placement of CBT in traumatic thoracolumbar fractures could be an alternative technique to the traditional utilization of PS. Methods Single surgeon, retrospective study was performed at a Level 1 Trauma Center from 2013 to 2017. All patients aged between 18 and 90 years with operative AO classification A, B, and C traumatic thoracolumbar fractures were included. Patients with pathological fractures, active spinal infections, or history of vertebral augmentation were …

Restoration Of External Rotation Following Reverse Shoulder Arthroplasty Without Latissimus Dorsi Transfer., Derek D Berglund, Samuel Rosas, Jacob J Triplet, Jennifer Kurowicki, Brandon Horn, Jonathan C Levy

Surgery Articles

BACKGROUND: Latissimus dorsi transfers have been considered necessary to restore active external rotation following reverse shoulder arthroplasty (RSA). The purpose of this study was to assess the effectiveness of an RSA system that lateralizes the center of rotation in restoring active external rotation without a latissimus dorsi transfer in patients with a preoperative external rotation deficit (external rotation of < 0°).

METHODS: We retrospectively reviewed the records of patients who had undergone RSA with a lateralized center of rotation without a latissimus dorsi transfer. All patients had had a preoperative external rotation deficit (active external rotation of < 0°), and all were followed for a minimum of 2 years. Patients were stratified into 2 groups on the basis of the preoperative diagnosis: (1) those with a combined loss of active elevation and external rotation as a result of rotator cuff tear arthropathy (CLEER group) and (2) those with a combined loss of active elevation and external rotation as a result of other posttraumatic etiologies (non-CLEER group). The mean improvement of external rotation was analyzed. Subgroup analysis was performed on the basis of the Goutallier classification, glenosphere lateralization, and total prosthetic lateralization.

RESULTS: Thirty-three patients (24 in …

Incidence Of Dysphagia After Odontoid Screw Fixation Of Type Ii Odontoid Fracture In The Elderly., Rudy D Marciano, Brian Seaman, Saurabh Sharma, Teresa Wood, Chris Karas, Kailash Narayan

Surgery Articles

BACKGROUND: Although surgery may reduce mortality rates from type II odontoid fractures in the elderly population, post-operative dysphagia resulting from screw fixation remains a serious complication.

METHODS: We retrospectively performed a chart review of patients over 65 years of age who underwent odontoid screw placement for type II odontoid fractures (2009-2014) and sustained post-operative dysphagia. The severity of dysphagia was determined based on the requirements for modified diets, PEG tubes, and prolonged length of stay (LOS), while costs were based upon discharge disposition (e.g. home vs. rehabilitation facilities) and total hospital costs.

RESULTS: The incidence of postoperative dysphagia was 80%; …

Comparative Outcomes Between The First And Second Operated Shoulders In Bilateral Shoulder Arthroplasty., Derek D Berglund, Jennifer Kurowicki, Jacob J Triplet, Samuel Rosas, Molly Moor, Brandon Horn, Jonathan C Levy

Surgery Articles

INTRODUCTION: Studies that report outcomes after staged bilateral shoulder arthroplasty (BSA) are limited. This study compared the overall improvement between the first and second operated shoulders after BSA.

METHODS: Preoperative and postoperative motion and patient-reported outcomes for function, pain, and general health were assessed for patients who underwent BSA with a 2-year follow-up. Ultimate outcomes and the efficacy of treatment were compared between the first and second operated shoulders.

RESULTS: Seventy-three patients met the inclusion criteria (mean follow-up, 51.4 months). There were no notable differences between the first and second operated shoulders for all preoperative and postoperative variables except for …

Evidence-Based Approach To The Trauma Patient, M Chance Spalding, Peter G Thomas, M Shay O'Mara, Christine L Ramirez, Franz S Yanagawa, Heidi H Hon, Brian A Hoey, William S Hoff, James Cipolla, Stanislaw P Stawicki

Trauma and Acute Care Articles

No abstract provided.

Endocrinologists' Opinions Of Diabetology As A Primary Care Subspecialty., Amber M Healy, Jay H Shubrook, Frank L Schwartz, Doyle M Cummings, Almond J Drake, Robert J Tanenberg

Ambulatory and Primary Care Articles

IN BRIEF This study was conducted to ascertain the opinions of endocrinologists about diabetes care as it relates to the health care provider workforce. A survey was administered to endocrinologists in the Planning Research in Inpatient Diabetes and Planning Research in Outpatient Diabetes (PRIDE/PROUD) group and given to attendees of the American Diabetes Association (ADA) Scientific Sessions special interest group whose focus was primary care. The majority of respondents agreed that there is a need for more providers to be trained to take care of patients with diabetes and that more trained providers are needed, and almost half agreed that …

Transanal Drainage Of Coloanal Anastomotic Leaks., Bradley Sherman, Mark Arnold, Syed Husain

Surgery Articles

The conventional operative intervention for leaks following coloanal anastomoses has been proximal fecal diversion with or without take-down of anastomosis. A few of these cases are also amenable to percutaneous drainage. Ostomies created in this situation are often permanent, specifically in cases where coloanal anastomoses are taken down at the time of reoperation. We present two patients who developed perianastomotic pelvic abscesses that were treated with transanal large bore catheter drainage resulting in successful salvage of coloanal anastomoses without the need for a laparotomy or ostomy creation. We propose this to be an effective therapeutic approach to leaks involving low …

Pain Management: Time To Minimize Variations In Practice., Parag Bharadwaj, Brynn E Sheehan, Sunita Dodani, Charles F Von Gunten

Ambulatory and Primary Care Articles

There continue to be great variations in the management of pain in palliative care. Efforts need to be made within the field develop strategies to address this to avoid undue distress in patients.

Premature Ventricular Contraction-Induced Polymorphic Ventricular Tachycardia After Leadless Pacemaker Implantation: A Unique Adverse Effect Of Leadless Pacing., Anish K Amin, Sreedhar R Billakanty, Nagesh Chopra, Eugene Y Fu, Allan J Nichols, James M Kleman, Gregory A Kidwell

Heart and Vascular Articles

No abstract provided.

Very Late Occurrence Of Complete Heart Block Without Preexisting Atrioventricular Conduction Abnormalities: A Rare Complication After Transaortic Valvular Replacement., Nagesh Chopra, Matthew S Tong, Steven J Yakubov

Heart and Vascular Articles

No abstract provided.

Guidewire Method For Measuring Local Left Ventricular Electrical Activation Time During Cardiac Resynchronization Implantation., Seth J Rials, Michele Pershing, Christy Collins

OhioHealth Research Institute Articles

The timing of local activation at left ventricular (LV) pacing leads is measured from the onset of the QRS complex to the peak of the LV electrogram (QLV). Pacing from the sites of late activation is associated with higher response rates to cardiac resynchronization therapy (CRT). Prior studies have measured QLV from permanent pacing leads, or have used electroanatomic mapping systems. The current study compares QLV measurements made with a guidewire to those collected from permanent LV pacing leads positioned at the same venous site without the use of electroanatomic mapping systems. In this study, 20 patients undergoing CRT implantation …

Case Report Of Squamous Cell Cancer Arising In Perineal Epidermal Inclusion Cyst, Presenting As Rapidly Enlarging And Cavitating Lesion., Jose Vale, Yijun Pang, Arthur Kumpf, David Fitkin, Scott Drew

Oncology Articles

INTRODUCTION: Cutaneous squamous cell cancer (cSCC) is a common condition, with straight forward and well-known heuristics regarding diagnosis, treatment, and surveillance. cSCC arising in an epidermal inclusion cyst is rare, but not unheard of. In contrast, the authors' are unaware of any prior reports of cSCC arising in an epidermal inclusion cyst within an atypical cavernous and cavitating lesion in the perineum.

PRESENTATION OF CASE: A 48-year-old male presented with a cavitating and rapidly growing cutaneous perineal lesion. Preliminary diagnostic procedures (biopsy) showed benign pathology and imaging showed no involvement of perineal organs such as prostate or rectum. Discordance between …

Idiopathic Colonic Varices: A Rare Cause Of Recurrent Lower Gastrointestinal Bleeding., Ryan Kahl, Kruti Patel, Khalid George, Michael Piper

Ambulatory and Primary Care Articles

No abstract provided.

Rare Case Of An Extraosseous Cervical Chordoma With Both Intradural And Extensive Extraspinal Involvement., Victor Awuor, Christopher E Stewart, Albert Camma, Julie Renner, J M Tongson

Oncology Articles

BACKGROUND: Chordomas must be considered among the differential diagnoses for extradural spinal tumors, especially involving the clival or sacrococcygeal regions. They are often locally invasive and destructive to the osseous structures from which they arise, but rarely extend intradurally. Here, we report a unique chordoma that was intradural and spanned nearly four subaxial cervical vertebral levels.

CASE DESCRIPTION: We report the case of an atypical intradural chordoma that spanned four subaxial levels of the cervical spine in an 81-year-old female. It also extended through multiple neural foramina but did not invade or destroy the bony elements of the cervical vertebrae. …

Assessing Genetic Expression Profiles In Melanoma Prognosis., Aaron S Farberg, Alex M Glazer, Richard R Winkelmann, Darrell S Rigel

Oncology Articles

A 31-genetic expression profile (31-GEP) test (DecisionDx-Melanoma, Castle Biosciences Inc, Friendswood, TX, USA) was developed as a diagnostic test to assist physicians in the management of cutaneous malignant melanoma. Based on a patient's primary tumor expression levels of a panel of genes (28 discriminating genes and 3 control genes), a lesion is classified as "low risk" (class 1) or "high risk" (class 2) for metastasis. Studies evaluating the clinical utility and impact of the 31-GEP test showed it positively influenced clinical management and patient care, as clinicians incorporated the additional data to modify their clinical recommendations in a risk-appropriate manner.

Long-Term Detection Of Atrial Fibrillation With Insertable Cardiac Monitors In A Real-World Cryptogenic Stroke Population., Paul D Ziegler, John D Rogers, Scott W Ferreira, Allan J Nichols, Mark Richards, Jodi L Koehler, Shantanu Sarkar

Heart and Vascular Articles

BACKGROUND: The long-term incidence of atrial fibrillation (AF) in cryptogenic stroke (CS) patients has been explored in carefully controlled clinical trials but real-world data are limited. We investigated the two-year incidence of AF in real-world clinical practice among a large cohort of patients with an insertable cardiac monitor (ICM) placed for AF detection following CS.

METHODS: Patients in the de-identified Medtronic Discovery™ Link database who received an ICM (Reveal LINQ™) for the purpose of AF detection following CS were included and monitored for up to 2years. All detected AF episodes (≥2min) were adjudicated. We quantified the AF detection rate using …

A Pilot Clinical Trial Of Recombinant Human Angiotensin-Converting Enzyme 2 In Acute Respiratory Distress Syndrome., Akram Khan, Cody Benthin, Brian Zeno, Timothy E Albertson, John Boyd, Jason D Christie, Richard Hall, Germain Poirier, Juan J Ronco, Mark Tidswell, Kelly Hardes, William M Powley, Tracey J Wright, Sarah K Siederer, David A Fairman, David A Lipson, Andrew I Bayliffe, Aili L Lazaar

Trauma and Acute Care Articles

BACKGROUND: Renin-angiotensin system (RAS) signaling and angiotensin-converting enzyme 2 (ACE2) have been implicated in the pathogenesis of acute respiratory distress syndrome (ARDS). We postulated that repleting ACE2 using GSK2586881, a recombinant form of human angiotensin-converting enzyme 2 (rhACE2), could attenuate acute lung injury.

METHODS: We conducted a two-part phase II trial comprising an open-label intrapatient dose escalation and a randomized, double-blind, placebo-controlled phase in ten intensive care units in North America. Patients were between the ages of 18 and 80 years, had an American-European Consensus Criteria consensus diagnosis of ARDS, and had been mechanically ventilated for less than 72 h. …

Thoracic Spinal Cord Glioblastoma Mimicking Epidural Abscess: Case Report And Literature Review., Rudy Marciano, Zubair Ahammad, Victor Awuor

Oncology Articles

Spinal cord glioblastoma (SG) accounts for 1.5% of all spinal tumors and has a poor prognosis with survival ranging from 2 to 26 months from presentation. A 57-year-old male presented with one week of paraparesis and contrasted magnetic resonance imaging (MRI) findings of an epidural enhancing thoracic mass suspicious for an epidural abscess. Intraoperative and pathologic findings revealed SG. Spinal cord tumors can mimic epidural abscess on MRI. When planning to address extradural spinal pathologies, one should be cognizant of the potential for either isolated or concurrent intradural pathologies. When the epidural findings do not correlate with preoperative imaging, intraoperative …

Pulmonary Tumor Embolism Secondary To Soft Tissue And Bone Sarcomas: A Case Report And Literature Review., Nicholas Latchana, Vincent C Daniel, Robert W Gould, Raphael E Pollock

Oncology Articles

BACKGROUND: Tumor embolisms (TE) are an underappreciated source of pulmonary embolisms in sarcoma. Most evidence in the literature is limited to case reports and none have described the presence of TE secondary to myxofibrosarcoma. We report the first case of myxofibrosarcoma TE and perform a review of the literature for TE secondary to bone and soft tissue sarcomas (STS).

CASE PRESENTATION: A 36-year-old female presented with debilitating pain of the right upper extremity secondary to a recurrent soft tissue sarcoma. She had distant metastasis to the lung. An MRI revealed a 25-cm shoulder mass involving the proximal arm muscles with …