Split cord malformation associated with scoliosis in adults.

Split cord malformations (SCMs) are rare congenital abnormalities arising from a primary neurulation defect during embryological development of the spinal cord. SCMs can lead to progressively worsening scoliosis and gait difficulties if left untreated. We report on two patients who atypically presented with SCM in adulthood and review previous reports.

Insurance Payer Type and Patient Income Are Associated with Outcomes after Total Shoulder Arthroplasty.

Objective: To assess the independent association of insurance and patient income with total shoulder arthroplasty (TSA) outcomes.

Methods: We used the 1998-2014 US National Inpatient Sample. We used multivariable-adjusted logistic regression to examine whether insurance type and the patient's median household income (based on postal code) were independently associated with healthcare use (discharge destination, hospital stay duration, total hospital charges) and in-hospital complications post-TSA based on the diagnostic codes (fracture, infection, transfusion, or revision surgery).

Effects of a fully magnetically levitated centrifugal-flow or axial-flow left ventricular assist device on von Willebrand factor: A prospective multicenter clinical trial.

Background: Increased shear stress conferred upon the circulation by continuous-flow pumps is associated with hemocompatibility-related adverse events, principally bleeding within the gastrointestinal system, and linked to the degradation of high-molecular-weight multimers (HMWMs) of von Willebrand factor (vWF). We evaluated the structure and functional characteristics of vWF HMWMs in patients with the fully magnetically levitated centrifugal-flow HeartMate 3 (HM3) and the continuous axial-flow HeartMate II (HMII) pump. Findings were correlated with bleeding events.

Total knee arthroplasty outcomes in lupus: a study using the US National Inpatient Sample.

Objective: To assess whether patients with lupus have more complications and/or health care utilization than patients without lupus after primary total knee arthroplasty (TKA).

Methods: We used diagnostic codes to identify lupus (710.0) in patients who underwent primary TKA (procedure code, 81.

Lupus is associated with poorer outcomes after primary total hip arthroplasty.

Objective: The aim of this study was to assess whether lupus is associated with poorer outcomes after primary total hip arthroplasty (THA).

Methods: We used the 1998-2014 US National Inpatient Sample data. Multivariable-adjusted separate logistic regression models assessed the association of lupus with post-operative complications (implant infection, transfusion, THA revision and mortality) and health care utilization outcomes (total hospital charges, discharge to an inpatient facility and length of hospital stay >3 days) post-THA, adjusting for demographics, underlying diagnosis, comorbidity, insurance payer and hospital characteristics, using odds ratios (OR) and 95% confidence intervals (CI).

African American Specific Gene Panel Predictive of Poor Prostate Cancer Outcome.

Purpose: Most prostate cancer in African American men lacks the ETS (E26 transforming specific) family fusion event (ETS-). We aimed to establish clinically relevant biomarkers in African American men by studying ETS dependent gene expression patterns to identified race specific genes predictive of outcomes.

Materials And Methods: Two multicenter cohorts of a total of 1,427 men were used for the discovery and validation (635 and 792 men, respectively) of race specific predictive biomarkers.

BCL2 Amplicon Loss and Transcriptional Remodeling Drives ABT-199 Resistance in B Cell Lymphoma Models.

Drug-tolerant "persister" tumor cells underlie emergence of drug-resistant clones and contribute to relapse and disease progression. Here we report that resistance to the BCL-2 targeting drug ABT-199 in models of mantle cell lymphoma and double-hit lymphoma evolves from outgrowth of persister clones displaying loss of 18q21 amplicons that harbor BCL2. Further, persister status is generated via adaptive super-enhancer remodeling that reprograms transcription and offers opportunities for overcoming ABT-199 resistance.

Noteworthy Cardiac Surgical Literature 2018: Value-Based Bundled Payments, Opioid Crisis and Cardiac Surgery, Percutaneous Suction Thrombectomy for Intracardiac/Caval Thrombus and Vegetations, and Minimally Invasive Left Ventricular Assist Device Placement.

There has been tremendous evolution in the care of cardiac surgical patients in 2018. In this article, 4 topics of considerable impact on cardiac surgical care in the current landscape are reviewed based on recent publications. The first topic reviews the recent paradigm shift to value-based payments and the potential role of bundled payments on health care and physician reimbursement.

Predictors of Acute Kidney Injury Following Aortic Arch Surgery.

Background: Acute kidney injury (AKI) following open aortic arch surgery is a frequent complication associated with increased morbidity and mortality. The primary purpose of this study was to evaluate risk factors for postoperative AKI in patients who underwent open aortic arch surgery utilizing hypothermic circulatory arrest (HCA).

Materials And Methods: Included were 295 patients undergoing surgery between January 2011 and March 2018.

Improved Mortality Associated With the Use of Extracorporeal Membrane Oxygenation.

Background: Our objective was to evaluate the association of bridge to transplant (BTT) extracorporeal membrane oxygenation (ECMO) on survival after lung transplantation (LTx) and determine the degree to which transplant center volume affects this relationship.

Methods: Using the United Network for Organ Sharing database, we performed a retrospective cohort study evaluating the survival of patients undergoing LTx between 2005 and 2017. On the basis of previous literature, LTx centers were classified into 3 groups using their average annual LTx volume over the preceding 5 years: less than 25, 25 to 49, and more than 50.

A Systematic Review of In Vitro and In Vivo Radio Frequency Exposure Methods.

Recently, interest in the effects of radio frequency (RF) on biological systems has increased and is partially due to the advancements and increased implementations of RF into technology. As research in this area has progressed, the reliability and reproducibility of the experiments has not crossed multidisciplinary boundaries. Therefore, as researchers, it is imperative to understand the various exposure systems available as well as the aspects, both electromagnetic and biological, needed to produce a sound exposure experiment.

Rates of Total Joint Replacement in the United States: Future Projections to 2020-2040 Using the National Inpatient Sample.

Objective: To project future total hip and knee joint arthroplasty (THA, TKA) use in the United States to 2040.

Methods: We used the 2000-2014 US National Inpatient Sample (NIS) combined with Census Bureau data to develop projections for primary THA and TKA from 2020 to 2040 using polynomial regression to account for the nonlinearity and interactions between the variables, assuming the underlying distribution of the number of THA/TKA to be Poisson distributed. We performed sensitivity analyses using a negative binomial regression to account for overdispersion.

The Buffalo Trunk Technique for Aortic Arch Reconstruction.

Background: The frozen elephant trunk technique facilitates repair of aortic arch and proximal descending aortic pathologic processes. Commercially available hybrid grafts may simplify this approach by allowing for a single suture line, potentially streamlining the distal anastomosis and improving operative times. However, these devices are currently not readily available in United States.

Gout and chronic pain in older adults: a Medicare claims study.

To assess if gout is associated with a higher risk of incident chronic pain. This study used the 2006-2012 Medicare claims data. We used multivariable-adjusted Cox regression analyses to examine the association of pre-existing diagnosis of gout with incident (new) diagnosis of chronic pain, adjusting for demographics, medical comorbidity, and use of common medications for cardiovascular disease and gout.

Comparative effectiveness of allopurinol and febuxostat for the risk of atrial fibrillation in the elderly: a propensity-matched analysis of Medicare claims data.

Aims: Gout is associated with a higher risk of atrial fibrillation (AF). Comparative effectiveness of allopurinol or febuxostat for reducing the AF risk is unknown, which was our study's main objective.

Methods And Results: We used the 5% Medicare Beneficiary cohort (≥65 years) from 2006 to 2012 to identify people with a new filled prescription for allopurinol or febuxostat, with a baseline period of 365 days without respective medication and without AF.

A Fully Magnetically Levitated Left Ventricular Assist Device - Final Report.

Background: In two interim analyses of this trial, patients with advanced heart failure who were treated with a fully magnetically levitated centrifugal-flow left ventricular assist device were less likely to have pump thrombosis or nondisabling stroke than were patients treated with a mechanical-bearing axial-flow left ventricular assist device.

Methods: We randomly assigned patients with advanced heart failure to receive either the centrifugal-flow pump or the axial-flow pump irrespective of the intended goal of use (bridge to transplantation or destination therapy). The composite primary end point was survival at 2 years free of disabling stroke or reoperation to replace or remove a malfunctioning device.

Gout is associated with a higher risk of chronic renal disease in older adults: a retrospective cohort study of U.S. Medicare population.

Background: Hyperuricemia and gout have been linked to chronic kidney disease (CKD). Whether the increased risk of CKD in gout is due to shared risk factors such as hypertension, diabetes or heart disease, or due to gout itself is not known. Studies in older adults, who tend to have a high incidence of CKD, are limited.

Selecting Evidence-Based HIV Prevention Behavioral Interventions for HIV-Negative Persons for National Dissemination.

This paper describes the development of a formula to determine which evidence-based behavioral interventions (EBIs) targeting HIV-negative persons would be cost-saving in comparison to the lifetime cost of HIV treatment and the process by which this formula was used to prioritize those with greatest potential impact for continued dissemination. We developed a prevention benefit index (PBI) to rank risk-reduction EBIs for HIV-negative persons based on their estimated cost for achieving the behavior change per one would-be incident infection of HIV. Inputs for calculating the PBI included the mean estimated cost-per-client served, EBI effect size for the behavior change, and the HIV incidence per 100,000 persons in the target population.

Genomic Reorganization of Lamin-Associated Domains in Cardiac Myocytes Is Associated With Differential Gene Expression and DNA Methylation in Human Dilated Cardiomyopathy.

Rationale: LMNA (Lamin A/C), a nuclear membrane protein, interacts with genome through lamin-associated domains (LADs) and regulates gene expression. Mutations in the LMNA gene cause a diverse array of diseases, including dilated cardiomyopathy (DCM). DCM is the leading cause of death in laminopathies.

The risk of Sjogren's syndrome in the older adults with gout: A medicare claims study.

Objectives: In the absence of previous studies, our objective was to assess whether gout was associated with an increase or decrease in the risk of Sjogren's Syndrome (SS) in older adults, 65 years or older.

Methods: We used the 5% Medicare claims from 2006-2012. A multivariable Cox regression model assessed the association of gout with incident SS adjusting for age, sex, race, Charlson-Romano comorbidity index, and the use of medications for cardiovascular diseases (statins, beta-blockers, diuretics, ACE-inhibitors) and gout (allopurinol, febuxostat).

S100A9-induced overexpression of PD-1/PD-L1 contributes to ineffective hematopoiesis in myelodysplastic syndromes.

Myelodysplastic syndromes (MDS) are characterized by dysplastic and ineffective hematopoiesis that can result from aberrant expansion and activation of myeloid-derived suppressor cells (MDSCs) within the bone marrow (BM) niche. MDSCs produce S100A9, which mediates premature death of hematopoietic stem and progenitor cells (HSPCs). The PD-1/PD-L1 immune checkpoint impairs immune responses by inducing T-cell exhaustion and apoptosis, but its role in MDS is uncharacterized.