Utilization and Economic Impact of Posterolateral Fusion and Posterior/Transforaminal Lumbar Interbody Fusion Surgeries in the United States.

Study Design: Retrospective database study.

Objective: To analyze the economic and age data concerning primary and revision posterolateral fusion (PLF) and posterior/transforaminal lumbar interbody fusion (PLIF/TLIF) throughout the United States to improve value-based care and health care utilization.

Methods: The National Inpatient Sample (NIS) database was queried by the International Classification of Diseases, Ninth Revision, Clinical Modification codes for patients who underwent primary or revision PLF and PLIF/TLIF between 2011 and 2014.

Seizure Presentation in Patients with Brain Arteriovenous Malformations Treated with Stereotactic Radiosurgery: A Multicenter Study.

Background: Seizures are the second most common clinical presentation in patients with brain arteriovenous malformations (AVMs) and the most common presentation of unruptured AVMs. The aim of the present multicenter, retrospective cohort study was to identify the predictors of seizure presentation in patients with AVM who had undergone stereotactic radiosurgery (SRS).

Methods: We performed a retrospective review of patients with AVM who had been treated with SRS at 8 participating International Radiosurgery Research Foundation sites.

Key Articles and Guidelines in the Management of Heart Failure: 2018 Update.

Heart failure is one of the leading causes of hospitalizations in the United States, with >1 million admissions yearly and a 25% risk of readmissions within 1 month. In order to assist clinicians, we provide an update of the heart failure bibliography that was published in Pharmacotherapy in 2008, which followed the original bibliography published in 2004. A significant number of clinical trials and observational studies have been conducted since the early 1980s to guide management of heart failure patients.

National Survey of Hospitalists' Experiences with Incidental Pulmonary Nodules.

Incidental pulmonary nodules (IPNs) are common and often require follow-up. The Fleischner Society guidelines were created to support IPN management. We developed a 14-item survey to examine hospitalists' exposure to and management of IPNs.

Predictors of Surgical Intervention in Patients with Spontaneous Intracerebral Hemorrhage.

Objective: Despite no clear evidence from randomized trials, surgical intervention of spontaneous intracerebral hemorrhage (ICH) still occurs. We sought to describe the characteristics of patients undergoing surgical intervention in ICH.

Methods: Data from the ERICH (ERICH Ethnic/Racial Variations of Intracerebral Hemorrhage) study were analyzed, and patients with ICH were categorized into surgical intervention or nonoperative management groups.

Quantitative and qualitative analyses of spinal canal encroachment during cervical laminectomy using the kerrison rongeur versus High-Speed burr.

Background: Several cervical laminectomy techniques have been described. One commonly used method involves making bilateral trough laminotomies using either a Kerrison rongeur or a high speed burr, and then removing the lamina en-bloc. Alternatively, some surgeons prefer to thin the lamina with the burr, and then remove the lamina in a piecemeal fashion using Kerrison rongeurs.

PD-1/PD-L1 expression and interaction by automated quantitative immunofluorescent analysis show adverse prognostic impact in patients with diffuse large B-cell lymphoma having T-cell infiltration: a study from the International DLBCL Consortium Program.

Programmed cell death protein 1/programmed cell death protein ligand1 (PD-1/PD-L1) interaction is an important immune checkpoint targeted by anti-PD-1/PD-L1 immunotherapies. However, the observed prognostic significance of PD-1/PD-L1 expression in diffuse large B-cell lymphoma treated with the standard of care has been inconsistent and even contradictory. To clarify the prognostic role of PD-1/PD-L1 expression and interaction in diffuse large B-cell lymphoma, in this study we used 3-marker fluorescent multiplex immunohistochemistry and Automated Quantitative Analysis Technology to assess the CD3, PD-L1, and PD-1CD3 expression in diagnostic samples and PD-1/PD-L1 interaction as indicated by presence of PD-1CD3 cells in the vicinity of PD-L1 cells, analyzed their prognostic effects in 414 patients with de novo diffuse large B-cell lymphoma, and examined whether PD-1/PD-L1 interaction is required for the prognostic role of PD-1/PD-L1 expression.

Attitudes Toward Individuals With Mental Illness and Substance Use Disorders Among Resident Physicians.

Objective: Resident physicians frequently provide care for individuals diagnosed with mental illness and substance use disorders (SUDs). Clinicians-including psychiatrists and addiction professionals-have been shown to possess negative attitudes toward these individuals, which is concerning since negative attitudes may have an adverse impact on patient engagement, treatment, and outcomes. However, little is known about resident physicians' attitudes toward individuals with mental illness and SUDs.

Outcomes After Current Transcatheter Tricuspid Valve Intervention: Mid-Term Results From the International TriValve Registry.

Objectives: A large, prospective international registry was developed to evaluate the initial clinical applications of transcatheter tricuspid valve intervention (TTVI) with different devices.

Background: TTVI for native tricuspid valve dysfunction has been emerging during the last few years as an alternative therapeutic option to serve a large high-risk population of patients with severe symptomatic tricuspid regurgitation (TR).

Methods: The TriValve Registry included 312 high-risk patients with severe TR (76.

Deep learning using tumor HLA peptide mass spectrometry datasets improves neoantigen identification.

Neoantigens, which are expressed on tumor cells, are one of the main targets of an effective antitumor T-cell response. Cancer immunotherapies to target neoantigens are of growing interest and are in early human trials, but methods to identify neoantigens either require invasive or difficult-to-obtain clinical specimens, require the screening of hundreds to thousands of synthetic peptides or tandem minigenes, or are only relevant to specific human leukocyte antigen (HLA) alleles. We apply deep learning to a large (N = 74 patients) HLA peptide and genomic dataset from various human tumors to create a computational model of antigen presentation for neoantigen prediction.

Strength Measurement After Achilles Tendon Repair.

The goal of treatment after Achilles tendon rupture (ATR) is to restore appropriate tension to the tendon, so that normal baseline strength and functional soft-tissue length can be achieved. The assessment of plantarflexion strength has shown widespread variability. The purpose of this study is to document variations in strength assessment after the treatment of ATR in the literature.

Biomechanics of posterior shoulder instability - current knowledge and literature review.

Posterior instability of the shoulder is a rare condition and represents about 10% of shoulder instability. It has become more frequently recognized in the last year, even though it is more difficult to diagnose than anterior shoulder instability. As this form of shoulder pathology is somewhat rare, biomechanical knowledge is limited.

Topical tranexamic acid in spinal surgery: A systematic review and meta-analysis.

Tranexamic acid (TXA) is a commonly used antifibrinolytic agent for perioperative blood conservation in several surgical specialties. Although historically administered intravenously, such systemic administration may be accompanied by severe side effects. Thus, the topical usage of TXA has been established in several fields but remains poorly evaluated in spine surgery.

Pitfalls in liver MRI: Technical approach to avoiding misdiagnosis and improving image quality.

The following is an illustrative review of common pitfalls in liver MRI that may challenge interpretation. This article reviews common technical and diagnostic challenges encountered when interpreting dynamic multiphasic T -weighted imaging, hepatobiliary phase imaging, and diffusion-weighted imaging of the liver. Additionally, each section includes suggestions for avoiding diagnostic and technical errors.

Athletic Hip Injuries in Major League Baseball Pitchers Associated With Ulnar Collateral Ligament Tears.

Background: Ulnar collateral ligament (UCL) reconstruction is a reliable treatment for elite overhand throwers with UCL tears. In recent years, this procedure has become increasingly common among Major League Baseball (MLB) pitchers. Predisposing factors and associated comorbidities, however, have not been fully elucidated.

Management of the Failed Arthroplasty for Proximal Humerus Fracture.

A variety of reasons exist for failure of arthroplasty performed for management of proximal humerus fracture. Revision surgery for these failures is complex and has a high likelihood of inferior outcomes compared with primary arthroplasty. Successful management requires consideration of various modes of failure including tuberosity malunion or resorption, rotator cuff deficiency, glenoid arthritis, bone loss, component loosening, stiffness, or infection.

Optimal Management of Tethered Surgical Drains: A Cadaver Study.

Background: Tethered drains are a complication of drain usage and may result in unintentional retained broken drains, as well as anxiety and uncertainty for the surgeon and the patient. To date, no study has examined the optimal approach for management and removal of tethered drains.

Methods: The study design sought to identify suture size, mechanism of drain fixation (through versus around), points of constriction (one versus multiple) and the efficacy of weighted traction as potential sources of tethered drains by means of four study arms.

Ethical Issues in Contemporary Clinical Genetics.

As genetic sequencing capabilities become more powerful and costs decline, the reach of genomics is expanding beyond research laboratories to the wards, outpatient clinics, and, with the marketing of direct-to-consumer testing services, patients' homes. Increasingly, patients receiving various diagnoses-from cancer to cardiomyopathy-can reasonably expect to have conversations with their providers about indications for genetic testing. In this dynamic context, a grasp of the ethical principles and history underlying clinical genetics will provide clinicians with the tools to guide their practice and help patients navigate complex medical-psychosocial terrain.

Relationship Between Brain Arterial Pathology and Neurocognitive Performance Among Individuals With Human Immunodeficiency Virus.

Background: Human immunodeficiency virus-positive (HIV+) individuals have higher rates of cognitive impairment and cerebrovascular disease compared with uninfected populations. We hypothesize that cerebrovascular disease, specifically brain large artery disease, may play a role in HIV-associated neurocognitive disorders (HAND).

Methods: Participants (N = 94) in the Manhattan HIV Brain Bank study were followed on average 32 ± 33 months with repeated neuropsychological examinations until death.

Strategies for Recognizing and Managing Immune-Mediated Adverse Events in the Treatment of Hodgkin Lymphoma with Checkpoint Inhibitors.

The programmed death-1 (PD-1) receptor checkpoint inhibitors nivolumab and pembrolizumab represent an important therapeutic advance in the treatment of relapsed or refractory classical Hodgkin lymphoma (cHL). Clinical trials have shown substantial therapeutic activity and an acceptable safety profile in heavily pretreated patients, resulting in U.S.

Utilization of the 3D-printed spine model for freehand pedicle screw placement in complex spinal deformity correction.

Background: We aim to demonstrate the safety and efficacy of utilizing 3D-printed spine models to facilitate freehand pedicle screw placement in complex spinal deformity correction. Currently there is no data on using 3D-printed models for freehand pedicle screw placement spinal deformity correction.

Methods: All patients undergoing spinal deformity correction over a 16-month period (September 2015 - December 2016) at the Spine Hospital of Columbia University Medical Center by the senior surgeon were reviewed.