Preanalytics and Precision Pathology: Pathology Practices to Ensure Molecular Integrity of Cancer Patient Biospecimens for Precision Medicine.

Biospecimens acquired during routine medical practice are the primary sources of molecular information about patients and their diseases that underlies precision medicine and translational research. In cancer care, molecular analysis of biospecimens is especially common because it often determines treatment choices and may be used to monitor therapy in real time. However, patient specimens are collected, handled, and processed according to routine clinical procedures during which they are subjected to factors that may alter their molecular quality and composition.

Incidental breast carcinoma: incidence, management, and outcomes in 4804 bilateral reduction mammoplasties.

Introduction: Bilateral reduction mammoplasty is one of the most common plastic surgery procedures performed in the U.S. This study examines the incidence, management, and prognosis of incidental breast cancer identified in reduction specimens from a large cohort of reduction mammoplasty patients.

Laboratory Staff Turnover: A College of American Pathologists Q-Probes Study of 23 Clinical Laboratories.

Context.—: Knowledge of laboratory staff turnover rates are important to laboratory medical directors and hospital administrators who are responsible for ensuring adequate staffing of their clinical laboratories. The current turnover rates for laboratory employees are unknown.

Use of a transforming powder dressing in the lower leg wounds of two older patients: case studies.

This report describes the use of a transforming powder dressing to treat lower leg surgical wounds occurring in two older patients. Wounds in this location are difficult and slow to heal. Both of these wounds exhibited complete granulation within two weeks of powder application and total healing in under four weeks, all while requiring no patient or nursing wound care.

An upper bound computational model for investigation of fusion effects on adjacent segment biomechanics of the lumbar spine.

Prediction of the biomechanical effects of fusion surgery on adjacent segments is a challenge in computational biomechanics of the spine. In this study, a two-segment L3-L4-L5 computational model was developed to simulate the effects of spinal fusion on adjacent segment biomechanical responses under a follower load condition. The interaction between the degenerative segment (L4-5) and the adjacent segment (L3-4) was simulated using an equivalent follower spring.

Findings from a mobile application-based cohort are consistent with established knowledge of the menstrual cycle, fertile window, and conception.

Objective: To investigate the validity of self-reported fertility data generated by a mobile application-based cohort in comparison with data collected by traditional clinical methodologies.

Design: Data were collected from July 2013 to July 2018 through a mobile application designed to track fertility. Bayesian hierarchical models were used to assess day-specific pregnancy probabilities.

EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice.

Background: Acute diverticulitis (AD) presents a unique diagnostic and therapeutic challenge for general surgeons. This collaborative project between EAES and SAGES aimed to summarize recent evidence and draw statements of recommendation to guide our members on comprehensive AD management.

Methods: Systematic reviews of the literature were conducted across six AD topics by an international steering group including experts from both societies.

Diagnosis, Etiology and Outcomes of Revision Distal Biceps Tendon Reattachment.

Purpose: To evaluate the incidence, etiology, and clinical outcomes after revision distal biceps tendon repair. We hypothesized that re-ruptures are rare and can be reattached with satisfactory results.

Methods: Cases were identified from the case log of the senior author.

IN.PACT SFA Clinical Study Using the IN.PACT Admiral Drug-Coated Balloon in a Chinese Patient Population.

To confirm the safety and effectiveness of the IN.PACT Admiral drug-coated balloon (DCB) as a treatment for de novo and native artery restenotic lesions in the superficial femoral artery (SFA) and/or proximal popliteal artery in Chinese subjects. IN.

Dissections After Infrainguinal Percutaneous Transluminal Angioplasty: A Systematic Review and Current State of Clinical Evidence.

To systematically review the literature and extract information on the definitions, prevalence, implications, and treatment of dissections after infrainguinal balloon angioplasty, with a goal of summarizing current data and identifying gaps in knowledge to help direct future research. A systematic review was performed according to the PRISMA guidelines. Medline (PubMed), Scopus, and Cochrane CENTRAL databases were reviewed for prospective and retrospective studies reporting dissection identification, characterization, incidence, severity, and/or outcomes after infrainguinal balloon angioplasty up to January 30, 2019.

Factors influencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs.

Background: Management of proximal 5th metatarsal fractures remains a controversial topic in orthopaedic surgery. Both operative and non-operative approaches have been described in the clinical setting. This confusion has led to non-standardized treatment recommendations for proximal 5th metatarsal fractures.

Patterns of Care and Outcomes of Definitive External Beam Radiotherapy and Radioembolization for Localized Hepatocellular Carcinoma: A Propensity Score-adjusted Analysis.

Objectives: Most localized hepatocellular carcinoma (HCC) patients are not surgically operable or transplantation candidates, increasing the role for nonsurgical therapies. Ablative external beam radiotherapy (XRT) and transarterial radioembolization (TARE) are emerging radiotherapeutic treatments for localized HCC. We sought to evaluate their utilization and efficacy in a large nationwide cohort.

Evaluation of Syndesmosis Reduction on CT Scan.

Background: Computed tomography (CT) imaging has traditionally been considered the gold standard for evaluation of syndesmostic reduction, but there is no uniformly accepted method to assess reduction. The aim of this study was to evaluate the intra- and interobserver reliability of published measurement techniques for evaluation of syndesmotic reduction on weightbearing CT scan (WBCT) in hopes of determining which method is best.

Methods: Medical records were reviewed to identify patients who underwent operative stabilization of unilateral syndesmotic injuries.

Actinomyces in Crohn's-like appendicitis.

Aims: Appendicitis with a Crohn's-like histological appearance generally raises concern for Crohn's disease, Yersinia infection, and interval appendectomy. Actinomyces infection is a recognised cause of chronic appendicitis that can histologically mimic Crohn's disease.

Methods And Results: We report on 20 cases of appendicitis with Crohn's-like histological features that were due to Actinomyces.

Lumbar Spine MRI: Missed Opportunities for Abdominal Aortic Aneurysm Detection.

Purpose: The US Preventive Services Task Force (USPSTF) recommends 1-time sonographic screening for abdominal aortic aneurysms (AAAs) in male smokers ages 65-75 and other selected individuals in this age group based on risk factors. Patients in this age range are frequent utilizers of lumbar spine MRI, in which the abdominal aorta is typically fully imaged. The purpose of this study was to assess the potential detection rate of AAAs on lumbar spine MRI performed in the USPSTF screening age range with systematic aortic measurement and the frequency with which AAAs are currently reported in practice.

Opioid Consumption Rate Following Foot and Ankle Surgery.

Background: The rapid increase in the consumption of prescription opioids has become one of the leading medical, economic, and sociological burdens in North America. In the United States, orthopedic surgery is the fourth leading specialty in the number of opioids prescribed, and the largest among all operative specialties. There is insufficient evidence to guide surgeons about appropriate opioid prescription amounts after orthopedic foot and ankle (F&A) procedures.

Rapid, economical healing of two large Mohs surgery wounds with transforming powder dressing.

As dermatology has evolved into a medical/surgical specialty, care for the patient with difficult postsurgical wounds has emerged as an aspect of practice for an increasing number of dermatologists. Here, we present a transforming powder dressing which yielded fast, cost-effective healing of two such wounds, while also relieving the patient and his family of any wound care responsibility.

Vascular Teams in Peripheral Vascular Disease.

Peripheral vascular disease affects millions of individuals worldwide, and results in significant morbidity and mortality. The complex nature of the disease, the presence of multiple comorbidities, and the existence of a wide variety of therapeutic options suggests that a multidisciplinary approach to treatment has the potential to improve care of these patients. The success of the heart team for complex coronary artery and structural heart disease could serve as a model for the efficient and effective management of patients with peripheral vascular disease.

Time to conception and the menstrual cycle: an observational study of fertility app users who conceived.

The objective of this research was to evaluate the association between menstrual cycle characteristics (cycle length, cycle-length variability, and their interaction) and the amount of time it takes women to conceive using a robust multiple linear regression. Participants downloaded Ovia Fertility in 2015 indicated that they had just started trying to conceive, and reported conception within 12 months ( = 45,360, adjusted model  = 8835). The average time to conception among women in the adjusted model was 3.

Longitudinal Urgent Care Psychiatry as a Unique Access Point for Underserved Patients.

Objective: The authors sought to determine whether a walk-in psychiatry model with longitudinal follow-up capability could improve access for patients who traditionally miss appointments.

Methods: An urgent care clinic that offers treatment exclusively on a walk-in basis was opened within an adult psychiatry practice to accommodate patients who missed prior scheduled appointments. Electronic health records for patients who received an initial psychiatry evaluation at the practice during a 6-month period (N=355) were reviewed retrospectively to track the clinic's productivity and patient demographic characteristics.

ACR Appropriateness Criteria Left Lower Quadrant Pain-Suspected Diverticulitis.

This review summarizes the relevant literature regarding imaging of suspected diverticulitis as an etiology for left lower quadrant pain, and imaging of complications of acute diverticulitis. The most common cause of left lower quadrant pain in adults is acute sigmoid or descending colonic diverticulitis. Appropriate imaging triage for patients with suspected diverticulitis should address the differential diagnostic possibilities and what information is necessary to make a definitive management decision.

ACR Appropriateness Criteria Dysphagia.

This review summarizes the relevant literature for the initial imaging of patients with symptoms of dysphagia. For patients with oropharyngeal dysphagia who have an underlying attributable cause, a modified barium swallow is usually appropriate for initial imaging but for those who have unexplained dysphagia a fluoroscopic biphasic esophagram is usually appropriate. Fluoroscopic biphasic esophagram is usually appropriate for initial imaging in both immunocompetent and immunocompromised patients who have retrosternal dysphagia.

Postoperative Opioid Use Using Enhanced Recovery After Surgery Guidelines for Benign Gynecologic Procedures.

Study Objective: To evaluate opioid use after benign gynecologic surgery after implementation of Enhanced Recovery After Surgery (ERAS) opioid prescribing recommendations.

Design: A prospective cohort study.

Setting: An academic tertiary care hospital.

What Is the Association Between Articular Cartilage Damage and Subsequent THA 20 Years After Hip Arthroscopy for Labral Tears?

Background: Few studies have examined long-term outcomes for patients after arthroscopic treatment for intraarticular hip conditions, and none have done so beyond 10 years postarthroscopy. Examining outcomes beyond 10 years is necessary to determine factors that contribute to conversion to THA in patients undergoing hip arthroscopy for labrochondral damage.

Questions/purposes: (1) What is hip survivorship free from THA in patients who underwent arthroscopic labral débridement, with or without chondroplasty at least 15 years before? (2) What factors are associated with conversion to THA after arthroscopic labral débridement, with or without chondroplasty? (3) Can these data be used to estimate the risk of conversion to THA based on patient- and hip-related factors?

Methods: Between 1989 and 2000, one surgeon performed 552 arthroscopic hip procedures for symptomatic labral tears, with or without associated articular cartilage damage.