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Objective: Due to physiological and metabolic immaturity, prematurely born infants are at increased risk because of maternal separation in many neonatal intensive care units (NICUs). The stress induced from maternal–infant separation can lead to well-documented short-term physiologic instability and potentially lifelong neurological, sociological, or psychological sequelae. Based on previous studies of kangaroo mother care (KMC) that demonstrated improvement in physiologic parameters, we examined the impact of KMC on physiologic measures of stress (abdominal temperature, heart rate, oxygen saturation, perfusion index, near-infrared spectrometry), oxidative stress, and energy utilization/conservation in preterm infants. Methods: In this randomized, stratified study of premature neonates, we compared the effects on urinary concentrations of biomarkers of energy utilization and oxidative stress of 1 hr of KMC versus incubator care on Day 3 of life in intervention-group babies (n = 26) and control-group babies (n = 25), respectively. On Day 4, both groups received 1 hr of KMC. Urinary samples were collected 3 hr before and 3 hr after intervention/incubator care on both days. Energy utilization was assessed by measures of adenosine triphosphate (ATP) degradation (i.e., hypoxanthine, xanthine, and uric acid). Oxidative stress was assessed using urinary allantoin. Mixed-models analysis was used to assess differences in purine/allantoin. Results: Mean allantoin levels over Days 3 and 4 were significantly lower in the KMC group than in the control group (p =.026). Conclusions: Results provide preliminary evidence that KMC reduces neonatal oxidative stress processes and that urinary allantoin could serve as an effective noninvasive marker for future studies. [ABSTRACT FROM AUTHOR]

Background: There is evidence that tibial slope may play a role in revision risk after anterior cruciate ligament reconstruction (ACLR); however, prior studies are inconsistent. Purpose: To determine (1) whether there is a difference in lateral tibial posterior slope (LTPS) or medial tibial posterior slope (MTPS) between patients undergoing revised ACLR and those not requiring revision and (2) whether the medial-to-lateral slope difference is different between these 2 groups. Study Design: Case-control study; Level of evidence, 3. Methods: We conducted a matched case-control study (2006-2015). Cases were patients aged ≤21 years who underwent revision surgery after primary unilateral ACLR; controls were patients aged ≤21 years without revision who were identified from the same source population. Controls were matched to cases by age, sex, body mass index, race, graft type, femoral fixation device, and post-ACLR follow-up time. Tibial slope measurements were made by a single blinded reviewer using magnetic resonance imaging. The Wilcoxon signed rank test and McNemar test were used for continuous and categorical variables, respectively. Results: No difference was observed between revised and nonrevised ACLR groups for LTPS (median: 6° vs 6°, P =.973) or MTPS (median: 4° vs 5°, P =.281). Furthermore, no difference was found for medial-to-lateral slope difference (median: −1 vs −1, P =.289). A greater proportion of patients with revised ACLR had an LTPS ≥12° (7.6% vs 3.8%) and ≥13° (4.7% vs 1.3%); however, this was not statistically significant after accounting for multiple testing. Conclusion: We failed to observe an association between revision ACLR surgery and LTPS, MTPS, or medial-to-lateral slope difference. However, there was a greater proportion of patients in the revision ACLR group with an LTPS ≥12°, suggesting that a minority of patients who have more extreme values of LTPS have a higher revision risk after primary ACLR. A future cohort study evaluating the angle that best differentiates patients at highest risk for revision is needed. [ABSTRACT FROM AUTHOR]

Immigrants account for a significant proportion of the nursing workforce in the United States (U.S.). Although different cultural backgrounds may affect immigrant nurses' perceptions of work and occupational health risks, little research has been conducted. Defining immigrant nurses as those who received initial nursing education in foreign countries, this study examined the differences in work-related perceptions and experiences of musculoskeletal (MS) symptoms and injuries between U.S.-educated and foreign-educated nurses. We analyzed data from a cross-sectional study using a statewide random sample of 419 California registered nurses. Foreign-educated nurses reported a more positive safety climate (p =.017) and perceived their jobs as less demanding (p =.008) than did U.S.-educated nurses. The prevalence of work-related MS symptoms was significantly lower in foreign-educated nurses than in U.S.-educated nurses (p =.044), but the difference was not significant in the multivariable analyses. Positive safety climate was significantly associated with a decreased risk of work-related MS symptoms and injuries, and this relationship was greater among U.S.-educated nurses than among foreign-educated nurses. Our findings suggest that immigrant nurses may have different perceptions about safety climate and job demand, which may modify their occupational health risks. [ABSTRACT FROM AUTHOR]

Background: Off-track Hill-Sachs lesions have been associated with high rates of recurrent shoulder instability. Both arthroscopic Bankart with remplissage and modified Latarjet have been described to treat off-track Hill-Sachs lesions. However, few comparative studies exist between the 2 techniques in heterogeneous populations. Hypothesis: Remplissage would have similar recurrence rates and clinical outcomes to modified Latarjet for off-track Hill-Sachs lesions with subcritical glenoid bone loss. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2005 and 2015, 189 patients with recurrent anterior shoulder instability, off-track Hill-Sachs lesion, and less than 25% glenoid bone loss were identified. Arthroscopic Bankart with remplissage (group A) was performed in 98 patients, and modified Latarjet (group B) was performed in 91 patients. Surgeries were performed by multiple fellowship-trained surgeons at 2 centers. The mean follow-up time was 3.2 years. Patients were assessed for their risk of recurrence using the Instability Severity Index Score and had preoperative 3-dimensional imaging to assess humeral and glenoid bone loss, along with measurement of the glenoid track. Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), visual analog scale (VAS) for pain, range of motion, recurrence rate, subsequent procedures, and complications were analyzed. Results: When comparing the remplissage and Latarjet groups, the remplissage group had a higher VAS pain score (2.2 vs 1.55, P = .041) and less internal rotation motion in abduction (40.9° vs 53.2°, P = .006). The complication rate was higher in the Latarjet group (12.1% vs 1%, P = .002). There was no difference between the 2 groups in patient-reported outcomes, such as WOSI and SANE. In addition, there was no difference between the 2 groups in revision rate and episodes of recurrent instability. In subgroup univariate analysis of revision patients, the remplissage group had higher VAS pain score (3.6 vs 2.2, P = .001), higher recurrence rate (34.8% vs 10.3%, P = .042), higher revision rate (43.5% vs 15.4%, P = .019), and lower complication rate (4.35% vs 28.2%, P = .024). For patients with >15% glenoid bone loss, Latarjet had lower recurrence rate (6.06% vs 28.6%, P = .034) and lower revision rate (3.03% vs 21.4%, P = .041). In collision and contact athletes, Latarjet had better WOSI scores (138 vs 231, P = .019) and lower recurrence rate (30% vs 0%, P = .005). In multivariate analysis, the odds of recurrence in the remplissage group were higher than in the Latarjet group in patients with previous instability surgery (3.56, P = .006), collision and contact athletes (2.37, P = .02), those with 10% to 15% glenoid bone loss (1.28, P = .04), and those with >15% glenoid bone loss (6.48, P = .001). Conclusion: For off-track Hill-Sachs lesions with subcritical glenoid bone loss, both the remplissage and modified Latarjet can achieve satisfactory results with the initial surgical intervention in the general population, but a higher complication rate was observed in the Latarjet group. However, Latarjet appears to be a better choice in patients with revision instability surgery, collision and contact athletes, and those with >10% glenoid bone loss. [ABSTRACT FROM AUTHOR]

Background: Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. Purpose: To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions. The mean age was 29.6 ± 11.4 years, and 62.9% were male. The majority of patients (62.2%) presented for cartilage repair because of osteochondritis dissecans. The mean graft area, used as a surrogate for absolute size of the lesion, was 6.4 cm2 (range, 2.3-11.5 cm2). The relative size of the lesion was calculated as the tibial width ratio (TWR; ratio of graft area to tibial width) and affected femoral condyle ratio (AFCR; ratio of graft area to affected femoral condyle width) using preoperative radiographs. All patients had a minimum follow-up of 2 years. Further surgical procedures were documented, and graft failure was defined as revision OCA transplantation or conversion to arthroplasty. International Knee Documentation Committee (IKDC) pain, function, and total scores were obtained. Satisfaction with OCA transplantation was assessed. Results: The mean follow-up among patients with grafts remaining in situ was 6.0 years (range, 1.9-16.5 years). The OCA failure rate was 5.8%. Overall survivorship of the graft was 97.2% at 5 years and 93.5% at 10 years. No difference in postoperative outcomes between groups was found in absolute or relative size. Change in IKDC scores (from preoperative to latest follow-up) was greater for knees with large lesions compared to knees with small lesions, among all measurement methods. Overall satisfaction with the results of OCA transplantation was 89.8%. Conclusion: The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee. [ABSTRACT FROM AUTHOR]

Background: Femoroacetabular impingement (FAI) can lead to hip pain and early joint degeneration. There have been few reports to date on the outcomes of hip arthroscopy for the treatment of FAI in the military population. Purpose/Hypothesis: The purpose of this study was to compare patient demographics with postoperative outcomes after hip arthroscopy for symptomatic FAI and to identify preoperative risk factors for poor outcomes. The hypothesis was that certain preoperative patient characteristics will be predictive of poorer outcomes and that lower outcomes scores will be associated with a higher likelihood of medical separation from the military. Study Design: Case series; Level of evidence, 4. Methods: Retrospective chart review of active-duty and dependent patients older than 18 years who underwent hip arthroscopy for symptomatic FAI from 2009 to 2014 at a single institution. Results: A total of 469 (309 males and 160 females) surgeries were performed on 456 active-duty personnel and 13 dependent civilians, with a mean 2.5-year follow-up. Overall, 39% (n = 179) were able to return to duty (RTD), 18% (n = 82) were medically cleared to return to normal daily activities but did not remain on active duty, and 43% (n = 195) required referral to the Disability Evaluation System (DES). Increasing rank and male sex were positive predictors and Axis 1 psychiatric diagnosis, revision surgery, concomitant psoas tenotomy, multiple medical comorbidities, and complaints of generalized pelvic pain were negative predictors for returning to duty. US Marine Infantry and Special Forces showed improved RTD rates (50%-86%) compared with administrative, more sedentary, occupations (22%). On average, Single Alpha Numeric Evaluation (SANE) and visual analog scale (VAS) scores improved after surgery, with SANE scores improving 37 ± 28 points and VAS scores improving 2.6 ± 2.5 points. The mean postoperative SANE and VAS scores differed significantly between the RTD group and those not returning to duty; 87 and 1.2 points compared with 69 and 3.6 points, respectively (P < .0001). Conclusion: Hip arthroscopy for the treatment of symptomatic FAI effectively improves pain symptoms and self-reported overall function but shows a much lower than expected return to full, unrestricted active duty in the general active-duty military population. Underlying psychiatric diagnoses, female sex, and more sedentary occupations are associated with lower RTD rates. Furthermore, lower postoperative SANE and VAS scores are associated with lower RTD rates. Only the more active and elite components of the military study population showed RTD rates consistent with previously reported outcomes of return to competitive sports after hip arthroscopy for FAI. [ABSTRACT FROM AUTHOR]

Primary gastrointestinal non-Hodgkin's lymphoma (PGINHL) is a heterogeneous family of tumors, with treatment modalities including chemotherapy, surgery, and radiotherapy. Because the role of surgery in PGINHL remains disputed, this study aims to assess the impact of operative resection on survival. We used a pathology database to identify all cases of PGINHL diagnosed at a single academic-affiliated medical center from 1988 to 2013. Demographic and clinical data were abstracted from the medical record. We summarized the clinical courses of patients with PGINHL and then performed a survival analysis to compare overall and disease-free survival, stratified by demographic and clinical variables. We identified 33 patients diagnosed with PGINHL during the study period. Of 29 who subsequently received treatment at the institution, 15 initially underwent chemotherapy, 10 underwent surgical resection, and 4 underwent surgery for other reasons such as diagnosis without resection or management of disease complications. Three patients suffered surgical complications and two of these patients died. We found no difference in overall survival between patients receiving surgical resection and patients managed initially with chemotherapy. This case series supports a continued role for surgical resection in the management of patients with PGINHL, though anticipated benefits should be weighed against the risk of complications. [ABSTRACT FROM AUTHOR]

Invasive candidiasis is associated with worse outcomes and increased mortality in critically ill patients. The Candida score (CS) provides a clinical tool for identifying patients at risk for invasive candidiasis. Outcomes of severely injured trauma patients with positive candida cultures stratified by their CS have not been well described. In this retrospective observational study, all severely injured trauma patients (Injury Severity Score ≥16) admitted to the Los Angeles County and University of Southern California Medical Center from April 2008 to April 2014 with positive Candida cultures were included. Outcomes of patients with a low risk for invasive candidiasis (CS < 3) were compared with those with a high risk (CS ≥ 3). A CS ≥ 3 was significantly associated with higher mortality (35.9% vs 5.0%, P = 0.001), longer length of stay (LOS) (median 49.0 vs 28.0, P = 0.002), longer intensive care unit LOS (35.0 vs 20.0, P < 0.001), requirement for renal replacement therapy (38.5% vs 4.9%, P < 0.001), and increased ventilator days (22.0 vs 12.0, P < 0.001). Multivariable regression analysis revealed a CS ≥ 3 as a significant predictor for increased mortality [OR 6.983], longer LOS [regression coefficient (RC) 1.572] and intensive care unit LOS (RC 1.698), more frequent need for renal replacement therapy (OR 13.268), and increased ventilator days (RC 1.836). In conclusion, a CS ≥ 3 is significantly associated with increased mortality and worse outcomes in severely injured trauma patients with positive Candida cultures. The CS thus may serve as a clinical tool to predict outcomes in this patient population. [ABSTRACT FROM AUTHOR]

Gastric adenocarcinoma has a high recurrence rate. The goal of this study was to determine the timing and pattern of recurrence after gastrectomy. A retrospective review was performed of patients with gastric adenocarcinoma having curative partial or total gastrectomy with R0/D2 lymph node resection from 1999 to 2013. Follow-up included CT scans of the chest, abdomen, and pelvis at 3-month intervals for the first three years, at 6-month intervals for the next two years, and annually thereafter. There were 62 patients, 38 males and 24 females, with a median age of 65 years. Median follow-up was 29 months and recurrence was identified in 21 per cent of patients. Median time to recurrence was 12 months and 92 per cent of recurrences occurred within two years. The last recurrence was identified at 34 months. Abdominal CT scan identified all patients with recurrence, although some patients had disease elsewhere in addition to the abdominal disease. There were no extra-abdominal isolated recurrences. In conclusion, recurrence after complete resection for gastric adenocarcinoma typically occurs within the first two years, and can be found by abdominal CT scan. Close cancer follow-up appears unnecessary after three years because all recurrences were identified within 34 months of resection. [ABSTRACT FROM AUTHOR]

Optimal surgical management of traumatic duodenal injury (DI) remains controversial. The National Trauma Data Bank was queried for all blunt trauma patients with DI. Patients with isolated injury were identified by excluding chest and head Abbreviated Injury Score > 3 and nonduodenal intra-abdominal Organ Injury Scale ≥ 3. Demographics, OIS, and operative intervention were collected. Outcomes included mortality and hospital length of stay (HLOS). During the study period, 3,456,098 blunt trauma patients were entered into the National Trauma Data Bank, 388,137 of which had abdominal trauma. Overall, 1.0 per cent patients with abdominal trauma had DI with isolated DI in only 0.6 per cent (n = 2220). The majority of isolated DI was low grade with only 158 patients sustaining severe injury and overall mortality was 5.2 per cent. Overall 743 patients were operated, of which 353 (47.5%) patients underwent duodenal operation, 280 (37.7%) had primary repair (PR), and 68 (9.2%) had gastroenterostomy (GE). Patients with PR had similar mortality to those with GE (6.6% vs 4.5%, P = 0.777); however, HLOS was shorter (median 11 days, vs 18 days, P < 0.001). In only OIS 4 and 5 injuries, PR was also associated with shorter HLOS (P = 0.004) and similar mortality (P = 1.000) when compared with GE. Isolated DI after blunt abdominal trauma is rare. In severe injuries, PR is associated with a shorter HLOS without effecting mortality when compared with GE. [ABSTRACT FROM AUTHOR]

Esophageal adenocarcinoma is typically observed in the older non-Hispanic white population. Changing demographics are altering the epidemiology of the disease. The aim of this study is to review the presentation and outcomes of esophageal adenocarcinoma patients <40 years old at our institution. A retrospective review was performed of patients diagnosed with esophageal adenocarcinoma between 1990 and 2013. Demographics, presentation, and outcomes were compared in those <40 years old and those ≥40 years old. There were 772 total cases with 42 (5%) <40 years old consisting of 37 (88.1%) males, five females and median age of diagnosis of 35 (interquartile range: 31-38). The two most common ethnicities were White non-Hispanic/Latino in 19 (45.2%), Hispanic /Latino in 18 (42.9%). Compared with patients 40 years and older, the younger group had more Hispanic/Latinos than the older group (43% vs 17%, P < 0.001), more frequently presented with stage IV disease (50% vs 29%) and had a shorter median survival. In conclusion, younger patients tend to present at a much later stage than the older counterparts, which may be due to a delay in diagnosis as well as more aggressive biology. Esophageal adenocarcinoma seems to be increasing in the Hispanic/Latino population. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the effectiveness of the Pharmacist-Managed Telephone Tobacco Cessation Clinic (PMTTCC) compared to the standard of care (SOC) at the Veterans Affairs San Diego Healthcare System. Method. A retrospective cohort study was performed investigating the proportion of veterans who quit smoking at 6 months while enrolled in the PMTTCC. Chart review was performed using the Veterans Affairs Computerized Patient Record System. The PMTTCC group included patients who had received medication and counseling from the tobacco cessation pharmacists. The cohort was compared to a matched SOC group who did not receive counseling, only tobacco cessation medication therapy through a primary care provider. The primary outcome for this study was patient-reported tobacco cessation at 6 months. Secondary outcomes were abstinence at 1 and 3 months. Results. A total of 1,006 patients were included in the analysis, 503 patients from the PMTTCC and 503 patients from SOC. The overall study population was 54 years old on average, 92.5% male, 70.0% Caucasian, 45.5% with history of psychiatric conditions, and had an average smoking history of 33-pack years. Patients in the PMTTCC group had statistically significant improvements in abstinence at 6 months versus the SOC group (81/503, 16.1% vs. 48/503, 9.5%; p < .0001). Quitters were older on average versus non-quitters (56.03 vs. 53.65 years; p = .01). Conclusion. Patients enrolled in the PMTTCC had improved tobacco abstinence rates at 6 months compared to SOC. Although the study was not designed to test for causality, the results lend support for using intensive tobacco cessation management in veteran population. [ABSTRACT FROM PUBLISHER]