Alcohol Use and the Risk of Colorectal Liver Metastasis: A Systematic Mapping Review.

The consumption of alcohol has long been associated with the development of liver disease as well as cancers including colorectal cancer (CRC). Leading healthcare concerns include the prevalent use of alcohol and the high burden of CRC mortality. Many CRC deaths are attributed to the development of colorectal liver metastasis (CRLM) as the liver is the foremost site of CRC spread. However, an association has not been defined for the role of alcohol intake and related liver injury with the development of CRLM. Here, a mapping review of recent research was undertaken to evaluate the relationship between alcohol consumption and the risk of CRLM. The literature search revealed 14 articles meeting the inclusion criteria that included patient database analyses and preclinical studies. Most of the human data analyses found alcohol use independently associates with worse CRC outcomes. The preclinical evaluations identified several pathways involved in the alcohol-mediated promotion of CRLM burden and CRC cell metastatic behavior. The limited number of studies identified exposes a significant need for more prospective analyses to define the role of alcohol intake and advanced CRC as well as the translation of preclinical research to fully characterize targetable mechanisms for the generation of new therapeutic options.

Functional improvement in hip pathology is related to improvement in anxiety, depression, and pain catastrophizing: an intricate link between physical and mental well-being.

BACKGROUND: Pain catastrophizing, anxiety, and depression are risk factors for poor functional outcomes and worse post-treatment pain that can be treated alongside physical care given to orthopedic patients. While these factors have been shown to be common in patients with hip pathology, there is limited literature that follows these conditions throughout treatment. The purpose of this study was to track psychological factors in patients with various hip pathology to determine if they improved alongside functional measures following treatment. METHODS: Patients presenting to a specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, depression, and hip function. Pre- and post-treatment assessments were undertaken: Pain Catastrophizing Scale, the Hospital Anxiety Depression Scale, the Hip Outcome Survey, and Hip Disability and Osteoarthritis Outcome Score (HOOS). Patient characteristics were recorded. A correlation analysis, using the Spearman partial correlation coefficient (rs), was conducted to evaluate the relationship between change in psychological factors with change in functional outcomes. RESULTS: A total of 201 patients (78 male, 123 female) with a mean age of 53.75 ± 18.97 years were included, with diagnoses of hip dysplasia (n = 35), femoroacetabular impingement (n = 35), lateral trochanteric pain syndrome (n = 9), osteoarthrosis (n = 109), and avascular necrosis of the hip (n = 13). Statistical analysis revealed a significant negative relationship between change in function level (as measured by HOOS ADL) and change in pain catastrophizing (rs = - 0.373, p < 0.0001), depression (rs = - 0.363, p < 0.0001), and anxiety (rs = - 0.264, p = 0.0002). Pain catastrophizing, depression, and anxiety improved with function. Spearman correlation coefficients also revealed that pain catastrophizing, HADS anxiety, and HADS depression improved with improvement in other patient-reported functional outcomes. CONCLUSIONS: Patients with hip pathology often exhibit pain catastrophizing, anxiety, and depression, but improvements in hip functionality are associated with decreased severity of these psychological comorbidities. Exploring this connection demonstrates the correlation between musculoskeletal impairment and psychosocial outcomes and mental health. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care.

Exosomes: Novel Players of Therapy Resistance in Neuroblastoma.

Neuroblastoma is a solid tumor (a lump or mass), often found in the small glands on top of the kidneys, and most commonly affects infants and young children. Among neuroblastomas, high-risk neuroblastomas are very aggressive and resistant to most kinds of intensive treatment. Immunotherapy, which uses the immune system to fight against cancer, has shown great promise in treating many types of cancer. However, high-risk neuroblastoma is often resistant to this approach as well. Recent studies revealed that small vesicles known as exosomes, which are envelopes, could deliver a cargo of small RNA molecules and provide communication between neuroblastoma cells and the surrounding cells and trigger metastasis and resistance to immunotherapy. In this chapter, we describe the role of exosomes and small RNA molecules in the metastasis and regression of neuroblastoma and the potential therapeutic approaches to combat this menace.

Preoperative mental health status is a significant predictor of postoperative outcomes in adolescents treated with hip preservation surgery.

PURPOSE: This study was designed to evaluate predictive factors that influence pain, mental health symptoms and postoperative outcomes at six-months post-hip preservation surgery (HPS) in adolescent surgical candidates. METHODS: In total, 58 HPS candidates (39 female, 19 male; mean age 15.53 years (10 to 19)) were evaluated. Diagnoses included: acetabular dysplasia (34); idiopathic femoroacetabular impingement (15); Perthes disease (six); avascular necrosis (six); and slipped capital femoral epiphysis (six). All patients underwent periacetabular osteotomy (36), surgical hip dislocation (17) or arthroscopy (five). Patients completed the following: Numerical Pain Rating Scale (NPRS); Child Health Questionnaire-87 (CHQ-87); Pediatric Symptom Checklist-Youth (PSC-Y), preoperatively and six months postoperatively. A single psychologist assessed patients in clinics and one to two additional appointments. RESULTS: In all, 78% of patients reported one to three years of pain prior to HPS (modified Harris hip score). All pain scores (NPRS) significantly decreased at six months postoperatively. Preoperative mental health scores (CHQ-87) significantly predicted postoperative pain scores (F(1, 57) = 4.07; p < 0.048; R2 = 0.068). Mental health symptoms (PSC-Y) decreased significantly (p < 0.001). Patients who were seen by a psychologist two or more times reported better six-month postoperative outcomes than those seen once: usual pain (NPRS; p = 0.012); patient-reported physical function (CHQ-87; p = 0.029); and mental health (PSC-Y; p = 0.019). HPS patients seen ≥ 60 days prior to surgery showed marked improvements at six months compared with patients seen < 60 days prior to surgery. CONCLUSION: HPS candidates evaluated preoperatively by psychology, as part of an integrated treatment approach, demonstrated statistically significant improvements in pain, health-related quality of life and mental health symptoms. Two+ visits, more than 60 days prior to surgery appears to be impactful. Preoperative pain and mental health symptoms were predictive of postoperative pain.Level of Evidence: II.

Biofilm facilitates metal accumulation onto microplastics in estuarine waters.

In aquatic environments, plastic debris accumulates chemical pollutants from the surrounding water, potentially altering the fate of xenobiotics in these ecosystems. The effects of biofouling on the potential for plastic to sorb environmental pollutants remain poorly understood. In this study, we test the hypothesis that concentrations of metals are directly related to biofilm accumulation on microplastics submerged in natural estuarine waters. Two types of pre-production plastic pellets (polylactic acid (PLA) and low-density polyethylene (LDPE)) and glass pellets, were suspended for up to 28 days in an urbanized estuary (San Francisco Bay, California) to investigate how biofilm affects the accumulation of metals on these materials. During the initial weeks of the experiment, biofilm growth differed between locations, but after 28 days, PLA and LDPE had similar amounts of biofilm at the two field sites. Biofilm was the only significant predictor variable for Ba, Cs, Fe, Ga, Ni and Rb, and simple regressions of these metals after one month of submersion predicted much of the variability in the data (respective adjusted R2 values: 0.46, 0.90, 0.86, 0.81, 0.87, 0.90; p < 0.001). For other metals influenced by location or substrate material, multivariate analysis showed that increases in metal concentrations were predicted by increases in biofilm for Cu, Pb, Al, K, U, Co, Mg (p < 0.001) and Mn (p < 0.01). This work highlights the role of biofilm in facilitating metal accumulation on plastic debris and contributes to current understanding of the underlying processes that influence the behavior of microplastics as aquatic contaminants.

Perioperative Interdisciplinary Intervention Contributes to Improved Outcomes of Adolescents Treated With Hip Preservation Surgery.

BACKGROUND: Adolescent hip preservation surgery (HPS) candidates typically present with chronic pain, which can negatively affect psychological function and surgical outcomes. A previous study demonstrated high rates of psychological symptoms and maladaptive behaviors in this population. This study quantified psychological and functional improvements in these patients from preoperative presentation to postoperative follow-up. An integrated interdisciplinary approach is also described. METHODS: A total of 67 patients undergoing HPS were evaluated preoperatively and postoperatively at 1 year by staff psychologists. Perioperative psychological intervention consisted of education, counseling, and administration of self-report measures. Self-report measure scores were compared preoperatively and postoperatively, grouped by orthopaedic diagnoses. Frequency analysis, correlational analysis, and analysis of variance were conducted. RESULTS: Psychological function improved significantly at follow-up: decreased emotional symptomatology (46.1 to 43.6, P=0.013), anxiety (49.6 to 45.8, P<0.001), school problems (46.6 to 44.7, P=0.035), internalizing problems (46.3 to 44.1, P=0.015), social stress (44.5 to 42.3, P=0.024), sense of inadequacy (49.0 to 46.0, P=0.004), and increased self-concept (51.1 to 54.1, P=0.003). Resiliency factors also significantly improved: increased mastery (50.3 to 52.9, P=0.001) and resourcefulness (49.7 to 52.0, P=0.046), decreased emotional reactivity (46.3 to 42.9, P=0.001), and vulnerability (47.7 to 44.7, P=0.011). Physical function and return to activity also significantly improved (University of California-Los Angeles: 7.1 to 8.7, P=0.017; modified Harris Hip Score: 67.3 to 83.8, P<0.001). Return to activity positively correlated with optimism and self-efficacy (P=0.041). Femoroacetabular impingement and hip dysplasia patients consistently reported feeling less depressed (P=0.036), having fewer somatic complaints (P=0.023), fewer internalized problems (P=0.037), and exhibiting fewer atypical behaviors (P=0.036) at follow-up. Slipped capital femoral epiphysis patients did not demonstrate improvements in psychological functioning postoperatively. CONCLUSIONS: Perioperative psychological education and counseling, in combination with HPS, improved postoperative psychological and physical function. Patients reported reduced anxiety, school problems, and social stress, with marked increase in resilience. Increased mobility and return to activity significantly correlated with improved optimism and self-efficacy. LEVEL OF EVIDENCE: Level II-therapeutic studies-investigating the results of treatment.

Long-term Follow-up of Neonatal Brachial Plexopathy: Psychological and Physical Function in Adolescents and Young Adults.

PURPOSE: The prevalence of neonatal brachial plexus palsy (NBPP) has been increasing since the early 1980s. No known studies have examined long-term psychological health and quality of life (QOL) in young adults. The purpose of this study was to investigate the psychosocial and intellectual aspects of NBPP during adolescence into young adulthood. METHODS: A total of 31 patients were enrolled in the adolescent group (16 to 18 y) and 25 in the young adult group (23 to 28 y). Clinical assessment included functional ability, range of motion and strength, weight and body mass index, and education level. Patients were administered measures of psychiatric symptomatology, self-concept, QOL, and cognitive function. RESULTS: Narakas injury level for the adolescent group included 11 level I, 6 level II, 8 level III, and 6 level IV. The young adult group had 10 level I, 2 level II, 9 level III, and 4 level IV. The degree of physical impairment determined by the Modified Mallet Classification showed persistent impairment in both groups. The average DASH scores were higher than the normal range for the adolescent and young adult groups. Forty-five percent of the adolescents and 68% of the young adults were either overweight or obese. All received high school diplomas with 20 of the young adults pursuing higher education.Scores on measures of psychiatric symptomatology and self-concept showed that both groups fell within the normal range. QOL for both groups was also within the normal range. All participants scored average to above average on the cognitive assessment. All measurements were patient reported. CONCLUSIONS: Patients with NBPP can adapt and participate in most activities. This patient sample demonstrated persistent functional limitations and a higher rate of comorbid obesity. However, these patients function psychologically and cognitively within the normal range and many have pursued higher education. LEVEL OF EVIDENCE: Level IV.

School Scoliosis Screenings: Family Experiences and Potential Anxiety After Orthopaedic Referral.

STUDY DESIGN: Cross-sequential study design that used data from Texas Scottish Rite Hospital for Children (TSRHC). OBJECTIVE: Examine anxiety symptoms and family experiences subsequent to school scoliosis screening (SSS) referrals. SUMMARY OF BACKGROUND DATA: Use of SSS remains controversial. Prior research suggested that SSS programs may result in anxiety for both children and parents. Unfortunately, no study has examined the SSS referral processes and anxiety in families. METHODS: Study consisted of 2 groups-patients/parents from TSRHC evaluated for Adolescent Idiopathic Scoliosis (AIS) (n = 27) and control participants/parents (n = 27) between ages 9 and 17. All participants completed the primary outcome measure (State-Trait Anxiety Inventory) before and after the scoliosis evaluation or controlled wait time. Parents also rated experience and satisfaction with SSS. RESULTS: Compared with the control group, children/parents in patient group experienced significantly elevated levels of state-anxiety at preappointment. Children/parents in the patient group not diagnosed with AIS experienced a significant decline in state-anxiety. Children/parents in the patient group diagnosed with AIS continued to report elevated levels of anxiety. The control group remained consistent, reporting of low levels of anxiety pre to post. More than half (55.5%) of families indicated they received no information from the school about scoliosis. A third of the families who received information indicated it did not adequately address their concerns. Nonetheless, most families reported overall satisfaction with SSS. CONCLUSION: This study suggested that children and parents referred through the SSS program experienced significantly elevated levels of state-anxiety. This supports the subjective concerns of anxiety experiences in families voiced by researchers previously. However, families deemed the costs of the SSS referral process as worth the benefits. Though challengers of SSS programs were accurate in observing anxiety in families, it may not constitute significant burden to eliminate SSS programs altogether. Improvements to the current system may be warranted. LEVEL OF EVIDENCE: 3.

Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations.

BACKGROUND: Pediatric limb reconstruction using circular external fixation is a prolonged treatment that interrupts patients' daily function. Patient personality characteristics and expectations may interfere with planned treatment, making complicated medical procedures more challenging. The aims of this study are to identify factors impacting treatment outcome and recommendations for preoperative evaluation and planning. QUESTIONS/PURPOSES: (1) Are there group differences between patients with and without a preexisting mental health condition(s) in terms of unplanned reoperations? (2) Does the number of surgical procedures before current external fixator placement correlate with the number of unplanned readmissions, unplanned reoperations, and days spent in circular external fixation? (3) Are there group differences between single- compared with two-parent households in terms of inpatient narcotic doses, length of inpatient stay, number of unplanned readmissions, length of readmission(s), and/or unplanned outpatient clinic visits? (4) Does patient age at the time of surgery have an impact on treatment duration, postoperative complications, and treatment outcome? METHODS: This is a retrospective chart review of pediatric patients who underwent limb reconstruction between 2008 and 2012. Patients with limb length discrepancy > 4 cm or severe angular deformity and who agreed to intervention were treated with circular external fixation. Sixty-seven patients were included; 16 patients were excluded. Statistical analyses included Pearson r correlation and t-test. RESULTS: Patients who reported preexisting mental health diagnosis (13%) had more unplanned reoperations than patients who did not (no mental health diagnosis; 87%) (mental health diagnosis 3.4 ± 10.3 versus no mental health diagnosis 0.2 ± 0.5 reoperation[s], p = 0.022). Number of previous surgical procedures correlated with number of unplanned reoperations (r = 0.448, p < 0.001), number of unplanned readmissions (r = 0.375, p < 0.001), and number of days in an apparatus (r = 0.275, p = 0.018). Compared with patients from two-parent households, patients from single-parent households received a greater number of inpatient narcotic doses (single-parent 129 ± 118 versus two-parent 73 ± 109 doses, p = 0.039), longer length of inpatient stay (single-parent 73 ± 63 versus two-parent 40 ± 65 days, p = 0.036), more unplanned readmissions (single-parent 0.4 ± 0.1 versus two-parent 0.2 ± 0.2 readmission, p = 0.024), longer hospitalization when readmitted (single-parent 5 ± 11 versus two-parent 1 ± 3 day(s), p = 0.025), and fewer unplanned outpatient visits (single-parent 0.2 ± 0.8 versus two-parent 0.9 ± 1.1 visit, p = 0.005). Apparatus applications with successful outcome had higher average age than those with poor outcome (successful outcome 16 ± 3 versus poor outcome 13 ± 4 years old, p = 0.011). Age at time of apparatus application correlated with number of prescribed antibiotics (r = 0.245, p = 0.036) and number of days in an apparatus (r = 0.233, p = 0.047). CONCLUSIONS: As a result of the inherent challenges of limb reconstruction, surgical candidates should be preoperatively assessed and mitigating psychosocial factors managed to maximize successful treatment outcome. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Preoperative psychological findings in adolescents undergoing hip preservation surgery.

BACKGROUND: Chronic pain is associated with increased anxiety, depression, and maladaptive behaviors, especially in adolescents. We hypothesized that adolescents with chronic hip pain selected for hip preservation surgery (HPS) would demonstrate increased anxiety and depression compared with same-age peers. We designed a study to assess the psychological state of adolescents before HPS. METHODS: We prospectively evaluated 58 patients (23 males, 35 females), average age 16.5 years (range, 11 to 19 y) before HPS. Their diagnoses included: femoroacetabular impingement (n=25), acetabular dysplasia (16), Perthes disease (11), and slipped capital femoral epiphysis (6). Psychological questionnaires included patient-completed and parent-completed Behavioral Assessment System for Children, Second Edition (BASC-2), Beck Youth Inventory, Second Edition (BYI-II), and Resiliency Scales. Self-reported functional questionnaires included the modified Harris hip score (mHHS, max 100) and the UCLA activity score. Psychological scores were compared between diagnoses, procedures performed, and self-reported functional scores with a Student t test and ANOVA. RESULTS: All patients reported pain, 52 (90%) reported pain >6 months with 28 (54%) >1 year. A total of 44 patients (76%) reported moderate or severe pain. All reported decreased function: average UCLA 7.25 (range, 2 to 10), average HHS 65.5 (range, 27.5 to 97.9). At presentation, 10 patients (17.2%) were receiving psychological intervention and 30% had a family history of mental illness. On the basis of the BYI-II scales, 10% and 31% of patients reported at-risk or clinically significant symptoms of anxiety and depression, respectively. Similarly, using the BASC-2 measure, 28% and 14% reported at-risk or clinically significant anxiety and depression, respectively. Resiliency scales demonstrated that 21% to 36% of patients report maladaptive behavior. There were no significant correlations between any psychological score and diagnosis, procedure, or preoperative functional score. CONCLUSIONS: Preoperative evaluation identified patients who reported at-risk or clinically significant symptoms of anxiety and/or depression, with up to one third of patients reporting maladaptive behavior that may significantly influence their postoperative outcomes. Preoperative psychological evaluation, with appropriate intervention and follow-up, if needed, should be considered before surgery selection as mental health conditions may be undiagnosed and will likely influence functional outcomes.

A multicenter collaborative approach to reducing pediatric codes outside the ICU.

OBJECTIVES: The Child Health Corporation of America formed a multicenter collaborative to decrease the rate of pediatric codes outside the ICU by 50%, double the days between these events, and improve the patient safety culture scores by 5 percentage points. METHODS: A multidisciplinary pediatric advisory panel developed a comprehensive change package of process improvement strategies and measures for tracking progress. Learning sessions, conference calls, and data submission facilitated collaborative group learning and implementation. Twenty Child Health Corporation of America hospitals participated in this 12-month improvement project. Each hospital identified at least 1 noncritical care target unit in which to implement selected elements of the change package. Strategies to improve prevention, detection, and correction of the deteriorating patient ranged from relatively simple, foundational changes to more complex, advanced changes. Each hospital selected a broad range of change package elements for implementation using rapid-cycle methodologies. The primary outcome measure was reduction in codes per 1000 patient days. Secondary outcomes were days between codes and change in patient safety culture scores. RESULTS: Code rate for the collaborative did not decrease significantly (3% decrease). Twelve hospitals reported additional data after the collaborative and saw significant improvement in code rates (24% decrease). Patient safety culture scores improved by 4.5% to 8.5%. CONCLUSIONS: A complex process, such as patient deterioration, requires sufficient time and effort to achieve improved outcomes and create a deeply embedded culture of patient safety. The collaborative model can accelerate improvements achieved by individual institutions.