Traumatic hangman's fracture after cervical disk arthroplasty with device in-tact: A case report and literature review.

BACKGROUND CONTEXT: Cervical disk arthroplasty (CDA) has been demonstrated to be a safe and effective method to treat myelopathy with the added benefit of preserving neck mobility compared to anterior cervical discectomy and fusion (ACDF). Few studies describe complications of trauma after CDA, and to our knowledge this is the only study describing a grossly intact artificial cervical disk (ACD) without extrusion after high energy trauma. Based on our case and a review of literature, we hypothesize that, given adequate osseous integration (OI), CDA may be a safe intervention despite their risk for higher energy trauma. PURPOSE: To present a rare case of high-energy trauma after CDA resulting in a Hangman's fracture and grossly in-tact ACD and to engage a biomechanical discussion of trauma after CDA and ACDF utilizing a literature review. STUDY DESIGN/SETTING: Case-report with literature review and discussion. PATIENT SAMPLE: Electronic medical record data. OUTCOME MEASURES: Computed Tomography, Magnetic Resonance Imaging, and X-Ray physiologic measures. METHODS: We report the case of a 44-year-old woman who received a C5-C6 level CDA with a (Synthes Prodisc-C©, Synthes Spine Company, L.P., West Chester, PA) and was subsequently involved in a high-speed motorcycle accident one-and-a-half years later resulting in a Hangman's fracture. RESULTS: Radiographic evidence after the motorcycle wreck demonstrated a minimally displaced Hangman's fracture at the C2 vertebrae through the pedicles on both sides, partially involving the transverse foramina with approximately 5 mm of displacement. The ACD at C5-C6 was grossly intact and no malalignment was noted. Three years later the patient elected to have an ACDF due to recurrence of facet pain that appeared by way of selective medial branch block injections to originate posteriorly in the facets of C5-6. A literature review revealed reports of trauma induced adjacent disk herniation, metallosis, and implant extrusion after CDA. No accounts of intact hardware, or concomitant Hangman's fracture after CDA were found following high-energy trauma. CONCLUSIONS: Our case reveals the first reported occurrence of a traumatic Hangman's fracture with intact fusion hardware after CDA. We hypothesize that the preserved mobility in the affected spinal level after the CDA exerted a protective effect compared to an ACDF following the high-speed trauma, particularly on the adjacent segments. This case and included literature review, reveal the need for future research efforts to guide decision making in whether ACDF or CDA is superior in younger patients at higher risk for trauma.

Using Skin-to-Skin Contact to Increase Exclusive Breastfeeding at a Military Medical Center.

Evidence shows that early formula supplementation leads to early weaning from exclusive breastfeeding. We implemented an evidence-based practice project on skin-to-skin contact (SSC) for healthy term newborns at a large military treatment facility in an effort to decrease formula supplementation in the early postpartum period. Military women face unique challenges when it comes to breastfeeding. SSC in the early postpartum period is an effective intervention to increase exclusive breastfeeding during the hospital stay and foster future positive breastfeeding outcomes. Through this project, staff knowledge of the benefits of SSC to women and newborns improved and the hospital's exclusive breastfeeding rate increased by 20 percent.

Persistent ERK/MAPK activation promotes lactotrope differentiation and diminishes tumorigenic phenotype.

The signaling pathways that govern the lactotrope-specific differentiated phenotype, and those that control lactotrope proliferation in both physiological and pathological lactotrope expansion, are poorly understood. Moreover, the specific role of MAPK signaling in lactotrope proliferation vs differentiation, whether activated phosphorylated MAPK is sufficient for prolactinoma tumor formation remain unknown. Given that oncogenic Ras mutations and persistently activated phosphorylated MAPK are found in human tumors, including prolactinomas and other pituitary tumors, a better understanding of the role of MAPK in lactotrope biology is required. Here we directly examined the role of persistent Ras/MAPK signaling in differentiation, proliferation, and tumorigenesis of rat pituitary somatolactotrope GH4 cells. We stimulated Ras/MAPK signaling in a persistent, long-term manner (over 6 d) in GH4 cells using two distinct approaches: 1) a doxycycline-inducible, oncogenic V12Ras expression system; and 2) continuous addition of exogenous epidermal growth factor. We find that long-term activation of the Ras/MAPK pathway over 6 days promotes differentiation of the bihormonal somatolactotrope GH4 precursor cell into a prolactin-secreting, lactotrope cell phenotype in vitro and in vivo with GH4 cell xenograft tumors. Furthermore, we show that persistent activation of the Ras/MAPK pathway not only fails to promote cell proliferation, but also diminishes tumorigenic characteristics in GH4 cells in vitro and in vivo. These data demonstrate that activated MAPK promotes differentiation and is not sufficient to drive tumorigenesis, suggesting that pituitary lactotrope tumor cells have the ability to evade the tumorigenic fate that is often associated with Ras/MAPK activation.