Publications by authors named "Susan Shott"

82 Publications

What Protects Certain Nerves from Stretch Injury?

Anat Rec (Hoboken) 2016 Jan 25;299(1):111-7. Epub 2015 Nov 25.

Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, Illinois.

The human tibial nerves is less prone to injury following joint arthroplasty compared with the peroneal nerves. Besides the anatomical distribution, other features may confer protection from stretch injury. We therefore examined the size, shape and connective tissue distribution for the two nerves. The tibial and peroneal nerves from each side of nine fresh human cadavers we reharvested mid-thigh. Proximal segments manually stretched 20%-25% were fixed in aldehyde, while the adjacent distal segments were fixed in their natural length. Paraffin sections stained by Masson's trichrome method for connective tissue were examined by light microscopy. Tibial nerves had 2X more fascicles compared with the peroneal, but the axonal content appeared similar. Analysis showed that neither nerve had a significant reduction in cross sectional area of the fascicles following stretch. However, fascicles from stretched tibial nerves become significantly more oval compared with those from unstretched controls and peroneal nerves. Tibial nerves had a greater proportion that was extrafascicular tissue (50-55%) compared with peroneal nerves (38%-42%). This epineurium was typically adipose tissue. Perineurial thickness in both nerves was directly related to fascicular size. Tibial nerves have several unique histological features associated with size, shape and tissue composition compared with the peroneal nerve. We suggest that more fascicles with their tightly bound perineurium and more robust epineurium afford protection against stretch injury. Mechanical studies should clarify how size and shape contribute to nerve protection and/or neurapraxia.
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http://dx.doi.org/10.1002/ar.23286DOI Listing
January 2016

Occurrence and recurrence of gastric dilatation with or without volvulus after incisional gastropexy.

Can Vet J 2014 Oct;55(10):981-4

VCA Aurora Animal Hospital, Aurora, Illinois, USA (Przywara, Abel, Peacock); Biostatistics Unit, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA (Shott).

This study investigated recurrence of gastric dilatation without (GD) or with volvulus (GDV) after incisional gastropexy (IG) in dogs that underwent IG for prevention of GDV. Signalment, concurrent surgical procedures, presence of GD or GDV at the time of IG were obtained from medical records of dogs that underwent IG. Owners were contacted to determine whether the dogs experienced GD or GDV after IG, dates of postoperative GD or GDV episodes, survival status, date of death for deceased dogs. Gastric dilatation and GDV recurrence rates were calculated for 40 dogs that had at least 2 y follow-up from the time when IG was performed and for dogs that experienced GD or GDV during the follow-up period. No dogs experienced GDV after IG and 2 dogs (5.0%) experienced GD after IG. The results suggest that GD and GDV rates after IG may be comparable to recurrence rates after other methods of gastropexy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187373PMC
October 2014

Thermal effusivity changes as a precursor to moist desquamation.

Radiat Res 2012 Oct 23;178(4):295-303. Epub 2012 Jul 23.

Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois, USA.

Skin toxicity is a ubiquitous side effect in radiotherapy and can be difficult to predict. Moist desquamation in cancer patients can decrease quality of life and occasionally demand unplanned treatment breaks thus worsening outcome. In breast cancer patients, moist desquamation occurs approximately one-third of the time, and while avenues such as intensity-modulated radiation therapy exist to decrease skin side effects, they may be prohibitively expensive to distribute widely. To selectively target patients who are at risk for high skin toxicity, toxicity prediction beyond heuristics is required. This study presents 3D thermal tomography, a translation technology that employs active thermal imaging to map the thermal effusivity of skin. Irradiated mice were imaged throughout reaction development to establish a correlation between effusivity changes and eventual toxicity severity. Female hairless mice (n = 11) were anesthetized and irradiated to 40 Gy in one fraction using a 1 cm Leipzig brachytherapy applicator with an Ir-192 source. After irradiation, thermal imaging was conducted daily with a flash lamp and infrared camera. Effusivity was calculated using custom software and tracked within irradiated and contralateral control regions. Mice were retrospectively grouped into high-grade (moist desquamation present, n = 6) and low-grade (n = 5). All mice showed an increase in the relative average effusivity difference among the treated and control regions between irradiation and peak reaction between 12 and 15 days after irradiation. The high-grade group showed an earlier increase in relative average effusivity difference (mean 1.7 days after irradiation versus 4.4 days after irradiation) than the low-grade group, and had a significantly greater relative average effusivity difference between 2-5 days after irradiation. We concluded that 3D thermal tomography is quick, non-invasive, non-ionizing and exhibited a correlative difference between mice that eventually developed moist desquamation and those that only presented dry desquamation. With further development, it may prove to be a useful tool in the clinic for differentiating patients who require preventative measures to reduce skin toxicity.
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http://dx.doi.org/10.1667/rr2745.1DOI Listing
October 2012

Comparison of topical anesthetics for intravitreal injections : a randomized clinical trial.

Retina 2012 Apr;32(4):701-5

Illinois Retina Associates, Joliet, IL, USA.

Purpose: To determine whether there is a difference in anesthetic effect between topical proparacaine drops, 4% lidocaine solution, or 3.5% lidocaine gel, and whether this has an impact on the overall injection experience.

Methods: One hundred and twenty sequential patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group 1), proparacaine + 4% lidocaine-soaked cotton tipped swabs (Group 2), or 3.5% lidocaine gel (Group 3). Discomfort associated with the lid speculum, with the needle, and with burning sensation was graded on a scale of 0 to 10 (0 = no pain, 10 = worst pain ever). The overall injection experience was graded as Excellent, Very Good, Fair, Poor, or Awful.

Results: The average lid speculum pain score for Group 1 was 0.85, Group 2 was 0.50, and Group 3 was 0.65 (P = 0.32). The average needle pain score for Group 1 was 1.78, Group 2 was 1.75, and Group 3 was 1.48 (P = 0.38). The average burning pain score for Group 1 was 1.45, Group 2 was 1.58, and Group 3 was 1.13 (P = 0.23). Overall satisfaction was rated as Excellent or Very Good in 95%, 97.5%, and 92.5% of Group 1, 2, and 3 patients, respectively (P = 0.64).

Conclusion: The use of topical proparacaine drops provides very effective and cost-effective anesthesia during office-based intravitreal injections.
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http://dx.doi.org/10.1097/IAE.0b013e31822f27caDOI Listing
April 2012

Wrapping it all up. Statistics in veterinary medicine. Flowcharts.

Authors:
Susan Shott

J Am Vet Med Assoc 2011 Oct;239(7):948-50

Statistical Communications, Harvard, IL 60033, USA.

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http://dx.doi.org/10.2460/javma.239.7.948DOI Listing
October 2011

Relationships between more than two variables.

Authors:
Susan Shott

J Am Vet Med Assoc 2011 Sep;239(5):587-93

Statistical Communications, PO Box 671, Harvard, IL 60033, USA.

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http://dx.doi.org/10.2460/javma.239.5.587DOI Listing
September 2011

Relationships between categorical dependent variables and other variables and between waiting times and other variables.

Authors:
Susan Shott

J Am Vet Med Assoc 2011 Aug;239(3):322-7

Statistical Communications, PO Box 671, Harvard, IL 60033, USA.

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http://dx.doi.org/10.2460/javma.239.3.322DOI Listing
August 2011

Relationships between two categorical variables and between two noncategorical variables.

Authors:
Susan Shott

J Am Vet Med Assoc 2011 Jul;239(1):70-4

Statistical Communications, PO Box 671, Harvard, IL 60033, USA.

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http://dx.doi.org/10.2460/javma.239.1.70DOI Listing
July 2011

Comparing means or distributions.

Authors:
Susan Shott

J Am Vet Med Assoc 2011 Jun;238(11):1422-8

Statistical Communications, Harvard, IL 60033, USA.

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http://dx.doi.org/10.2460/javma.238.11.1422DOI Listing
June 2011

Surgical treatment of medial patellar luxation without femoral trochlear groove deepening procedures in dogs: 91 cases (1998-2009).

J Am Vet Med Assoc 2011 May;238(9):1168-72

Norwood Park Animal Hospital, 4321 N Harlem Ave, Norridge, IL 60706, USA.

Objective: To assess signalment, outcomes, and complications for dogs surgically treated for medial patellar luxation (MPL) with a combination of lateral retinacular imbrication and tibial crest transposition procedures without femoral trochlear groove deepening techniques, and to determine whether osteoarthritis progressed in these patients during the 8-week period following surgery.

Design: Retrospective case series. Animals-91 dogs.

Procedures: Medical records were reviewed for information on signalment, clinical history, unilateral versus bilateral disease, preoperative and postoperative MPL grades, duration of follow-up, and perioperative and postoperative complications. Radiographs obtained preoperatively and during 8-week follow-up examinations were reviewed and assigned degenerative joint disease (DJD) scores (range, 0 to 3). Data were analyzed to determine factors influencing outcomes. Kaplan-Meier curves were constructed for recurrence of MPL.

Results: Minor postoperative complications were reported for 31 of 91 (34.1%) dogs. Patellar reluxation occurred in 18 of 91 (19.8%) dogs. Reluxation or complications for which additional surgery was recommended developed in 6 of 91 (6.6%) dogs. At last clinical follow-up, 10 of 91 (11.0%) dogs had at least occasional lameness. No difference was revealed between preoperative and postoperative (8-week follow-up) radiographic DJD scores.

Conclusions And Clinical Relevance: Results of surgical treatment of MPL without femoral trochlear groove deepening procedures were comparable to those in studies of surgical treatment that included groove deepening procedures. Radiographic indices of DJD did not increase during the 8 weeks following surgery. These results suggest that trochlear groove deepening procedures are not always necessary, and patients that undergo these techniques should be carefully selected.
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http://dx.doi.org/10.2460/javma.238.9.1168DOI Listing
May 2011

Comparing percentages.

Authors:
Susan Shott

J Am Vet Med Assoc 2011 May;238(9):1122-5

Statistical Communications, PO Box 671, Harvard, IL 60033.

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http://dx.doi.org/10.2460/javma.238.9.1122DOI Listing
May 2011

Testing ideas and estimating clinical importance.

Authors:
Susan Shott

J Am Vet Med Assoc 2011 Apr;238(7):871-6

Statistical Communications, Harvard, IL 60033, USA.

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http://dx.doi.org/10.2460/javma.238.7.871DOI Listing
April 2011

Statistics simplified. Describing data.

Authors:
Susan Shott

J Am Vet Med Assoc 2011 Mar;238(5):588-91

Statistical Communications, Harvard, IL 60033, USA.

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http://dx.doi.org/10.2460/javma.238.5.588DOI Listing
March 2011

Clinical characteristics affecting the outcome of pneumatic retinopexy.

Arch Ophthalmol 2011 Feb;129(2):163-6

Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA.

Objectives: To review characteristics and outcomes of patients who underwent primary pneumatic retinopexy (PR) for repair of rhegmatogenous retinal detachment in a multioffice retina practice and to determine what preoperative characteristics were associated with success or failure of PR.

Methods: A retrospective medical record review was conducted of patients who underwent primary PR from September 2001 to March 2009. Patients with less than 6 months of follow-up were excluded. Data collected on each patient included age, sex, affected eye, preoperative visual acuity, lens status, presence of posterior vitreous detachment, presence of vitreous hemorrhage, macular status, presence of lattice degeneration, number and location of retinal breaks, clock hour extent of detachment, final visual acuity, final retinal status, number of procedures to reattach retina, and duration of follow-up.

Results: Two hundred thirteen patients were included. The mean age was 59.3 years and 53.5% were male. Mean follow-up was 24.6 months, and 64.8% of patients had a successful PR. Vitreous hemorrhage and retinal detachment greater than 4.5 clock hours were the 2 factors that significantly affected successful outcome (P = .04 and .01, respectively). The overall mean final visual acuity was 20/40, with a mean of 20/30 in the success group and a mean of 20/60 in the failure group (P < .001).

Conclusions: Pneumatic retinopexy is a treatment option for certain types of rhegmatogenous retinal detachment. In patients with vitreous hemorrhage and detachments greater than 4.5 clock hours, the success rate may be lower. Final visual acuity is better with successful reattachment with a single procedure.
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http://dx.doi.org/10.1001/archophthalmol.2010.352DOI Listing
February 2011

Detecting statistical errors in veterinary research.

Authors:
Susan Shott

J Am Vet Med Assoc 2011 Feb;238(3):305-8

Statistical Communications, PO Box 671, Harvard, IL 60033, USA.

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http://dx.doi.org/10.2460/javma.238.3.305DOI Listing
February 2011

Designing studies that answer questions.

Authors:
Susan Shott

J Am Vet Med Assoc 2011 Jan;238(1):55-8

Statistical Communications, PO Box 671, Harvard, IL 60033, USA.

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http://dx.doi.org/10.2460/javma.238.1.55DOI Listing
January 2011

Vaginal mesh for prolapse: a randomized controlled trial.

Obstet Gynecol 2010 Aug;116(2 Pt 1):293-303

From Washington Hospital Center, Washington, DC; Stanford University, Stanford, California; MedStar Research Institute, Washington, DC; and Rush Medical College, Chicago, Illinois.

Objective: To present 3-month outcomes of a double-blind, multicenter randomized controlled trial comparing traditional vaginal prolapse surgery without mesh with vaginal surgery with mesh.

Methods: Women with pelvic organ prolapse quantification prolapse stages 2-4 were randomized to vaginal colpopexy repair with mesh or traditional vaginal colpopexy without mesh. The primary outcome measure was objective treatment success (pelvic organ prolapse quantification stage 1 or lower) at 3 months. Secondary outcome measures included quality-of-life variables and complication rates.

Results: Sixty-five women were recruited from January 2007 to August 2009, when the study was halted due to predetermined stopping criteria for vaginal mesh erosion at a median follow-up of 9.7 months (range, 2.4-26.7 months). Thirty-two women underwent mesh colpopexy (24 anterior mesh, eight total mesh), and 33 women had vaginal colpopexies without mesh (primarily uterosacral ligament suspension) and concurrent colporrhaphy. There were no statistically significant baseline differences between the mesh and no-mesh groups with respect to demographics, menopausal status, and race. Analysis of the mesh and no-mesh women found no difference with respect to overall recurrence (mesh: 19 [59.4%] compared with no mesh: 24 [70.4%], P=.28). There were five (15.6%) vaginal mesh erosions. Two cystotomies and one blood transfusion occurred in the mesh group only. Subjective cure of bulge symptoms was noted in 93.3% of mesh patients and 100% of no-mesh patients. Furthermore, subjective quality-of-life measurements did not differ between the two groups at baseline or 3 months postoperatively.

Conclusion: At 3 months, there is a high vaginal mesh erosion rate (15.6%) with no difference in overall objective and subjective cure rates. This study questions the value of additive synthetic polypropylene mesh for vaginal prolapse repairs.

Clinical Trial Registration: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00475540.

Level Of Evidence: I.
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http://dx.doi.org/10.1097/AOG.0b013e3181e7d7f8DOI Listing
August 2010

Thumb carpometacarpal suspension arthroplasty using interference screw fixation: surgical technique and clinical results.

J Hand Surg Am 2010 Jun;35(6):913-20

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.

Purpose: Arthritis of the thumb carpometacarpal (CMC) joint is a common condition, for which reconstruction using the flexor carpi radialis (FCR) is a standard treatment. We describe the technique and clinical results for thumb CMC arthroplasty using interference screw fixation of the FCR to the first metacarpal through a single incision.

Methods: Over 12 months, 29 consecutive CMC arthroplasties were performed in 29 patients using FCR transfer tenotomized at the level of the scaphoid with an absorbable biotenodesis screw for fixation. There were 24 women and 5 men, with a mean age of 58 years. Patients were evaluated at a minimum of one year with radiographs, standardized outcome instruments, and measurements of motion and strength. The scaphoid to first metacarpal distance was measured at 2 weeks, 3 months, and greater than 1 year to assess settling.

Results: A total of 28 patients were available at a mean of 19 months. No arthroplasties required revision. Postoperative scaphoid to first metacarpal distance was 5.9 mm, which had decreased by a mean of 1.4 mm at final follow-up. There were no side-to-side differences in range of motion or strength in the entire cohort except for lateral key pinch, which was lower on the reconstructed side. The mean postoperative Disabilities of the Arm, Shoulder, and Hand score was 15, and the mean visual analog scale score was 1. Correlations were found between age and lateral key pinch strength for the reconstructed and contralateral sides. There were no significant relationships among Disabilities of the Arm, Shoulder, and Hand score, visual analog scale, radiographic settling, side-to-side strength or range of motion versus gender, Eaton stage, or workers' compensation status.

Conclusions: Our series demonstrates excellent clinical outcomes with no revisions at an average of 19 months for this technique. Strength, range of motion, and radiographic settling compare favorably with published results of alternative techniques. Except for lateral key pinch, there was no statistically significant difference in strength compared with the contralateral side.

Type Of Study/level Of Evidence: Therapeutic IV.
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http://dx.doi.org/10.1016/j.jhsa.2010.03.013DOI Listing
June 2010

Prevalence of bowel symptoms in women with pelvic floor disorders.

Int Urogynecol J 2010 Aug 7;21(8):933-8. Epub 2010 May 7.

Division of Female Pelvic Medicine and Reconstructive Surgery, Urogynecology Consultants, St. Louis, MO 63128, USA.

Introduction And Hypothesis: To determine the prevalence of a variety of bowel symptoms in women with pelvic floor disorders

Methods: We reviewed charts of consecutive new patients presenting to our urogynecologic clinic between July 2006 and April 2008. Women completed two bowel symptom questionnaires: (1) a nonvalidated questionnaire inquiring about symptoms of fecal/flatal incontinence, painful bowel movements, difficulties in bowel movement, and the need for splinting and (2) the validated, Colorectal-Anal Distress Inventory (CRADI) subscale of the short form of the Pelvic Floor Distress Inventory. Demographic and clinical information were extracted from patients' charts.

Results: Four hundred sixty-three women were included. Only 3% of the women presented with defecatory dysfunction or fecal incontinence as their chief complaint. However, 83% answered affirmatively to the presence of at least one CRADI bowel symptom. The most common bowel symptom was incomplete emptying at the end of a bowel movement (56%), followed by straining to have a bowel movement (55%), and flatal incontinence (54%).

Conclusions: Women rarely seek urogynecologic care primarily for bowel symptoms, although they have a high prevalence of bowel symptoms.
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http://dx.doi.org/10.1007/s00192-010-1143-zDOI Listing
August 2010

Relationships between osteoprotegerin (OPG), receptor activator of nuclear factor kappaB ligand (RANKL), and growth hormone (GH) secretory status in short children.

J Pediatr Endocrinol Metab 2009 Dec;22(12):1105-12

Women's and Children's Hospital, 4704 Ambassador Caffery Pkwy, Lafayette, LA 70508, USA.

GH deficiency places children at risk for decreased bone density and increased fracture rates. The RANKL/RANK/OPG system plays an important role in linking bone formation to bone resorption. Although OPG is thought to be secreted as a compensatory response to states of low bone density, its concentrations have not been found to differ significantly between GH-deficient, acromegalic, and healthy adults.

Aim: To evaluate the associations between OPG and RANKL serum levels and GH secretory status in children.

Children: 54 short children were recruited.

Methods: Serum OPG and RANKL, IGF-I, IGFBP-3, stimulated GH levels, bone DEXA results, and growth velocity were assessed. Regression modeling was used to evaluate significant predictors of OPG and RANKL levels.

Results: There were no significant differences in OPG and RANKL serum levels or bone DEXA results between GH-deficient and GH-sufficient children. A statistically significant quadratic relationship between OPG and IGFBP-3 concentrations was observed.

Conclusions: IGFBP-3 was found to be the only significant predictor of OPG serum levels, allowing us to speculate that increased OPG levels may represent a compensatory response to the missing anabolic actions of IGF-I and/or GH in children with GH deficiency.
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http://dx.doi.org/10.1515/jpem.2009.22.12.1105DOI Listing
December 2009

Application of holographic display in radiotherapy treatment planning II: a multi-institutional study.

J Appl Clin Med Phys 2009 May 28;10(3):115-124. Epub 2009 May 28.

Rush University Medical Center, Chicago, IL.

We hypothesized that use of a true 3D display providing easy visualization of patient anatomy and dose distribution would lead to the production of better quality radiation therapy treatment plans. We report on a randomized prospective multi-institutional study to evaluate a novel 3D display for treatment planning.The Perspecta Spatial 3D System produces 360 degrees holograms by projecting crosssectional images on a diffuser screen rotating at 900 rpm. Specially-developed software allows bi-directional transfer of image and dose data between Perspecta and the Pinnacle planning system.Thirty-three patients previously treated at three institutions were included in this IRB-approved study. Patient data were de-identified, randomized, and assigned to different planners. A physician at each institution reviewed the cases and established planning objectives. Two treatment plans were then produced for each patient, one based on the Pinnacle system alone and another in conjunction with Perspecta. Plan quality was then evaluated by the same physicians who established the planning objectives. All plans were viewable on both Perspecta and Pinnacle for review. Reviewing physicians were blinded to the planning device used. Data from a 13-patient pilot study were also included in the analysis.Perspecta plans were considered better in 28 patients (61%), Pinnacle in 14 patients (30%), and both were equivalent in 4 patients. The use of non-coplanar beams was more common with Perspecta plans (82% vs. 27%). The mean target dose differed by less than 2% between rival plans. Perspecta plans were somewhat more likely to have the hot spot located inside the target (43% vs. 33%). Conversely, 30% of the Pinnacle plans had the hot spot outside the target compared with 18% for Perspecta plans. About 57% of normal organs received less dose from Perspecta plans. No statistically significant association was found between plan preference and planning institution or planner.The study found that use of the holographic display leads to radiotherapy plans preferred in a majority of cases over those developed with 2D displays. These data indicate that continued development of this technology for clinical implementation is warranted.
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http://dx.doi.org/10.1120/jacmp.v10i3.2902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720557PMC
May 2009

Association between moxifloxacin ophthalmic solution and fungal infection in patients with corneal ulcers and microbial keratitis.

J Ocul Pharmacol Ther 2009 Jun;25(3):279-84

Private Practice, Hoffman Estates, IL 60169, USA.

Background: Fungal keratitis is a painful and dangerous fungal infection of the cornea. Recently, use of a contact lens solution with a novel ophthalmic preservative was linked to an increased risk of fungal keratitis. This study investigated whether fungal contamination was present in bottles of a widely used moxifloxacin ophthalmic solution, and whether there was an association between the use of this solution and fungal keratitis in a corneal referral practice.

Methods: Fungal cultures were obtained for 32 moxifloxacin bottles brought in by 32 keratitis patients referred to our cornea practice from June 2003 to March 2006. Demographic and clinical data were also collected for 29 patients with fungal keratitis and 82 patients with bacterial keratitis, referred to our practice for corneal ulcers between June 2003 and April 2006. These two groups were compared with respect to moxifloxacin use and other variables. Logistic regression was carried out to determine whether an association between fungal keratitis and moxifloxacin use was present after taking into account potential confounding variables.

Results: Thirteen (41%) of the bottles of moxifloxacin solution grew fungus on culture. Patients with fungal keratitis were nearly twice as likely as patients with bacterial keratitis to report the use of moxifloxacin ophthalmic solution: 41% vs. 22% (P = 0.043). The association between fungal keratitis and moxifloxacin use persisted after taking into account potential confounding variables.

Conclusions: Fungal contamination is present in the moxifloxacin bottles used by some keratitis patients. There appears to be an association between the use of moxifloxacin ophthalmic solution and fungal keratitis.
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http://dx.doi.org/10.1089/jop.2008.0047DOI Listing
June 2009

Short and long term failure of the modular oncology knee prosthesis.

Orthopedics 2008 04;31(4):362

Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.

This retrospective study investigated the modes of implant failure in 80 patients with modular oncology knee prostheses. Twenty patients (25%) required revision: 12 (60%) for stem loosening, 6 (30%) for bearing failure, and 2 (10%) for infection. Patients with bone sarcomas survived longer; however, long-term prosthetic survivorship was a problem. A higher failure rate was found in patients with tibial tumors and with adjuvant treatment of chemotherapy. This study demonstrates for improved long-term survivorship of modular oncology knee prostheses, there must be improvement in the methods of stem fixation, prosthetic materials, and bearing mechanics.
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http://dx.doi.org/10.3928/01477447-20080401-10DOI Listing
April 2008

Revision of the acetabulum with a contemporary cementless component.

J Arthroplasty 2009 Sep 17;24(6 Suppl):58-63. Epub 2009 Mar 17.

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.

We evaluated the performance of a contemporary cementless acetabular component at a minimum of 5 years postoperatively. One hundred eighty-seven consecutive acetabular component revisions were performed using a hemispherical porous-coated component. Patients were followed prospectively with radiographs and Harris hip scores. Twenty patients died, leaving 158 patients (166 hips) available for follow-up at a mean of 91 months. No patients were lost. Eleven acetabular components (7%) required repeated revision, including 4 (2%) for aseptic loosening. Seven of the 145 unrevised acetabular components with radiographic follow-up (5%) were loose. The results of acetabular revision with this contemporary acetabular component were good but inferior to those of earlier-generation implants. This difference is likely multifactorial.
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http://dx.doi.org/10.1016/j.arth.2009.02.011DOI Listing
September 2009

Self-care strategies to cope with taste changes after chemotherapy.

Oncol Nurs Forum 2009 Mar;36(2):E47-56

Midwest Palliative and Hospice Carecenter, Glenview, IL, USA.

Purpose/objectives: To describe factors related to taste changes, to examine patients' use of a self-care suggestion sheet to manage taste changes associated with chemotherapy, and to identify potentially useful strategies for managing specific taste changes after chemotherapy.

Design: Quasi-experimental, pre/post design.

Setting: Four outpatient urban and suburban oncology centers in Illinois.

Sample: 42 patients who had received at least two cycles of chemotherapy previously identified to be associated with taste changes.

Methods: Pre- and postintervention survey of taste changes; patient education regarding self-care for taste changes.

Main Research Variables: Taste changes, taste change strategies, and self-care.

Findings: Most patients that reported taste changes had affected their ability to eat. Taste changes and strategies varied somewhat according to chemotherapy regimen. Avoiding strong-smelling or -tasting foods, eating blander foods, drinking more water with foods, oral care before eating, and eating smaller, more frequent meals were reported to help.

Conclusions: Taste changes are common in patients receiving cisplatin, carboplatin, or cyclophosphamide. At-risk patients may benefit from prechemotherapy teaching regarding specific taste change management suggestions. Use of a taste change suggestion sheet encouraged self-care, and counseling patients regarding strategies to deal with taste changes may help them during chemotherapy.

Implications For Nursing: Nurses should incorporate patient education tools that promote self-care regarding the management of taste changes in patients with known factors that could affect taste early in their chemotherapy.
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http://dx.doi.org/10.1188/09.onf.e47-e56DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893729PMC
March 2009

Observations relating to urinary sensation during detrusor overactivity.

Neurourol Urodyn 2009 ;28(6):497-500

Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics/Gynecology and Urology, Loyola Medical Center, Chicago, Illinois, USA.

Aims: To describe the temporal relationship between increases in lower urinary tract (LUT) sensation and changes in detrusor and/or urethral pressures measured in real time.

Methods: We reviewed 33 multichannel urodynamic tracings that included a continuous recording of LUT sensation and that demonstrated detrusor overactivity incontinence (DOI) or detrusor overactivity (DO). Four physicians reviewed each urodynamic tracing and reached agreement about the temporal relationship between LUT sensation and detrusor contraction.

Results: Median age was 60 (36-82) years. Fourteen (42%) had urodynamic diagnoses of mixed incontinence, 18 (55%) had DOI, and 1 (3%) had DO without DOI. We reviewed 119 episodes of detrusor overactivity from the 33 recordings. We found no difference in change in sensation level when comparing DO episodes with DOI episodes or between different urodynamic diagnoses (P > 0.5). There was no dominant temporal pattern seen for the whole group (P = 0.84), that is, there was no evidence that the change in sensation level was more likely to occur before, during, or after DO/DOI episodes. When evaluating the changes in the urethral pressure, the most common pattern seen was an increase in sensation level after a fall in urethral pressure, but no dominant pattern was seen.

Conclusions: Our findings suggest that increased LUT sensation during DO/DOI is not reliably caused by measurable alterations in bladder or urethral pressure.
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http://dx.doi.org/10.1002/nau.20680DOI Listing
November 2009

Assessment of axonal growth into collagen nerve guides containing VEGF-transfected stem cells in matrigel.

Anat Rec (Hoboken) 2009 Feb;292(2):214-24

Department of Anatomy and Cell Biology, Rush University Medical Center, 600 S Paulina Ave., Chicago, IL 60612, USA.

The early events associated with axonal growth into 10-mm nerve gaps were studied histologically in the rat sciatic nerve model to determine if the outgrowth of blood vessels, Schwann cells, and axons could be enhanced. In the first two experimental groups, collagen nerve guides were filled with either saline or Matrigel. Marrow-derived mesenchymal stem cells (MSCs) were added to Matrigel in two other groups, one of which contained cells transfected with VEGF (MSC/VEGF). After 21 days, the injury site was exposed, fixed, sectioned, and volume fractions of the conduit contents were determined by point counting. The bioresorbable collagen conduits appropriately guided the axons and vessels in a longitudinal direction. The volume fraction of axons was significantly greater in the group with saline when compared with all three groups with Matrigel. This measure had a significant positive correlation with actual counts of myelinated axons. The blood vessel volume fraction in the Matrigel group decreased compared with the saline group, but was restored in the MSC/VEGF group. All Matrigel groups had comparable cellularity and showed a distribution of residual Matrigel in acellular zones. The saline group, by contrast, sustained a network of delicate fibroblastic processes that compartmentalized the nerve and its natural matrix as it became infiltrated by axons as minifascicles. In conclusion, the reduction of axonal outgrowth in the Matrigel groups, when compared with the saline group, suggests that Matrigel may impede the early regenerative process even when enriched by the addition of MSCs or VEGF-transfected cells.
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http://dx.doi.org/10.1002/ar.20844DOI Listing
February 2009

Early behavioral and histological outcomes following a novel traumatic partial nerve lesion.

J Neurosci Methods 2008 Jul 14;172(2):236-44. Epub 2008 May 14.

Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL 60612, United States.

A new partial nerve lesion (PNL) model is needed to better simulate traumatic lesions seen clinically that result in both dysfunction and neuropathic pain. We assessed surgical variability and several outcome measures including histology during the acute postoperative period. A surgical lesion was created in the rat tibial nerve by removing a segment, later confirmed by myelinated axon counts. Variability in the model was assessed with four different outcome measures during the first postoperative week (n=24), with additional histological outcomes at 7 days (n=13) and pain testing at 21 days (n=9). At 7 days postoperative, the PNL resulted in a tibial functional index (TFI) of -41.3% distinct from a percent motor deficit (PMD) of -76.3%. However, the respective deficits from 2 to 7 days were similar. Either test could detect outliers, but PMD measurements had a lower coefficient of variation and were easier to perform and analyze. The deleted segment contained 26% of the myelinated axons and resulted in distal degeneration that was either 46% based on axon counts or 54% based on area. Replicated experiments confirmed the PMD, muscle atrophy, and formation of neuropathic pain. In conclusion, our partial lesion histologically progresses twofold during the first postoperative week with profound behavioral deficits involving both motor and sensory loss. These results based on sensitive and correlative outcome measures support the application of this novel model in experimental nerve lesion studies.
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http://dx.doi.org/10.1016/j.jneumeth.2008.05.002DOI Listing
July 2008

Pelvic floor fitness using lay instructors.

Obstet Gynecol 2008 Jun;111(6):1298-304

Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Loyola University, Chicago, Illinois 60153, USA.

Objective: Typically, pelvic muscle training for women with pelvic floor disorders is provided by medical personnel. We sought to evaluate the feasibility and symptom improvement after a nonmedical pelvic muscle training class in a prospective cohort.

Methods: Study participants volunteered to participate in an 11-week pelvic fitness and education class taught by a lay instructor at five fitness classrooms in the Chicago area. Participation was limited to adult women who verbally indicated that their pelvic symptoms included a minimum of some urge urinary symptom. Standardized assessments were completed before class, at the end of class, and 1 year after completion of the classes. These assessments included the 12-item short-form, validated pelvic questionnaires (Urogenital Distress Inventory Short Form, Incontinence Impact Questionnaire Short Form, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), and self-reported goals selection and achievement.

Results: Eighty-seven of 102 participants provided before and after class data, and 76 also provided 1-year data. Participants had a mean age of 58 years and a mean body mass index of 26.3. Most (91%) were white, and 63% had at least completed college. After class improvements in Urogenital Distress Inventory Short Form bothersomeness ratings were noted for all items and maintained at 1 year for all but pain or discomfort. Significant quality-of-life and sexual function improvements were reported after class and at 1 year. The 12-item short-form responses documented improvements in six areas of general health. The most important self-selected goal was achieved in 71% after class and maintained by 67% at 1 year.

Conclusion: Nonmedical pelvic fitness classes are promising for pelvic symptom improvement in self-selected participants.

Level Of Evidence: II.
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http://dx.doi.org/10.1097/AOG.0b013e3181742d98DOI Listing
June 2008

Do racial differences in knowledge about urogynecologic issues exist?

Int Urogynecol J Pelvic Floor Dysfunct 2008 Oct 9;19(10):1371-8. Epub 2008 May 9.

Division of Urogynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

The objective of this study is to assess knowledge about urinary incontinence and pelvic organ prolapse in white versus nonwhite women. We hypothesize that there are racial differences in patient knowledge about these issues. One hundred twenty-six women presenting to our institution's gynecology clinic completed a two-scale, validated questionnaire assessing knowledge about incontinence and prolapse. Responses were compared for white versus nonwhite women using nonparametric statistical methods. Logistic regression was used to control for confounding variables. Mean score for white women exceeded that for nonwhite women for the incontinence (p = 0.019) but not the prolapse scale (p = 0.354). Of the white patients, 37.9% versus 19.1% of the nonwhite patients scored > or =80% on the incontinence scale (p = 0.019). This difference remained significant after controlling for potential confounders using logistic regression (p = 0.039). White women may have improved tested urinary incontinence knowledge as compared to nonwhite women.
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http://dx.doi.org/10.1007/s00192-008-0639-2DOI Listing
October 2008
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