Research Spotlight

Posted July 15th 2016

Randomized controlled trial of vertebroplasty versus kyphoplasty in the treatment of vertebral compression fractures.

Kennith F. Layton M.D.

Kennith F. Layton M.D.

Evans, A. J., K. E. Kip, W. Brinjikji, K. F. Layton, M. L. Jensen, J. R. Gaughen and D. F. Kallmes (2016). “Randomized controlled trial of vertebroplasty versus kyphoplasty in the treatment of vertebral compression fractures.” J Neurointerv Surg 8(7): 756-763.

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BACKGROUND: We present the results of a randomized controlled trial evaluating the efficacy of vertebroplasty versus kyphoplasty in treating vertebral body compression fractures. METHODS: Patients with vertebral body compression fractures were randomly assigned to treatment with kyphoplasty or vertebroplasty. Primary endpoints were pain (0-10 scale) and disability assessed using the Roland-Morris Disability Questionnaire (RMDQ). Outcomes were assessed at 3 days, 1 month, 6 months, and 1 year following the procedure. RESULTS: 115 subjects were enrolled in the trial with 59 (51.3%) randomly assigned to kyphoplasty and 56 (48.7%) assigned to vertebroplasty. Mean (SD) pain scores at baseline, 3 days, 30 days, and 1 year for kyphoplasty versus vertebroplasty were 7.4 (1.9) vs 7.9 (2.0), 4.1 (2.8) vs 3.7 (3.0), 3.4 (2.5) vs 3.6 (2.9), and 3.0 (2.8) vs 2.3 (2.6), respectively (p>0.05 at all time points). Mean (SD) RMDQ scores at baseline, 3 days, 30 days, 180 days, and 1 year were 17.3 (6.6) vs 16.3 (7.4), 11.8 (7.9) vs 10.9 (8.2), 8.6 (7.2) vs 8.8 (8.5), 7.9 (7.4) vs 7.3 (7.7), 7.5 (7.2) vs 6.7 (8.0), respectively (p>0.05 at all time points). For baseline to 12-month assessment in average pain and RMDQ scores, the standardized effect size between kyphoplasty and vertebroplasty was small at -0.36 (95% CI -1.02 to 0.31) and -0.04 (95% CI -1.68 to 1.60), respectively. CONCLUSIONS: Our study indicates that vertebroplasty and kyphoplasty appear to be equally effective in substantially reducing pain and disability in patients with vertebral body compression fractures.


Posted July 15th 2016

Editorial: Magnetic Resonance Elastography and Non-Alcoholic Fatty Liver Disease: Time for an Upgrade?

Sumeet K. Asrani M.D.

Sumeet K. Asrani M.D.

Flores, A. and S. K. Asrani (2016). “Editorial: Magnetic resonance elastography and non-alcoholic fatty liver disease: Time for an upgrade?” Am J Gastroenterol 111(7): 995-996.

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Elastography techniques, such as two-dimensional magnetic resonance elastography (2D-MRE) are increasingly used for the non-invasive assessment of liver fibrosis in patients with nonalchoholic fatty liver disease (NAFLD). Loomba et al. demonstrate that 3D-MRE (shear wave frequency 40 Hz) had even greater diagnostic accuracy than the commercially available 2D-MRE (shear wave frequency 60 Hz) in diagnosing advanced fibrosis (area under the receiver operator curve, AUROC 0.981 vs. 0.921, P<0. 05) using liver biopsy as reference standard. Despite limitations, MRE serves as an important tool in risk stratification for patients with NAFLD.


Posted July 15th 2016

Efficacy of pharmacokinetics-directed busulfan, cyclophosphamide, and etoposide conditioning and autologous stem cell transplantation for lymphoma: Comparison of a multicenter phase ii study and cibmtr outcomes.

Joseph W. Fay M.D.

Joseph W. Fay M.D.

Flowers, C. R., L. J. Costa, M. C. Pasquini, J. Le-Rademacher, M. Lill, T. B. Shore, W. Vaughan, M. Craig, C. O. Freytes, T. C. Shea, M. E. Horwitz, J. W. Fay, S. Mineishi, D. Rondelli, J. Mason, I. Braunschweig, W. Ai, R. F. Yeh, T. E. Rodriguez, I. Flinn, T. Comeau, A. M. Yeager, M. A. Pulsipher, I. Bence-Bruckler, P. Laneuville, P. Bierman, A. I. Chen, K. Kato, Y. Wang, C. Xu, A. J. Smith and E. K. Waller (2016). “Efficacy of pharmacokinetics-directed busulfan, cyclophosphamide, and etoposide conditioning and autologous stem cell transplantation for lymphoma: Comparison of a multicenter phase ii study and cibmtr outcomes.” Biol Blood Marrow Transplant 22(7): 1197-1205.

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Busulfan, cyclophosphamide, and etoposide (BuCyE) is a commonly used conditioning regimen for autologous stem cell transplantation (ASCT). This multicenter, phase II study examined the safety and efficacy of BuCyE with individually adjusted busulfan based on preconditioning pharmacokinetics. The study initially enrolled Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) patients ages 18 to 80 years but was amended due to high early treatment-related mortality (TRM) in patients > 65 years. BuCyE outcomes were compared with contemporaneous recipients of carmustine, etoposide, cytarabine, and melphalan (BEAM) from the Center for International Blood and Marrow Transplant Research. Two hundred seven subjects with HL (n = 66) or NHL (n = 141) were enrolled from 32 centers in North America, and 203 underwent ASCT. Day 100 TRM for all subjects (n = 203), patients > 65 years (n = 17), and patients


Posted July 15th 2016

Seizure Prophylaxis Guidelines Following Traumatic Brain Injury: An Evaluation of Compliance.

Simon Driver Ph.D.

Simon Driver Ph.D.

Zaman, A., R. Dubiel, S. Driver, M. Bennett, V. Diggs and L. Callender (2016). “Seizure prophylaxis guidelines following traumatic brain injury: An evaluation of compliance.” J Head Trauma Rehabil: 2016 June [Epub ahead of print].

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OBJECTIVE: To determine degree of adherence to guidelines for seizure prophylaxis following traumatic brain injury (TBI). SETTING: Tertiary care level 1 trauma center and affiliated inpatient rehabilitation facility. PARTICIPANTS: A total of 173 individuals with TBI who required inpatient rehabilitation from January 1, 2007, to December 31, 2013. DESIGN: Retrospective medical record review. MAIN MEASURES: Overutilization rate of prophylactic antiepileptic drugs (AEDs); failure to stop rate of AED utilization upon admission to and during inpatient rehabilitation; and duration of overutilization. RESULTS: Of the 173 participants included, 77 were started on seizure prophylaxis at hospital presentation and 96 were not. Of the 77 participants, 11 had a posttraumatic seizure. Of the 66 remaining, 18 participants (10.4%) were continued on AEDs for more than 7 days after injury. Of these 18 participants, 12 were continued on AEDs without indication upon admission to inpatient rehabilitation. Finally, 8 of the 12 were continued on AEDs at discharge from rehabilitation, resulting in a failure to stop rate of 66.67%. CONCLUSION: Despite existing guidelines for stopping seizure prophylaxis after TBI, some patients remain on AEDs and may be inappropriately exposed to possible medication side effects. These findings highlight the importance of communication at the time of rehabilitation transfer and the need for ongoing education about AED guidelines.


Posted July 15th 2016

Idiopathic intracranial hypertension eliminated by counterclockwise maxillomandibular advancement: a case report.

Larry M. Wolford D.M.D.

Larry M. Wolford D.M.D.

Wardly, D., L. M. Wolford and V. Veerappan (2016). “Idiopathic intracranial hypertension eliminated by counterclockwise maxillomandibular advancement: A case report.” Cranio: 1-9 [Epub ahead of print].

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INTRODUCTION: Obstructive sleep apnea (OSA) is a secondary cause of intracranial hypertension (IH). Decreased jugular venous drainage has been seen in patients with idiopathic IH. CLINICAL PRESENTATION: A complex case of a 48-year-old female whose idiopathic IH was put into remission after counterclockwise maxillomandibular advancement (CC-MMA), despite persistence of her OSA. CONCLUSION: This case highlights the relationship between OSA and IH and points to the significant morbidity that can result from mild OSA and from what are considered borderline intracranial pressures. This indicates the need for a high index of suspicion for actual underlying pathology that can be surgically corrected when patients manifest symptoms of a somatic syndrome. This is the first report in the medical literature of clinical elimination of IH by CC-MMA. The authors propose that this positive outcome was effected via mandibular advancement producing a decrease in jugular venous resistance, allowing improved absorption of cerebrospinal fluid.