Research Spotlight

Trotter, J. F. (2016). “Editorial for neuroendocrine tumor for liver transplant.” Am J Transplant: 2016 June [Epub ahead of print].

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Neuroendocrine tumor (NET) of the gastrointestinal tract and pancreas is a very rare indication for liver transplantation. The most definitive treatment of gastrointestinal NET is resection of the primary tumor and isolated hepatic metastasis, if possible. Other therapeutic options include local ablation and medical therapies (mTOR inhibitors and somatostatin analogues which significantly improve progression-free survival, but provide no survival benefit).

Thompson, M. G., M. J. Gaglani, A. L. Naleway, S. H. Dowell, S. Spencer, S. Ball, M. Levine and A. Fry (2016). “Reduced serologic sensitivity to influenza a virus illness among inactivated influenza vaccinees.” Vaccine 34(30): 3443-3446.

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We compared >/=4-fold increases in antibody titers by hemagglutination inhibition assay to RT-PCR results among 42 adults with PCR-confirmed influenza A virus illnesses. Serologic sensitivity was higher among unvaccinated (69%, 95% confidence interval [CI]=48-90%) than vaccinated healthcare personnel (38%, 95% CI=29-46%) in a 2010-11 prospective cohort.

Shibuya, N., J. C. Thorud, L. R. Martin, B. S. Plemmons and D. C. Jupiter (2016). “Evaluation of hallux valgus correction with versus without akin proximal phalanx osteotomy.” J Foot Ankle Surg: 2016 June [Epub ahead of print].

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Although the efficacy of Akin proximal phalanx closing wedge osteotomy as a sole procedure for correction of hallux valgus deformity is questionable, when used in combination with other osseous corrective procedures, the procedure has been believed to be efficacious. However, a limited number of comparative studies have confirmed the value of this additional procedure. We identified patients who had undergone osseous hallux valgus correction with first metatarsal osteotomy or first tarsometatarsal joint arthrodesis with (n = 73) and without (n = 81) Akin osteotomy and evaluated their radiographic measurements at 3 points (preoperatively, within 3 months after surgery, and >/=6 months after surgery). We found that those people who had undergone the Akin procedure tended to have a larger hallux abduction angle and a more laterally deviated tibial sesamoid position preoperatively. Although the radiographic correction of the deformity was promising immediately after corrective surgery with the Akin osteotomy, maintenance of the correction was questionable in our cohort. The value of additional Akin osteotomy for correction of hallux valgus deformity is uncertain.

Rocha, V., A. Ruggeri, S. Spellman, T. Wang, R. Sobecks, F. Locatelli, M. Askar, G. Michel, W. Arcese, A. P. Iori, D. Purtill, R. Danby, G. F. Sanz, E. Gluckman and M. Eapen (2016). “Killer cell immunoglobulin-like receptor-ligand matching and outcomes after unrelated cord blood transplantation in acute myeloid leukemia.” Biol Blood Marrow Transplant 22(7): 1284-1289.

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The effect of killer cell immunoglobulin-like receptor (KIR)-ligand matching on outcomes after unrelated cord blood (CB) transplantation was studied in 461 patients with acute myeloid leukemia, categorizing KIR ligand for HLA-C groups C1 and C2 and Bw4. Donor-recipient HLA matching considered allele-level matching at HLA-A, -B, -C, and -DRB1. Separate analyses were conducted for 6-7/8 HLA-matched and 3-5/8 HLA-matched transplants because HLA matching confounded KIR-ligand matching (ie, KIR-ligand mismatching was less likely with better HLA matching). All patients received single CB unit and myeloablative conditioning. There were no significant differences in nonrelapse mortality (NRM), relapse, and overall mortality by KIR-ligand match status. However, among recipients of 3-5/8 HLA-matched transplants, NRM (HR, 2.26; P = .008) and overall mortality (HR, 1.78; P = .008) but not relapse were higher with KIR-ligand mismatched (host-versus-graft direction) compared with KIR-ligand matched transplants. These data do not support selecting CB units based on KIR-ligand match status for transplants mismatched at 1 or 2 HLA loci. Although transplants mismatched at 3 or more HLA loci are not recommended, avoiding KIR-ligand mismatching in this setting lowers mortality risks.

Martin, H. D., A. Khoury, R. Schroder and I. J. Palmer (2016). “Ischiofemoral impingement and hamstring syndrome as causes of posterior hip pain: Where do we go next?” Clin Sports Med 35(3): 469-486.

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Recent advances in understanding hip joint anatomy and biomechanics have contributed to improvement of diagnosis and treatment decisions for distal causes of deep gluteal syndrome (DGS). Ischiofemoral impingement and hamstrings syndrome are sources of posterior hip pain that can simulate symptoms of DGS. The combination of a comprehensive history and physical examination with imaging and ancillary testing are critical for diagnosis. Six key physical examination tests are described to differentiate distal versus proximal sources of extrapelvic posterior hip pain. Outcomes depend on patient compliance and the understanding of the entire anatomy, biomechanics, clinical presentation, and open versus endoscopic treatment options.