Editorial Commentary: Smarter Than a Sixth Grader? Hip Arthroscopists,Check Your Training at the Door

Literacy is one of the best predictors of an individual's health, and providing effective, patient-centered communication to our less literate patients has become a challenge for the entire medical community. The internet has become patients' first-line source of medical information, and as caretakers of musculoskeletal medicine, it is orthopaedists' responsibility to provide high-quality, patient-centric resources that are simple and clear. When creating our own practice or institution's websites, we must check our training and technicality at the door to create resources that are easily readable and digestible.     

Aortic arch origin of the left vertebral artery

Complications from anterior approaches to the cervical spine are uncommon with normal anatomy. However, variant anatomy might predispose one to an increased incidence of injury during such procedures. We hypothesized that left vertebral arteries that arise from the aortic arch instead of the subclavian artery might take a more medial path in their ascent making them more susceptible to iatrogenic injury. Fifty human adult cadavers were examined for left vertebral arteries having an aortic arch origin and these were dissected along their entire cervical course. Additionally, two radiological databases of CTA and arteriography procedures were retrospectively examined for cases of aberrant left vertebral artery origin from the aortic arch over a two‐year period. Two cadaveric specimens (4%) were found to have a left vertebral artery arising from the aortic arch. The retrospective radiological database analysis identified 13 cases (0.87%) of left vertebral artery origin from the aortic arch. Of all cases, vertebral arteries that arose from the aortic arch were much more likely to not only have a more medial course (especially their preforaminal segment) over the cervical vertebral bodies but also to enter a transverse foramen that was more cranially located than the normal C6 entrance of the vertebral artery. Spine surgeons who approach the anterior cervical spine should be aware that an aortic origin of the left vertebral artery is likely to be closer to the midline and less protected above the C6 vertebral level. Clin. Anat. 30:811–816, 2017. © 2017Wiley Periodicals, Inc.     

Moderators of Psycho‐Oncology Therapy Effectiveness: Addressing Design Variable Confounds in Meta‐Analysis

This meta‐analysis begins to organize the complex field of psycho‐oncology intervention for psychological distress using a two‐part analysis strategy: preliminary analyses of primary study design variables, reported here, followed by the analysis of variables of substantive interest (person and therapy characteristics) using a structure which accounts for the otherwise confounding potential of moderators found in preliminary analyses. Using 146 published and unpublished prospective controlled trials, outcomes were anxiety, depression, and general distress. Two design variables produced higher effects: studies recruiting patients with elevated baseline distress and/or with no history of distress; and studies with an untreated control group. Exclusion of nonrandomized trials was not empirically justified and exclusion for lack of blindness was also seen to be inappropriate.     

Vitamin D in organ transplantation

Vitamin D deficiency is prevalent among patients with end-stage organ failure awaiting transplant. Low serum 25-hydroxyvitamin D (25-OHD) levels in these patients may be related to many disease-specific factors, as well as decreased sunlight exposure and limited intake of foods containing vitamin D. Low serum 25-OHD levels are also extremely common following solid organ transplantation, both during the immediate postoperative period and in long-term graft recipients. Demographic and lifestyle factors are important in determining D status in transplant recipients. Worse vitamin D status is associated with poorer general health, lower albumin, and even decreased survival among these patients. Although several studies have demonstrated that active forms of vitamin D and its analogues prevent bone loss following transplantation, the data do not show consistent benefit. These therapies may have particular utility after renal transplantation. However, given the narrow therapeutic window with respect to hypercalcemia and hypercalciuria, and the demonstrated efficacy of bisphosphonates to prevent post-transplantation bone loss, we regard these agents as adjunctive rather than primary therapy for transplantation osteoporosis. The effects of 1,25(OH)₂D on the immune system, which are still being elucidated, may have potential for reducing infections and preventing allograft rejection after transplantation.