bluuebunny/crossref_metadata_2025 huggingface dataset:
Topographic Anatomy and Physiologic Considerations
Authors: Harvey N. Robert , Wilson Sylvia H.
Published: April 2023

The ability to select the optimal regional technique requires a detailed understanding of anatomy and local anesthetic properties. Anatomic knowledge must include gross surface anatomy as it corresponds with neurologic innervation and include basic neurologic anatomy. Further, neuraxial blocks require an intricate knowledge of the dermatomal distribution where analgesia is needed, combined with the posterior anatomic landmarks that will guide correct needle placement to deliver targeted analgesia. In the same way, comprehension of peripheral nerve and plexus anatomy is also needed to ensure that anesthetic coverage is maximized and analgesia optimized during placement of plexus, peripheral nerve block, or fascial blocks. Similarly, various factors may impact both the onset and duration of neuraxial and peripheral techniques. In this regard, comprehension of local anesthetic characteristics, basic nerve properties, and the risks and benefits of different regional techniques is needed. Ultimately the regional technique, local anesthetic type, and local anesthetic dose and volume will depend on patient factors and procedure factors.
Prolonging Nerve Blocks
Authors: Alexander Brenton , Gabriel Rodney
Published: April 2023

The anesthesia community has been interested in prolonging nerve blockade for over 100 years. While continuous analgesia via peripheral nerve catheters (PNCs) remains the best option for extending block duration, many adjuvants to local anesthetics (LAs) have been investigated and used clinically. This chapter reviews the available clinical research for the most popular perineural LA additives, with the intention of providing the reader with clinical education and practice guidance. While there is an abundance of publications exploring this topic, and some recommendations can be made, there remain significant knowledge gaps that must be addressed before any of the options can be confidently recommended.
Cervical Plexus Block for Carotid Endarterectomy
Authors: Farkas Shimon Gabriel , Vlassakov Kamen V.
Published: April 2023

Carotid artery stenosis is a life-threatening condition caused by accumulation of atheromatous plaques in the carotid arteries, typically at the carotid bifurcation. These plaques restrict blood flow and can shower micro emboli into the ipsilateral cerebral hemisphere, causing transient ischemic attacks, as well as fatal ischemic strokes. The treatment options for carotid stenosis depend on symptomology, severity of stenosis, and whether the risk of surgery outweighs the risk of intraoperative myocardial infarction or stroke. Medical management focuses on optimizing blood pressure, cholesterol, cessation of smoking, and anti-platelet therapy, but the mainstay therapy remains surgical correction with a carotid endarterectomy (CEA), which has been shown to be very effective in specific patient populations. Patients with atherosclerotic carotid disease typically have other comorbidities, such as coronary artery disease (CAD), hypertension, diabetes, and peripheral vascular disease, complicating intraoperative management. Currently, most institutions employ either general endotracheal or regional anesthesia techniques for CEA, with each having their specific benefits, but with comparable records of efficacy and safety. Cervical plexus block (CPB), in its variety of techniques, has been shown to be very effective at providing surgical anesthesia. However, due to perceived technical difficulty and the potential complication risks on one hand, and surgeon and patient preferences on the other hand, this method remains relatively underutilized, leading to further lack of consistent clinical teaching and practice across US training programs.
Breast Surgery
Authors: Chiao Franklin , Chin Simon , Nada Eman
Published: April 2023

Breast surgery is a common surgical procedure. It includes a range of surgeries as an excisional biopsy, lumpectomy, mastectomy, cosmetic surgery, and mastectomy with breast reconstruction. Mastectomy with autologous breast reconstruction is a big surgery. The graft is usually taken from the rectus abdominus muscle, latissimus dorsi, or the gluteal muscles. The breast and the donor sites are sources of significant postoperative pain; however, the donor site is usually more painful. Without nerve blocks, patients use significant amounts of opioids. This chapter discusses the different regional anesthesia techniques for treating postoperative pain control in breast reconstructive surgery and their pros and cons. It also discusses the breast-enhanced recovery program and its impact on the length of hospital stay.
Emergency Exploratory Laparotomy
Authors: Salinas Francis V.
Published: April 2023

Emergent exploratory laparotomy is not an uncommon procedure faced by the practicing anesthesiologist. The most common surgical approach (incision) is via a midline vertical incision. The extent of the incision is determined by the underlying surgical pathology, and the exposure required to explore the abdominal cavity and associated visceral and vascular organs of interest. The incision may be limited to the upper abdomen, lower abdomen, periumbilical region, or may extend from the xiphoid to the pubic symphysis. Regional anesthesia-analgesia with ultrasound-guided nerve blocks of the thoracolumbar nerves supplying the anterolateral abdominal wall can provide clinically relevant analgesia after emergent exploratory laparotomy and may offer a wider application and decreased risk profile compared to thoracic epidural analgesia. A thorough understanding of the anatomy and sensory innervation of the anterolateral abdominal wall is the key to choosing which approach to utilize, maximizing the success rate for correct placement of local anesthetic injection, and decreasing the incidence of potential complications.
Postoperative Pain Management for Living Liver Donor
Authors: Polshin Victor , Said Engy T.
Published: April 2023

Acute postoperative pain management for patients undergoing open hepatectomy is often severe. The procedure entails a large upper abdominal incision the majority of these patients are healthy and undergo this procedure for altruistic reasons. It is important to reduce the impact of the surgery on them. The postoperative physiologic and pain are challenging and affect the recovery markedly. Proper treatment of postoperative pain is a big factor in their recovery and satisfaction. This chapter discusses the various pharmacologic as well as procedural options, for the management of postoperative pain in this patient population. The chapter will discuss the limitations of the neuraxial procedures and the pros and cons of all the treatments.
Regional Anesthesia for Abdominoplasty
Authors: Ahuja Sanchit , Kolli Sree
Published: April 2023

Lipoabdominoplasty refers to extensive liposuction in conjunction with abdominoplasty— known to improve outcomes and simultaneously reduce the risk of associated complications. Control of postoperative pain following abdominoplasty remains challenging and may lead to significant morbidity if left untreated. A wide variety of regional techniques, including neuraxial and peripheral nerve blocks, exists. Thoracic epidural analgesia appears to have excellent analgesic effects with additive advantages of reduced postoperative pulmonary complications. However, obvious contraindications, associated risks of hypotension and enhanced recovery after surgery (ERAS) protocols may not make it the standard of care. Ultrasound-guided truncal blocks, on the other hand, do not have the same risk profile and therefore are swiftly gaining favor. Transversus abdominis plane and rectus sheath block have shown success in these cases. Paravertebral nerve block, quadratus lumborum block, and newer paraspinal blocks appear promising due to paravertebral spread and recently identified fascial plane communications. Research is scarce and currently ongoing regarding which regional block is better for lipoabdominoplasty and similar surgeries. Until then, thoracic epidural anesthesia, transversus abdominis, and rectus sheath block are the most commonly used for analgesia in major upper abdominal surgery like lipoabdominoplasty.
Anesthesia for Anorectal Surgery
Authors: Imbelloni Luiz Eduardo , De Aguilar-Nascimento José Eduardo , Chu Iris , Said Engy T. , Nada Eman
Published: April 2023

Anorectal surgeries are common procedures that are typically performed as ambulatory surgery. The success of ambulatory surgery depends largely on a safe and efficient anesthetic technique. Well-placed local anesthesia in the anal canal with sedation can be cost-effective and can improve efficiency. Modification of the spinal anesthesia dose and techniques can provide suitable surgical anesthesia and postoperative analgesia. Modifications include spinal anesthesia with low-dose local anesthetics, saddle-block technique, and posterior hypobaric anesthesia. Transient neurologic syndrome can develop after spinal anesthesia with short-acting local anesthetics; however, with some modifications, the syndrome can be largely avoidable. Postoperative pain after anorectal surgery is very intense, especially at the onset of the first postoperative defecation. Caudal block provides the added benefit of prolonged postoperative analgesia. Bilateral pudendal nerve block provides excellent analgesia without urinary retention. Local infiltration using liposomal bupivacaine after anorectal surgery is effective and safe, and provides prolonged analgesia with opioid-sparing effects. The optimal anesthetic technique would provide excellent operating conditions, a rapid recovery, no postoperative side effects, and high patient satisfaction.
Inadequate Labor Epidural Analgesia
Authors: Ibrahim Mohamed , Vadhera Rakesh
Published: April 2023

Epidural analgesia is the most common method used to control labor pain. However, it has a failure rate of 8%–12%. For that reason, anesthesiologists need to be familiar with the different etiologies that may contribute to the failure of achieving adequate analgesia. These factors include, e.g., unilateral epidural analgesic coverage, epidural space anatomical barriers, and sacral sparing and catheter malposition. Methods and techniques to troubleshoot and improve the success of epidural analgesia are available. Combined spinal epidural (CSE) and dural puncture epidural (DPE) have been successfully used over the years, providing better labor analgesia compared to the traditional labor epidural technique. However, concerns over possible maternal and fetal complications have been studied. Over the last decade, the programmed intermittent epidural (PIEB) regimen has become more popular for maintaining labor analgesia. Meanwhile, some experts have voiced concerns regarding its efficiency, the associated motor block, and the logistics needed for pump programming and education for anesthesia and nursing team members.
Regional Anesthesia Techniques for Circumcision and Congenital Inguinal Hernia Repair
Authors: Webb Leah Margalit Winters , Peterson Melissa Brooks
Published: April 2023

This chapter reviews the anesthetic and analgesic options and implications for two common pediatric procedures: herniorrhaphy and circumcision in former preterm patients. Several regional techniques are available for circumcision including the penile, pudendal nerve, ring blocks and topical anesthesia. For the hernia repair caudal analgesia, ilioinguinal/iliohypogastric nerve block, or field block are options. These techniques are reviewed, including block performance, safety, and risks/benefits. Local anesthetic systemic toxicity in pediatrics will be discussed. The chapter will also discuss disruptive behavior in the operating room. Management of disruptive behavior will be touched on as well.
Regional Anesthesia for Major Abdominal Surgery in Pediatric Patients
Authors: Lazar Alina
Published: April 2023

Major abdominal surgery in children is optimally managed with a multimodal approach with the goals of reducing opioid use and its associated side effects, providing high-quality analgesia, and promoting faster recovery. Multimodal anesthesia includes some form of regional anesthetic block, either central neuraxial or truncal, wound infiltration, pharmacological interventions, and non-pharmacological techniques. Although for many providers epidural analgesia remains the gold standard, its potential for devastating complications remains a concern. Development of new and accessible nerve blocks and improved ultrasound technology has increased the focus on non-neuraxial regional anesthesia techniques in pediatrics. Recent large registries have confirmed the safety of regional anesthesia in children, but more research is needed to determine the mechanisms of action, effectiveness, and safety profile of the newer regional anesthesia techniques.
Surgery in the Presence of Active Addiction or Medication Assisted Addiction Treatment
Authors: Batta Neil , Elkassabany Nabil , Badiola Ignacio
Published: April 2023

The opioid epidemic has proved challenging for pain physicians and the entire healthcare industry. Opioid therapy has been a cornerstone of a multimodal approach to the management of chronic and acute pain. The number of individuals using—and misusing—opioids has also risen in the United States. It is estimated that 5–8 million Americans take daily opioids to treat chronic pain. In 2015 an estimated 20.5 million Americans older than 12 years of age had a substance use disorder, including 2 million to prescription analgesics and heroin. These individuals present to the hospital, for both surgical and non-surgical care, with acute pain that may be very difficult to treat due to opioid tolerance and opioid-induced hyperalgesia. Buprenorphine adds another layer of complexity as it intrinsically blocks full opioid agonists from exerting an effect. Some patients may be on buprenorphine/naloxone and related medications that decrease the effectiveness of opioids in pain management. Other patients on maintenance therapy may wish to avoid exposure to opioids for fear of relapse. Ultimately, poor pain management may result in increased suffering, delayed discharge, decreased patient satisfaction, and increased risk of developing persistent post-surgical pain.
Young Adult Responses to Peer Crowd-Based Targeting in E-cigarette Advertisements: An Experimental Study
Authors: Kim Minji , Neilands Torsten B , Gregorich Steven E , Jordan Jeffrey W , Ling Pamela M
Published: April 2023

Aims

To examine the effects of psychographically targeted e-cigarette advertisements on young adults.

Methods

A total of 2100 young adults (18–29 years old) representing five peer crowds (groups with shared values, interests, and lifestyle: Mainstream, Young Professional, Hip Hop, Hipster, and Partier) were recruited from a nationwide opt-in online panel. Participants were randomly assigned to view e-cigarette advertisements featuring characters that either did or did not match their own peer crowd affiliation and evaluated advertising effectiveness using Likert-type and semantic differential scales. Participants also reported their attitudes toward using e-cigarettes.

Results

No significant overall effect of peer crowd matching was observed. However, significant two-way interaction effects emerged where matching advertisements yielded higher evaluations than mismatching advertisements among those who currently do not use tobacco and nicotine products and among Mainstream participants. Advertisements featuring Mainstream characters were in general rated more highly than other advertisements. Additional analyses found significant effects of peer crowd matching among those who viewed advertisements featuring non-Mainstream characters.

Conclusions

Peer crowd-based targeting can increase the effectiveness of e-cigarette advertisements which may impact initiation among current nonusers, requiring stricter marketing regulations. More research is needed to determine if anti-tobacco messaging tailored by peer crowds may effectively counteract targeted e-cigarette marketing.

Implications

E-cigarette advertisements often use psychographic targeting strategies, using lifestyles, attitudes, and values. Low-risk young adults (eg, those who currently do not use tobacco and nicotine products) are susceptible to psychographically targeted e-cigarette advertisements. This may result in the initiation of e-cigarette use among young adults who would otherwise be less likely to use tobacco and nicotine products. Stricter marketing regulations for emerging tobacco and nicotine products are required to reduce marketing exposure.
Counting Like a State: The Politics of Intergovernmental Partnerships in the 2020 Census
Authors: Rocco Philip
Published: April 2023

State and local officials played an almost unprecedented role in the implementation of the 2020 census. Given a variety of fiscal and political challenges, subnational governments collectively invested billions of dollars to motivate participation in the count, especially among historically undercounted populations. Nevertheless, state and local investments in the census varied substantially. This article examines the roots of variation in state and local census investments, drawing on a set of 76 interviews with public officials and nonprofit leaders, as well as quantitative analyses of state and local decisions. The results indicate that census investments depend on the salience of the 2020 count to public officials, the partisan identities and incentives of governing coalitions, and the availability of subnational institutional capacity for census operations. These findings have important implications for how we think about the role of intergovernmental relations in supporting critical governance tasks in an increasingly turbulent institutional context.
A neglected among the neglected: a review of cutaneous leishmaniasis in Guatemala
Authors: Lopez Yaimie , Arana Byron , Rizzo Nidia , Duran Erick , Acosta-Serrano Álvaro , Mendizabal-Cabrera Renata
Published: April 2023

Cutaneous leishmaniasis (CL) is a parasitic vector-borne disease affecting mostly low- and middle-income countries. CL is endemic in Guatemala, where an increase in the number of cases and incidence and a changing disease distribution in the past decade have been reported. Important research was conducted in Guatemala in the 1980s and 1990s to understand the epidemiology of CL and two Leishmania species were identified as the aetiologic agents. Several species of sand flies have been reported, five of which are naturally infected with Leishmania. Clinical trials conducted in the country evaluated different treatments against the disease and provided solid evidence for CL control strategies that are applicable worldwide. More recently, in the 2000s and 2010s, qualitative surveys were conducted to understand community perceptions of the disease and to highlight the challenges and enablers for disease control. However, limited recent data have been generated regarding the current CL situation in Guatemala, and key information necessary for effective disease control, such as incrimination of vectors and reservoirs, is still lacking. This review describes the current state of knowledge of CL in Guatemala, including the main parasite and sand fly species, disease reservoirs, diagnosis and control, as well as the perceptions of communities in endemic regions.
Monosodium urate crystals alter the circadian clock in macrophages leading to loss of NLRP3 inflammasome repression: Implications for timing of the gout flare
Authors: Popov Dmitry , Jain Lekha , Alhilali Mariam , Dalbeth Nicola , Poulsen Raewyn C.
Published: April 2023

Gout is caused by monosodium urate (MSU) crystal deposition within joints. This leads to acute episodes of inflammation (“gout flares”) driven by NLRP3 inflammasome activation in macrophages. Gout flares are frequently present during late night/early morning. The reason for this timing is unclear. Recent evidence suggests the NLRP3 inflammasome is under circadian control. The purpose of this study was to determine whether MSU crystals cause changes in the circadian clock in macrophages leading to time‐of‐day differences in NLRP3 inflammasome activation. Levels of circadian clock components were measured in undifferentiated “monocytic” and PMA‐differentiated “macrophagic” THP‐1 cells cultured with/without MSU crystals. Caspase‐1 activity was measured to assess NLRP3 inflammasome activity. MSU crystal exposure resulted in minimal effects on clock genes in THP‐1 monocytes but BMAL1, CRY1, PER2, and REV‐ERBα showed altered expression with reduced protein levels of BMAL1 and REV‐ERBα in THP‐1 macrophages. REV‐ERBα activation or BMAL1 over‐expression resulted in reduced MSU crystal‐induced caspase‐1 activity. BMAL1 knockdown resulted in a further increase in MSU crystal‐induced caspase‐1 activity, but only at times of day when BMAL1 levels were naturally high. MSU crystal‐induced NLRP3 inflammasome activation was greatest at the time of day when BMAL1 levels were naturally low. MSU crystals alter the expression of circadian clock components in THP‐1 macrophages leading to loss of BMAL1 and REV‐ERBα‐mediated repression of NLRP3 inflammasome activity and time‐of‐day differences in susceptibility to inflammasome activation. Our findings suggest that the nocturnal risk of gout flare is at least partially a consequence of altered circadian control of immune cell function.
An Evolutionary Concept Analysis in People With Heart Failure—Symptom Clusters or Symptom Cluster Profiles?
Authors: Wang Zequan , Conley Samantha , Redeker Nancy S. , Tocchi Christine
Published: April 2023

The concept of symptom clusters in heart failure (HF) has been defined and measured inconsistently. We used Rodgers’ evolutionary method to review related concepts in the HF literature. Symptom clusters and symptom cluster profiles are characterized by multiple symptoms, a synergistic relationship, and result in a myriad of poor outcomes. Researchers should carefully consider the conceptual differences underpinning symptom clusters and symptom cluster profiles and choose the appropriate concept aligned with their research questions, empirical methods, and target HF population.
Tgr5 −/− mice are protected from ethanol-induced metabolic alterations through enhanced leptin and Fgf21 signaling
Authors: Pokhrel Sabita , Dilts Matthew , Stahl Zachary , Boehme Shannon , Frame Gabrielle , Chiang John Y.L. , Ferrell Jessica M.
Published: April 2023

Background:

Alcohol-associated liver disease (ALD) is caused by chronic use of alcohol and ranges from hepatic steatosis to fibrosis and cirrhosis. Bile acids are physiological detergents that also regulate hepatic glucose and lipid homeostasis by binding to several receptors. One such receptor, Takeda G protein–coupled receptor 5 (TGR5), may represent a therapeutic target for ALD. Here, we used a chronic 10-day + binge ethanol-feeding model in mice to study the role of TGR5 in alcohol-induced liver injury.

Methods:

Female C57BL/6J wild-type mice and Tgr5
−/− mice were pair-fed Lieber-DeCarli liquid diet with ethanol (5% v/v) or isocaloric control diet for 10 days followed by a gavage of 5% ethanol or isocaloric maltose control, respectively, to represent a binge-drinking episode. Tissues were harvested 9 hours following the binge, and metabolic phenotypes were characterized through examination of liver, adipose, and brain mechanistic pathways.

Results:

Tgr5
−/− mice were protected from alcohol-induced accumulation of hepatic triglycerides. Interestingly, liver and serum levels of Fgf21 were significantly increased during ethanol feeding in Tgr5
−/− mice, as was phosphorylation of Stat3. Parallel to Fgf21 levels, increased leptin gene expression in white adipose tissue and increased leptin receptor in liver were detected in Tgr5

−/−
mice fed ethanol diet. Adipocyte lipase gene expression was significantly increased in Tgr5
−/− mice regardless of diet, whereas adipose browning markers were also increased in ethanol-fed Tgr5
−/− mice, indicating potential for enhanced white adipose metabolism. Lastly, hypothalamic mRNA targets of leptin, involved in the regulation of food intake, were significantly increased in Tgr5

−/−
mice fed ethanol diet.

Conclusions:

Tgr5
−/− mice are protected from ethanol-induced liver damage and lipid accumulation. Alterations in lipid uptake and Fgf21 signaling, and enhanced metabolic activity of white adipose tissue, may mediate these effects.
Automated and subjective refraction with monofocal, multifocal, and EDOF intraocular lenses: review
Authors: Bellucci Carlo , Mora Paolo , Tedesco Salvatore Antonio , Gandolfi Stefano , Bellucci Roberto
Published: April 2023

Automated refraction (Scheiner principle) is universally used to start a visual examination. Although the results are reliable in eyes implanted with monofocal intraocular lenses (IOLs), they may be less precise with multifocal (mIOL) or extended depth-of-focus (EDOF) IOLs and can even indicate a refractive error that does not clinically exist. Autorefractor results with monofocal, multifocal, and EDOF IOLs were investigated through literature search analyzing the papers reporting the difference between automated and clinical refraction. The average difference ranged between −0.50 diopter (D) and −1.00 D with most mIOL and EDOF IOLs. The differences in astigmatism were generally much lower. Autorefractors using infrared light cannot measure eyes with high technology IOLs precisely because of the influence of the refractive or of the diffractive near add. The systematic error induced with some IOLs should be mentioned in the IOL label to prevent possible inappropriate refractive procedures to treat apparent myopia.
Psychiatric disorders, personality traits, and childhood traumatic events predicting incidence and persistence of chronic pain: results from the CoLaus|PsyCoLaus study
Authors: Rouch Isabelle , Strippoli Marie-Pierre F. , Dorey Jean-Michel , Ranjbar Setareh , Laurent Bernard , von Gunten Armin , Preisig Martin
Published: April 2023

Chronic pain (CP) is often accompanied by mental disorders (MDs). However, little is known concerning the long-term effect of MDs, personality traits, and early-life traumatic events (ETEs) on CP course. Accordingly, we aimed to prospectively assess the associations of major depressive disorders (MDDs), anxiety disorders, personality traits, and ETEs with the incidence and the persistence of CP in middle-aged and older community dwellers. Data stemmed from the 3 first follow-up evaluations of CoLaus|PsyCoLaus, a prospective cohort conducted in the general population of Lausanne (Switzerland). Diagnostic criteria for MDs and ETEs were elicited using semistructured interviews. CP and personality traits were assessed by self-rating questionnaires. Follow-up intervals were subdivided into 2 groups: those without (n = 2280) and those with (n = 1841) CP initially. The associations between the psychological variables and the occurrence or persistence of CP 5 years later were assessed using serially adjusted logistic regression models. Higher neuroticism (odds ratio [95% confidence interval] 1.21 [1.08; 1.36]) and extraversion (1.18 [1.06; 1.32]) were associated with higher 5-year CP incidence, whereas current (2.14 [1.34; 3.44]) and remitted MDD (1.29 [1.00; 1.66]) as well as lower extraversion (0.83 [0.74; 0.94]) were associated with persistence of CP. By contrast, ETEs and anxiety disorders were not associated with the incidence or persistence of CP. Our results suggest that personality traits are associated with both CP occurrence and persistence, whereas the MDDs may be more associated with CP persistence. Both personality and MDD are accessible to psychotherapy, and MDD is also accessible to pharmacotherapy. Hence, these therapeutic measures might decrease the risk of CP and its persistence.
Coronary artery calcium progression and all-cause mortality
Authors: Eghtedari Bibinaz , Kinninger April , Roy Sion K. , Budoff Matthew J.
Published: April 2023

Background

Coronary artery calcium (CAC) has been demonstrated as a noninvasive, low-cost means of assessing atherosclerotic burden and risk of major cardiovascular events. While it has been previously shown that CAC progression predicts all-cause mortality, we sought to quantify this association by examining a large cohort over a follow-up period of 1–22 years.

Methods

We studied 3260 persons aged 30–89 years referred by their primary physician for CAC measurement, with a follow-up scan at least 12 months from the initial scan. Receiver operator characteristic (ROC) curves assessed a level of annualized CAC progression that predicted all-cause mortality. Multivariate analyses using Cox proportional hazards models were used to compute hazard ratios and 95% confidence intervals (CIs) for the association between annualized CAC progression and death after adjusting for relevant cardiovascular risk factors.

Results

The average time between scans was 4.7 ± 3.2 years with an additional average of 9.1 ± 4.0 years of follow-up time. The average age of the cohort was 58.1 ± 10.5 years, 70% being male, and 164 deaths occurred. Annualized CAC progression of 20 units optimized sensitivity (58%) and specificity (82%) in ROC curve analysis. Annualized CAC progression of 20 units was significantly associated with mortality while adjusting for age, sex, race, diabetes, hypertension, hyperlipidemia, smoking, baseline CAC level, family history, and time between scans, hazard ratio 1.84 (95% CI, 1.28–2.64) P = 0.001.

Conclusion

Annualized CAC progression of greater than 20 units per year significantly predicts all-cause mortality. This may add clinical value in encouraging close surveillance and aggressive treatment of individuals within this range.
Assessment of the Value of a Carriage System to Organize and Elevate Intravenous Tubing
Authors: Hartman Jane H. , Bena James F. , Morrison Shannon L. , Albert Nancy M.
Published: April 2023

Caregiver/patient fall injury risks increase when medical tubing drapes on floors. The objective of this research was to examine the value of a novel carriage system that organizes and elevates medical and intravenous (IV) tubing. Using a prospective, multicenter, cohort design, value of the IV carriage system was assessed using a valid, reliable survey that provided the total score and scores of 3 involvement factors: personal relevance, attitude, and importance. The survey was scored on a 0-100 scale, and questions about tubing elevation, patient mobility, and ease of use were rated on 0-10 scales. Participants were adult and pediatric inpatient caregivers (n = 131). In adult intensive care environments (n = 61), carriage system value scores were higher in the quaternary care site compared to 4 enterprise adult intensive care sites (median [Q1, Q3]: 90.0 [69.2, 97.5] vs 72.5 [52.5, 78.3], respectively; P = .008). Compared to nurses working in adult environments (n = 58), pediatric nurses (n = 40) had higher value scores (median [Q1, Q3]: 89.2 [68.3, 97.5] vs 97.5 [85.8, 100.0], respectively; P = .007). High median score ratings (9-10) were given for tubing elevation, patient mobility, and ease of use. In conclusion, the IV carriage system was valued by nurses as an important tool in clinical practice.
Hospital Catchment Areas Characteristics and Geographic Regions Associated With Higher COVID-19 Veterans Health Administration Hospitalization During the Omicron Surge
Authors: Wong Michelle S. , Frochen Stephen , Steers W. Neil , Washington Donna L.
Published: April 2023

Context:

Surges in the ongoing coronavirus-19 (COVID-19) pandemic and accompanying increases in hospitalizations continue to strain hospital systems. Identifying hospital-level characteristics associated with COVID-19 hospitalization rates and clusters of hospitalization “hot spots” can help with hospital system planning and resource allocation.

Objective:

To identify (1) hospital catchment area–level characteristics associated with higher COVID-19 hospitalization rates and (2) geographic regions with high and low COVID-19 hospitalization rates across catchment areas during COVID-19 Omicron surge (December 20, 2021-April 3, 2022).

Design:

This observational study used Veterans Health Administration (VHA), US Health Resource & Services Administration's Area Health Resources File, and US Census data. We used multivariate regression to identified hospital catchment area–level characteristics associated with COVID-19 hospitalization rates. We used ESRI ArcMap's Getis-Ord Gi* statistic to identify catchment area clusters of hospitalization hot and cold spots.

Setting and Participants:

VHA hospital catchment areas in the United States (n = 143).

Main Outcome Measures:

Hospitalization rate.

Results:

Greater COVID-19 hospitalization was associated with serving more high hospitalization risk patients (34.2 hospitalizations/10 000 patients per 10-percentage point increase in high hospitalization risk patients; 95% confidence intervals [CI]: 29.4, 39.0), fewer patients new to VHA during the pandemic (−3.9, 95% CI: −6.2, −1.6), and fewer COVID vaccine-boosted patients (−5.2; 95% CI: −7.9, −2.5).

We identified 2 hospitalization cold spots located in the Pacific Northwest and in the Great Lakes regions, and 2 hot spots in the Great Plains and Southeastern US regions.

Conclusions:

Within VHA's nationally integrated health care system, catchment areas serving a larger high hospitalization risk patient population were associated with more Omicron-related hospitalizations, while serving more patients fully vaccinated and boosted for COVID-19 and new VHA users were associated with lower hospitalization. Hospital and health care system efforts to vaccinate patients, particularly high-risk patients, can potentially safeguard against pandemic surges.

Hospitalization hot spots within VHA include states with a high burden of chronic disease in the Great Plains and Southeastern United States.
Core stabilization exercise in prenatal and postnatal women with urinary incontinence: A systematic review and meta-analysis of randomized controlled trials
Authors: Yu Chin-Yin , Yu Tzu-Yin , Chen Yi-Wen , Lin Li-Fong , Peng Chih-Wei , Chen Hung-Chou
Published: April 2023

Objective

To evaluate the effect size of core stabilization exercise for prenatal and postnatal women through measures of urinary symptoms, voiding function, pelvic floor muscle strength and endurance, quality of life, and pain scores.

Design

The PubMed, EMBASE, Cochrane Library, and Scopus databases were searched. Randomized controlled trials were selected and subjected to meta-analysis and risk of bias assessment.

Results

Ten Randomized controlled trials were selected, and 720 participants were included. Ten articles using seven outcomes were analyzed. Relative to the control groups, the core stabilization exercise groups exhibited superior results for urinary symptoms (standardized mean difference [SMD] = −0.65, 95% confidence interval [CI] = −0.97–0.33), pelvic floor muscle strength (SMD = 0.96, 95% CI = 0.53,1.39), pelvic floor muscle endurance (SMD = 0.71, 95% CI = 0.26,1.16), quality of life (SMD = −0.9, 95% CI = −1.23–0.58), transverse muscle strength (SMD = −0.45, 95% CI = −0.9,–0.01), and voiding function (SMD = −1.07, 95% CI = −1.87–0.28).

Conclusion

Core stabilization exercises are safe and beneficial for alleviating urinary symptoms, improving quality of life, strengthening pelvic floor muscles, and improving transverse muscle function in prenatal and postnatal women with urinary incontinence.
Analysis of side effects of cryoneurolysis for the treatment of spasticity
Authors: Winston Paul , MacRae Fraser , Rajapakshe Shanika , Morrissey Isabella , Boissonnault Ève , Vincent Daniel , Hashemi Mahdis
Published: April 2023

Objective

To report side effects from clinical studies on ultrasound-guided percutaneous cryoneurolysis for spasticity.

Design

Patients were prospectively enrolled in three studies at a single institution. Cryoneurolysis was performed to primarily motor nerve branches (medial and lateral pectoral, musculocutaneous, radial, median, ulnar, tibial, obturator) and mixed motor sensory nerve trunks (median, ulnar, suprascapular, radial, and tibial).

Results

Cryoneurolysis was performed for 277 nerves (99 mixed motor sensory), on 113 patients (59F, 54 M, average age 54.4 years). One patient had a local skin infection, two patients had bruising or swelling; all resolved within one month. 9 reported nerve pain or dysesthesia (two motor, seven mixed motor sensory nerves). Four received no treatment, four oral or topical medications, two perineural injections, one botulinum toxin. Three patients' symptoms remained until three months, one had numbness at six. One patient had botulinum toxin injections for cramping. All had at minimum three months follow-up; seven withdrew (x̄ = 5.4 months), four passed away. None of these eleven reported side effects.

Conclusions

96.75% of nerve treatments had no pain or dysesthesias beyond treatment. Few had pain or numbness beyond three months. Cryoneurolysis has potential to be a safe spasticity treatment with manageable side effects.
Superimposition Study to Determine the Angular Arterial Distribution and its Clinical Application
Authors: Shin Hyun Jin , Kim Hee-Jin , Song Wu-Chul
Published: April 2023

Purpose:

To determine the distribution of the angular artery (AA) in the medial canthal area with the aim of defining an arterial course to prevent AA injury during facial surgery in this region.

Methods:

We dissected 36 hemifaces of 18 cadavers. The horizontal distance from the vertical level through the medial canthus to the AAs was measured. The AA course of each specimen was then recorded, and all of them were then superimposed to determine the AA course. The diameter and depth of the AA around the medial canthal area were also investigated using ultrasonography on living subjects.

Results:

The horizontal distances from the medial canthus level and 2 cm below the medial canthus were 9.0±2.0 mm (mean±standard deviation) and 1.9±2.4 mm, respectively. The superimposed image demonstrated that most of the AAs were present inside the vertical line through the medial canthus. Ultrasonography indicated that the AA was 2.3±0.9 mm below the skin and 1.7±0.3 mm in diameter.

Conclusions:

The AA course was relatively constant along the nasojugal fold. The AAs were most often present between the middle of the medial canthus and the facial midline, but were very scarce in both the medial and lateral thirds. Knowledge of the detailed course of the AA may help surgeons to avoid arterial injury and decrease the risk of surgical morbidities around the nasal root and medial canthal area.

Levels of Evidence:

Basic science and clinical study
Early Ophthalmology Findings in Nonsyndromic Craniosynostosis
Authors: Tien Christopher , Johns Alexis L. , Choi Dylan G. , de Castro-Abeger Alexander , Buswell Nichole , McComb J. Gordon , Durham Susan R. , Urata Mark M.
Published: April 2023

Craniosynostosis (CS) occurs 1 in 2500 births and surgical intervention is indicated partly due to risk for elevated intracranial pressure (EICP). Ophthalmological examinations help identify EICP and additional vision concerns. This study describes preoperative and postoperative ophthalmic findings in CS patients (N=314) from chart review. Patients included nonsyndromic CS: multisuture (6.1%), bicoronal (7.3%), sagittal (41.4%), unicoronal (22.6%), metopic (20.4%), and lambdoidal (2.2%). Preoperative ophthalmology visits were at M=8.9±14.1 months for 36% of patients and surgery was at M=8.3±4.2 months. Postoperative ophthalmology visits were at age M=18.7±12.6 months for 42% with follow-up at M=27.1±15.1 months for 29% of patients. A marker for EICP was found for a patient with isolated sagittal CS. Only a third of patients with unicoronal CS had normal eye exams (30.4%) with hyperopia (38.2%) and anisometropia (16.7%) at higher rates than the general population. Most children with sagittal CS had normal exams (74.2%) with higher than expected hyperopia (10.8%) and exotropia (9.7%). The majority of patients with metopic CS had normal eye exams (84.8%). About half of patients with bicoronal CS had normal eye exams (48.5%) and findings included: exotropia (33.3%), hyperopia (27.3%), astigmatism (6%), and anisometropia (3%). Over half of children with nonsyndromic multisuture CS had normal exams (60.7%) with findings of: hyperopia (7.1%), corneal scarring (7.1%), exotropia (3.6%), anisometropia (3.6%), hypertropia (3.6%), esotropia (3.6%), and keratopathy (3.6%). Given the range of findings, early referral to ophthalmology and ongoing monitoring is recommended as part of CS care.
Xenorhabdus bovienii subsp. africana subsp. nov., isolated from Steinernema africanum entomopathogenic nematodes
Authors: Machado Ricardo A. R. , Bhat Aashaq H. , Fallet Patrick , Turlings Ted C. J. , Kajuga Joelle , Yan Xun , Toepfer Stefan
Published: April 2023

Four Gram-negative bacterial strains isolated fromSteinernema africanumentomopathogenic nematodes were biochemically and molecularly characterized to determine their taxonomic position. Results of 16S rRNA gene sequencing indicated that they belong to the classGammaproteobacteria, familyMorganellaceae, genusXenorhabdus, and that they are conspecific. The average 16S rRNA gene sequence similarity between the newly isolated strains and the type strain of its more closely related species,Xenorhabdus bovieniiT228T, is 99.4 %. We therefore selected only one of them, XENO-1T, for further molecular characterization using whole genome-based phylogenetic reconstructions and sequence comparisons. Phylogenetic reconstructions show that XENO-1Tis closely related to the type strain ofX. bovienii, T228T, and to several other strains that are thought to belong to this species. To clarify their taxonomic identities, we calculated average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) values. We observed that the ANI and dDDH values between XENO-1TandX. bovieniiT228Tare 96.3 and 71.2 %, respectively, suggesting that XENO-1Trepresents a novel subspecies within theX. bovieniispecies. Noteworthy, the dDDH values between XENO-1Tand several otherX. bovieniistrains are between 68.7 and 70.9 % and ANI values are between 95.8 and 96.4 %, which could be interpreted, in some instances, as that XENO-1Trepresents a new species. Considering that for taxonomic description the genomic sequences of the type strains are compared, and to avoid future taxonomic conflicts, we therefore propose to assign XENO-1Tto a new subspecies withinX. bovienii. ANI and dDDH values between XENO-1Tand any other of the species with validly published names of the genus are lower than 96 and 70 %, respectively, supporting its novel status. Biochemical tests andin silicogenomic comparisons show that XENO-1Texhibit a unique physiological profile that differs from all theXenorhabdusspecies with validly published names and from their more closely related taxa. Based on this, we propose that strain XENO-1Trepresents a new subspecies within theX. bovieniispecies, for which we propose the nameX. bovieniisubsp.africanasubsp. nov, with XENO-1T(=CCM 9244T=CCOS 2015T) as the type strain.
Transcriptomics in serum and culture medium reveal shared and differential gene regulation in pathogenic and commensal Streptococcus suis
Authors: Fredriksen Simen , Ruijten Suzanne D. E. , Murray Gemma G. R. , Juanpere-Borràs Maria , van Baarlen Peter , Boekhorst Jos , Wells Jerry M.
Published: April 2023

Streptococcus suis

colonizes the upper respiratory tract of healthy pigs at high abundance but can also cause opportunistic respiratory and systemic disease. Disease-associated

S. suis

reference strains are well studied, but less is known about commensal lineages. It is not known what mechanisms enable some

S. suis

lineages to cause disease while others persist as commensal colonizers, or to what extent gene expression in disease-associated and commensal lineages diverge. In this study we compared the transcriptomes of 21 

S

.

suis

strains grown in active porcine serum and Todd–Hewitt yeast broth. These strains included both commensal and pathogenic strains, including several strains of sequence type (ST) 1, which is responsible for most cases of human disease and is considered to be the most pathogenic

S. suis

lineage. We sampled the strains during their exponential growth phase and mapped RNA sequencing reads to the corresponding strain genomes. We found that the transcriptomes of pathogenic and commensal strains with large genomic divergence were unexpectedly conserved when grown in active porcine serum, but that regulation and expression of key pathways varied. Notably, we observed strong variation of expression across media of genes involved in capsule production in pathogens, and of the agmatine deiminase system in commensals. ST1 strains displayed large differences in gene expression between the two media compared to strains from other clades. Their capacity to regulate gene expression across different environmental conditions may be key to their success as zoonotic pathogens.
Structure-Property-Processing Correlations of Graphene Bioscaffolds for Proliferation and Differentiation of C2C12 Cells
Authors: Karriem Lynn , Eixenberger Joshua , Frahs Stephanie , Convertino Domenica , Webb Tyler , Pandhi Twinkle , McLaughlin Kari , Enrriques Ashton , Davis Paul , Subbaraman Harish , Colletti Camilla , Oxford Julia T. , Estrada David
Published: April 2023

Graphene – an atomically thin layer of carbon atoms arranged in a hexagonal lattice – has gained interest as a bioscaffold for tissue engineering due to its exceptional mechanical, electrical, and thermal properties. Graphene’s structure and properties are tightly coupled to synthesis and processing conditions, yet their influence on biomolecular interactions at the graphene-cell interface remains unclear. In this study, C2C12 cells were grown on graphene bioscaffolds with specific structure–property– processing–performance (SP3) correlations. Bioscaffolds were prepared using three different methods - chemical vapor deposition (CVD), sublimation of silicon carbide (SiC), and printing of liquid phase exfoliated graphene. To investigate the biocompatibility of each scaffold, cellular morphology and gene expression patterns were investigated using the bipotential mouse C2C12 cell line. Using a combination of fluorescence microscopy and qRT-PCR, we demonstrate that graphene production methods determine the structural and mechanical properties of the resulting bioscaffold, which in turn determine cell morphology, gene expression patterns, and cell differentiation fate. Therefore, production methods and resultant structure and properties of graphene bioscaffolds must be chosen carefully when considering graphene as a bioscaffold for musculoskeletal tissue engineering.