bluuebunny/crossref_metadata_2025 huggingface dataset:
Is explicit instruction effective? The learning of English noun-noun and adjective-noun structures by L1 Spanish school children (¿Es efectiva la instrucción explícita? El aprendizaje de las estructuras nombre-nombre y adjetivo-nombre del inglés por escolares de L1 español)
Authors: Gómez-Garzarán Eduardo , Fernández-Fuertes Raquel
Published: May 2020

The relative order of constituents within determiner phrases (DP) in which the noun is modified by an adjective (AN) has traditionally been taught in English as an L2 subject in the Spanish context. This is not the case for the same type of phrase in which the N-head is modified by another N (NN). This study aims to assess the impact of direct instruction in English NNs as part of the school curriculum. Acceptability judgement data and production have been elicited from two groups of L1 Spanish-L2 English children living in Spain, one receiving explicit NN instruction and the other following the regular only-AN instruction. Results show an advancement of the instruction group not only in NNs but also in ANs. This has a double implication: that NNs and ANs might share a common morphosyntactic underlying structure and that explicit teaching of grammatical properties that are shared by different structures might result in better attainment.
Does von Neumann Entropy Correspond to Thermodynamic Entropy?
Authors: Chua Eugene Y. S.
Published: May 2020

Conventional wisdom holds that the von Neumann entropy corresponds to thermodynamic entropy, but Meir Hemmo and Orly Shenker have recently argued against this view by attacking von Neumann’s argument. I argue that Hemmo and Shenker’s arguments fail because of several misunderstandings about statistical-mechanical and thermodynamic domains of applicability, about the nature of mixed states, and about the role of approximations in physics. As a result, their arguments fail in all cases: in the single-particle case, the finite-particles case, and the infinite-particles case.
Effects of high temperature treatment of carbon nanotube arrays on graphite: increased crystallinity, anchoring and inter-tube bonding
Authors: Hansson Josef , Nylander Andreas , Flygare Mattias , Svensson Krister , Ye Lilei , Nilsson Torbjörn , Fu Yifeng , Liu Johan
Published: May 2020

Thermal treatment of carbon nanotubes (CNTs) can significantly improve their mechanical, electrical and thermal properties due to reduced defects and increased crystallinity. In this work we investigate the effect of annealing at 3000 °C of vertically aligned CNT arrays synthesized by chemical vapor deposition (CVD) on graphite. Raman measurements show a drastically reduced amount of defects and, together with transmission electron microscope (TEM) diffraction measurements, an increased average crystallite size of around 50%, which corresponds to a 124% increase in Young’s modulus. We also find a tendency for CNTs to bond to each other with van der Waals (vdW) forces, which causes individual CNTs to closely align with each other. This bonding causes a densification effect on the entire CNT array, which appears at temperatures >1000 °C. The densification onset temperature corresponds to the thermal decomposition of oxygen containing functional groups, which otherwise prevents close enough contact for vdW bonding. Finally, the remaining CVD catalyst on the bottom of the CNT array is evaporated during annealing, enabling direct anchoring of the CNTs to the underlying graphite substrate.
Is Adaptation Studies Sustainable?
Authors: Meikle Kyle
Published: May 2020

The protagonists of Michel Gondry’s Be Kind Rewind recycle twice over, using junkyard stuff like tires and plastic bags to remake famous films in a series of no-budget shorts. This essay turns to Be Kind Rewind to ask how the recycling of materials may relate to the recycling of intellectual properties. It argues that such a question is paramount at a moment when adaptation not only represents a major media practice but also one major response to climate change. As such, the essay offers several different approaches to thinking about media adaptation in the age of global warming, drawing variously from sociologists, political ecologists, film theorists, and designers.
Variable Sculpting in Dynamic Definition Body Contouring: Procedure Selection and Management Algorithm
Authors: Hoyos Alfredo E , Perez Mauricio E , Domínguez-Millán Rodrigo
Published: May 2020

Background

Currently, corporal perception has evolved among different ethnic groups and a tendency to change from a slim to an athletic shape has been influenced by geography, culture, race, gender, and social media. Although exercise improves health status, physical appearance does as well in the long term. Patients often opt for an immediate solution for which high-definition (HD) liposculpture has been the best choice. However, they differ on their preference regarding muscular definition.

Objectives

The authors presented a new therapeutic algorithm for HD liposculpture in harmony with body biotypes and patients’ preferences.

Methods

The authors reported their experience with 1772 consecutive patients, classified according to their body type in endomorph (217), ectomorph (195), and mesomorph (1360), and treated according to our new algorithm. Patients in general good health requesting HD liposculpture were included from June 2013 to September 2019. Pre- and postoperative photographs were taken to evaluate results.

Results

A total of 479 men and 1293 women were analyzed. Age ranged from 23 to 69 years in men and 18 to 57 years in women. Variable-degree HD liposculpture was successfully performed in all cases. Minor complications included port wound dehiscence (1.2%), seroma (4.1%), prolonged bruising (1.5%), and hyperchromia (10.4%). Superficial burns (0.7%), localized infection (0.4%), erratic skin adhesion (1%), and flap necrosis (0.4%) were also reported. A high-satisfaction index was reported in a nonstandardized patient survey.

Conclusions

The authors’ new algorithm helps in the decision-making for HD liposculpture according to variable degrees of muscle definition due to patients’ preferences.

Level of Evidence: 4
ENANO: Encoder for NANOpore FASTQ files
Authors: Dufort y Álvarez Guillermo , Seroussi Gadiel , Smircich Pablo , Sotelo José , Ochoa Idoia , Martín Álvaro
Published: May 2020

Motivation

The amount of genomic data generated globally is seeing explosive growth, leading to increasing needs for processing, storage and transmission resources, which motivates the development of efficient compression tools for these data. Work so far has focused mainly on the compression of data generated by short-read technologies. However, nanopore sequencing technologies are rapidly gaining popularity due to the advantages offered by the large increase in the average size of the produced reads, the reduction in their cost and the portability of the sequencing technology. We present ENANO (Encoder for NANOpore), a novel lossless compression algorithm especially designed for nanopore sequencing FASTQ files.

Results

The main focus of ENANO is on the compression of the quality scores, as they dominate the size of the compressed file. ENANO offers two modes, Maximum Compression and Fast (default), which trade-off compression efficiency and speed. We tested ENANO, the current state-of-the-art compressor SPRING and the general compressor pigz on several publicly available nanopore datasets. The results show that the proposed algorithm consistently achieves the best compression performance (in both modes) on every considered nanopore dataset, with an average improvement over pigz and SPRING of >24.7% and 6.3%, respectively. In addition, in terms of encoding and decoding speeds, ENANO is 2.9× and 1.7× times faster than SPRING, respectively, with memory consumption up to 0.2 GB.

Availability and implementation

ENANO is freely available for download at: https://github.com/guilledufort/EnanoFASTQ.

Supplementary information

Supplementary data are available at Bioinformatics online.
Mapping the Brain-Wide Network Effects by Optogenetic Activation of the Corpus Callosum
Authors: Chen Yi , Sobczak Filip , Pais-Roldán Patricia , Schwarz Cornelius , Koretsky Alan P , Yu Xin
Published: May 2020

Optogenetically driven manipulation of circuit-specific activity enables causality studies, but its global brain-wide effect is rarely reported. Here, we applied simultaneous functional magnetic resonance imaging (fMRI) and calcium recording with optogenetic activation of the corpus callosum (CC) connecting barrel cortices (BC). Robust positive BOLD was detected in the ipsilateral BC due to antidromic activity, spreading to the ipsilateral motor cortex (MC), and posterior thalamus (PO). In the orthodromic target, positive BOLD was reliably evoked by 2 Hz light pulses, whereas 40 Hz light pulses led to reduced calcium, indicative of CC-mediated inhibition. This presumed optogenetic CC-mediated inhibition was further elucidated by pairing light pulses with whisker stimulation at varied interstimulus intervals. Whisker-induced positive BOLD and calcium signals were reduced at intervals of 50/100 ms. The calcium-amplitude-modulation-based correlation with whole-brain fMRI signal revealed that the inhibitory effects spread to contralateral BC, ipsilateral MC, and PO. This work raises the need for fMRI to elucidate the brain-wide network activation in response to optogenetic stimulation.
Assessing Regional Sensitivity and Desensitization to Capsaicin Among Oral Cavity Mucosae
Authors: Berry Danica N , Simons Christopher T
Published: May 2020

This study aimed to determine perceptual response differences and characterize desensitization to capsaicin over time across several oral cavity mucosae– the tongue, cheek, hard palate, and lip. For each region, subjects rated the intensity of capsaicin and a vehicle control over a 10-min period. Following a rest period, capsaicin was reapplied on each pretreated area and subjects indicated which side felt more irritated, then rated each side every 30 s over 3.5 min. Results from the initial task indicated significantly greater irritation on the tongue than hard palate, hard palate than cheek and lip, but no significant differences between the cheek and lip. Time to maximum intensity was delayed on the hard palate compared to the tongue, cheek, and lip. Desensitization, as indicated by a significant proportion of subjects choosing the vehicle-pretreated side over capsaicin-pretreated side as having stronger irritation, was exhibited on the tongue and hard palate but not the cheek and lip. Given these data, a secondary experiment that utilized a higher capsaicin concentration was conducted on the cheek and lip only. Results showed significantly higher overall irritation on the lip than the cheek. Desensitization was exhibited on both areas, although the extent was greater on the lip. Based on differences in sensitivity and the extent of desensitization among these areas, these results indicate that oral cavity mucosae respond to, but are impacted differently by, capsaicin exposure.
Importance of Pediatric Inclusion in COVID-19 Therapeutic Trials
Authors: Raabe Vanessa N , Lighter Jennifer , Caplan Arthur L , Ratner Adam J
Published: May 2020

Pediatric patients are excluded from most coronavirus disease 2019 (COVID-19) therapeutic trials. We outline a rationale for the inclusion of children in COVID-19 therapeutic trials, which enabled us to include children of all ages in a therapeutic COVID-19 trial at our institution.
Dabigatran and the Risk of Staphylococcus aureus Bacteremia: A Nationwide Cohort Study
Authors: Butt Jawad H , Fosbøl Emil L , Verhamme Peter , Gerds Thomas A , Iversen Kasper , Bundgaard Henning , Bruun Niels Eske , Larsen Anders R , Petersen Andreas , Andersen Paal S , Skov Robert L , Gislason Gunnar H , Torp-Pedersen Christian , Køber Lars , Olesen Jonas B
Published: May 2020

Background

Treatment with dabigatran, an oral direct thrombin inhibitor, reduces the virulence of Staphylococcus aureus in in vitro and in vivo models. However, it remains to be determined whether dabigatran reduces the risk of S. aureus infections in humans. We investigated the incidence rate of S. aureus bacteremia (SAB) in patients with atrial fibrillation treated with the direct thrombin inhibitor dabigatran compared with patients treated with the factor Xa-inhibitors rivaroxaban, apixaban, and edoxaban.

Methods

In this observational cohort study, 112 537 patients with atrial fibrillation who initiated treatment with direct oral anticoagulants (August 2011–December 2017) were identified from Danish nationwide registries. The incidence rates of SAB in patients treated with dabigatran versus patients treated with the factor Xa-inhibitors were examined by multivariable Cox regression accounting for time-dynamic changes in exposure status during follow-up.

Results

A total of 112 537 patients were included. During a median follow-up of 2.0 years, 186 patients in the dabigatran group and 356 patients in the factor Xa-inhibitor group were admitted with SAB. The crude incidence rate of SAB was lower in the dabigatran group compared with the factor Xa-inhibitor group (22.8 [95% confidence interval [CI], 19.7–26.3] and 33.8 [95% CI, 30.5–37.6] events per 10 000 person-years, respectively). In adjusted analyses, dabigatran was associated with a significantly lower incidence rate of SAB compared with factor Xa-inhibitors (incidence rate ratio, .76; 95% CI, .63–.93).

Conclusions

Treatment with dabigatran was associated with a significantly lower incidence rate of SAB compared with treatment with factor Xa-inhibitors.
Antimalarial Activity of Artefenomel Against Asexual Parasites and Transmissible Gametocytes During Experimental Blood-Stage Plasmodium vivax Infection
Authors: Collins Katharine A , Abd-Rahman Azrin N , Marquart Louise , Ballard Emma , Gobeau Nathalie , Griffin Paul , Chalon Stephan , Möhrle Jörg J , McCarthy James S
Published: May 2020

Background

Interventions that effectively target Plasmodium vivax are critical for the future control and elimination of malaria. We conducted a P. vivax volunteer infection study to characterize the antimalarial activity of artefenomel, a new drug candidate.

Methods

Eight healthy, malaria-naive participants were intravenously inoculated with blood-stage P. vivax and subsequently received a single oral 200-mg dose of artefenomel. Blood samples were collected to monitor the development and clearance of parasitemia, and plasma artefenomel concentration. Mosquito feeding assays were conducted before artefenomel dosing to investigate parasite transmissibility.

Results

Initial parasite clearance occurred in all participants after artefenomel administration (log10 parasite reduction ratio over 48 hours, 1.67; parasite clearance half-life, 8.67 hours). Recrudescence occurred in 7 participants 11–14 days after dosing. A minimum inhibitory concentration of 0.62 ng/mL and minimum parasiticidal concentration that achieves 90% of maximum effect of 0.83 ng/mL were estimated, and a single 300-mg dose was predicted to clear 109 parasites per milliliter with 95% certainty. Gametocytemia developed in all participants and was cleared 4–8 days after dosing. At peak gametocytemia, 75% of participants were infectious to mosquitoes.

Conclusions

The in vivo antimalarial activity of artefenomel supports its further clinical development as a treatment for P. vivax malaria.

Clinical Trials Registration

NCT02573857.
When Prospective Leader Turnover Promotes Peace
Authors: Schub Robert
Published: May 2020

Scholars typically associate leader turnover with a high risk of military conflict. This article shows that under some conditions, a higher likelihood of leader turnover in the future fosters peace today. When states take costly peaceful measures (e.g., arming to deter adversaries), the range of settlements preferable to war shrinks and the risk of conflict rises. If peace costs are onerous, potential leader turnover in adversaries promotes peace by introducing uncertainty about the future need for and costs of deterrent measures. When locked in a costly peace with minimal chance of leader turnover in the adversary, states attack. When locked in that same costly peace but with high prospects for leader turnover, states endure an unfavorable peace today given the potential for a favorable one tomorrow. Asymmetric consequences of future shifts in peace costs ensure the relationship holds even if costs do not change in expectation and could rise. Quantitative analyses of the prospects for future leader turnover, military spending, and war initiation among rivals accord with the hypothesized relationships. In theory and practice, expectations of leadership volatility make it prudent to exercise peaceful forbearance.
Updates and challenges of axon regeneration in the mammalian central nervous system
Authors: Qian Cheng , Zhou Feng-Quan
Published: May 2020

Axon regeneration in the mammalian central nervous system (CNS) has been a long-standing and highly challenging issue. Successful CNS axon regeneration will benefit many human diseases involving axonal damage, such as spinal cord injury, traumatic brain injury, glaucoma, and neurodegenerative diseases. The current consensus is that the diminished intrinsic regenerative ability in mature CNS neurons and the presence of extrinsic inhibitors blocking axon regrowth are two major barriers for axon regeneration. During the past decade, studies targeting the intrinsic axon growth ability via regulation of gene transcription have produced very promising results in optic nerve and/or spinal cord regeneration. Manipulations of various signaling pathways or the nuclear transcription factors directly have been shown to sufficiently drive CNS axon regrowth. Converging evidence reveals that some pro-regenerative transcriptomic states, which are commonly accomplished by more comprehensive epigenetic regulations, exist to orchestrate the complex tasks of injury sensing and axon regeneration. Moreover, genetic reprogramming achieved via transcriptome and epigenome modifications provides novel mechanisms for enhancing axon regeneration. Recent studies also highlighted the important roles of remodeling neuronal cytoskeleton in overcoming the extrinsic inhibitory cues. However, our knowledge about the cellular and molecular mechanisms by which neurons regulate their intrinsic axon regeneration ability and response to extrinsic inhibitory cues is still fragmented. Here, we provide an update about recent research progress in axon regeneration and discuss major remaining challenges for long-distance axon regeneration and the subsequent functional recovery.
The Association Between Serum Leptin Levels and Cardiovascular Events in Patients with Rheumatoid Arthritis
Authors: Chen Jiliang , Xie Zhiping , Bin Zou
Published: May 2020

Objective

Cardiovascular diseases (CVDs) are important complications for patients with rheumatoid arthritis (RA). The study aimed to explore whether serum leptin is associated with a increased risk of cardiovascular (CV) events in patients with RA.

Methods

Two hundred twenty-three patients with RA were followed for a mean of 40 (range = 8-42) months. Serum leptin levels were measured at baseline. Cox regression analysis was performed to assess the association between leptin levels and the risk of CV events.

Results

The univariate analysis showed that patients with RA with higher serum leptin levels had higher rates of CV events and CV mortality, respectively (P <.001). The logistic regression model showed that leptin was independently related to CVD history (odds ratio = 1.603, 95% confidence interval [CI], 1.329–2.195; P =.005) after adjusting for confounding factors in patients with RA at baseline. The multivariate Cox proportional hazard model suggested that leptin was an independent prognostic factor for CV events in patients with RA after adjustments were made for clinical confounding factors (hazard ratio = 2.467, 95% CI, 2.019–4.495; P <.001). The Kaplan-Meier analysis showed that compared with patients with RA with leptin levels below the median value (≤15.4 mg/L), patients with leptin above the median value (>15.4 μg/L) had a higher rate of CV events (P <.001).

Conclusion

Leptin was significantly associated with CV events in patients with RA. Elevated serum leptin levels may be a reliable prognostic factor for predicting CV complications in patients with RA.
Factors Associated With Weight Gain in People Treated With Dolutegravir
Authors: Taramasso Lucia , Bonfanti Paolo , Ricci Elena , Orofino Giancarlo , Squillace Nicola , Menzaghi Barbara , De Socio Giuseppe Vittorio , Madeddu Giordano , Pellicanò Giovanni Francesco , Pagnucco Layla , Celesia Benedetto Maurizio , Calza Leonardo , Conti Federico , Martinelli Canio Vito , Valsecchi Laura , Cascio Antonio , Bolla Cesare , Maggi Paolo , Vichi Francesca , Dentone Chiara , Angioni Goffredo , Mastroianni Antonio , Falasca Katia , Cenderello Giovanni , Di Biagio Antonio
Published: May 2020

Background

An unexpected excess in weight gain has recently been reported in the course of dolutegravir (DTG) treatment. The aim of the present study was to investigate whether weight gain differs among different DTG-containing regimens.

Methods

Adult naïve and experienced people with HIV (PWH) initiating DTG-based antiretroviral therapy (ART) between July 2014 and December 2019 in the Surveillance Cohort Long-Term Toxicity Antiretrovirals (SCOLTA) prospective cohort were included. We used an adjusted general linear model to compare weight change among backbone groups and a Cox proportional hazard regression model to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for weight increases >10% from baseline.

Results

A total of 713 participants, 25.3% women and 91% Caucasian, were included. Of these, 195 (27.4%) started DTG as their first ART regimen, whereas 518 (72.6%) were ART-experienced. DTG was associated with abacavir/lamivudine in 326 participants, tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in 148, boosted protease inhibitors in 60, rilpivirine in 45, lamivudine in 75, and tenofovir alafenamide (TAF)/FTC in 59. At 6 and 12 months, weight gain was highest among PWH on TDF/FTC+DTG and TAF/FTC+DTG. Baseline CD4 <200 cells/mm3 (HR, 1.84; 95% CI, 1.15 to 2.96), being ART-naïve (HR, 2.24; 95% CI, 1.24 to 4.18), and treatment with TDF/FTC+DTG (HR, 1.92; 95% CI, 1.23 to 2.98) or TAF/FTC+DTG (HR, 3.80; 95% CI, 1.75 to 8.23) were associated with weight gain >10% from baseline. Higher weight (HR, 0.97 by 1 kg; 95% CI, 0.96 to 0.99) and female gender (HR, 0.54; 95% CI, 0.33 to 0.88) were protective against weight gain.

Conclusions

Naïve PWH with lower CD4 counts and those on TAF/FTC or TDF/FTC backbones were at higher risk of weight increase in the course of DTG-based ART.
Accuracy of Ultrasound-Guided Pudendal Nerve Block in the Ischial Spine and Alcock’s Canal Levels: A Cadaveric Study
Authors: Soucy Béatrice , Luong Dien Hung , Michaud Johan , Boudier-Revéret Mathieu , Sobczak Stéphane
Published: May 2020

Background

Blockade of the pudendal nerve (PN) using ultrasound (US) guidance has been described at the levels of the ischial spine and Alcock’s canal. However, no study has been conducted to compare anatomical accuracy between different approaches in targeting the PN.

Objective

To investigate the accuracy of US-guided injection of the PN at the ischial spine and Alcock’s canal levels. This study also compared the accuracy of the infiltrations by three sonographers with different levels of experience.

Subjects

Eight Thiel-embalmed cadavers (16 hemipelvises).

Methods

Three physiatrists trained in musculoskeletal US imaging with 12 years, five years, and one year of experience performed the injections. Each injected a 0.1-mL bolus of colored dye in both hemipelvises of each cadaver at the ischial spine and Alcock’s canal levels under US guidance. Each cadaver received three injections per hemipelvis. The accuracy of the injection was determined following hemipelvis dissection by an anatomist.

Results

The injections were accurate 33 times out of the total 42 attempts, resulting in 78% accuracy. Sixteen out of 21 injections at the ischial spine level were on target (76% accuracy), while the approach at Alcock’s canal level yielded 17 successful injections (81% accuracy). The difference between the approaches was not statistically significant. There was also no significant difference in accuracy between the operators.

Conclusions

US-guided injection of the PN can be performed accurately at both the ischial spine and Alcock’s canal levels. The difference between the approaches was not statistically significant.
Catastrophic Drug Errors Involving Tranexamic Acid Administered During Spinal Anesthesia
Authors: Patel S. , Robertson B. , McConachie
Published: May 2020

(Anaesthesia. 2019;74:904–914)

Drug administration errors during neuraxial anesthesia can result in dire outcomes. These authors had previously reported on neuraxial drug administration errors, but have since learned of several incidents of accidental intrathecal administration of tranexamic acid during spinal anesthesia. This article reviewed reports of these occurrences, identified contributing factors to the drug errors, and discussed prevention strategies.
Induction of Labor at Full-term in Pregnant Women With Uncomplicated Singleton Pregnancy: A Systematic Review and Meta-analysis of Randomized Trials
Authors: Saccone G. , Della Corte L. , Maruotti G.M. , Quist-Nelson J. , Raffone A. , De Vivo V. , Esposito G. , Zullo F. , Berghella V.
Published: May 2020

(Acta Obstet Gynecol Scand. 2019;98:958–966)

Some care providers have advocated for induction of labor for all pregnancies once they reach full-term, to avoid an elevated risk of perinatal morbidity and mortality. Critics assert that induction is commonly associated with an increased risk of cesarean delivery, although previous trials do not support this argument. Saccone and colleagues conducted this study to examine the effects of labor induction in women with full-term singleton gestations with no complications.
Incidence of Maternal Sepsis and Sepsis-related Maternal Deaths in the United States
Authors: Hensley M.K. , Bauer M.E. , Admon L.K. , Prescott H.C.
Published: May 2020

(JAMA. 2019;322:890–892)

The burden of sepsis and sepsis-related deaths in pregnancy may be higher than currently estimated. Prior studies focused on select populations or did not follow patients longitudinally; therefore estimates of maternal sepsis following delivery have been limited. The aim of this study was to assess the nationwide incidence and outcomes of maternal sepsis within 42 days of delivery hospitalization discharge using all-payer data.
Measuring What Matters to Moms Most
Authors: Mhyre J.M. , Bateman B.T.
Published: May 2020

(Anesthesiology. 2019;131:223–225)

In the United States, the risks of maternal morbidity and mortality have moved into public focus as the US falls behind other countries in terms of safe maternity care. Current quality measures are lacking, as they do not adequately represent safe maternal care and are not risk-adjusted. Poor performance in hospitals is often attributed to patient population and dismissed.
Guidelines for Postoperative Care in Cesarean Delivery: Enhanced Recovery After Surgery (ERAS) Society Recommendations (Part 3)
Authors: Macones G.A. , Caughey A.B. , Wood S.L. , Wrench I.J. , Huang J. , Norman M. , Pettersson K. , Fawcett W.J. , Shalabi M.M. , Metcalfe A. , Gramlich L. , Nelson G. , Wilson R.D.
Published: May 2020

(Am J Obstet Gynecol. 2019;221:247.e1–247.e9)

Enhanced recovery after surgery (ERAS) is a perioperative care program that is standardized in various formats for disciplines including colorectal, urologic, gynecologic, and hepatobiliary surgery. ERAS has been shown to reduce hospital length of stay, complications, readmissions, and cost. Creating a standardized ERAS guideline for perioperative care in cesarean delivery will provide best practice recommendations for part 1 (antenatal/preoperative), part 2 (intraoperative), and part 3 (postoperative phases) with a maternal focus.
Women’s Perceptions of Medication Use During Pregnancy and Breastfeeding: A Swedish Cross-sectional Questionnaire Study
Authors: Wolgast E. , Lindh-Åstrand L. , Lilliecreutz C.
Published: May 2020

(Acta Obstet Gynecol Scand. 2019;98:856–864)

Medications are used frequently during pregnancy to treat an array of symptoms and conditions, from diabetes and asthma to nausea and depression. Women may view medication use as potentially unsafe during pregnancy, particularly due to the thalidomide scandal of the 1960s. One study on herbal medicine use during pregnancy found that 19% of women used herbal medicines during pregnancy and 20% believed they were safer than prescribed medications. This current study examined the perceptions among Swedish pregnant women of overall medication use and herbal medicine use during pregnancy and postpartum when breastfeeding. They also investigated patients’ sense of reliability of the sources from which they got their information about medication use during pregnancy.
Tranexamic Acid in the Routine Treatment of Postpartum Hemorrhage in the United States: A Cost-effectiveness Analysis
Authors: Sudhof L.S. , Shainker S.A. , Einerson B.D.
Published: May 2020

(Am J Obstet Gynecol. 2019;221:275.e1–275.e12)

From 2011 to 2015, postpartum hemorrhage (PPH) was the cause of 11% of pregnancy-related deaths in the United States and the incidence of PPH is increasing. However, as major obstetric hemorrhage is uncommon and unpredictable, often requiring implementation of multiple nonpharmacological interventions after uterotonic administration, it remains difficult to study. Major obstetric hemorrhage requires significant resources.
Vaginal Delivery in Women With a Low-lying Placenta: A Systematic Review and Meta-analysis
Authors: Jansen C. , de Mooij Y.M. , Blomaard C.M. , Derks J.B. , van Leeuwen E. , Limpens J. , Schuit E. , Mol B.W. , Pajkrt E.
Published: May 2020

(BJOG. 2019;126:1118–1126)

While physicians strive to avoid unnecessary cesarean sections, they must weigh this goal with the possible risks of hemorrhage in patients with low-lying placentas. Guidelines and recommendations vary widely on whether patients with low-lying placentas should deliver by cesarean delivery. The Royal College of Obstetricians and Gynaecologists states patients with a low-lying placenta should deliver via cesarean, while in the Netherlands, vaginal delivery is suggested for patients with an internal os distance (IOD) of >10 mm. This systematic review and meta-analysis aimed to evaluate the possibility of successful vaginal delivery with a low-lying placenta.
Providing Patient-centered Perinatal Care for Transgender Men and Gender-diverse Individuals: A Collaborative Multidisciplinary Team Approach
Authors: Hahn M. , Sheran N. , Weber S. , Cohan D. , Obedin-Maliver J.
Published: May 2020

(Obstet Gynecol. 2019;134:959–963)

Over the course of the last decade, the experience of pregnancy in transgender men (and other gender-diverse people who were assigned female sex at birth) has secured higher visibility within medical journals. While some gender-affirming treatments eliminate fertility, such as hysterectomy or oophorectomy, some transgender men may retain or even desire reproductive capability. Both intended and unintended pregnancies after undergoing gender-affirming processes have occurred, and some transgender men aspire for subsequent pregnancy and parenthood depending on their stage of transition and age. As there is little clinical guidance for medical care from prenatal to postpartum, this is a divulsion of a case intended to help create a more equitable and inclusive health care experience for transgender men and to assure patient-centered care.
Development and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa
Authors: Alexander L.A. , Newton M.W. , McEvoy K.G. , Newton M.J. , Mungai M. , DiMiceli-Zsigmond M. , Sileshi B. , Watkins S.C. , McEvoy M.D.
Published: May 2020

(Anesth Analg. 2019;128:993–998)

The maternal mortality rate in low- and middle-income countries (LMICs) is 20 times higher than in developed countries, at a rate of 239 deaths per 100,000 live births. Sub-Saharan Africa in particular is considered by the World Health Organization (WHO) to be the most dangerous place in the world for women undergoing childbirth. On the basis of the success of WHO’s surgical checklist, this current study investigated the development and use of a context-sensitive obstetric anesthesia checklist for use during cesarean delivery (CD) in East Africa, with the goal that they could demonstrate an improvement in adherence to best practice guidelines for anesthesia for CD in LMICs.
A Biased Coin Up-and-Down Sequential Allocation Trial to Determine the Optimum Programmed Intermittent Epidural Bolus Time Interval Between 5 mL Boluses of Bupivacaine 0.125% With Fentanyl 2 µg/mL
Authors: Bittencourt R. , Arzola C. , Zakus P. , Downey K. , Ye X.Y. , Carvalho J.C.A.
Published: May 2020

(Can J Anesth. 2019 66:1075–1081)

Programmed intermittent epidural bolus (PIEB) for labor analgesia has garnered a lot of attention and is the focus of ongoing research. PIEB when compared with continuous epidural infusion results in higher maternal satisfaction, reduced local anesthetic consumption, lower incidence of motor block, fewer unilateral blocks, and less breakthrough pain. The optimal epidural solution and PIEB settings for labor analgesia have yet to be decided. This study aimed to determine the effective PIEB time interval when using 5 mL boluses of bupivacaine 0.125% with fentanyl 2 mcg/mL.
Intravenous Dexmedetomidine for the Treatment of Shivering During Cesarean Delivery Under Neuraxial Anesthesia: A Randomized-controlled Trial
Authors: Lamontagne C. , Lesage S. , Villeneuve E. , Lidzborski E. , Derstenfeld A. , Crochetieìe C.
Published: May 2020

(Can J Anesth/J Can Anesth. 2019;66:762–771)

Neuraxial anesthesia is preferable for cesarean deliveries (CDs), as it allows mothers to be awake and avoids the associated risks of general anesthesia. However, an estimated 53% of patients under neuraxial anesthesia suffer from shivering. Uncontrolled shivering intervenes with vital sign monitoring, causes physiological stress, and affects a patient’s satisfaction and comfort. The most common pharmacological treatment for shivering is meperidine (a synthetic opioid). However, as this drug becomes increasingly scarce in North American hospitals, an effective alternative agent is desired. Dexmedetomidine is an alternative treatment for shivering and can alleviate shivering while avoiding side effects associated with opioids. The aim of this study was to test whether a single bolus of 30 μg intravenous (IV) dexmedetomidine, administered 5 minutes after childbirth, could reduce shivering during CD under neuraxial anesthesia.
The Impact of Reclassifying Suicides in Pregnancy and in the Postnatal Period on Maternal Mortality Ratios
Authors: Lommerse K. , Knight M. , Nair M. , Deneux-Tharaux C. , van den Akkerb T.
Published: May 2020

(BJOG. 2019;126:1088–1092)

As lowering maternal mortality rates continues to be a global priority, attention should be given to maternal mental health care. UK experts estimate half of all maternal suicides could have been prevented by better care. The World Health Organization in 2012 introduced the International Classification of Diseases for Maternal Mortality, which changed all suicides in pregnancy and up to 12 months postpartum to be classifed as a direct obstetric death. This recommendation was meant to reduce underreporting, but some countries have raised concerns that some of these deaths should be regarded as “indirect” obstetric deaths, as many women who die by suicide had mental illness before pregnancy.
Office-based nursing in practice
Authors: Steppie Suzanne , Kirchner Jeffrey
Published: May 2020

Most healthcare delivery occurs in in primary care settings such as patient-centered medical homes or provider offices, where office-based nurses play an important role in collaborative patient management. This article explores the continuous evolution and expansion of that role.
Systematic Review on Late Cochlear Implantation in Early-Deafened Adults and Adolescents: Clinical Effectiveness
Authors: Debruyne Joke A. , Janssen A. Miranda , Brokx Jan P.L.
Published: May 2020

Objectives:

Cochlear implantation in early-deafened patients, implanted as adolescents or adults, is not always advised due to poor expected outcomes. In order to judge whether such reluctance is justified, the current systematic review aimed to gather all available evidence on postoperative outcomes obtained by early-deafened patients using a state-of-the art cochlear implant (CI).

Design:

Five electronic databases (PubMed, Embase, the Cochrane library, CINAHL, and PsycInfo) were systematically searched for studies in English, French, German, or Dutch, published between 2000 and September 2017. Studies that reported pre- and postoperative outcomes on any measure of speech or sound perception, audiovisual or subjective benefit (quality of life) were included. Study quality was assessed with the Institute of Health Economics quality appraisal tool for case series studies.

Results:

The systematic search and subsequent full-text evaluation identified 38 studies meeting the inclusion criteria. Only a limited number of studies were judged to be of high quality according to the Institute of Health Economics tool, with lack of (clear) presentation of relevant study information being a recurring problem. Twenty-five studies presented viable outcomes on open-set speech understanding in quiet: mean postoperative scores obtained with CI remained below 50% for the vast majority of studies; significant postoperative improvements were found in 16 studies, although this number might have been higher if appropriate statistical testing had been performed in all studies. Eight studies observed increased audiovisual performance after implantation, which was statistically significant in six studies. A validated measure of hearing-related quality of life was used in only 5 of the 16 studies assessing subjective outcomes, showing significant postoperative improvements for most questionnaire domains. The relation between auditory and subjective outcomes was assessed in two studies, with contradictory results.

Conclusions:

The current review showed that late cochlear implantation in early-deafened subjects resulted in significantly improved open-set speech perception, audiovisual speech perception, and (hearing-related) quality of life in the majority of the studies involved. Nonetheless, more and especially higher-quality research is needed in order to gain a more detailed understanding of the outcomes of cochlear implantation in this population.
A quality improvement initiative to reduce cast transitions in a pediatric hospital
Authors: Rowan Mallory R. , Balch Samora Julie
Published: May 2020

A quality improvement protocol was implemented in a large tertiary care pediatric hospital to reduce the rate of transitions from emergency department (ED)-applied casts to another form of immobilization (waterproof cast, removable brace, or sling). The local standard of care prior to implementing this quality improvement project involved applying long-arm casts in the ED for children presenting with stable upper extremity injuries (those not requiring a reduction). We created a multidisciplinary quality improvement team with orthopedic and ED providers, as well as cast technicians, with the aim of reducing the transition rate of ED-applied casts in clinic by 50%. Multiple Plan-Do-Study-Act cycles were performed and data were evaluated monthly. Charge fees were determined to assess differences in costs between splints and casts. An independent samples t-test for equality of means was used to determine the ED length of stay of each group. Baseline data determined a cast transition rate of 59.9%. After implementing the quality improvement protocol, the cast transition rate was reduced to 25.0%, a 58% reduction. The length of stay in the ED for a patient receiving a splint as opposed to a cast was 26.2 ± 8.0 min shorter. The charge to a patient receiving a splint rather than an ED-applied cast was $291.25 less. In conclusion, implementation of a multidisciplinary quality improvement protocol resulted in a more than 50% reduction in the transition rate of ED-applied casts in the clinic. Furthermore, healthcare charges to families were reduced by nearly $130 000 annually after implementation of this protocol.
A Feasibility Study of a New Muscle Sparing “C3 Dome-Hybrid Open-Door Laminoplasty”
Authors: Liu Gabriel , Fung Gerald , Tan Joshua , Ng Jing Han , Tan Jun-Hao
Published: May 2020

Study Design.

Retrospective case series to investigate the result of a new C3 dome-hybrid open-door laminoplasty technique.

Objective.

This study reports the design and feasibility of a new hybrid laminoplasty technique aimed to reduce the complications of the conventional laminoplasty, with the incorporation of C3 dome-osteotomy, an open-door C4–6 instrumented laminoplasty and C7 cephalad dome-osteotomy.

Summary of Background Data.

Recent findings showed that the preservation of the dorsal muscles attached at either C2 or C7 cervical spine reduced the complications of C3–C7 open-door laminoplasty.

Methods.

A retrospective review of consecutive patients who underwent the C3 dome-hybrid laminoplasty technique by a single surgeon with at least 2 years follow-up was performed. The surgical technique was described in detail. Clinical and radiological outcome data were analyzed.

Results.

Twenty six patients with cervical cord compression who underwent C3 dome-hybrid laminoplasty were recruited. The mean postoperative follow-up was 45.6 ± 24.7 (24–101) months. Significant improvements were observed in the preoperative to postoperative mean Japanese Orthopaedic Association (JOA) score (13→15, P < 0.001), Nurick grade (2.3→1.2, P < 0.001), neck disability index (NDI) (23→11, P = 0.011), 36-item short form survey (SF-36) physical component score (40→46, P = 0.027), and neck visual analogue scale (VAS) (3.1→0.3, P < 0.001). There was no significant loss in cervical lordosis from 12° preoperatively to 8° at final follow-up. Postoperative cervical range of motion (ROM) was preserved at 85% and 78% of the preoperative ROM at 2 years and at final follow-up, respectively. When comparing the first 10 patients with the next 16 patients, there was a reduction in mean operation time from 252 ± 75 to 208 ± 7 minutes, mean blood loss from 359 ± 326 to 211 ± 177 mL, and median hospital stay from 7 days (interquartile range [IQR]: 34) to 5 days (IQR: 6).

At final follow-up, no patients had revision surgery, spinal infection, C5 palsy, symptomatic cervical kyphosis, or axial neck pain.

Conclusion.

The new C3 dome-hybrid laminoplasty technique is safe, feasible, and reproducible with good clinical outcomes. This technique may be considered as an alternative to traditional laminoplasty for patients with C3–C7 multi-level myelopathic disease.

Level of Evidence: 3
Arthroscopic Tenovaginotomy and Ganglion Excision of the Flexor Carpi Radialis Fibro-Osseous Tendon Sheath
Authors: Landström Jerone T.
Published: May 2020

The treatment of flexor carpi radialis (FCR) tendon stenosing tenosynovitis recalcitrant to nonsurgical intervention has been open or blind tenovaginotomy of the volar trapezial fibro-osseous sheath of the FCR tendon. The surgical literature has not reported arthroscopic tenovaginotomy of the FCR fibro-osseous tendon sheath with or without associated ganglia. This report describes a technique of arthroscopic tenovaginotomy for stenosing tenosynovitis of the FCR tendon at the trapezial fibro-osseous sheath with or without excision of any associated ganglion through a not previously described new volar radial trapezial arthroscopic portal.
Ultrasound-guided Percutaneous Tendon Scraping: A Novel Technique for Treating Patellar Tendinopathy
Authors: Baria Michael R. , Plunkett Evan , Miller Meghan M. , Borchers James , Miller Timothy L. , Magnussen Robert A.
Published: May 2020

Patellar tendinopathy is commonly encountered in orthopedic and sports medicine clinics. Ultrasound-guided (USG) percutaneous tendon scraping is well described for Achilles tendinopathy, but not patellar tendinopathy. This manuscript describes the technique and reports results from a case series of patients with patellar tendinopathy treated with USG percutaneous tendon scraping. A retrospective review of the medical record identified 6 patients who underwent tendon scraping for patellar tendinopathy. This was a retrospective case series performed by searching the medical record for patients who underwent tendon scraping for patellar tendinopathy. Six patients met the criteria for inclusion. Five had primary patellar tendinopathy and 1 had continued pain despite open debridement. There were 3 competitive athletes and 3 recreational athletes. No major adverse events were reported. All competitive athletes safely returned to the sport at 1 month. At an average follow-up of 13.5±6 months, mean improvement in the Victorian Institute of Sport Assessment-Patellar Tendon (VISA-P) score was 53±24.2 points. At the final follow-up, 83% of patients experienced a clinically significant improvement in symptoms. USG percutaneous patellar tendon scraping is a minimally invasive intervention that may improve symptoms and help patients safely return to sport/activity. Because the intervention is entirely outside of the tendon, it is low risk and may be useful for in-season athletes.
Emergency management of immune-related toxicity
Authors: Cooksley Tim , Stutman Robin , Klotz Adam
Published: May 2020

Purpose of review

Emergency presentations in patients treated with immune checkpoint inhibitors (ICIs) are a clinical challenge. Clinicians need to be vigilant in diagnosing and treating immune-mediated toxicities. In this review, we consider the approach to managing an acutely unwell patient being treated with ICIs presenting as an emergency.

Recent findings

A minority of acutely unwell patients treated with ICIs will have an immune-mediated toxicity. Early recognition and intervention in those with immune-mediated toxicity can reduce the duration and severity of the complications. The use of early immunosuppressive agents along corticosteroid therapy may improve outcomes in patients with life-threatening immune-mediated toxicity.

Individualized management of immune-mediated toxicities is a key challenge for emergency oncology services; this has become part of routine cancer care.
New drugs in gastrointestinal stromal tumors
Authors: Martin-Broto Javier , Moura David S.
Published: May 2020

Purpose of review

Tyrosine kinase inhibitors (TKIs) are the backbone for advanced gastrointestinal stromal tumor (GIST) treatment. The increasing knowledge concerning the structure and the changing conformational status because of some mutations in KIT and PDGFRα, allowed the development of new efficient compounds, with the main goal to overcome resistance in GIST. This review summarizes the latest developments in the treatment of GIST patients.

Recent findings

Amongst the several TKIs currently being studied in GIST, ripretinib, avapritinib and crenolanib had shown promising potent activity in preclinical studies and clinical trials. Ripretinib is a type II inhibitor that exerts its main action in the switch pocket of the activation loop, by mimicking the inhibition exerted by the regulatory region in this domain. Ripretinib is considered the new standard in the fourth line in advanced GIST. Avapritinib is a type I inhibitor synthesized to exerts its activity in the active conformation of the activation loop of KIT and PDFGRα. The relevant activity reported with avapritinib in patients carrying the D842 v mutation represents, for first time, an active therapeutic option in this resistant mutant. Crenolanib is a type I selective inhibitor of PDGFRα-resistant mutants, mainly D842 V, which is currently under clinical trial.

New potent TKIs are being approved, adding value to the already three registered drugs. Other agents, such as MEK inhibitors, immunotherapy and TRK-targeted therapy are potential new options in specific subsets of GIST patients.