bluuebunny/crossref_metadata_2025 huggingface dataset:
Particulate Hexavalent Chromium Inhibits E2F1 Leading to Reduced RAD51 Nuclear Foci Formation in Human Lung Cells
Authors: Speer Rachel M , Toyoda Jennifer H , Croom-Perez Tayler J , Liu Ke Jian , Wise John Pierce
Published: February 2021

Lung cancer is the leading cause of cancer death; however, the mechanisms of lung carcinogens are poorly understood. Metals, including hexavalent chromium [Cr(VI)], induce chromosome instability, an early event in lung cancer. Failure of homologous recombination repair is a key mechanism for chromosome instability. Particulate Cr(VI) causes DNA double-strand breaks and prolonged exposure impairs homologous recombination targeting a key effector protein in this pathway, RAD51. Reduced RAD51 protein is a key endpoint of particulate Cr(VI) exposure. It is currently unknown how Cr(VI) reduces RAD51 protein. E2F1 is the predominant transcription factor for RAD51. This study sought to identify if E2F1 modulates the RAD51 response to particulate Cr(VI). Particulate Cr(VI) reduced RAD51 protein and mRNA levels but had a minimal effect on RAD51 half-life. E2F1 protein and mRNA were also inhibited by particulate Cr(VI) exposure. To connect these two outcomes, we tested if modulating E2F1 affects RAD51 outcomes after particulate Cr(VI) exposure. E2F1 knockdown inhibited RAD51 nuclear foci formation after acute particulate Cr(VI) exposure. These data indicate reduced RAD51 protein levels after prolonged particulate Cr(VI) exposure are predominantly due to inhibited expression. Particulate Cr(VI) also inhibits E2F1 expression. However, although loss of E2F1 does not modulate RAD51 expression after particulate Cr(VI) exposure, RAD51 nuclear foci formation is inhibited. These findings suggest E2F1 is important for RAD51 localization to double-strand breaks, but not expression after particulate Cr(VI) exposure in human lung cells.
Delivery in Pregnant Women Infected With SARS-Co-2: A Fast Review
Authors: Parazzini F. , Bortolus R. , Mauri P.A. , Favilli A. , Gerli S. , Ferrazzi E.
Published: February 2021

(Int J Gynecol Obstet. 2020;150:41–46)

There is still much to be learned about the effects of coronavirus disease 2019 (COVID-19) on pregnant women. The risk of transmission of the virus to the fetus is still unclear. There are now some published case reports and clinical series on pregnancies and deliveries in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to review the current evidence concerning mode of delivery, immediate neonatal outcomes, and vertical or peripartum transmission in pregnant patients with confirmed SARS-CoV-2 infection.
What are the Risks of COVID-19 Infection in Pregnant Women?
Authors: Qiao J.
Published: February 2021

(Lancet. 2020;395:760–761)

The 2019 novel coronavirus disease (COVID-19) broke out in China in December 2019 and by February 11, 2020, had caused 38,800 cases and 1113 (2.9%) deaths in China. Chinese health officials have published guidelines for the prevention, diagnosis, and treatment of pneumonia caused by COVID-19 based on emerging evidence. In developing prevention and treatment practices for pregnant women with COVID-19, as well as determining the risk of vertical transmission, more evidence is needed.
Uterine Balloon Tamponade for the Treatment of Postpartum Hemorrhage: A Systematic Review and Meta-analysis
Authors: Suarez S. , Conde-Agudelo A. , Borovac-Pinheiro A. , Suarez-Rebling D. , Eckardt M. , Theron G. , Burke T.F.
Published: February 2021

(Am J Obstet Gynecol. 2020;222:293.e1–293.e52)

A leading cause of worldwide maternal death is postpartum hemorrhage (PPH). In 2017, there were 38,000 maternal deaths worldwide, with over 90% occurring in low- and middle-income countries. In addition, an annual 1.5 million women experience hemorrhage-related complications during pregnancy or postpartum. Effective treatment for PPH includes uterotonics, uterine massage, uterine artery embolization, tranexamic acid, uterine balloon tamponade (UBT), and additional surgical intervention. The aim of this study was to conduct a meta-analysis and systematic review to determine the effectiveness, efficacy, and safety of UBT for the treatment of PPH.
Neuraxial Labor Analgesia Utilization, Incidence of Postdural Puncture Headache, and Epidural Blood Patch Placement for Privately Insured Parturients in the United States (2008-2015)
Authors: Delgado C. , Bollag L. , Van Cleve W.
Published: February 2021

(Anesth Analg. 2020;131:850–856)

Neuraxial labor analgesia (NLA) is a common and effective approach to pain relief during labor, but it is also associated with postdural puncture headache (PDPH). Epidural blood patch (EBP) placement is considered to be a more effective intervention for PDPH than conservative treatments. Yet, the incidence of PDPH and EBP is unclear because most studies assessing these incidence rates have been conducted at single institutions or academic medical centers. The aim of this study was to estimate the incidence of NLA, PDPH, and EBP among privately insured women in the United States.
Third-trimester Prediction of Successful Vaginal Birth After One Cesarean Delivery: A Swedish Model
Authors: Fagerberg M.C. , Källén K.
Published: February 2021

(Acta Obstet Gynecol Scand. 2020;99:660–668)

In women with one previous cesarean delivery (CD), the decision to deliver by cesarean or trial of labor can be a difficult one. In Sweden, ∼75% of women choosing a trial of labor after cesarean (TOLAC) would have a successful vaginal birth after cesarean (VBAC). The study aimed to adapt and validate a US prediction model for use in Sweden, adding several important factors and the rate of VBAC in TOLAC for the specific delivery ward.
Characteristics and Outcomes of Pregnant Women Admitted to Hospital With Confirmed SARS-CoV-2 Infection in the UK: National Population-based Cohort Study
Authors: Knight M. , Bunch K. , Vousden N. , Morris E. , Simpson N. , Gale C. , O’Brien P. , Quigley M. , Brocklehurst P. , Kurinczuk J.J.
Published: February 2021

(BMJ. 2020;369:m2107)

Although cases of coronavirus disease 2019 (COVID-19) continue to rise, information on the transmission, effect, and prevalence of the disease in pregnant women and their newborns is still emerging. This study aimed to describe the characteristics and outcomes of a national cohort of pregnant women in the UK hospitalized with COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Genomic Insights Into Stillbirth
Authors: Wojcik M.H.
Published: February 2021

(N Engl J Med. 2020;383;1182–1183)

The majority of stillbirths in the United States are unexplained. Over the past few years, technology for sequencing and interpreting genomic data have improved, but it’s unclear if techniques will be useful in addressing unexplained stillbirth.
Comparison of Supraglottic Airway Devices With Endotracheal Intubation in Low-Risk Patients for Cesarean Delivery: Systematic Review and Meta-analysis
Authors: White L.D. , Thang C. , Hodsdon A. , Melhuish T.M. , Barron F.A. , Godsall M.G. , Vlok R.
Published: February 2021

(Anesth Analg. 2020;131:1092–1101)

While there are guidelines and protocols in place for safe intubation during cesarean delivery, failed intubation occurs in 2.3 of every 1000 general anesthetics, and 1 in 60 failed intubation results in maternal death. Reattempting intubation is associated with certain risks, like aspiration, and other options include using a supraglottic airway (SGA) or using neuraxial blockade. SGA has been demonstrated to be reasonably safe in low-risk, elective cesareans. This meta-analysis aimed to compare the first-pass success rate and insertion time of SGA with that of endotracheal intubation in elective cesarean delivery, as well as identify the rate of airway related adverse events using SGA compared with endotracheal intubation.
Electrical Stimulation Test for Epidural Catheter Placement After Receiving Intrathecal Local Anesthetic During a Combined Spinal-epidural Technique for Cesarean Delivery: Confirmation of the Spinal Nerve Root as Epidural Site of Action
Authors: Stewart M. , Carvalho B. , Tsui B.C.H.
Published: February 2021

(Can J Anesth/J Can Anesth. 2020;67:498–499)

For the prediction of adequate epidural analgesia following abdominal surgery, the epidural stimulation test (EST) has been shown to have a higher sensitivity than the local anesthetic test dose. This test could confirm proper epidural catheter placement for combined spinal epidurals (CSEs) in either laboring women or women having a cesarean delivery. As epidural failure is a known complication of the CSE procedure, confirmation of the epidural catheter placement is a crucial step following a full spinal dose CSE for cesarean delivery. This case describes using EST to confirm CSE placement in a woman having cesarean delivery.
Recurrent bacterial vaginosis
Authors: Ellington Kelly , Saccomano Scott J.
Published: February 2021

Bacterial vaginosis increases the risk of sexually transmitted infections, including HIV, and treatment is crucial to avoid complications. This article reviews the evidence-based options for treating bacterial vaginosis to improve patient outcomes.
The impact of obesity on immune function in pediatric asthma
Authors: Hay Ceire , Henrickson Sarah E.
Published: February 2021

Purpose of review

Pediatric obese asthma is a complex disease that remains poorly understood. The increasing worldwide incidence of both asthma and obesity over the last few decades, their current high prevalence and the challenges in treating obese asthmatic patients all highlight the importance of a better understanding of the pathophysiological mechanisms in obese asthma. While it is well established that patients with obesity are at an increased risk of developing asthma, the mechanisms by which obesity drives the onset of asthma, and modifies existing asthma, remain unclear. Here, we will focus on mechanisms by which obesity alters immune function in asthma.

Recent findings

Lung parenchyma has an altered structure in some pediatric obese asthmatics, known as dysanapsis. Central adiposity is linked to reduced pulmonary function and a better predictor of asthma risk in children than BMI. Obesity in young children is associated with an increased risk of developing asthma, as well as early puberty, and hormonal alterations are implicated in obese asthma. Obesity and asthma each yield immunometabolic dysregulation separately and we are learning more about alterations in these pathways in pediatric obese asthma and the potential impact of bariatric surgery on those processes.

The recent progress in clarifying the connections between childhood obesity and asthma and their combined impacts on immune function moves us closer to the goals of improved understanding of the pathophysiological mechanisms underpinning obese asthma and improved therapeutic target selection. However, this common inflammatory disease remains understudied, especially in children, and much remains to be learned.
Professional Stigma of Mental Health Issues: Physicians Are Both the Cause and Solution
Authors: Brower Kirk J.
Published: February 2021

After a medical student prompted medical faculty to tell their stories of depression and related mental health issues, the author wrote this article with the aim of decreasing the stigma of mental illness and encouraging treatment, as needed, in the medical profession. The professional culture of the house of medicine not only mimics society in attributing stigma to people with mental health issues but may also contribute to high rates of suicide in the ranks of health care professionals by leading to a delay in seeking treatment. Acculturation accelerates in the first year of medical school such that medical students experience an increase in burnout and depressive symptoms from prematriculation levels. It follows that faculty have a responsibility to improve the learning environment. Survey data from medical faculty at the author’s institution showed that depression decreased respondents’ willingness to seek mental health treatment because of the stigma and issues of access to help. Faculty attitudes toward mental health issues, including reluctance to admit having such issues, may be conveyed to medical students in the hidden curriculum that teaches them to keep depression hidden. Moreover, the fear of mental disorders is manifested in licensing and privileging applications under the guise of patient safety, contributing to a culture of shame and silence. As creators and guardians of this professional culture, medical faculty and other physicians must be the ones who change it. The same faculty who play a part in causing and perpetuating stigma related to mental health issues have the power to derive and enact some of the solutions. In addition to giving voice to a personal experience of mental health issues, this article offers suggestions for normalizing moderate to severe depression as a medical disorder, decreasing the stigma of mental health issues, and encouraging faculty to seek treatment.
Approaching the COVID-19 Pandemic Response With a Health Equity Lens: A Framework for Academic Health Systems
Authors: Golden Sherita H. , Galiatsatos Panagis , Wilson Cheri , Page Kathleen R. , Jones Vanya , Tolson Tina , Lugo April , McCann Nicki , Wilson Alicia , Hill-Briggs Felicia
Published: February 2021

Racially and ethnically diverse and socioeconomically disadvantaged communities have historically been disproportionately affected by disasters and public health emergencies in the United States. The U.S. Department of Health and Human Services’ Office of Minority Health established the National Consensus Panel on Emergency Preparedness and Cultural Diversity to provide guidance to agencies and organizations on developing effective strategies to advance emergency preparedness and eliminate disparities among racially and ethnically diverse communities during these crises. Adopting the National Consensus Panel recommendations, the Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; Language Services; and academic–community partnerships used existing health equity resources and expertise to develop an operational framework to support the organization’s COVID-19 response and to provide a framework of health equity initiatives for other academic medical centers. This operational framework addressed policies to support health equity patient care and clinical operations, accessible COVID-19 communication, and staff and community support and engagement, which also supported the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Johns Hopkins Medicine identified expanded recommendations for addressing institutional policy making and capacity building, including unconscious bias training for resource allocation teams and staff training in accurate race, ethnicity, and language data collection, that should be considered in future updates to the National Consensus Panel’s recommendations.
Perfectionism, Power, and Process: What We Must Address to Dismantle Mental Health Stigma in Medical Education
Authors: Bynum William E. , Sukhera Javeed
Published: February 2021

In this commentary, the authors draw on 2 personal accounts of mental illness published by Kirk J. Brower, MD, and Darrell G. Kirch, MD, in this issue to consider how and why mental health stigma is maintained in medical education. In particular, they explore how perfectionism, power differentials, and structural forces drive mental illness stigma in medical education. They argue that mental health stigma in medical education, while deeply embedded in the physician archetype and medical culture, is not inevitable and that dismantling it will require individual courage, interpersonal acceptance, and institutional action.
Telehealth and Medical Student Education in the Time of COVID-19—and Beyond
Authors: Muntz Martin D. , Franco Jose , Ferguson Catherine C. , Ark Tavinder K. , Kalet Adina
Published: February 2021

The COVID-19 pandemic continues to limit medical students’ full reintegration into clinical learning environments, thus exacerbating an ongoing challenge in identifying a robust number of clinical educational activities at excellent clinical sites for all students. Because medical students across the United States were removed from direct patient care activities in mid-March 2020 due to COVID-19, medical centers have prioritized and implemented changes to the process of patient care. As some barriers are being lifted in the face of a highly contagious and deadly infection, the use of telehealth (delivery of health services remotely via telephone, video, and secure messaging), although not new, is rapidly expanding into all aspects of patient care. Health care providers have been encouraged to conduct many interactions at a physical distance. Telehealth largely replaced face-to-face visits for nonemergency care in an attempt to slow viral transmission while enabling physicians to continue to deliver patient education, manage acute and chronic illness, and nurture caring doctor–patient relationships. Health care providers, many of whom were initially reluctant to embrace telehealth technology and logistics, are becoming nimbler and more aware of the many positive aspects of telehealth. The authors suggest that integrating medical students into telehealth activities would help maintain and improve patients’ health, extend the capabilities of health care teams and systems during and after the pandemic, and increase medical students’ opportunities for experiential learning and professional identity formation. The authors expand on these 3 goals, suggest several concrete student telehealth activities, propose a curricular strategy, and outline opportunities to overcome key barriers to full alignment of telehealth and undergraduate medical education.
A Comparative Case Study Analysis of Cultural Competence Training at 15 U.S. Medical Schools
Authors: Vasquez Guzman Cirila Estela , Sussman Andrew L. , Kano Miria , Getrich Christina M. , Williams Robert L.
Published: February 2021

Purpose

Twenty years have passed since the Liaison Committee on Medical Education (LCME) mandated cultural competence training at U.S. medical schools. There remain multiple challenges to implementation of this training, including curricular constraints, varying interpretations of cultural competence, and evidence supporting the efficacy of such training. This study explored how medical schools have worked to implement cultural competence training.

Method

Fifteen regionally diverse public and private U.S. medical schools participated in the study. In 2012–2014, the authors conducted 125 interviews with 52 administrators, 51 faculty or staff members, and 22 third- and fourth-year medical students, along with 29 focus groups with an additional 196 medical students. Interviews were recorded, transcribed, and imported into NVivo 10 software for qualitative data analysis. Queries captured topics related to students’ preparedness to work with diverse patients, engagement with sociocultural issues, and general perception of preclinical and clinical curricula.

Results

Three thematic areas emerged regarding cultural competence training: formal curriculum, conditions of teaching, and institutional commitment. At the formal curricular level, schools offered a range of courses collectively emphasizing communication skills, patient-centered care, and community-based projects. Conditions of teaching emphasized integration of cultural competence into the preclinical years and reflection on the delivery of content. At the institutional level, commitment to institutional diversity, development of programs, and degree of prioritization of cultural competence varied.

Conclusions

There is variation in how medical schools approach cultural competence. Among the 15 participating schools, longitudinal and experiential learning emerged as important, highlighting the needs beyond mere integration of cultural competence content into the formal curriculum. To determine efficacy of cultural competence programming, it is critical to conduct systematic assessment to identify and address gaps. While LCME standards have transformed aspects of medical education, further research is needed to clarify evidence-based, effective approaches to this training.
Pregnant Patients Using Opioids: Treatment Access Barriers in the Age of COVID-19
Authors: Lensch Ashley C. , Hairston Essence , Carter Ginny , Jones Hendrée E.
Published: February 2021

Objectives:

Before the COVID-19 pandemic, many pregnant patients experienced barriers in accessing opioid use disorder (OUD) medication. This project surveyed buprenorphine treatment clinics to determine how many accepted pregnant women before and then during the pandemic. Of those clinics accepting pregnant patients during the pandemic, respondents were asked what services were provided and what forms of payment they accepted.

Methods:

Between July and September 2020, phone contact was made with every sixth unduplicated clinic in North Carolina listed in the Substance Abuse and Mental Health Administration treatment locator (N = 490 clinics). The response rate was 53%.

Results:

Of the 128 clinics responding, 62 clinics (48%) failed to treat pregnant patients both before and during the pandemic, whereas 66 clinics (52%) accepted pregnant patients before the COVID-19 pandemic, with only 44 (66%) of these clinics accepting pregnant patients during the pandemic. Thus, 33% fewer clinics accepted pregnant women for OUD treatment. Of these 44 clinics, 52% provided same-day intake, 45% prescribed naltrexone, and 57% offered detoxification with opioid agonists. Self-pay (95%), private insurance (77%), and Medicaid (55%) were accepted as payment. Clinics commonly reported providing individual counseling (86%). No clinics provided childcare or transportation.

Conclusions:

Almost half of the buprenorphine clinics in North Carolina turned away pregnant patients before the pandemic. During the pandemic, only 34% accepted pregnant patients, with 33% clinics that had provided medication treatment before the pandemic declining to treat pregnant patients for OUD. Thus, it is critical that policymakers ensure OUD treatment clinics accept pregnant patients.
Pattern of Tobacco Smoking Among Egyptian Patients With Bipolar Disorder
Authors: Shorub Eman , ElShahawi Heba , Abdel Maksooud Menan , Wagdy Mohamed , Eid Maissa
Published: February 2021

Background:

Individuals with bipolar disorder (BD) have a higher prevalence of tobacco smoking than the general population. In Egypt, the accurate data about the pattern of tobacco smoking and prevalence of nicotine dependence among BD patients are still scarce.

Objective:

The objective of this study was to detect the pattern of tobacco smoking and to assess the occurrence of nicotine dependence syndrome among Egyptian cigarette and waterpipe smoker patients suffering from BD.

Methods:

A cross-sectional study using a semistructured interview to assess 100 patients with BD at the inpatient department and the outpatient mood clinic of The Institute of Psychiatry, Ain Shams University. The assessment tools included the Mini-International Neuropsychiatric Interview, Sixth Edition (M.I.N.I.), the Young Mania Rating Scale (YMRS), the Fagerström Test for Nicotine Dependence (FTND), and the Lebanon Waterpipe Dependence Scale (LWDS-11).

Results:

Of the 100 recruited bipolar patients (43% women and 57% men), it was found that 45% of bipolar cases were cigarette smokers, 18% were waterpipe smokers, and 17% smoked both cigarette and waterpipe with a statistically significant difference. Bipolar I in the acute phase showed the most prevalent type of BDs with moderate (31%) and high (13.8%) nicotine dependence. Bipolar II cases have never smoked neither cigarette nor waterpipe; 5% of patients with bipolar I smoked waterpipe during disease activity.

Conclusion:

Patients with BD have a relatively high frequency of nicotine (cigarettes and waterpipe) dependence (17%) in relation to the general population (1.0%), especially bipolar I type.
Predictors of Drug Abuse Relapse for Iranian Addicted Women: An Application of Social Cognitive Theory
Authors: Bashirian Saeid , Barati Majid , Mohammadi Younes , Ghazanfari Zarnagh Hadi , Bagheri Sharareh
Published: February 2021

Objectives:

Substance abuse prevalence has risen over the past decade among women, and accordingly, sex-specific barriers impede women’s access and participation in treatment programs, while the chief issue in providing treatment programs for women with substance abuse is the high relapse rate seen in the subjects. With all these in mind, the present study was conducted with the objective of recognizing the sociocognitive factors that concern the relapse of substance abuse in women.

Methods:

Two hundred women subjects under treatment in outpatient addiction treatment and rehabilitation centers in Kurdistan province in 2019 participated in this descriptive study. Data were obtained by means of a questionnaire that included demographic questions, history of substance use, and structures of social cognitive theory. Data were analyzed by SPSS software version 21 that further used logistic regression, χ2, and independent t tests.

Results:

The average age of the respondents was estimated 37.75±10.49. The relapse rate amounted to 80% among the participants. Logistic regression test analysis designated that the structures of situational perception, social support, and self-efficacy act as the factors that predict substance abuse relapses in women (R=0.42; P<0.05).

Conclusions:

Social cognitive theory is considered a valid theoretical method for deciphering the relation observed between substance abuse relapse predictors in women. Therapists’ consciousness on gaining social support and strengthening self-efficacy in the subjects may serve to improve the aftermaths of substance abuse treatment programs in women.
Low Back Pain Flares
Authors: Costa Nathalia , Smits Esther J. , Kasza Jessica , Salomoni Sauro E. , Ferreira Manuela , Hodges Paul W.
Published: February 2021

Objective:

The term flare is commonly used to describe low back pain (LBP) fluctuations, but individuals with LBP consider that it does not always correspond to increased pain. This case cross-over study aimed to: (1) determine the extent to which days with a flare identified according to a multidimensional definition (self-reported flare, SRF) corresponded to days with greater than average pain (pain-defined flare, PDF) and (2) to investigate whether physical and psychosocial features differ between PDF and SRF.

Materials and Methods:

Individuals with LBP for ≥3 months (N=126) provided data on flares, physical, and psychosocial features daily for 28 days using a smartphone application.

Results:

Most days with SRF (68%) did not have greater than average pain (ie, PDF), but most days with greater than average pain (64%) were reported as an SRF. On days with SRF-only all physical and psychosocial features were worse than nonflare days. SRF+PDF had lower sleep quality and higher pain intensity, fatigue, disability, pain catastrophizing, and fear avoidance than SRF-only. SRF+PDF had higher pain in the afternoon and evening, disability and pain catastrophizing than PDF-only. Self-efficacy at work and during leisure activities was worse on SRF+PDF days than SRF-only and PDF-only days.

Discussion:

These findings highlight that when individuals with LBP consider they have a flare, they do not always have greater than average pain, but have worse psychosocial features. This emphasizes that flare has broader dimensions than pain alone. Consideration of flare according to broad dimensions is important when investigating symptom fluctuations across different LBP trajectories.
Pain and Disability in Low Back Pain Can be Reduced Despite No Significant Improvements in Mechanistic Pain Biomarkers
Authors: Palsson Thorvaldur S. , Christensen Steffan W.M. , De Martino Enrico , Graven-Nielsen Thomas
Published: February 2021

Objective:

Altered balance in nociception in response to noxious stimuli is commonly reported in chronic low back pain (LBP). However, it is unclear whether an improvement in the clinical presentation is contingent on a reduction in pain sensitivity. This study investigated whether the quantitative sensory testing (QST) profile changes in people undergoing rehabilitation for LBP.

Design:

A prospective, observational case-control study.

Methods:

Forty males and females, 18 to 40 years’ old (20 with LBP) participated in 2 sessions. QST was performed at baseline and after discharge from rehabilitation (LBP) or after 3 to 8 weeks (controls). The QST battery consisted of determining pressure-pain thresholds at the low back and shoulder, temporal summation of pain, and conditioned pain modulation. Questionnaire data was used to determine pain (Numeric Rating Scale [NRS]), disability (Roland-Morris Questionnaire [RMQ]), Fear Avoidance Beliefs (FABQ), and The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) at baseline and discharge. The treatment effect was determined by calculating the Cohen d.

Results:

No significant group×time interactions or main factor effect was found for any of the QST measures. The LBP group reported a significant reduction in NRS (P<0.0002, d=1.23), RMQ (P<0.0001, d=1.58), FABQ (P<0.001, d=0.87), and in the ÖMPSQ (P<0.00001, d=1.44).

Conclusions:

The results indicate that an improvement of clinical LBP is not contingent upon changes in the pain sensory profile. The value of screening pain sensitivity in LBP patients in primary care, needs to be investigated further, due to the patient population heterogeneity and the sensitivity of assessment methods.
Decreased Reemerging Auditory Brainstem Responses Under Ipsilateral Broadband Masking as a Marker of Noise-Induced Cochlear Synaptopathy
Authors: Giraudet Fabrice , Labanca Ludimila , Souchal Marion , Avan Paul
Published: February 2021

Objectives:

In mammals, a 2-hr exposure to an octave-band noise (OBN) at 100 to 108 dB SPL induces loss of synaptic ribbons between inner hair cells and auditory nerve fibers with high thresholds of response (hiT neurons), that encode high-intensity sounds. Here, we tackle the challenge of diagnosing this synaptopathy by a noninvasive functional audiological test, ultimately in humans, despite the expected absence of auditory-threshold elevation and of clear electrophysiological abnormality, hiT neuron contributions being hidden by those of more sensitive and robust neurons.

Design:

The noise-induced synaptopathy was replicated in mice (at 94, 97, and 100 dB SPL; n = 7, 7, and 8, respectively, against 8 unexposed controls), without long-lasting auditory-threshold elevation despite a twofold decrease in ribbon-synapse number for the 100-dB OBN exposure. Auditory brainstem responses (ABRs) were collected using a simultaneous broadband noise masker just able to erase the ABR response to a 60-dB tone burst. Tone burst intensity was then increased up to 100 dB SPL for eliciting reemerging ABRs (R-ABRs), dependent on hiT neurons as more sensitive neurons are masked.

Results:

In most ears exposed to 97-dB-SPL and all ears exposed to 100-dB-SPL OBN, contrary to controls, R-ABRs from the overexposed region have vanished, whereas standard ABR distributions widely overlap.

Conclusions:

R-ABRs afford an individual noninvasive marker of normal-auditory-threshold cochlear synaptopathy. A simple modification of standard ABRs would allow hidden auditory synaptopathy to be searched in a patient.

Abbreviations:

ABR: auditory brainstem response; dB SPL: decibel sound pressure level; DPOAE: distortion-product otoacoustic emission; hiT neuron: high-threshold neuron; IHC: inner hair cell; loT neuron: low-threshold neuron; OBN: octave-band noise; OHC: outer hair cell; PBS: phosphate buffer saline; R-ABR: reemerging ABR
Optimized Diagnostic Approach to Patients Suspected of Superior Semicircular Canal Dehiscence
Authors: Noij Kimberley S. , Remenschneider Aaron K. , Herrmann Barbara S. , Guinan John J. , Rauch Steven D.
Published: February 2021

Objectives:

Current methods of diagnosing superior semicircular canal dehiscence syndrome (SCDS) include a clinical exam, audiometric testing, temporal bone computer tomography (CT) imaging, and vestibular evoked myogenic potential (VEMP) testing. The main objective of this study was to develop an improved diagnostic approach to SCDS optimized for accuracy, efficiency, and safety that utilizes clinical presentation, audiometric testing, CT imaging, high-frequency cervical VEMP (cVEMP) testing, and patient treatment preference. A secondary aim was to investigate the cost associated with the current versus proposed diagnostic paradigms.

Design:

All patients who underwent cVEMP testing since introduction of the 2 kHz cVEMP in our clinical protocol in July 2018 were screened. Patients suspected of SCDS based upon symptoms who also had available audiogram, CT scan, and 2 kHz cVEMP were included (58 ears). Patients were categorized as dehiscent, thin, or not dehiscent based on their CT scan. Symptom prevalence and cVEMP outcomes were analyzed and compared for all groups. The accuracy of the 2 kHz cVEMP was calculated using CT imaging as the standard. Using a combination of patient symptomatology, audiometric, CT and 2 kHz cVEMP data, as well as patient preference, a best clinical practice approach was developed. The cost associated with this approach was calculated and compared with cost of the current SCDS diagnostic workup using Medicare reimbursement rates.

Results:

In the overall patient population suspected of SCDS based on clinical presentation, the sensitivity and specificity of 2 kHz cVEMP were 76% and 100%, respectively, while the positive and negative predictive values were 100% and 84.6%, assuming that the CT scan finding was correct. Autophony was the most common symptom in patients who had both superior semicircular canal dehiscence on CT imaging plus abnormal 2 kHz cVEMP (p < 0.001). Combining patient symptomatology, 2 kHz normalized peak to peak cVEMP amplitude, and patient treatment preference to determine, which patients should undergo CT scanning resulted in a potential cost reduction between 45% and 61%.

Conclusion:

In patients suspected of SCDS based on their clinical presentation, the combination of symptomatology, 2 kHz cVEMP data, and patient preference can be used to determine which patients should undergo CT scanning, resulting in a diagnostic cost reduction and reduced patient radiation exposure.
Long-term Functional Outcomes and Complications in Operative Versus Nonoperative Treatment for Displaced Midshaft Clavicle Fractures in Adolescents: A Retrospective Comparative Study
Authors: Riiser Martin O. , Molund Marius
Published: February 2021

Introduction:

Traditionally, midshaft clavicular fractures in adolescents are treated nonoperatively. In later years, a trend toward operative treatment can be observed. Documentation of the benefit of surgery in this group is scarce. The purpose of this study is to evaluate the long-term patient reported functional outcomes and complications for patients treated operatively and nonoperatively for displaced midshaft clavicular fractures. Using the same outcomes we also compared the operative methods.

Methods:

One hundred nine adolescents aged 12 to 18 years sustaining displaced midshaft clavicular fractures in the period 2010 to 2016 were identified in our computerized files. Sixty-one were treated nonoperatively, 48 operatively (22 plate and 26 intramedullary nail). Their radiographs and patient journals were examined for fracture classification, wound infection, sensory affection, surgery duration, hardware removal, and nonunion (n=109). Long-term function, pain, and satisfaction were measured with Quick Disability of Arm, Shoulder, and Hand (QuickDASH), Oxford Shoulder Score and Visual Analogue Scale (n=87).

Results:

Operative treatment: We could find no difference in functional score outcomes. The main outcome QuickDASH was excellent in both groups (median 0 nail vs. 2.26 plate). Surgery duration was shorter with intramedullary nail. We found 2 infections and 2 sensory affections in the plate group, and 1 infection and 1 sensory affection in the intramedullary nail group. There were 2 refractures in the nail group. Operative versus nonoperative treatment: there were no differences in functional outcomes between the operative and nonoperative groups. For the main outcome QuickDASH both groups scored excellently (median 1.12 operative vs. 0 nonoperative). The nonoperative group was more satisfied with the cosmetic result. There was 1 nonunion in the nonoperative group that later was operated.

Conclusions:

Adolescents aged 12 to 18 years with displaced midshaft clavicular fractures show good long-term functional results after plate fixation, intramedullary nail, and nonoperative treatment. No additional benefit is demonstrated for surgery in our material. Nonoperatively treated patients are more satisfied with the cosmetic results. Little difference is seen between the operative methods in our study. We conclude that surgery should rarely be the choice of treatment for displaced midshaft clavicular fractures in adolescents.

Level of Evidence:

Level III study—retrospective comparative study.
Vertebral Body Rotational Osteotomy for Decompressing an Eccentrically Protruded Ossification of the Posterior Longitudinal Ligament
Authors: Lee Dong-Ho , Park Sehan , Cho Jae Hwan , Hwang Chang Ju , Lee Choon Sung
Published: February 2021

Vertebral body sliding osteotomy has been reported as a technique to manage cervical myelopathy caused by ossification of the posterior longitudinal ligament. It involves mobilization and anteriorly translating the vertebral body and ossified mass as a whole. The main advantage of the procedure is decreased rate of complication such as dural tear, implant dislodgement, and pseudarthrosis, which demonstrates high rate in anterior cervical corpectomy and fusion. Vertebral body rotational osteotomy is a modification of vertebral body sliding osteotomy. It is indicated for laterally deviated ossified mass to achieve further decompression. This is a technical note describing the procedures of vertebral body rotational osteotomy.
Posterior Osteotomy and Osteosynthesis for Malunited Atlas Fracture
Authors: De Iure Federico , Corghi Alessandro , Amendola Luca , Cappuccio Michele
Published: February 2021

Conservative treatment is commonly accepted and widely used for most atlas compression fractures. Malunion due to mismatching of the articular surfaces in C0–C1 and C1–C2 is therefore frequent even without associated instability. Such a result is considered acceptable in the elderly with low functional requests but should be avoided in young patients. Authors describe a new surgical technique to reduce and fix a nonunion and malunited fracture of the atlas through a posterior arch osteotomy followed by articular masses stabilization with polyaxial screws and precurved titanium rod. Rod prebending reduces lateral inclination of the screw heads during the reduction maneuver through compression applied between screw heads making it effective.
Posterior Ankle Pain After Ankle Sprain: Bony and Soft Tissue Impingement and Flexor Hallucis Longus (FHL) Tenosynovitis
Authors: Chao Wen , Lee Wonyong
Published: February 2021

The proper diagnosis of posterior ankle pain after ankle sprains is often missed. This can occur as an overuse injury or as a result of acute trauma in patients performing repetitive forced plantar flexion sports. An understanding of various causes of posterior ankle impingement, both bony and soft tissue, is critical to make the proper diagnosis and provide appropriate treatment. Nonoperative treatment should be considered as the initial treatment for the posterior ankle pathology. Surgical intervention is indicated if pain persists despite nonsurgical treatment, particularly for athletes or dancers who want to continue to train and perform their sport. Surgery can be performed using an open or arthroscopic approach.

Level of Evidence

Level V—expert opinion. See Instructions for Authors for a complete description of levels of evidence.
Lisfranc Injuries
Authors: Gentchos Christopher
Published: February 2021

Lisfranc injuries represent a heterogenous group of ligamentous and combined osseous-ligamentous injuries to the tarsometatarsal/midtarsal articulations. Higher-energy Lisfranc injuries rarely present delayed. Operative treatments have included percutaneous reduction internal fixation, open reduction internal fixation, and primary arthrodesis (PA). Outcomes in higher-energy injuries can be poor and salvage by secondary arthrodesis, if not performed as primary treatment, remains an option. Subtle, lower-energy injuries, or purely ligamentous Lisfranc injuries may be commonly overlooked. These injuries frequently require multiple imaging modalities to fully define, and optimal treatment continues to be controversial. It is universally agreed that regardless of surgical treatment, anatomic reduction of the affected joints is critical to maximize function and minimize pain. One prospective randomized controlled trial supports PA for ligamentous Lisfranc injuries and 1 retrospective comparative study reported PA results similarly favorable in both ligamentous and combined osseous-ligamentous injuries. One prospective randomized controlled trial and all other retrospective comparative studies and meta-analyses concluded that PA is not superior to open reduction internal fixation for ligamentous or combined injuries. Arthrodesis remains a successful option for failed prior nonarthrodesis treatments.

Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Volatile Sedation for Acute Respiratory Distress Syndrome Patients on Venovenous Extracorporeal Membrane Oxygenation and Ultraprotective Ventilation
Authors: Grasselli Giacomo , Giani Marco , Scaravilli Vittorio , Fumagalli Benedetta , Mariani Carminia , Redaelli Sara , Lucchini Alberto , Zanella Alberto , Patroniti Nicolò , Pesenti Antonio , Foti Giuseppe
Published: February 2021

Objectives:

Patients on extracorporeal support for severe acute respiratory distress syndrome may require a prolonged period of deep sedation. In these patients, volatile sedation may represent a valid alternative to IV drugs. The aim of our study was to describe the feasibility of volatile sedation in a large cohort of acute respiratory distress syndrome patients undergoing venovenous extracorporeal membrane oxygenation and ultraprotective ventilation.

Design:

Retrospective monocentric study.

Setting:

Adult ICU, ASST Monza, Italy.

Patients:

Adult patients who underwent volatile sedation with isoflurane during venovenous extracorporeal membrane oxygenation between 2009 and 2019.

Interventions:

Isoflurane was delivered via the AnaConDa system. The sedation level, hemodynamics, and laboratory tests were compared between the volatile sedation phase and the IV sedation phases before and after the isoflurane sedation period.

Measurements and Main Results:

About 74 patients (50 yr [43–56 yr]) were included. Median duration of venovenous extracorporeal membrane oxygenation support was 22 days (14–51 d). Volatile sedation started on day 3 (2–6) of extracorporeal membrane oxygenation support, and its median duration was 7 days (4–13 d), ranging from 1 to 38 days. A total of 970 venovenous extracorporeal membrane oxygenation days were analyzed. During the volatile phase, the sedation level was slightly deeper (bispectral index 39 ± 6) compared with the IV phase before and after isoflurane (42 ± 8 and 43 ± 9, respectively, p < 0.001). Requirements of fentanyl and remifentanyl were reduced during the volatile phase. Minor differences in hemodynamics were observed during volatile sedation: mean arterial pressure was lower (75 ± 13 vs 79 ± 14 and 80 ± 15; p < 0.001), whereas cardiac output was higher (8.5 ± 1.9 vs 7.9 ± 1.8 and 8.0 ± 1.8; p = 0.003). Aspartate aminotransferase levels were lower during the volatile sedation phases (p < 0.001), whereas alanine aminotransferase, triglycerides, and creatine phosphokinase were more altered during the IV sedation phase before isoflurane (p < 0.001).

Conclusions:

Volatile sedation represents an alternative to IV agents to achieve long-term deep sedation in critically ill patients on extracorporeal membrane oxygenation undergoing ultraprotective ventilation.
Impact of a Whole-Room Atomizing Disinfection System on Healthcare Surface Contamination, Pathogen Transfer, and Labor Efficiency
Authors: Reynolds Kelly A. , Sexton Jonathan D. , Garavito Fernanda , Anderson Brandie , Ivaska Joan M.
Published: February 2021

Objectives:

Healthcare surfaces contribute to nosocomial disease transmission. Studies show that despite standard guidelines and practices for cleaning and disinfection, secondary infection spread among healthcare workers and patients is common in ICUs. Manual terminal cleaning practices in healthcare are subject to highly variable results due to differences in training, compliance, and other inherent complexities. Standard cleaning practices combined with no-touch disinfecting technologies, however, may significantly lower nosocomial infection rates. The objective of this study was to evaluate the efficacy of a whole-room, no-touch disinfection intervention to reduce the concentration and cross-contamination of surface bacteria when used in tandem with manual cleaning protocols.

Design:

Bacterial tracers were seeded onto hospital room surfaces to quantitatively evaluate the efficacy of manual terminal cleaning practices alone and in tandem with a no-touch, whole-room atomization system. Cross-contamination potentials and labor efficiency were also evaluated.

Subjects and Intervention:

Environmental service personnel cleaning efficacy was evaluated pre and post application of manual terminal cleaning protocols alone and in tandem with a whole-room atomization system with an United States Environmental Protection Agency-registered hospital-grade hypochlorous acid disinfectant.

Setting:

The study was conducted in an unoccupied patient room at Banner University Medical Center in Tucson, AZ. The room was located in a newly constructed ICU suite.

Measurements and Main Results:

Manual terminal cleaning averaged a 2.4 log10 reduction in seeded bacterial counts compared with a 4.9 average and up to a 6 log10 reduction with tandem cleaning. Cross-contamination among surfaces following terminal cleaning alone was documented in 50% of the samples compared with 0% with tandem cleaning, with the latter achieving a 64% improvement in manual labor efficiency.

Conclusions:

The use of whole-room atomized disinfection with terminal cleaning protocols lowered manual labor times, improved disinfection outcomes, and eliminated the transfer of bacterial pathogens in healthcare environments.