bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Cervical Plexus Block for Neck and Shoulder Pain Due to Myofascial Pain
Authors: Naja Ahmad S. , Madi Naji , Tfayli Yehia , Ziade Fouad , Haber Georges , Kanawati Saleh , Naja Zoher 
Published: December 2020

Objectives:
Myofascial pain is one of the most common causes of regional pain with no definitive treatment. This randomized clinical trial was conducted to assess the efficacy of deep cervical plexus block versus placebo injection (sham block) for the treatment of myofascial neck and shoulder pain in terms of analgesic consumption and pain during a follow-up period of 2 weeks after the block.

Materials and Methods:
Patients were randomly divided into 2 groups. Group I (block) received deep cervical plexus block and group II (placebo) received normal saline. A total of 66 patients were included in the study, 34 patients in the block group and 32 patients in the placebo group.

Results:
Two weeks after the intervention, the average pain duration was significantly lower in the block group: 1.38±1.39 versus 5.25±1.72 for the block and placebo groups, respectively (P<0.0001). Pain intensity was significantly less in the block group such that 2.9% of patients in the block group had severe pain compared with 53.1% of patients in the placebo group (P<0.0001). Two weeks after receiving the block, the mean opioid consumption calculated as tramadol equivalent was 21.1±44.2 mg compared with 166.1±118.8 mg for the block and placebo groups, respectively. Multivariate analysis showed that patients with a longer history of pain had a higher pain score after 2 weeks. The possibility of recovery is affected by pain duration as patients with a history of chronic pain were least affected by the block.

Discussion:
This technique could be an alternative to pharmacological and other nonpharmacological treatments for myofascial pain.
Statewide Severe Maternal Morbidity Review in Illinois
Authors: Geller Stacie E. , Garland Caitlin E. , Horne Ashley A. 
Published: December 2020

OBJECTIVE
To address rising rates of severe maternal morbidity and persistent racial disparities, Illinois established severe maternal morbidity review in all obstetric hospitals. The purpose of this study is to describe the findings from the statewide severe maternal morbidity review in 2018.

METHODS
This is a retrospective analysis of a hospital-level severe maternal morbidity review that occurred in 2018 (n=408) compared with all 2018 Illinois live births (n=141,595), inclusive of any severe maternal morbidity cases resulting in a live birth before hospital discharge. Cases were chosen for review based on completeness of records, complexity of the case, or an assessment that cases presented opportunities for learning and quality improvement; ie, not all severe maternal morbidity cases were reviewed. We present descriptive characteristics that contributed to the severe maternal morbidity event, and health care professional, system, and patient opportunities to alter the severe maternal morbidity outcome.

RESULTS
A total of 408 severe maternal morbidity cases were reviewed. Women with severe maternal morbidity were more likely to be non-Hispanic Black, multiparous, aged 35 years or older, have public insurance, and receive inadequate prenatal care. The most common causes of severe maternal morbidity were hemorrhage (48%), and preeclampsia and eclampsia (20%). Overall, 42% of severe maternal morbidity cases had opportunities to improve care. Non-Hispanic Black women had a disproportionately high burden of severe maternal morbidity due to preeclampsia and eclampsia (31% vs 18.1%) and were more likely to need improvement in care compared with non-Hispanic White women (53% vs 39.0%). The most common opportunities to alter the severe maternal morbidity outcome were health care professional factors during the intrapartum (9%) and postpartum (10%) periods.

CONCLUSION
Standardized severe maternal morbidity review gives a fuller view of the state of maternal health and highlights opportunities to improve quality of care.
Endothelial Biomarkers Are Associated With Indirect Lung Injury in Sepsis-Associated Pediatric Acute Respiratory Distress Syndrome
Authors: Whitney Jane E. , Feng Rui , Koterba Natalka , Chen Fang , Bush Jenny , Graham Kathryn , Lacey Simon F. , Melenhorst Jan Joseph , Parikh Samir M. , Weiss Scott L. , Yehya Nadir 
Published: December 2020

Objectives:
Acute respiratory distress syndrome occurring in the setting of direct versus indirect lung injury may reflect different pathobiologies amenable to different treatment strategies. We sought to test whether a panel of plasma biomarkers differed between children with sepsis-associated direct versus indirect acute respiratory distress syndrome. We hypothesized that a biomarker profile indicative of endothelial activation would be associated with indirect acute respiratory distress syndrome.

Design:
Observational cohort.

Setting:
Academic PICU.

Subjects:
Patients less than 18 years old with sepsis-associated direct (pneumonia, n = 52) or indirect (extrapulmonary sepsis, n = 46) acute respiratory distress syndrome.

Interventions:
None.

Measurements and Main Results:
Of 58 biomarkers examined, 33 differed by acute respiratory distress syndrome subtype. We used classification and regression tree methodology to examine associations between clinical and biochemical markers and acute respiratory distress syndrome subtype. The classification and regression tree model using only clinical variables (age, sex, race, oncologic comorbidity, and Pediatric Risk of Mortality-III score) performed worse than the classification and regression tree model using five clinical variables and 58 biomarkers. The best classification and regression tree model used only four endothelial biomarkers, including elevated angiopoietin-2/angiopoietin-1 ratio, vascular cell-adhesion molecule, and von Willebrand factor, to identify indirect acute respiratory distress syndrome. Test characteristics were 89% (80–97%) sensitivity, 80% (69–92%) specificity, positive predictive value 84% (74–93%), and negative predictive value 86% (76–96%).

Conclusions:
Indirect lung injury in children with acute respiratory distress syndrome is characterized by a biomarker profile indicative of endothelial activation, excess inflammation, and worse outcomes. A model using four biomarkers has the potential to be useful for more precisely identifying patients with acute respiratory distress syndrome whose pathobiology may respond to endothelial-targeted therapies in future trials.
Behavior Change Techniques in Continuing Professional Development
Authors: Konnyu Kristin J. , McCleary Nicola , Presseau Justin , Ivers Noah M. , Grimshaw Jeremy M. 
Published: December 2020

Abstract
Continuing professional development (CPD) is a widely used and evolving set of complex interventions that seeks to update and improve the knowledge, skills, and performance of health care professionals to ultimately improve patient care and outcomes. While synthesized evidence shows CPD in general to be effective, effects vary, in part due to variation in CPD interventions and limited understanding of CPD mechanisms of action. We introduce two behavioral science tools—the Behavior Change Technique Taxonomy version 1 and the Theoretical Domains Framework—that can be used to characterize the content of CPD interventions and the determinants of behaviour potentially targeted by the interventions, respectively. We provide a worked example of the use of these tools in coding the educational content of 43 diabetes quality improvement trials containing clinician education as part of their multicomponent intervention. Fourteen (of a possible 93; 15%) behavior change techniques were identified in the clinician education content of the quality improvement trials, suggesting a focus of addressing the behavioral determinants beliefs about consequences, knowledge, skills, and social influences, of diabetes care providers' behavior. We believe that the Behavior Change Technique Taxonomy version 1 and Theoretical Domains Framework offer a novel lens to analyze the CPD content of existing evidence and inform the design and evaluation of future CPD interventions.
Targeted inhibition of myeloid-derived suppressor cells in the tumor microenvironment by low-dose doxorubicin to improve immune efficacy in murine neuroblastoma
Authors: Xu Wei-Li , Shi Bao-Jun , Li Suo-Lin , Yu Feng-Xue , Guo Li-Na , Li Meng , Hu Zhi-Gang , Li Gui-Xin , Zhou Hui 
Published: December 2020

Abstract

Background
High agglomeration of myeloid-derived suppressor cells (MDSCs) in neuroblastoma (NB) impeded therapeutic effects. This study aimed to investigate the role and mechanism of targeted inhibition of MDSCs by low-dose doxorubicin (DOX) to enhance immune efficacy in NB.

Methods
Bagg albino (BALB/c) mice were used as tumor-bearing mouse models by injecting Neuro-2a cells, and MDSCs were eliminated by DOX or dopamine (DA) administration. Tumor-bearing mice were randomly divided into 2.5 mg/kg DOX, 5.0 mg/kg DOX, 50.0 mg/kg DA, and control groups (n = 20). The optimal drug and its concentration for MDSC inhibition were selected according to tumor inhibition. NB antigen-specific cytotoxic T cells (CTLs) were prepared. Tumor-bearing mice were randomly divided into DOX, CTL, anti-ganglioside (GD2), DOX+CTL, DOX+anti-GD2, and control groups. Following low-dose DOX administration, immunotherapy was applied. The levels of human leukocyte antigen (HLA)-I, CD8, interleukin (IL)-2 and interferon (IFN)-γ in peripheral blood, CTLs, T-helper 1 (Thl)/Th2 cytokines, perforin, granzyme and tumor growth were compared among the groups. The Wilcoxon two-sample test and repeated-measures analysis of variance were used to analyze results.

Results
The slowest tumor growth (F = 6.095, P = 0.018) and strongest MDSC inhibition (F = 14.632, P = 0.001) were observed in 2.5 mg/kg DOX group. Proliferation of T cells was increased (F = 448.721, P < 0.001) and then decreased (F = 2.047, P = 0.186). After low-dose DOX administration, HLA-I (F = 222.489), CD8 (F = 271.686), Thl/Th2 cytokines, CD4+ and CD8+ lymphocytes, granzyme (F = 2376.475) and perforin (F = 488.531) in tumor, IL-2 (F = 62.951) and IFN-γ (F = 240.709) in peripheral blood of each immunotherapy group were all higher compared with the control group (all of P values < 0.05). The most significant increases in the aforementioned indexes and the most notable tumor growth inhibition were observed in DOX+anti-GD2 and DOX+CTL groups.

Conclusions
Low-dose DOX can be used as a potent immunomodulatory agent that selectively impairs MDSC-induced immunosuppression, thereby fostering immune efficacy in NB.
Prevalence and risk factors for bone mineral density changes in antiretroviral therapy-naive human immunodeficiency virus-infected adults: a Chinese cohort study
Authors: Zeng Yong-Qin , Xiao Jiang , Li Cui-Lin , Wang Yu , Zhang Ling , Pang Xiao-Li , Wang Di , Du Juan , Zhao Hong-Xin 
Published: December 2020

Abstract

Background
Studies have reported that low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected patients; however, the factors that contribute to HIV-related BMD changes are yet to be fully understood. Due to the application of dual X-ray absorptiometry (DXA) among a select group of hospitals only, the prevalence and risk factors of low BMD in HIV-infected populations have not been intensively investigated in China. Thus, the aim of our study was to investigate the prevalence of and risk factors associated with BMD changes among antiretroviral therapy (ART)-naive HIV-positive patients in China.

Methods
The assessment of the prevalence of and risk factors associated with BMD changes was conducted among 156 ART-naive HIV-infected patients. Demographic and clinical data, as well as results of fasting blood tests were obtained from patients. Further, all patients underwent DXA scans to determine BMD, which was then used to classify patients with osteopenia/osteoporosis. The risk factors of reduced BMD were then evaluated using binary logistic regression.

Results
Among the 156 ART-naive HIV-infected participants, osteopenia and osteoporosis were diagnosed in 48.7% (76/156) and 4.5% (7/156) of patients, respectively. The lumbar spine was most likely to have reduced BMD (49.4% [77/156]), and the proportion of osteopenia in the left hip (32.7% [51/156]) was higher than in the right hip (24.4% [38/156]). In the lumbar spine, bone loss rate in the L1 section (60.9% [95/156]) was the most significant (L2, 53.2% [83/156]; L3, 45.5% [71/156]; L4, 52.6% [82/156]). Further analysis showed that, compared with the neck (26.9% [42/156] in the left, 18.6% [29/156] in the right) and the interior (15.4% [24/156] in the left, 13.5% [21/156] in the right), the trochanter had the greatest probability of reduced BMD (46.2% [72/156] in the left, 28.8% [45/156] in the right). In the risk factor analysis, low body mass index (BMI: <18.5 kg/m2) was positively associated with reduced BMD (Exp (B) = 39.743, 95% confidence interval: 3.234–488.399, P = 0.004), and was specifically positively correlated with BMD values at three sites (r = 0.335 at right hip, r = 0.327 at left hip, r = 0.311 at lumbar spine).

Conclusion
Reduced BMD was found in the majority of ART-naive HIV-infected patients and BMI was identified as an additional risk factor for reduced BMD. Our results show that BMD reduction was simultaneously present in the left hip, right hip, and lumbar spine among nearly one fifth of patients. Our work highlights the importance of closely monitoring BMD in ART-naive patients and provides a foundation for the clinical intervention of bone demineralization in them.
When Healthcare Isn't Enough
Authors: Lathrop Breanna 
Published: December 2020

ABSTRACT:
Education, employment, housing, neighborhood safety, and traumatic life experiences influence people's health, and poor health as a result of inequities in these areas cannot be remedied by medical care alone. Although social determinants of health threaten the attainment of a healthy life for people across North America, nurses are positioned to be leaders in a movement toward health equity. Nurses can follow the example of Jesus in loving their neighbors as themselves by addressing the social needs of patients, championing health system change, educating their communities, and advocating for Health in All Policies.
Effect of dexmedetomidine on Nociception Level Index-guided remifentanil antinociception
Authors: Coeckelenbergh Sean , Doria Stefano , Patricio Daniel , Perrin Laurent , Engelman Edgard , Rodriguez Alexandra , Di Marco Livia , Van Obbergh Luc , Estebe Jean-Pierre , Barvais Luc , Kapessidou Panayota 
Published: December 2020

BACKGROUND
The effect of dexmedetomidine on Nociception Level Index-guided (Medasense, Israel) antinociception to reduce intra-operative opioid requirements has not been previously investigated.

OBJECTIVE
We aimed to determine if low-dose dexmedetomidine would reduce remifentanil requirements during Nociception Level Index-guided antinociception without increasing complications associated with dexmedetomidine.

DESIGN
Double-blind randomised controlled trial.

SETTING
Two university teaching hospitals in Brussels, Belgium.

PATIENTS
American Society of Anesthesiologists 1 and 2 patients (n = 58) undergoing maxillofacial or cervicofacial surgery under propofol--remifentanil target-controlled infusion anaesthesia.

INTERVENTIONS
A 30 min infusion of dexmedetomidine, or equal volume of 0.9% NaCl, was infused at 1.2 μg kg−1 h−1 immediately preceding induction and then decreased to 0.6 μg kg−1 h−1 until 30 min before ending surgery. Nociception Level Index and frontal electroencephalogram guided the remifentanil and propofol infusions, respectively.

MAIN OUTCOMES
The primary outcome was the remifentanil requirement. Other outcomes included the propofol requirement, cardiovascular status and postoperative outcome.

RESULTS
Mean ± SD remifentanil (3.96 ± 1.95 vs. 4.42 ± 2.04 ng ml−1; P = 0.0024) and propofol (2.78 ± 1.36 vs. 3.06 ± 1.29 μg ml−1; P = 0.0046) TCI effect site concentrations were lower in the dexmedetomidine group at 30 min postincision and remained lower throughout surgery. When remifentanil (0.133 ± 0.085 vs. 0.198 ± 0.086 μg kg−1 min−1; P = 0.0074) and propofol (5.7 ± 2.72 vs. 7.4 ± 2.80 mg kg−1 h−1; P = 0.0228) requirements are represented as infusion rates, this effect became statistically significant at 2 h postincision.

CONCLUSION
In ASA 1 and 2 patients receiving Nociception Level Index-guided antinociception, dexmedetomidine decreases intra-operative remifentanil requirements. Combined frontal electroencephalogram and Nociception Level Index monitoring can measure dexmedetomidine's hypnotic and opioid-sparing effects during remifentanil-propofol target-controlled infusion anaesthesia.

TRIAL REGISTRATIONS
Clinicaltrials.gov: NCT03912740, EudraCT: 2018-004512-22.
Effect of Secondary Prevention Medication on the Prognosis in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease
Authors: Abdu Fuad A. , Liu Lu , Mohammed Abdul-Quddus , Xu Bin , Yin Guoqing , Xu Siling , Xu Yawei , Che Wenliang 
Published: December 2020

Abstract:
Myocardial infarction with nonobstructive coronary arteries (MINOCA) has been and remained a puzzling clinical entity. The role of secondary prevention therapy in patients with MINOCA remains unclear. This study aimed to evaluate the associations between secondary prevention medications and outcomes in patients with MINOCA. A total of 259 patients with MINOCA were consecutively enrolled. Basic information and medication of patients were assessed. We defined major adverse cardiovascular events as the primary end point and angina rehospitalization as the secondary end point. Logistic regression models were used to assess the correlation between treatment and outcomes. The proportion of statins, aspirin, clopidogrel, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB), and β-blocker used at admission was 88.8%, 86.9%, 84.6%, 51.7%, and 61.4%, respectively. At discharge, patients with MINOCA were less likely to be released on statins, aspirin, clopidogrel, ACEI/ARB, and β-blocker. The use of secondary prevention medications was significantly lower at 2 years of follow-up with the most significant reductions being clopidogrel 29.4%, ACEI/ARB 39.0%, and aspirin 42.3%. About 19.1% of patients with MINOCA suffered adverse events during the follow-up period. Adverse events risk decreased when statins and ACEI/ARB were used, whereas the risk of adverse events was not lower in patients with aspirin, clopidogrel, and β-blocker. In conclusion, patients with MINOCA were less likely to receive secondary prevention medications at the time of discharge and early discontinuation of medications at the time of follow-up. Statins and ACEI/ARB were the only medications substantially associated with lower adverse events; by comparison, aspirin, clopidogrel, and β-blocker seem to have no impact on prognosis.
Characterization of Endothelial Cell Loss in Pre-Descemet Endothelial Keratoplasty Graft Preparation
Authors: Bedard Peter , Hou Joshua H. 
Published: December 2020

Purpose:
To characterize the pattern and factors affecting endothelial cell loss (ECL) in pre-Descemet Endothelial Keratoplasty (PDEK) graft preparation.

Methods:
A prospective study was performed to characterize the pattern of ECL and the impact of inflation pressure in PDEK. Donor corneas were randomized to inflation with air versus Optisol GS storage media. PDEK preparation was performed under continuous pressure monitoring. Trypan blue was used to grade the tissue as acceptable (<25% ECL) or unacceptable (≥25% ECL). Rate of unacceptable ECL was correlated with injection media type and inflation pressure. A retrospective study was then performed of all attempted PDEK preparations at Lions Gift of Sight to evaluate impact of donor tissue factors on ECL. Donor age and tissue preservation time were evaluated and correlated with ECL with PDEK bubbling.

Results:
Twenty-five corneas were tested prospectively. A reticular pattern of ECL that varied in severity occurred with bubbling. There was no difference in peak inflation pressure or mean expansion pressure between air (706.0, 510.7 mm Hg) and Optisol GS (852.9, 653.0 mm Hg). Increasing peak inflation pressure and mean expansion pressure were associated with an increased risk for unacceptable ECL. On retrospective evaluation of 131 attempted PDEKs, only 44.0% of cases with successful bubbles had acceptable endothelium after processing. Increasing donor age and decreasing preservation time were associated with increased rates of acceptable endothelium.

Conclusions:
PDEK processing can result in a reticular pattern of ECL. Higher inflation pressures are associated with greater ECL. Older donor tissues with shorter preservation times might be preferable for PDEK.
Systematic Review of Postcochlear Implant Electrode Migration: What Is Known?
Authors: Alenzi Saad , Khurayzi Tawfiq , Alshalan Afrah , Almuhawas Fida , Alsanosi Abdulrahman 
Published: December 2020

Background and Objectives:
Electrode migration after cochlear implantation (CI) is a rare complication that accounts for 1to 15% of all revision surgery. This study is a systematic review of the literature for investigating the knowledge and approaches to the incidence of electrode migration after CI.

Methods:
A systematic electronic search of the literature was carried out using PubMed, Cochrane, Virtual Health Library, Scopus and Web of Science (ISI). All original articles that reported electrode migration after CI surgery were included. The Newcastle-Ottawa Scale and CARE checklist were utilized for the assessment of the risk of bias. Descriptive data analysis was performed using SPSS software.

Results:
A total of 26 studies including 4,316 patients were included. Out of them, 289 patients had electrode migration following CI. To diagnose electrode migration, traditional computed tomography scan was used in 13 studies, while cone-beam computed tomography was applied in three studies. In addition, electrode migration was detected during intraoperative exploration in eight studies. The most common presenting symptom was change in sound/poor performance (n = 43) followed by pain sensation (n = 15) and facial nerve stimulation (n = 10). Cholesteatoma was the most common associated pathology (n = 10) followed by infection (n = 9) and ossification of the basal turn of the cochlea (n = 8).

Conclusion:
Electrode migration is a major complication of CI and could be more common than previously thought. As it may occur with or without clinical complaints, long-term follow-up through routine radiological scanning is recommended. Further studies are warranted to identify the underlying mechanism of electrode extrusion and the appropriate fixation method.