bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal Tobacco Exposure and Childhood Neurodevelopment among Infants Born Prematurely
Authors: Robbins Lindsay S. , Blanchard Christina T. , Sinkey Rachel G. , Harris Stacy L. , Tita Alan T. , Harper Lorie M. 
Published: August 2020

Objective Nicotine is an established neuroteratogen, and prenatal tobacco exposure alters the structure of the developing nervous system. An association between prenatal tobacco exposure and impaired neurologic function is less well established. We examine the association between prenatal tobacco exposure and childhood neurodevelopment among infants born preterm.
Study Design Secondary analysis of a multicenter randomized controlled trial assessing the benefits of magnesium sulfate for the prevention of cerebral palsy in preterm infants. Women were included if they delivered a singleton and nonanomalous infant before 37 weeks. Exposure was any self-reported prenatal tobacco use. Primary outcome was the original trial composite outcome of moderate or severe cerebral palsy at 2 years of age, or stillbirth, or infant death by 1 year of age. Secondary outcomes included components of the composite and mild cerebral palsy at 2 years, Bayley Scales of Infant Development II motor and mental scores, death before two years, and use of auditory aids or corrective lenses. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals.
Results Of 1,826 women included, 503 (27.5%) used tobacco. Tobacco users were more likely to be older, unmarried, and white; have a prior preterm birth; have received no prenatal care; and to use illicit drugs or alcohol. Gestational age at delivery, betamethasone exposure, and magnesium exposure were not different between groups. There were no differences in the composite primary outcome or in rates of cerebral palsy by tobacco use. Moderate developmental delay was more common among tobacco exposed in bivariate but not adjusted analysis (20.5 vs. 15.9%, p = 0.035). In adjusted analysis, tobacco exposure was associated with increased use of corrective lenses (5.0 vs. 2.9%, aOR: 2.28, 95% confidence interval: 1.28–4.07).
Conclusion Prenatal tobacco exposure is not associated with neurodevelopmental impairment in infants born preterm. However, tobacco exposure may be associated with impaired vision.
Key Points
Evaluation of the Emergency Severity Index (Version 4) in Postpartum Women after Cesarean Delivery
Authors: Kawakita Tetsuya , Thomas Alexandra , Landy Helain J. 
Published: August 2020

Objective The Emergency Severity Index (ESI) version 4 is a 5-level triage system (1 being the highest acuity and 5 being the lowest acuity) used in the emergency department (ED). Our goal of the study was to compare rates of readmission according to ESI in postpartum women.
Study Design This was a secondary analysis of a retrospective cohort study of all women who presented to the ED within 6 weeks after cesarean delivery. The acuity level was assigned by triage nurses at the time of triage presentation. Our primary outcome was postpartum readmission. To examine if the addition of blood pressure to vital sign abnormalities would improve the prediction for readmission, we created a modified ESI. We identified women who had an ESI of level 3 and reassigned to a modified ESI of level 2 if blood pressure was in the severe range. Receiver operating characteristic curves with area under the curve (AUC) were created and compared between ESI and modified ESI.
Results Of 439 women, ESI distribution was 0.2% ESI 1, 23.7% ESI 2, 56.0% ESI 3, 19.4% ESI 4, and 0.7% ESI 5. Readmission rates by ESI level were 100% ESI 1, 47% ESI 2, 18% ESI 3, 2% ESI 4, and 0% ESI 5 (p < 0.001). Of 246 women who were assigned an ESI of 3, total 25 had severe range blood pressures and were reassigned to a modified ESI of 2. Of these 25 women, 14 were readmitted. The AUC of the modified ESI was statistically higher than that of the standard ESI (AUC: 0.77 and 95% confidence interval: 0.72–0.82 vs. AUC: 0.73 and 95% confidence interval: 0.68–0.78; p < 0.01).
Conclusion The ESI was a useful tool to identify women who required postpartum readmission. Incorporation of severe range blood pressure as a parameter of acuity improved the prediction of readmission.
Key Points
A Cadaveric Anatomical and Histological Study of Recipient Intercostal Nerve Selection for Sensory Reinnervation in Autologous Breast Reconstruction
Authors: Mohan Anita T. , Suchyta Marissa , Vyas Krishna S. , Lachman Nirusha , Mardini Samir , Saint-Cyr Michael 
Published: August 2020

Abstract
Background Autologous breast reconstruction (ABR) has grown in popularity due to improved aesthetic and long-term patient reported outcomes, but data regarding sensory reinnervation of autologous flaps remain limited. Traditionally, the lateral cutaneous branch of the fourth intercostal nerve has been used for flap neurotization, but the use of the anterior cutaneous branch of the intercostal nerves (ACB) offer a more optimal location to the microsurgical field when using internal mammary vessels for the microanastomosis. This study aimed to evaluate the optimum ACB recipient site level for sensory nerve coaptation in ABR.
Methods Twelve hemi-chests were dissected from six fresh cadaveric females. Costal cartilages were removed and the anterior cutaneous intercostal nerve (ACB) and the lateral (subcutaneous) division of the anterior cutaneous branch (LACB) of the intercostal nerve were exposed. Anatomical measurements were recorded, and nerve samples were evaluated histologically with carbonic anhydrase staining to differentiate sensory fascicles. Assessment of fascicular diameter, axonal counts, and fascicular area were compared.
Results A total of 75 nerve specimens were assessed. The ACB was identified at all levels (100%) and the subcutaneous LACB was noted consistently in the second to fourth rib space (96% cadavers), with a median length of 43, 37.5, and 37 mm, respectively. Across all rib spaces, the fascicular and axonal counts were comparable between the LACB and ACB. Nerves in the second intercostal space had a significantly larger mean fascicular area mean (112,816 ± 157,120 µm2) compared with that in the fourth (mean 26,474 ± 38,626 µm2), p = 0.03. Axonal count of sensory fascicles was the highest in the second intercostal nerves (p < 0.05).
Conclusion This study provides anatomical and histological basis to determine the optimum recipient site choice for sensory coaptation in microsurgical breast reconstruction. This would aid in operative decision-making regarding the ideal recipient anterior cutaneous intercostal nerve branches for recipient site coaptation in ABR.
Impact of Intraoperative Hypothermia on Microsurgical Free Flap Reconstructions
Authors: Moellhoff Nicholas , Broer Peter Niclas , Heidekrueger Paul I. , Ninkovic Milomir , Ehrl Denis 
Published: August 2020

Abstract
Background Patients requiring microsurgical defect reconstruction are highly susceptible to intraoperative hypothermia, given oftentimes long operative times and exposure of large skin surface areas. While the impact of hypothermia has been extensively studied across various surgical fields, its role in the setting of microsurgical free flap reconstruction remains elusive. This study evaluates the effects of hypothermia on outcomes of free flap reconstructions.
Methods Within 7 years, 602 patients underwent 668 microvascular free flap reconstructions. The cases were divided into two groups regarding the minimal core body temperature during free flap surgery: hypothermia (HT; < 36.0°C) versus normothermia (NT; ≥36.0°C). The data were retrospectively screened for patients' demographics, perioperative details, flap survival, surgical complications, and outcomes.
Results Our data revealed no significant difference with regard to the rate of major and minor surgical complications, or the rate of revision surgery between both groups (p > 0.05). However, patients in the HT group showed significantly higher rates of total flap loss (6.6% [HT] vs. 3.0% [NT], p < 0.05) and arterial thrombosis (4.6% [HT] vs. 1.9% [NT], p < 0.05). This translated into a significantly longer hospitalization of patients with reduced core body temperature (HT: mean 16.8 days vs. NT: mean 15.1 days; p < 0.05).
Conclusion Hypothermia increases the risk for arterial thrombosis and total flap loss. While free flap transfer is feasible also in hypothermic patients, surgeons' awareness of core body temperature should increase. Taken together, we suggest that the mean intraoperative minimum temperature should range between 36 and 36.5°C during free flap surgery as a pragmatic guideline.
Intercostal Nerve Transfers to the Musculocutaneous–A Reliable Nerve Transfer for Restoration of Elbow Flexion in Birth-Related Brachial Plexus Injuries
Authors: Lara Alex Muset , Bhatia Anil , Correa Jorge Clifton , Gammal Tarek Abdalla El 
Published: August 2020

Abstract
Introduction There is consensus on the need for early microsurgical reconstruction in birth palsies involving three or more roots, that is, extensive partial palsies and total palsies. The fundamental principles of these operations are complete exploration and judicious use of the ruptured stumps by nerve grafting to suitable distal targets. The frequent observation of root avulsions in such cases makes it imperative to look for extraplexual nerve donors for some functions. Intercostal nerves are readily available in such patients.
Materials and Methods This is a study of 50 patients of extensive partial and total birth palsies operated upon by the senior author between 1995 and 2010. These included 33 patients with total palsies, 16 patients with near total palsies, and one patient with C56 deficit (operated upon more than 20 years ago). These children were all operated upon between 3 and 6 months of age, except for two patients in whom surgery was delayed till a year due to the phrenic nerve deficit noted at birth. Four intercostal nerves were transferred to the musculocutaneous nerve (MCN) by direct approximation with fibrin glue.
Results No respiratory complication was noted from the intercostal harvest. The follow-up ranged from 8 to 20 years (mean 10 years). As many as 48 of the 50 patients regained fully independent elbow flexion. In two cases, the procedure failed completely and had to be salvaged with a free functioning muscle transfer and reuse of the intercostal nerves.
Conclusion Intercostal nerve transfers can be relied upon for restoration of elbow flexion in birth palsies. The ruptured roots can then be utilized for augmenting shoulder function in partial palsies or for hand function in total palsies.
To Evaluate the Effect of Water Temperature and Duration of Immersion on the Marginal Accuracy and Microhardness of Provisional Restoration: An In Vitro Study
Authors: Verma Sanjan , Kalra Tarun , Kumar Manjit , Bansal Ajay , Batra Ritu , Avasthi Abhishek 
Published: August 2020

Abstract
Introduction Provisional restoration is a critical component of fixed prosthodontics treatment, which must satisfy many inter-relative factors such as biological, mechanical, and esthetic. These restorations should have accurate marginal adaptation and optimum strength to maintain functional demands. The present “in vitro” study was conducted to evaluate the effect of water temperature and duration of immersion, on the marginal adaptation and microhardness of four different commercially available provisional restorative materials.
Materials and Methods The 240 specimens were then seated on the stainless-steel die which simulated the prepared tooth, and evaluated for the marginal gap for four different provisional restorative materials and divided into four different groups A, B, C, and D. Each group was further divided into six subgroups according to temperature of water and time of immersion. In each group the samples were immersed in water at 20, 30, and 40 degrees, respectively for 5 and 10-minutes duration. Four different temporary restorative materials for crown fabrication were loaded each time to make temporary crowns.
Results Each sample was placed under travelling stereoscopic microscope (20× magnification) and photographed. Results for each surface were obtained, and the average of three surfaces was calculated. Knoop hardness was measured using a microhardness tester. The study was subjected to statistical analysis, to know the statistical significance, of the effect of difference in time and temperature changes at the time of final polymerization on surface microhardness and marginal integrity of four different provisional restorative materials.
Discussion The mean marginal discrepancies of bis-GMA (group B) at 20, 30, and 40°C for 5 and 10 minutes in water were smaller than the results of other groups. Microhardness evaluation showed that the poly ethyl methacrylate (PEMA) type resin exhibited significantly lower microhardness than the bis-acryl resin composites (Protemp 4 and Systemp.c&b) at both time and temperature intervals.
Conclusion The bis-acryl composites material has the least marginal discrepancy in comparison with PEMA and polymethyl methacrylate (PMMA). The bis-acryl composites materials exhibit superior surface microhardness followed by PEMA and PMMA.
Internal Fixation of a Complicated Mandibular Fracture in a Filly Using a String-of-Pearls Locking Plate Assisted by a 3D Printed Model
Authors: Boorman Sophie , Lascola Kara , Mora-Pereira Mariano , Ceriotti Serena , Boone Lindsey 
Published: August 2020

AbstractObjective The aim of this study was to describe the successful surgical treatment of a complicated mandibular fracture with a 3.5 mm string-of-pearls (SOP) locking plate in a 5-month-old Appaloosa filly presenting with neurological signs.Study Design This is a case report.Results The neurological signs were due to severe head trauma and stabilized with medical treatment. Financial concerns initially prevented advanced imaging; radiographs identified a mandibular symphysis fracture, a fracture of the left vertical ramus that originated at the junction between the horizontal and vertical ramus and extended toward the coronoid process and rostral maxillary fractures. Following intra-dental wiring of the symphysis fracture, a lateral malocclusion developed. Computed tomography additionally identified fractures of the right wing of the basisphenoid bone, right zygomatic arch, left paracondylar process and the lateral body of the mandible. The vertical ramus fracture was repaired utilizing a 20-hole 3.5 mm SOP plate contoured to the ventral aspect of the angle of the mandible. A scaled (1:4) three-dimensional printed model aided pre- and intra-operative surgical planning. The filly was comfortable and eating well at the 4-week recheck. Radiographs showed good callus formation at the maxilla, healing of the mandibular symphysis and ramus. Just prior to the 10-week recheck, the filly suffered severe enterocolitis and was euthanatized.Conclusion The locking function of the SOP plate provided adequate stability for the fracture to heal without the expense of locking screws. The three-dimensional printed model aided in navigation of the complex fracture without the availability of fluoroscopy.
Tracheal Allotransplantation–Lessons Learned
Authors: Iyer Subramania , Subramaniam Narayana , Vidhyadharan Sivakumar , Thankappan Krishnakumar , Balasubramanian Deepak , R. Balasubramanian K. , Nair Arun , Purushottaman Kishore , Ramu Janarthanan , Paul Zachariah 
Published: August 2020

AbstractReconstruction of long tracheal defects still proves to be a challenge. Free fasciocutaneous flaps with cartilaginous struts or an allotransplant trachea have been reported but not been widely performed. This article reports with the experience of using a tracheal allotransplant in such a defect.A 43-year-old lady presented with adenoid cystic carcinoma involving the entire trachea from subglottic area up to the carina, leading to a life-threatening airway occlusion. After preliminary stenting, allotransplant trachea obtained from a brain-dead individual was revascularized in the forearm of the patient after mechanical decellularization to reduce the immune load and fulfil the need for immunosuppression in the background of active cancer. Subsequently, the trachea and larynx were resected. The vascularized neotrachea was transferred successfully into the neck. The patient did well initially but succumbed to a fatal hemorrhage due to innominate vein aneurysmal rupture on the 22nd day after the transplant.The technical details of resection, fabrication of the neotrachea, its transfer, and the lessons learnt in this tracheal allotransplant are described.
Music attenuates a widened central pulse pressure caused by resistance exercise: A randomized, single‐blinded, sham‐controlled, crossover study
Authors: Tagawa Kaname , Nakata Yoshio , Yokota Atsumu , Sato Tomohito , Maeda Seiji 
Published: August 2020

AbstractIncreasing central blood pressure is an independent predictor of cardiovascular disease and is an acute effect of high‐intensity resistance exercise. It has been shown that classical music suppresses increased peripheral pressure during exercise. We hypothesized that classical music would suppress increased central pressure induced by high‐intensity resistance exercise. To confirm this hypothesis, we examined the effect of classical music on central pressure following high‐intensity resistance exercise in 18 young men. A randomized, single‐blinded, sham‐controlled, crossover trial was conducted under parallel experimental conditions on four separate days. The order of experiments was randomized between sham control (seated rest), music (20‐min classical music track compilation), resistance exercise (5 sets of 10 repetitions at 75% of 1 repetition maximum), and resistance exercise with music conditions. Aortic pressure was measured in all subjects. No significant interaction between time, music, and resistance exercise was observed for aortic systolic pressure and diastolic pressure. In contrast, aortic pulse pressure showed a significant interaction; that is, aortic pulse pressure significantly widened after resistance exercise, whereas music significantly attenuated this widening. No significant change was observed in aortic pulse pressure in sham control and music conditions. The present findings suggest that music attenuates resistance exercise‐induced increase in central pressure.
p‐Synephrine, the main protoalkaloid of Citrus aurantium, raises fat oxidation during exercise in elite cyclists
Authors: Gutiérrez‐Hellín Jorge , Baltazar‐Martins Gabriel , Rodríguez Iván , Lara Beatriz , Ruiz‐Moreno Carlos , Aguilar‐Navarro Millán , Del Coso Juan 
Published: August 2020

AbstractThe aim of this study was to investigate the acute effects of p‐synephrine ingestion on substrate oxidation during exercise in elite cyclists. Fifteen elite cyclists volunteered to participate in a double blind, crossover, randomized and placebo‐controlled experimental trial. During two different trials, participants either ingested a placebo (cellulose) or 3 mg/kg of p‐synephrine. After 60 min for substances absorption, participants performed an incremental maximal cycle ergometer test until volitional fatigue (25 W/min). Breath‐by‐breath gas exchange data was continuously recorded during the entire test to estimate energy expenditure, carbohydrate oxidation, and fat oxidation rates by stoichiometric equations. Heart rate was continuously measured by using a heart rate monitor. The ingestion of p‐synephrine had no significant effects on energy expenditure (F = 0.71, P = 0.40) or heart rate (F = 0.66, P = 0.43) during exercise. However, there was a main effect of p‐synephrine to increase the rate of fat oxidation over the placebo (F = 5.1, P = 0.04) and the rate of fat oxidation was higher with p‐synephrine in the following loads: 45 ± 2%, 51 ± 3%, 62 ± 3%, 67 ± 4%, 79 ± 5% and 85 ± 5% of the maximum wattage obtained in the test (all P < 0.05). The ingestion of p‐synephrine did not modify the maximal rate of fat oxidation during the ramp test (mean value; 95%CI = 0.91; 0.79–1.03 vs 1.01; 0.91–1.11 g/min, respectively, P = 0.06) nor the exercise intensity at which maximal fat oxidation was achieved (i.e. Fatmax = 49; 48–53 vs 50; 47–51% Wmax, P = 0.52). Acute p‐synephrine ingestion moved the fat oxidation‐exercise intensity curve upwards during an incremental cycling test without affecting Fatmax.
Acute effects of caffeine supplementation on resistance exercise, jumping, and Wingate performance: no influence of habitual caffeine intake
Authors: Grgic Jozo , Mikulic Pavle 
Published: August 2020

AbstractThis study explored the influence of habitual caffeine intake on the acute effects of caffeine ingestion on resistance exercise, jumping, and Wingate performance. Resistance‐trained males were tested following the ingestion of caffeine (3 mg/kg) and placebo (3 mg/kg of dextrose). Participants were classified as low caffeine users (n = 13; habitual caffeine intake: 65 ± 46 mg/day) and as moderate‐to‐high caffeine users (n = 11; habitual caffeine intake: 235 ± 82 mg/day). Exercise performance was evaluated by measuring: (a) movement velocity, power, and muscular endurance in the bench press; (b) countermovement jump; and, (c) a Wingate test, performed in that order. Two‐way repeated‐measures ANOVA revealed a significant main effect (p < 0.05) for condition in the majority of analyzed exercise outcomes. In all cases, effect sizes for condition favoured caffeine and ranged from 0.14 to 0.97. Mean increases in velocity and power in resistance exercise ranged from 0.02 to 0.08 m/s and 42 to 156 W, respectively. The number of performed repetitions increased by 1.2 and jump height by 0.9 cm. Increases in power in the Wingate test ranged from 31 to 75 W. We did not find significant group × condition interaction effect (p > 0.05) in any of the analyzed exercise outcomes. Additionally, there were no significant correlations (p > 0.05; r ranged from −0.29 to 0.32) between habitual caffeine intake and the absolute change in exercise performance. These results suggest that habitual caffeine intake might not moderate the ergogenic effects of acute caffeine supplementation on resistance exercise, jumping, and Wingate performance.
Human Dignity, the Right to be Heard, and Algorithmic Judges
Authors: Dao André 
Published: August 2020

Abstract
This article examines the requirements of the right to a fair trial in the context of the use of machine-learning algorithms (MLAs) in judicial proceedings, with a focus on a core component of this right, the right to be heard. Though NGOs and scholars have begun to note that the right to a fair trial may be the best framework to address the challenges raised by MLAs, the actual requirements of the right in this novel context are underdeveloped. This article evaluates two normative approaches to filling this gap. The first approach, the argument from fairness, produces three broad categories of measures for ensuring fairness: measures for increasing the transparency and accountability of MLAs, measures for ensuring the participation of litigants, and measures for securing the impartiality of the human judge. However, this article argues that the argument from fairness cannot provide the necessary normative grounding for the right to a fair trial in the context of MLAs, as it collapses into the concept of ‘algorithmic fairness’. The second approach is based on the concept of human dignity as a status. The primary argument of this article is that the concept of human dignity as a status can provide better normative grounding for the right to a fair trial because it offers an account of human personhood that resists the de-humanization of data subjectification. That richer account of human personhood allows us to think of the trial not only as a vehicle for accurate outcomes, but also as a forum for the expression of human dignity.