bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dexamethasone Dose and Early Postoperative Recovery after Mastectomy
Authors: Steinthorsdottir Kristin Julia , Awada Hussein Nasser , Abildstrøm Hanne , Kroman Niels , Kehlet Henrik , Kvanner Aasvang Eske 
Published: January 2020

Abstract

Background
Pain and nausea are the most common challenges in postoperative recovery after mastectomy. Preventive measures include multimodal analgesia with preoperative glucocorticoid. The aim of this study was to investigate whether 24 mg of preoperative dexamethasone was superior to 8 mg on early recovery after mastectomy in addition to a simple analgesic protocol.

Methods
In a randomized, double-blind trial, patients 18 yr of age or older having mastectomy were randomized 1:1 to 24 mg or 8 mg dexamethasone, and all received a standardized anesthetic and surgical protocol with preoperative acetaminophen, total intravenous anesthesia, and local anesthetic wound infiltration. The primary endpoint was number of patients transferred to the postanesthesia care unit according to standardized discharge criteria (modified Aldrete score). Secondary endpoints included pain and nausea at extubation, transfer from the operating room and upon arrival at the ward, length of stay, seroma occurrence, and wound infections.

Results
One hundred thirty patients (65 in each group) were included and analyzed for the primary outcome. Twenty-three (35%) in each group met the primary outcome, without significant differences in standardized discharge scores (odds ratio, 1.00 [95% CI, 0.49 to 2.05], P > 0.999). More patients had seroma requiring drainage in the 24 mg versus 8 mg group, 94% versus 81%, respectively (odds ratio, 3.53 [95% CI, 1.07 to 11.6], P = 0.030). Median pain scores were low at all measured time points, numeric rating scale less than or equal to 2 versus less than or equal to 1 in the 24 mg versus 8 mg group, respectively. Six patients in each group (9%) experienced nausea at any time during hospital stay (P > 0.999). Length of stay was median 11 and 9.2 h in the 24 and 8 mg group, respectively (P = 0.217).

Conclusions
The authors found no evidence of 24 mg versus 8 mg of dexamethasone affecting the primary outcome regarding immediate recovery after mastectomy. The authors observed a short length of stay and low pain scores despite a simple analgesic protocol.

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Supraspinal Opioid Circuits Differentially Modulate Spinal Neuronal Responses in Neuropathic Rats
Authors: Dickenson Anthony H. , Navratilova Edita , Patel Ryan , Porreca Frank , Bannister Kirsty 
Published: January 2020

Abstract

Background
The anterior cingulate cortex and central nucleus of the amygdala connect widely with brainstem nuclei involved in descending modulation, including the rostral ventromedial medulla. Endogenous opioids in these circuits participate in pain modulation. The hypothesis was that a differential opioidergic role for the brain nuclei listed in regulation of spinal neuronal responses because separable effects on pain behaviors in awake animals were previously observed.

Methods
This study utilized in vivo electrophysiology to determine the effects of morphine microinjection into the anterior cingulate cortex, right or left central nucleus of the amygdala, or the rostral ventromedial medulla on spinal wide dynamic range neuronal responses in isoflurane-anesthetized, male Sprague–Dawley rats. Ongoing activity in the ventrobasal thalamus was also measured. In total, 33 spinal nerve ligated and 26 control age- and weight-matched control rats were used.

Results
Brainstem morphine reduced neuronal firing to 60-g von Frey stimulation in control rats (to 65 ± 12% of control response (means ± 95% CI), P < 0.001) with a greater inhibition in neuropathic rats (to 53 ± 17% of control response, P < 0.001). Contrasting anterior cingulate cortex morphine had only marginal modulatory effects on spinal neuronal responses with limited variance in effect between control and neuropathic rats. The inhibitory effects of morphine in the central nucleus of the amygdala were dependent on pain state and laterality; only right-side morphine reduced neuronal firing to 60-g stimulation in neuropathic rats (to 65 ± 14% of control response, P = 0.001). In addition, in neuropathic rats elevated ongoing neuronal activity in the ventral posterolateral thalamus was not inhibited by anterior cingulate cortex morphine, in contrast to evoked responses.

Conclusions
Cumulatively the data support opioid modulation of evoked responses predominately through a lateralized output from the right amygdala, as well as from the brainstem that is enhanced in injured conditions. Minimal modulation of dorsal horn responses was observed after anterior cingulate cortex opioid administration regardless of injury state.

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Relationships Between Coping Behaviors and Social Loneliness in Adults With Self-reported Hearing Problems
Authors: Warringa Leontine T.L. , Henke Celina E. , Pronk Marieke , Kramer Sophia E. , Stam Mariska 
Published: January 2020

Objectives:
To determine the association between various coping behaviors and social loneliness (self-reported deficits in social integration and embeddedness) in adults with self-reported hearing problems. It is hypothesized that adults who frequently use adequate coping behaviors experience less feelings of social loneliness than persons who use these behaviors less often.

Design:
Cross-sectional data of 686 participants with hearing-impairment (24–75 years of age) of the online Netherlands Longitudinal Study on Hearing were analyzed. Six coping behaviors were measured using six subscales of the Communication Profile for the Hearing Impaired (maladaptive behavior, verbal strategies, nonverbal strategies, self-acceptance, acceptance of loss, and stress and withdrawal). The De Jong-Gierveld loneliness scale was used to measure social loneliness. Multiple logistic multinomial regression analyses were applied to determine associations between each of the coping behaviors and (1) moderate social loneliness (reference category: no loneliness) and (2) severe social loneliness (reference category: no loneliness). Potential subgroup effects and confounders were examined.

Results:
Almost two-thirds of the sample reported feeling moderately or severely socially lonely. Significantly less feelings of social loneliness were experienced by participants who reported relatively high levels of self-acceptance or acceptance of loss, relatively infrequent use of maladaptive behavior, or relatively low levels of stress and withdrawal. Particularly those participants whose hearing loss dated back to ≤5 years, better coping with verbal strategies was associated with a lower likelihood of either moderate or severe social loneliness. More frequent use of nonverbal strategies was only associated with a lower likelihood of severe social loneliness for participants with paid work.

Conclusions:
To the best of our knowledge, this study is the first in which the relationship between a wide range of hearing coping behaviors and social loneliness was studied. The results show that more frequent use of adequate coping behaviors is significantly associated with less feelings of social loneliness. The findings underline the importance of recognizing and tackling inadequate coping behaviors so that social loneliness can be prevented or combated.
Spontaneous Incidence of Vertebral Body Infection Following Osteoporotic Vertebral Fracture
Authors: Uto Takaaki , Tokuumi Yuji , Komine Nobuhiko , Yonezawa Noritaka , Demura Satoru , Tsuchiya Hiroyuki 
Published: January 2020

Study Design.
Retrospective case series.

Objective.
The aim of this study was to examine the spontaneous incidence rate and features of pyogenic vertebral osteomyelitis in osteoporotic vertebral fracture (OVF).

Summary of Background Data.
Pyogenic vertebral osteomyelitis is a rare complication of OVF. We experienced some cases of vertebral body infection after OVF.

Methods.
In this retrospective, single-center study, clinical data were collected by chart review. We examined the number of cases of pyogenic vertebral osteomyelitis following OVF between April 2014 and August 2018. Further, we examined the mechanism of injury, age, sex, duration from the diagnosis of OVF to the diagnosis of vertebral body infection, C-reactive protein level at the time of diagnosis of OVF, medical history, primary infection site, and serious events.

Results.
The spontaneous incidence rate of complications was 0.7% (4/554). In all cases (two males and two females), fall history was present and vertebral body infection was not suspected to be present at the point of injury. The average age was 81.8 (range, 75–89, SD, 5.7) years. The average duration from the diagnosis of OVF to the diagnosis of vertebral body infection was 55.0 (range, 16–132, SD, 52.4) days. The average C-reactive protein level at the time of diagnosis of OVF was 11.5 (range, 0.5–29.7, SD, 12.7) mg/L. Medical history included rheumatoid arthritis (n = 1), diabetes mellitus (n = 1), malignant tumor (stage IV) (n = 1), and brain infarction (n = 2). The primary sources of infection were pneumonia (n = 3), and urinary tract infection (n = 1), and all patients experienced bacillemia at/after the diagnosis of fracture. All patients died due to septic shock.

Conclusion.
The spontaneous incidence rate of vertebral body infection among OVF patients was 0.7%; however, the occurrence of this complication led to serious events. Clinicians should pay attention to the possibility of bacillemia in elderly or immunocompromised OVF patients.

Level of Evidence: 4
MagnetOs, Vitoss, and Novabone in a Multi-endpoint Study of Posterolateral Fusion
Authors: van Dijk Lukas A. , Barrère-de Groot Florence , Rosenberg Antoine J.W.P. , Pelletier Matthew , Christou Chris , de Bruijn Joost D. , Walsh William R. 
Published: January 2020

Study Design:This study was a multi-endpoint analysis of bone graft substitutes implanted as a standalone graft in a clinically relevantOvinemodel of instrumented posterolateral spinal fusion (PLF).Objective:The objective of this study was to obtain high-quality evidence on the efficacy of commercial bone graft substitutes compared with autograft in instrumented PLF using a state-of-the-art model with a complete range of assessment techniques.Summary of Background Data:Preclinical and clinical data on the quality of spinal fusions obtained with bone graft substitutes are often limited. Calcium phosphates with submicron topography have shown promising results in PLF, as these are able to induce bone formation in tissues distant from the host bone, which facilitates bony union.Methods:Nine female, skeletally mature sheep (4–5 y) underwent posterior pedicle screw/rods instrumented PLF at L2–L3 and L4–L5 using the following bone graft materials as a standalone graft per spinal segment: (1) biphasic calcium phosphate with submicron topography (BCP<µm), (2) 45S5 Bioglass (BG), and (3) collagen-β-tricalcium phosphate with a 45S5 Bioglass adjunct (TCP/BG). Autograft bone (AB) was used as a positive control treatment. Twelve weeks after implantation, the spinal segments were evaluated by fusion assessment (manual palpation, x-ray, micro-computed tomography, and histology), fusion mass volume quantification (micro-computed tomography), range of motion (ROM) testing, histologic evaluation, and histomorphometry.Results:Fusion assessment revealed equivalence between AB and BCP<µmby all fusion assessment methods, whereas BG and TCP/BG led to significantly inferior results. Fusion mass volume was highest for BCP<µm, followed by AB, BG, and TCP/BG. ROM testing determined equivalence for spinal levels treated with AB and BCP<µm, while BG and TCP/BG exhibited higher ROM. Histologic evaluation revealed substantial bone formation in the intertransverse regions for AB and BCP<µm, whereas BG and TCP/BG grafts contained fibrous tissue and minimal bone formation. Histologic observations were supported by the histomorphometry data.Conclusions:This study reveals clear differences in efficacy between commercially available bone graft substitutes, emphasizing the importance of clinically relevant animal models with multiendpoint analyses for the evaluation of bone graft materials. The results corroborate the efficacy of calcium phosphate with submicron topography, as this was the only material that showed equivalent performance to autograft in achieving spinal fusion.
HIV, aging, and adherence: an update and future directions
Authors: Mann Sarah Czarna , Castillo-Mancilla Jose R. 
Published: January 2020

Purpose of review
To highlight recent data on antiretroviral adherence in older people living with HIV (PLWH), describe the most relevant pharmacokinetic antiretroviral studies, and identify critical research gaps in this population.

Recent findings
Overall, studies have found that older PLWH are more likely to be adherent to antiretroviral therapy (ART). Although multiple methods to measure adherence are available (self-report, pharmacy refills, electronic device monitors, drug concentrations), there is currently no ‘gold standard’ adherence measure or sufficient evidence to suggest a preferred method in older patients. Recently, studies evaluating antiretroviral concentrations in hair and dried blood spots in older patients identified no major differences when compared with younger individuals. Similarly, although pharmacokinetic studies in older PLWH are scarce, most data reveal no significant pharmacokinetic differences in the aging population. Furthermore, no specific guidelines or treatment recommendations regarding ART dose modification or long-term toxicity in aging PLWH are available, mostly because of the exclusion of this population in clinical trials.

Summary
How aging influences adherence and pharmacokinetics remains poorly understood. As the population of older PLWH increases, research focusing on adherence, toxicity, drug--drug interactions, and the influence of comorbidities is needed.
Norepinephrine for the prevention of spinal-induced hypotension during caesarean delivery under combined spinal–epidural anaesthesia
Authors: Wei Changna , Qian Jin , Zhang Yinfa , Chang Xiangyan , Hu Huijing , Xiao Fei 
Published: January 2020

BACKGROUND
During caesarean delivery under spinal anaesthesia hypotension may be managed by norepinephrine in preference to phenylephrine due a perception of less bradycardia and fewer reductions in cardiac output.

OBJECTIVE
As the optimum prophylactic dose of norepinephrine is unclear, we aimed to investigate its dose–response for preventing postspinal hypotension in caesarean delivery.

DESIGN
A randomised, double-blinded, dose-finding study.

SETTING
Jiaxing University affiliated Women and Children Hospital, Jiaxing, China.

PATIENTS
Ninety-nine patients undergoing elective caesarean delivery from 1 February to 5 August: excluding patients with ASA III or above, preeclampsia or hypertension, pre-existing or gestational diabetes, BMI more than 35 kg m−2, height less than 150 cm or with more than 175 cm, or with contraindications to local anaesthesia.

INTERVENTIONS
Patients received 0, 0.04, 0.05, 0.06 or 0.07 μg kg−1 min−1 preventive norepinephrine infusions immediately after intrathecal injection of 10 mg bupivacaine with 5 μg sufentanil.

MAIN OUTCOME MEASURES
The norepinephrine (Median effective dose) or (95% effective dose) ED50 and ED95, which were estimated using Probit analysis to compare haemodynamic changes associated with the different doses.

RESULTS
The incidence of hypotension was 70, 47.4, 40, 20 and 15% in the 0, 0.04, 0.05, 0.06 and 0.07 μg kg−1 min−1 groups, respectively. The ED50, ED80 and ED95 values were 0.029 (95% CI 0.008 to 0.042 μg kg−1 min−1), 0.068 (95% CI 0.055 to 0.099 μg kg−1 min−1) and 0.105 μg kg−1 min−1 (95% CI 0.082 to 0.172 μg kg−1 min−1), respectively. Apgar scores or umbilical arterial pH were similar among groups.

CONCLUSION
The ED50, ED80 and ED95 were 0.029, 0.068 and 0.105 μg kg−1 min−1 respectively. A 0.07 μg kg−1 min−1 norepinephrine infusion may be optimum for preventing postspinal hypotension after intrathecal injection of 10 mg bupivacaine combined with 5 μg sufentanil.

TRIAL REGISTRATION
Chinese Clinical Trial Registry (identifier: ChiCTR-TRC-1800014614).
Management of Unreconstructable Saphenous Nerve Injury with Targeted Muscle Reinnervation
Authors: Janes Lindsay E. , Fracol Megan E. , Ko Jason H. , Dumanian Gregory A. 
Published: January 2020

Summary:
Neuroma pain significantly impacts patient quality of life and is associated with unemployment, chronic opioid dependence, and depression. Targeted muscle reinnervation (TMR), a surgical technique that coapts proximal stumps of cut nerves to distal motor nerves of adjacent muscles, has demonstrated efficacy in the treatment and prevention of neuroma pain. The objective of this study was to describe the surgical technique for TMR of the saphenous nerve, while providing a retrospective review. Between January 2015 and December 2018, 18 patients underwent TMR of the saphenous nerve: 1 nonamputee patient with chronic pain after ankle surgery and 17 amputee patients (10 for relief of chronic postamputation neuroma pain and phantom pain and 7 at the time of amputation for prevention of these symptoms). Six patients were lost to follow up; 2 patients had recurrent pain; and 10 patients had reduced or no pain after TMR surgery. TMR is a successful technique for the management of traumatic neuroma pain in both the amputee and nonamputee populations, and in this study, we describe the technique for saphenous nerve TMR.
The Use of Virtual Surgical Planning for Reduction Cranioplasty
Authors: Saleh Eli , Govshievich Alexander , Justino Julian , Weil Alexander G. , Borsuk Daniel E. 
Published: January 2020

Summary:
Hydrocephalic macrocephaly may occur as a result of untreated hydrocephalus. Reduction cranioplasty is the treatment of choice for these patients when the weight of their head interferes with normal development and negatively impacts quality of life. However, this procedure has several associated risks, including prolonged anesthesia, significant blood loss, and death. Virtual surgical planning (VSP) has been shown to be a useful adjunct for orthognathic and craniofacial surgery. The following report details the application and advantages of this technology in the setting of a reduction cranioplasty. We report the case of a 2-year-old girl with severe hydrocephalic macrocephaly who underwent a reduction cranioplasty guided by VSP with computer-aided design and manufacturing (CAD/CAM). Prefabricated cutting guides and a concave assembly bowl were used for precise fixation of bony segments. Our patient underwent a successful reduction cranioplasty using VSP and CAD/CAM. This technology allowed precise remodeling of the cranial vault with minimal bony gaps in the final construct. Head circumference and intracranial volume were reduced from 70 cm and 4,575 cm3 to 62 cm and 2,645 cm3, respectively. VSP with CAD/CAM can serve as a useful adjunct in complex cases of cranioplasty allowing for an increase in the precision, the efficacy, and the esthetic result.
Clinical Evaluation of an Off-the-Shelf Allogeneic Adipose Matrix for Soft Tissue Reconstruction
Authors: Kokai Lauren E. , Sivak Wesley N. , Schilling Benjamin K. , Karunamurthy Arivarasan , Egro Francesco M. , Schusterman M. Asher , Minteer Danielle M. , Simon Patsy , D’Amico Richard A. , Rubin J. Peter 
Published: January 2020

Background:
Biomaterials derived from human adipose extracellular matrix have shown promise in vitro and in animal studies as an off-the-shelf adipogenic matrix for sustained volume replacement. Herein, we report the results of a randomized prospective study conducted with allograft adipose matrix (AAM) grafted into the pannus of presurgical abdominoplasty patients 3 or 6 months before scheduled surgery. This is the first report of a longitudinal histologic analysis of AAM in clinical use.

Methods:
Ten healthy patients undergoing elective abdominoplasty were recruited to receive AAM before surgery. Enrolled subjects were randomized into either a 3-month follow-up cohort or a 6-month follow-up cohort. Subjects were monitored for adverse events associated with AAM grafting in addition to undergoing serial biopsy. Following surgical excision of the pannus, representative samples from the AAM surgical sites were stained and evaluated with hematoxylin and eosin for tissue morphology, Masson’s trichrome for collagen, and perilipin for adipocytes.

Results:
All subjects tolerated AAM with no severe adverse events reported. At 3 months following implantation, AAM remained visible within the confines of the subjects’ native surrounding adipose tissue with sparse adipocytes apparent within the matrix. By 6 months, AAM had remodeled and was primarily composed of perilipin-positive adipocytes. Histologic analysis confirmed tissue remodeling (hematoxylin and eosin), adipogenesis (perilipin), and angiogenesis (Masson’s trichrome) occurred with the presence of AAM.

Conclusions:
AAM is a safe, allogeneic, off-the-shelf regenerative matrix that is adipogenic and noninflammatory and promotes angiogenesis.
Operative Time as the Predominant Risk Factor for Transfusion Requirements in Nonsyndromic Craniosynostosis Repair
Authors: Chocron Yehuda , Azzi Alain J. , Galli Rafael , Alnaif Nayif , Atkinson Jeffrey , Dudley Roy , Farmer Jean-Pierre , Gilardino Mirko S. 
Published: January 2020

Background:
Despite recent advances in surgical, anesthetic, and safety protocols in the management of nonsyndromic craniosynostosis (NSC), significant rates of intraoperative blood loss continue to be reported by multiple centers. The purpose of the current study was to examine our center’s experience with the surgical correction of NSC in an effort to determine independent risk factors of transfusion requirements.

Methods:
A retrospective cohort study of patients with NSC undergoing surgical correction at the Montreal Children’s Hospital was carried out. Baseline characteristics and perioperative complications were compared between patients receiving and not receiving transfusions and between those receiving a transfusion in excess or <25 cc/kg. Logistic regression analysis was carried out to determine independent predictors of transfusion requirements.

Results:
A total of 100 patients met our inclusion criteria with a mean transfusion requirement of 29.6 cc/kg. Eighty-seven patients (87%) required a transfusion, and 45 patients (45%) required a significant (>25 cc/kg) intraoperative transfusion. Regression analysis revealed that increasing length of surgery was the main determinant for intraoperative (P = 0.008; odds ratio, 18.48; 95% CI, 2.14–159.36) and significant (>25 cc/kg) intraoperative (P = 0.004; odds ratio, 1.95; 95% CI, 1.23–3.07) transfusions.

Conclusions:
Our findings suggest increasing operative time as the predominant risk factor for intraoperative transfusion requirements. We encourage craniofacial surgeons to consider techniques to streamline the delivery of their selected procedure, in an effort to reduce operative time while minimizing the need for transfusion.