bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound to Detect Central Venous Catheter Placement Associated Complications
Authors: Smit Jasper M. , Haaksma Mark E. , Lim Endry H. T. , Steenvoorden Thei S. , Blans Michiel J. , Bosch Frank H. , Petjak Manfred , Vermin Ben , Touw Hugo R. W. , Girbes Armand R. J. , Heunks Leo M. A. , Tuinman Pieter R. 
Published: January 2020

Abstract

Background
Mechanical complications arising after central venous catheter placement are mostly malposition or pneumothorax. To date, to confirm correct position and detect pneumothorax, chest x-ray film has been the reference standard, while ultrasound might be an accurate alternative. The aim of this study was to evaluate diagnostic accuracy of ultrasound to detect central venous catheter malposition and pneumothorax.

Methods
This was a prospective, multicenter, diagnostic accuracy study conducted at the intensive care unit and postanesthesia care unit. Adult patients who underwent central venous catheterization of the internal jugular vein or subclavian vein were included. Index test consisted of venous, cardiac, and lung ultrasound. Standard reference test was chest x-ray film. Primary outcome was diagnostic accuracy of ultrasound to detect malposition and pneumothorax; for malposition, sensitivity, specificity, and other accuracy parameters were estimated. For pneumothorax, because chest x-ray film is an inaccurate reference standard to diagnose it, agreement and Cohen’s κ-coefficient were determined. Secondary outcomes were accuracy of ultrasound to detect clinically relevant complications and feasibility of ultrasound.

Results
In total, 758 central venous catheterizations were included. Malposition occurred in 23 (3.3%) out of 688 cases included in the analysis. Ultrasound sensitivity was 0.70 (95% CI, 0.49 to 0.86) and specificity 0.99 (95% CI, 0.98 to 1.00). Pneumothorax occurred in 5 (0.7%) to 11 (1.5%) out of 756 cases according to chest x-ray film and ultrasound, respectively. In 748 out of 756 cases (98.9%), there was agreement between ultrasound and chest x-ray film with a Cohen’s κ-coefficient of 0.50 (95% CI, 0.19 to 0.80).

Conclusions
This multicenter study shows that the complication rate of central venous catheterization is low and that ultrasound produces a moderate sensitivity and high specificity to detect malposition. There is moderate agreement with chest x-ray film for pneumothorax. In conclusion, ultrasound is an accurate diagnostic modality to detect malposition and pneumothorax.

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Postoperative Intracochlear Electrocochleography in Pediatric Cochlear Implant Recipients: Association to Audiometric Thresholds and Auditory Performance
Authors: Attias Joseph , Ulanovski David , Hilly Ohad , Greenstein Tally , Sokolov Merav , HabibAllah Suhail , Mormer Hen , Raveh Eyal 
Published: January 2020

Objectives:
The aim of this study was to compare intracochlear-recorded cochlear microphonics (CM) responses to behavioral audiometry thresholds in young children, with congenital hearing loss, 2 to 5 years after cochlear implantation early in life. In addition, differences in speech and auditory outcomes were assessed among children with and without residual hearing.

Design:
The study was conducted at a tertiary, university-affiliated, pediatric medical center. CM responses by intracochlear electrocochleography technique were recorded from 102 implanted ears of 60 children and those responses correlated to behavioral audiometry thresholds at 0.125 to 2 kHz frequencies. All children had received Advanced Bionics cochlear implant with High Focus J1 or MidScala electrodes, along with extensive auditory rehabilitation before and after implantation, including the use of conventional hearing aids. Speech Spatial and Hearing Qualities, Category of Auditory Performance scale, and educational settings information were obtained for each participant. Those cochlear implantation (CI) outcomes were compared between children with or without residual CM responses.

Results:
Two distinctive CM responses patterns were found among the implanted children. Of all ears diagnosed with cochlear hearing loss (n = 88), only in 29 ears, clear CM responses were obtained. In all other ears, no CM responses were obtained at the maximum output levels. The CM responses were highly correlated with coefficients ranging from 0.7 to 0.83 for the audiometric behavioral thresholds at 0.125 to 2 kHz frequency range. Of all ears diagnosed with auditory neuropathy syndrome disorder (n = 14), eight ears had residual hearing and recordable CM postimplantation. The other six ears showed no recordable CM responses at maximum output levels for all tested frequencies. Those showed supposedly better CM responses than the behavioral audiometry threshold, however with poor correlations with tested frequency thresholds. Children with residual hearing showed significantly better auditory outcomes with CI, compared with those without residual hearing.

Conclusions:
In children with congenital cochlear hearing loss, the objective CM intracochlear responses can reliably predict the residual audiometric threshold. However, in children with auditory neuropathy syndrome disorder, the CM thresholds did not match the behavioral audiometric responses. Postoperatively, children with recordable CM responses, showing preserved residual hearing, demonstrated better CI outcomes.
Autoimmunity and immunodeficiency
Authors: Hoyos-Bachiloglu Rodrigo , Chou Janet 
Published: January 2020

Purpose of reviewAdvances in genomics and animal models of human disease have enabled the discovery of mechanisms important for host immunity and self-tolerance. Here, we summarize conceptual and clinical discoveries identified from 2018 to 2019 in the field of primary immunodeficiencies and autoimmunity.Recent findingsThree new primary immunodeficiencies with autoimmunity were identified and the clinical phenotypes of NFKB1 haploinsufficiency and RASGRP1 deficiency were expanded. A diversity of novel mechanisms leading to autoimmunity associated with primary immunodeficiencies (PIDs) was reported, including pathways important for the metabolism and function of regulatory T cells and germinal B cells, the contribution of neutrophil extracellular traps to plasmacytoid dendritic cell activation and the influence of commensal bacteria on the generation of autoantibodies. With regard to therapeutic developments in the field, we highlight the use of janus kinase inhibitors for immune dysregulation associated with gain-of-function variants in STAT1 and STAT3, as well as the risks of persistent hypogammaglobulinemia associated with rituximab treatment.SummaryMechanistic studies of PIDs with autoimmunity elucidate key principles governing the balance between immune surveillance and self-tolerance.
Alleviation of Pain After Femur and Tibia Shaft Fractures Using Nothing Stronger Than Codeine and Tramadol
Authors: Reich Michael S. , Klahs Kyle J. , Fernandez Isaac , Nguyen Mai P. 
Published: January 2020

Objective:
To determine whether using nothing stronger than codeine and tramadol provides adequate pain alleviation in people recovering from fixation of a fracture of the femur or tibia shaft.

Design:
Retrospective case series.

Setting:
Level 1 trauma center in the United States.

Patients:
All adult patients from October 2016 to October 2018 with femur (OTA/AO 32) and tibial (OTA/AO 42) shaft fractures who were treated surgically were included. A nurse counseled patients on safe and effective alleviation of pain. Charts were reviewed for pain medication prescribed, noting utilization of schedule II opioid medications.

Main Outcome Measures:
Frequency of schedule II pain medication prescription on discharge or during follow-up, emergency department presentation for pain, or readmission for pain.

Results:
One hundred fifty patients with 162 fractures were treated for femoral (N = 73 fractures) or tibial (N = 89 fractures) shaft fractures. Sixty patients (40%) were multiple injured patients. Thirteen (8.7%) patients were discharged with hydrocodone, oxycodone, or fentanyl. Of the remaining patients with adequate follow-up (N = 109), 6.4% requested hydrocodone, oxycodone, or fentanyl after discharge. There was 1 patient presentation to the emergency department for pain, and there were no pain-related readmissions.

Conclusions:
Alleviation of pain can be achieved in most patients with femoral and tibial shaft fractures, including multiply injured patients, with one-on-one patient support and by using nothing stronger than codeine and tramadol.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A Biomechanical Study of Tuberosity-Based Locked Plate Fixation Compared with Standard Proximal Humeral Locking Plate Fixation for 3-Part Proximal Humeral Fractures
Authors: Walker Robert , Castaneda Paulo , Putnam Jill G. , Schemitsch Emil H. , McKee Michael D. 
Published: January 2020

Background:
One of the main shortcomings of current proximal humeral plate designs is their inability to reliably secure the greater tuberosity (GT) or lesser tuberosity, leading to fixation failure, nonunion, and rotator cuff dysfunction. Traditional proximal humeral locking plates (PHLPs) rely on isolated screw fixation or suture repair to maintain reduction of the greater and/or lesser tuberosities. This study evaluates a tuberosity-based plate (TBP) specifically designed to improve tuberosity fixation, which may decrease tuberosity displacement and related clinical sequelae.

Methods:
Five cadaveric specimens (10 shoulders) were randomized to receive either standard PHLP or TBP fixation. The specimens were skeletonized except for the rotator cuff insertion on the GT. A reproducible 3-part osteotomy was performed for each cadaver, creating head, shaft, and GT segments. Anatomic reduction and plate fixation were performed according to the surgical technique guide for each plate system, with an equal number of screws placed in each plate both proximally and distally. GT fixation was enhanced with standardized suture augmentation through the rotator cuff in every specimen in both groups. In each trial, fracture displacement, load to failure, number of cycles endured, and mechanism of failure were noted.

Results:
The mean load to tuberosity fixation failure for the PHLP and TBP groups was 220 and 502 N (P = 0.005), respectively.

Conclusions:
The TBP had a significantly higher load to failure and significantly lower mean fracture displacement compared with the PHLP.
Smoking history increases the risk of long-term mortality after thoracic endovascular aortic repair in patients with an uncomplicated type B dissection
Authors: Gao Hui-Qiang , Ren Chang-Wei , Yang Sheng , Huang Lian-Jun , Sun Li-Zhong , Xu Shang-Dong 
Published: January 2020

Abstract

Background:
The preferred treatment for uncomplicated type B dissection (thoracic endovascular aortic repair [TEVAR] or medical) is still under debate. Since 2001, our center has performed TEVAR for uncomplicated type B dissection. Based on our data, 5- and 10-year survival rates among patients with uncomplicated type B dissection after TEVAR were 96.5% and 83.0%, respectively. We, therefore, believe that TEVAR is preferable for uncomplicated type B dissections. This study analyzed the impact of a pre-operative smoking history on long-term survival after TEVAR in patients with uncomplicated type B dissections.

Methods:
From May 2001 to December 2013, data from 751 patients with type B dissections were collected and analyzed. Patients were divided into two groups (337 smoking patients and 414 non-smoking patients). The Kaplan-Meier method and log-rank test were used to compare survival curves of the two groups. Multivariable analyses using the Cox proportional hazards model were used to estimate the effects of smoking on survival rates.

Results:
The 5- and 10-year survival rates of non-smokers were 97.6% (95% confidence interval [CI], 96.0%–99.2%) and 87.0% (95% CI, 81.6%–92.7%), respectively, and 94.9% (95% CI, 92.2%–97.7%) and 73.8% (95% CI, 62.3%–87.5%) for smokers, respectively (Log-rank test, P = 0.006). Multivariable analyses showed that smoking increased the risk of death during follow-up, 2.1-fold when compared to non-smokers (P = 0.039).

Conclusion:
A pre-operative smoking history increases long-term mortality rates after TEVAR in patients with uncomplicated type B dissections.
Anxiety symptoms in patients with Mayer-Rokitansky-Küster-Hauser syndrome: a cross-sectional study
Authors: Song Shuang , Chen Na , Duan Yan-Ping , Kang Jia , Deng Shan , Pan Hong-Xin , Zhu Lan 
Published: January 2020

Abstract

Background:
As a congenital malformation that results in infertility and an inability to have vaginal intercourse, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome places a considerable psychological burden on patients, which results in anxiety symptoms. However, only single case studies or a few small to medium-sized cross-sectional studies were identified to focus on anxiety symptoms in MRKH patients. Thus, the aim of this study was to explore the status of anxiety symptoms and the related factors in patients with MRKH syndrome.

Methods:
This cross-sectional study involving 141 patients with MRKH syndrome and 178 healthy women was conducted from January 2018 to December 2018. All participants were required to complete a demographic questionnaire and the Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9, Eysenck Personality Questionnaire-Revised, Short Scale for Chinese, and Chinese Version of the Female Sexual Function Index. The main outcome was the anxiety symptoms measured by the GAD-7. Main outcome was compared between the MRKH syndrome group and the healthy control group. Then, we explored the related factors by comparing patients with and without anxiety symptoms.

Results:
Of the respondents, 24.1% experienced moderate to severe anxiety symptoms. Patients with MRKH syndrome manifested more severe anxiety symptoms than healthy women. Negative self-evaluation of femininity (odds ratio [OR] 2.706, 95% confidence interval [CI] 1.010–7.247), neurotic personality traits (OR 1.100, 95% CI 1.029–1.175), and coexisting depressive symptoms (OR 4.422, 95% CI 1.498–13.049) were more prevalent in anxious patients.

Conclusion:
The findings stress the importance of anxiety symptom screening in MRKH patients and identify patients at risk of anxiety symptoms, providing a possible basis for future intervention.
Intra-operative norepinephrine administration and cancer-related outcomes following radical cystectomy for bladder cancer
Authors: Löffel Lukas M. , Furrer Marc A. , Favre Aline , Engel Dominique , Gahl Brigitta , Burkhard Fiona C. , Wuethrich Patrick Y. 
Published: January 2020

BACKGROUND
The impact of anaesthetic techniques on recurrence of cancers is controversial. Elevated plasma catecholamine levels have been implicated in angiogenesis and metastasis in various cancers.

OBJECTIVES
To assess the potential association between continuous intra-operative norepinephrine administration and tumour-related outcome in muscle-invasive bladder cancer patients undergoing radical cystectomy with urinary diversion.

DESIGN
Retrospective observational cohort study.

SETTING
Single tertiary centre, from 2000 to 2017.

PATIENTS
We included a consecutive series of 1120 urothelial carcinoma patients undergoing radical cystectomy and urinary diversion, including 411/1120 patients (37%) who received a continuous intra-operative administration of more than 2 μg kg BW−1 h−1 norepinephrine.

MAIN OUTCOME MEASURES
The primary outcome was time to tumour recurrence within 5 years after surgery, with death as competing outcome. We used inverse probability of treatment weighting to adjust for imbalances between treatment groups, one having received more than 2 μg kg BW−1 h−1 norepinephrine and the other having received less. We furthermore adjusted for intra-operative variables or years of surgery as sensitivity analyses.

RESULTS
The continuous administration of more than 2 μg kg BW−1 h−1 norepinephrine slightly increased tumour recurrence (hazard ratio: 1.47, 95% CI 0.98 to 2.21; P = 0.061). After adjustment for intra-operative variables, and year of surgery hazard ratios were 1.82 (95% CI 1.13 to 2.91, P = 0.013) and 1.85 (95% CI 1.12 to 3.07, P = 0.017), respectively. Overall mortality (with or without tumour recurrence) was not affected by norepinephrine (hazard ratio: 0.84, 95% CI 0.65 to 1.08, P = 0.170).

CONCLUSION
Continuous administration of more than 2 μg kg BW−1 h−1 norepinephrine was associated with a slightly increased hazard ratio for tumour recurrence if adjusted for intra-operative variables and year of surgery. This observation could reflect a low potential pro-oncogenic effect of norepinephrine during the intra-operative period.

TRIAL REGISTRATION
Not applicable.
The effect of intravenous magnesium on postoperative morphine consumption in noncardiac surgery
Authors: Ng Ka T. , Yap Jasmine L.L. , Izham Ilyanna N. , Teoh Wan Y. , Kwok Pei E. , Koh Wen J. 
Published: January 2020

BACKGROUND
Several studies suggest that systemic magnesium reduces postoperative opioid consumption and the intensity of pain, but others report conflicting results. The efficacy and safety profile of intravenous magnesium in noncardiac surgery remain uncertain.

OBJECTIVES
The aim of this review was to investigate the effect of intravenous magnesium on the consumption of postoperative morphine in the first 24 h in adults undergoing noncardiac surgery.

DESIGN
Systematic review and meta-analysis with trial sequential analysis.

DATA SOURCES
MEDLINE, EMBASE, CENTRAL from their inception until January 2019.

ELIGIBILITY CRITERIA
All randomised clinical trials comparing intravenous magnesium versus placebo in noncardiac surgery were systematically searched in the databases. Observational studies, case reports, case series and nonsystematic reviews were excluded.

RESULTS
Fifty-one trials (n=3311) were included for quantitative meta-analysis. In comparison with placebo, postoperative morphine consumption at 24-h was significantly reduced in the magnesium group, with a mean difference [95% confidence interval (CI)] of −5.6 mg (−7.54 to −3.66, P < 0.001, I
2 = 92%, level of evidence low). The trial sequential analysis for the effect of magnesium on postoperative morphine consumption was conclusive. Patients who received magnesium had a longer time to the first analgesia request [143 (103 to 183) min, P < 0.001, I
2 = 99%, level of evidence low] and a lower incidence of shivering [0.26 (0.15 to 0.44), P < 0.001, I
2 = 35%, level of evidence very low]. However, no significance differences were demonstrated in postoperative pain scores in the first 24 h (mean difference, 95% CI) −0.30 (−0.69 to 0.09, P = 0.13, I
2 = 91%, level of evidence low), bradycardia (odds ratio, 95% CI) 1.13 (0.43 to 2.98, P = 0.80, I
2 = 35%, level of evidence very low) and postoperative nausea and vomiting (odds ratio, 95% CI) 0.90 (0.67 to 1.22, P = 0.49, I
2 = 25%, level of evidence moderate).

CONCLUSION
The current meta-analysis demonstrates that the use of intravenous magnesium as part of multimodal analgesia may reduce morphine consumption in the first 24 h after surgery and delay the time to the first request for analgesia in patients undergoing noncardiac surgery. However, the included studies were of low-quality with substantial heterogeneity.

TRIAL REGISTRATION
CRD42018086846.
Lights on MsFLASH: a review of contributions
Authors: Reed Susan D. , LaCroix Andrea Z. , Anderson Garnet L. , Ensrud Kristine E. , Caan Bette , Carpenter Janet S. , Cohen Lee , Diem Susan J. , Freeman Ellen W. , Joffe Hadine , Larson Joseph C. , McCurry Susan M. , Mitchell Caroline M. , Newton Katherine M. , Sternfeld Barbara , Guthrie Katherine A. 
Published: January 2020

Abstract

Objective:
The Menopause Strategies: Finding Lasting Answers for Symptoms and Health clinical trials network was funded by the National Institutes of Health to find new ways to alleviate the most common, bothersome menopausal symptoms by designing and conducting multiple concurrent clinical intervention studies, accommodating a wide scope of populations and intervention strategies.

Methods:
Trials were conducted in Boston, Indianapolis, Minneapolis, Oakland, Philadelphia, and Seattle, with the Data Coordinating Center in Seattle, and were designed with standardized eligibility criteria and endpoints. Primary outcomes focused on vasomotor symptoms, sleep quality and insomnia symptoms, and vaginal symptoms. Secondary outcomes included quality of life, sexual function, and mood.

Results:
We completed five randomized clinical trials and three ancillary studies, testing nine interventions in over 1,300 women and collecting nearly 16,000 bio-specimens. Escitalopram, venlafaxine hydrochloride extended release, and low-dose estradiol diminished hot flashes by approximately 50% as compared with a 30% decrease by placebo. No benefits on vasomotor symptoms were observed with yoga or exercise compared with usual activity, nor with omega-3 supplementation compared with placebo. Cognitive behavioral therapy for insomnia reduced self-reported insomnia symptoms and improved overall sleep quality compared with menopause education control. We did not find significant benefit from a vaginal estradiol tablet or a vaginal moisturizer compared with placebo tablet and gel in diminishing the severity of vaginal symptoms.

Conclusions:
The MsFLASH trials contributed substantially to our understanding of bothersome menopausal symptom treatment. It is important that clinicians counseling women about available treatment options consider all therapies—both nonhormonal and hormonal.
Intraoperative Laser Speckle Contrast Imaging in DIEP Breast Reconstruction: A Prospective Case Series Study
Authors: Zötterman Johan , Opsomer Dries , Farnebo Simon , Blondeel Phillip , Monstrey Stan , Tesselaar Erik 
Published: January 2020

Introduction:
Laser speckle contrast imaging (LSCI) is a laser-based perfusion imaging technique that recently has been shown to predict ischemic necrosis in an experimental flap model and predicting healing time of scald burns. The aims were to investigate perfusion in relation to the selected perforator during deep inferior epigastric artery perforator (DIEP) flap surgery, and to evaluate LSCI in assisting of prediction of postoperative complications.

Methods:
Twenty-three patients who underwent DIEP-procedures for breast reconstruction at 2 centers were included. Perfusion was measured in 4 zones at baseline, after raising, after anastomosis, and after shaping the flap. The perfusion in relation to the selected perforator and the accuracy of LSCI in predicting complications were analyzed.

Results:
After raising the flap, zone I showed the highest perfusion (65 ± 10 perfusion units, PU), followed by zone II (58 ± 12 PU), zone III (53 ± 10 PU), and zone IV (45 ± 10 PU). The perfusion in zone I was higher than zone III (P = 0.002) and zone IV (P < 0.001). After anastomosis, zone IV had lower perfusion than zone I (P < 0.001), zone II (P = 0.01), and zone III (P = 0.02). Flaps with areas <30 PU after surgery had partial necrosis postoperatively (n = 4).

Conclusions:
Perfusion is highest in zone I. No perfusion difference was found between zones II and III. Perfusion <30 PU after surgery was correlated with partial necrosis. LSCI is a promising tool for measurement of flap perfusion and assessment of risk of postoperative ischemic complications.