bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inhalational anaesthetics, ozone depletion, and greenhouse warming: the basics and status of our efforts in environmental mitigation
Authors: Lopes Rita , Shelton Cliff , Charlesworth Mike 
Published: May 2021

Purpose of review
Following their use for medicinal purposes, volatile inhalational anaesthetic agents are expelled into the atmosphere where they contribute to anthropogenic climate change. We describe recent evidence examining the benefits and harms associated with their use.

Recent findings
The environmental harms associated with desflurane and nitrous oxide likely outweigh any purported clinical benefits. Life cycle analyses are beginning to address the many gaps in our understanding, and informing choices made on all aspects of anaesthetic care. There is, however, an urgent need to move beyond the debate about anaesthetic technique A vs. B and focus also on areas such as sustainable procurement, waste management, pharmacological stewardship and joined-up solutions.

Summary
There is now compelling evidence that anaesthetists, departments and hospitals should avoid desflurane completely, and limit nitrous oxide use to settings where there is no viable alternative, as their environmental harms outweigh any perceived clinical benefit. Life cycle analyses seem supportive of total intravenous and/or regional anaesthesia. There are many other areas where choices can be made by individual anaesthetists that contribute towards reducing the environmental burden of healthcare, such as prioritising the reduction of inappropriate resource use and over-treatment. However, this all requires joined up solutions where all parts of an organisation engage.
Drugs in anesthesia: preventing postoperative nausea and vomiting
Authors: Schlesinger Tobias , Weibel Stephanie , Meybohm Patrick , Kranke Peter 
Published: May 2021

Purpose of review
Postoperative nausea and vomiting (PONV) continues to be a burden for patients, medical staff and healthcare facilities because of inadequate adherence to available recommendations. This review gives an overview on recent recommendations, new evidence and remaining issues in the field of PONV management.

Recent findings
A wide range of drugs is available for the management of PONV including corticosteroids, 5-HT3-antagonists, dopamine-antagonists, neurokinin-receptor-1 (NK1)-antagonists, antihistamines and anticholinergics. The updated PONV guidelines from 2020 recommend a universal multimodal strategy for PONV prophylaxis, which is an important paradigm shift to improve implementation of the existing evidence. A recent Cochrane network meta-analysis ranked single drugs and drug combinations for PONV prophylaxis in terms of efficacy and safety. Notably, NK1-antagonists and new 5-HT3-antagonists ranged among the most effective drugs. However, safety data on antiemetics are generally scarce.

Summary
Numerous drug (combinations) and strategies are available for PONV management. New and very effective (single) drugs could result in a simplification compared with a combination of several drugs, and thus lead to better implementation.
Milk Volume Outcomes in Pump-Dependent Mothers of Critically Ill Infants
Authors: Bendixen Marion M. , Weaver Michael T. , Parker Leslie A. 
Published: May 2021

Introduction:
Mother's own milk improves health outcomes in infants of all gestational ages. Although pump-dependent mothers of extremely premature infants are at risk of insufficient milk production, whether mother's milk production is impacted by gestational age and pump dependency in mothers of more mature critically ill infants is unknown.

Purpose:
To determine whether there is a relationship between gestational age, milk production, and time to secretory activation in mothers delivering a critically ill infant.

Methods:
A convenience sample of 136 pump-dependent mothers whose infants were admitted to the neonatal intensive care unit was enrolled between 2013 and 2016 as part of a quality improvement project. Group 1 (early preterm) delivered infants at 30 to 33 weeks of gestation (n = 41), group 2 (late preterm) 34 to 36 weeks (n = 48), and group 3 (term) 37 weeks and more (n = 47). Milk volume on days 1 to 7 was measured by weighing each vial of expressed milk and compared using general linear mixed-model analysis. Time to the onset of secretory activation was compared using censored regression analysis.

Results:
Main effect for gestational age controlling for day was statistically significant (P = .0234). The early preterm group produced more milk over the 7-day study than the term (P = .01) and late preterm (P = .02) groups. The early preterm group achieved secretory activation earlier than the late preterm group (adjusted P = .039).

Implications for Practice:
Pump-dependent mothers of all infants admitted to the neonatal intensive care unit may be at risk of inadequate milk production and delayed secretory activation and may therefore benefit from early milk production monitoring and lactation support.

Implications for Research:
Further studies should examine targeted interventions to increase milk production in pump-dependent mothers.
Pain Associated With Cervical Priming for First-Trimester Surgical Abortion
Authors: Hamdaoui Naima , Cardinale Chloé , Fabre Cyprien , Baumstarck Karine , Agostini Aubert 
Published: May 2021

OBJECTIVE:
To compare the effect of cervical priming with mifepristone with that of misoprostol on pain perception during surgical induced abortion under paracervical block.

METHODS:
We conducted a randomized, single-blind, two-center study of women undergoing surgical induced abortion at less than 14 weeks of gestation under paracervical block. Participants were randomized to receive cervical priming with 200 mg of oral mifepristone 36 hours or 400 micrograms buccal misoprostol 3 hours before surgery. The primary outcome was pain during mechanical cervical dilation evaluated by a 100-mm visual analog scale (VAS). Secondary outcomes were pain during aspiration, preoperative and postoperative pain, participant satisfaction, duration of the procedure, occurrence of complications, and ease of performing the procedure (assessed by a 100-mm VAS). We estimated that 110 women would have to be included to have 90% power to detect a 13mm-difference of VAS for pain.

RESULTS:
Between June 2017 and May 2019, 314 women were eligible and 110 were randomized (55 in each group). Patient characteristics were similar in the two groups. The mean VAS score during mechanical cervical dilation was lower in the mifepristone group (35.6±21 vs 43.5±21, P=.04) as was the mean VAS during aspiration (34±24 vs 47.8±23, P=.003). The preoperative and postoperative mean VAS, satisfaction and duration of procedures were similar between groups. The procedure was significantly easier to perform in the mifepristone group (88±16 vs 80±23, P=.004).

CONCLUSION:
Cervical priming with mifepristone for surgical induced abortion under paracervical block up to 14 weeks of gestation is more effective than misoprostol in reducing pain perception.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03043014.
Topical Imiquimod for the Treatment of High-Grade Squamous Intraepithelial Lesions of the Cervix
Authors: Fonseca Bruno O. , Possati-Resende Júlio C. , Salcedo Mila P. , Schmeler Kathleen M. , Accorsi Guilherme S. , Fregnani José H. T. G. , Antoniazzi Marcio , Pantano Naitielle P. , Santana Iara V. V. , Matsushita Graziela M. , dos Reis Ricardo 
Published: May 2021

OBJECTIVE:To evaluate the histologic response rate of high-grade squamous intraepithelial lesions (HSIL) of the cervix after topical application of 5% imiquimod cream.METHODS:In this phase II trial, women with cervical HSIL (cervical intraepithelial neoplasia [CIN] 2–3) were randomly assigned to 250 mg of 5% imiquimod cream applied to the cervix weekly for 12 weeks, followed by loop electrosurgical excision procedure (LEEP) without preceding treatment. The sample size was calculated based on the HSIL regression rates previously reported by Grimm et al. The primary outcome was rate of histologic regression (to CIN 1 or less) in LEEP specimens. Prespecified secondary endpoints included surgical margin status and adverse events. Outcomes were stratified by human papillomavirus type and lesion grade (CIN 2 or CIN 3). Results were reported according to per protocol (PP) and intention-to-treat (ITT) analyses.RESULTS:Ninety women were enrolled: 49 in the experimental group and 41 in the control group. In the PP population, histologic regression was observed in 23 of 38 participants (61%) in the experimental group compared with 9 of 40 (23%) in the control group (P=.001). Surgical margins were negative for HSIL in 36 of 38 participants (95%) in the experimental group and 28 of 40 (70%) in the control group (P=.004). In the ITT population, rates of histologic regression also were significantly higher in the experimental group. Rates of adverse events in the experimental group were 74% (28/38) in the PP population and 78% (35/45) in the ITT population. Adverse events were mild, with abdominal pain being the most common. Three patients in the experimental group had grade 2 adverse events, including vaginal ulcer, vaginal pruritus with local edema, and moderate pelvic pain.CONCLUSION:Weekly topical treatment with imiquimod is effective in promoting regression of cervical HSIL.CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, NCT03233412.
High-Dose Compared With Standard-Dose Oxytocin Regimens to Augment Labor in Nulliparous Women
Authors: Son Moeun , Roy Archana , Stetson Bethany T. , Grady Nancy Tunney , Vanecko Mary Clare , Bond Nicole , Swanson Kate , Grobman William A. , Miller Emily S. , Peaceman Alan M. 
Published: May 2021

OBJECTIVE:
To evaluate whether a high-dose oxytocin regimen reduces the risk for primary cesarean birth and other obstetric morbidities when compared with standard dosing.

METHODS:
In a double-blind randomized clinical trial of nulliparous women at or beyond 36 weeks of gestation who were undergoing augmentation of labor, participants were assigned to high-dose (initial and incremental rates of 6 milliunits/min) or standard-dose (initial and incremental rates of 2 milliunits/min) oxytocin regimens. The primary outcome was cesarean birth. Prespecified secondary outcomes included labor duration, clinical chorioamnionitis, endometritis, postpartum hemorrhage, Apgar score 3 or less at 5 minutes, umbilical artery acidemia, neonatal intensive care unit admission, perinatal death, and a severe perinatal morbidity composite. A sample size of 501 per group (n=1,002) was planned to detect a 6.6% absolute reduction in rate of the primary outcome, from 20% in the standard-dose group to 13.4% in the high-dose group with 80% power.

RESULTS:
From September 2015 to September 2020, 1,003 participants were randomized—502 assigned to high-dose and 501 assigned to standard dosing. The majority of participants were of White race, were married or living as married, and had commercial insurance. Baseline characteristics between groups were similar. The primary outcome occurred in 14.5% of those receiving high-dose compared with 14.4% of those receiving standard-dose oxytocin (relative risk, 1.01; 95% CI 0.75–1.37). The high-dose group had a significantly shorter mean labor duration (9.1 vs 10.5 hours; P<.001), and a significantly lower chorioamnionitis incidence (10.4% vs 15.6%; relative risk, 0.67; 95% CI 0.48–0.92) compared with standard dosing. Umbilical artery acidemia was significantly less frequent in the high-dose group in complete case analysis, but this finding did not persist after multiple imputation (relative risk, 0.55; 95% CI 0.29–1.04). There were no significant differences in other secondary outcomes.

CONCLUSION:
Among nulliparous participants who were undergoing augmentation of labor, a high-dose oxytocin regimen, compared with standard dosing, did not affect the cesarean birth risk but significantly reduced labor duration and clinical chorioamnionitis frequency without adverse effects on perinatal outcomes.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02487797.
Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus
Authors: Mitchell Leia , Goldstein Andrew T. , Heller Debra , Mautz Theodora , Thorne Chelsea , Joyce Kong So Yeon , Sophocles Maria E. , Tolson Hillary , Krapf Jill M. 
Published: May 2021

OBJECTIVE:
To estimate the efficacy of fractionated carbon dioxide (CO2) laser therapy for vulvar lichen sclerosus.

METHODS:
We conducted a prospective, double-blind, randomized, sham-controlled, trial conducted in a clinic specializing in vulvar disorders. The study participants were 40 women with active vulvar lichen sclerosus confirmed with biopsy who were abstaining from topical and systemic treatments for at least 4 weeks before enrollment. Women were randomized in a 1:1 ratio to receive either five sham laser treatments or five fractionated CO2 treatments in a 24-week period. Study participants, treating clinicians, and the evaluating pathologist were blinded. The primary endpoint was the change in the histopathology scale score between pretreatment and posttreatment biopsies. We estimated 20 per group for 80% power to detect a 40% reduction in the histopathology scale score with up to 10% attrition. A secondary endpoint was the change in the validated CSS (Clinical Scoring System for Vulvar Lichen Sclerosus).

RESULTS:
From November 2018 to June 2020, 40 women were randomized to participate in the trial, and 37 women (19 fractionated CO2, 18 sham) were included in an intention-to-treat (ITT) analysis. Three women were excluded from the ITT analysis because they did not have posttreatment biopsies and, therefore, a posttreatment histopathology scale score could not be obtained. There was a 0.20 reduction (improvement) in histopathology scale score from baseline in the active treatment group (95% CI −1.1, 0.80, P=.74) and a 0.1 increase from baseline in the sham treatment group (95% CI −0.90, 1.0, P=.91). The change in histopathology scale score between the active and sham arm was not statistically significant (95% CI −1.14, 1.06, P=.76).

CONCLUSION:
Fractionated CO2 is not an effective monotherapy treatment for vulvar lichen sclerosus.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03665584.

FUNDING SOURCE:
Additional funding for this study was supplied by El.En Group, Florence, Italy, the manufacturer of the laser used in this study. In addition, El.En Group supplied the laser used in the study.
Risk Factors for Axial Symptoms After Anterior Surgery Treating for Multilevel Cervical Disorder with kyphosis
Authors: Wang Tao , Ding Wen-Yuan 
Published: May 2021

Study Design.
A retrospective study.

Objective.
The aim of this study was to investigate the risk factors associated with axial symptoms (AS) after anterior surgery in treatment of multilevel cervical disorder with kyphosis based on subgroup of follow-up time.

Summary of Background Data.
Although many scholars reported on AS after cervical surgery, the risk factors associated with AS are controversial. Few studies have investigated the risk factors of AS after anterior cervical surgery treating multilevel cervical disorder with kyphosis.

Methods.
Totally, 103 patients who suffered from multilevel cervical disorder with kyphosis receiving anterior surgery from July 2015 to June 2017 were reviewed for clinical and radiological outcomes. These data were collected at the time of before surgery, 1 week, 3 months, 6 months, 1 year, and 2 years after surgery. Data were performed to compare between the patients with and without AS.

Results.
In our study, the occurrence of AS was 46.6%, 34.0%, 20.4%, 12.6%, and 10.7% at the time of 1 week, 3 months, 6 months,1 year, and 2 years after surgery, respectively. Our findings showed that patients with smoking, disease duration, preoperative Modic changes (Mcs), post-operative Cobb angle of C2–7, cervical range of motion (ROM) and T1 slope, and change of Cobb angle of C2–7, cervical ROM and T1 slope were associated with AS within 1 year after surgery. However, patients with smoking and preoperative Mcs were found to be risk factors associated with AS at at any follow-up.

Conclusion.
In the present study, many factors were related to AS during 1-year after surgery. What's more, patients with smoking and preoperative Mcs were associated with AS at any follow-up. We hope this article can provide a reference for spinal surgeons to predict which patients were susceptible to suffer from AS after anterior surgery in treatment of multilevel cervical disorder with kyphosis.

Level of Evidence: 3
Comparison of Surgical Outcomes After Open- and Double-Door Laminoplasties for Patients with Cervical Ossification of the Posterior Longitudinal Ligament
Authors: Nagoshi Narihito , Yoshii Toshitaka , Egawa Satoru , Sakai Kenichiro , Kusano Kazuo , Nakagawa Yukihiro , Hirai Takashi , Wada Kanichiro , Katsumi Keiichi , Fujii Kengo , Kimura Atsushi , Furuya Takeo , Kanchiku Tsukasa , Nagamoto Yukitaka , Oshima Yasushi , Nakashima Hiroaki , Ando Kei , Takahata Masahiko , Mori Kanji , Nakajima Hideaki , Murata Kazuma , Matsunaga Shunji , Kaito Takashi , Yamada Kei , Kobayashi Sho , Kato Satoshi , Ohba Tetsuro , Inami Satoshi , Fujibayashi Shunsuke , Katoh Hiroyuki , Kanno Haruo , Watanabe Kota , Imagama Shiro , Koda Masao , Kawaguchi Yoshiharu , Takeshita Katsushi , Nakamura Masaya , Matsumoto Morio , Yamazaki Masashi , Okawa Atsushi 
Published: May 2021

Study Design.
A prospective multicenter study.

Objective.
To evaluate and compare the surgical outcomes after open-door (OD) and double-door (DD) laminoplasties in subjects with cervical ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data.
Although previous studies compared clinical results after OD and DD laminoplasties, they were performed at a single institution with a relatively small sample size targeting mixed pathologies, including cervical spondylotic myelopathy.

Methods.
This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of these, 41 and 164 patients received OD and DD laminoplasties, respectively. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, and visual analog scale scores.

Results.
Age, sex, symptom duration, and comorbidities were not significantly different between the groups. Segmental ossification was the most frequent in both the groups. No significant differences in K-line type, canal occupying ratio, C2 to C7 angles, and range of motion were found. Both the procedures reduced the cervical range of motion postoperatively. A comparable frequency of perioperative complications was observed between the groups. The cervical Japanese Orthopaedic Association scores showed a similar improvement at 2 years postopera- tively. The reduction in visual analog scale score for neck pain was favorable in the OD group (P = 0.02), while other pain assessments did not show any significant differences between the groups. The functional outcomes assessed using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire presented equivalent effective rates.

Conclusion.
The results demonstrated almost comparable surgical outcomes between OD and DD laminoplasties. Lamino- plasty is a valuable technique as a therapeutic option for cervical OPLL.

Level of Evidence: 2
Biomechanical Investigation of Lumbar Interbody Fusion Supplemented with Topping-off Instrumentation Using Different Dynamic Stabilization Devices
Authors: Fan Wei , Guo Li-Xin 
Published: May 2021

Study Design.
A biomechanical comparison study using finite element method.

Objective.
The aim of this study was to investigate effects of different dynamic stabilization devices, including pedicle-based dynamic stabilization system (PBDSS) and interspinous process spacer (ISP), used for topping-off implants on biomechanical responses of human spine after lumbar interbody fusion.

Summary of Background Data.
Topping-off stabilization technique has been proposed to prevent adjacent segment degeneration following lumbar spine fusion. PBDSS and ISP are the most used dynamic stabilizers for topping-off instrumentation. However, biomechanical differences between them still remain unclear.

Methods.
A validated, normal FE model of human lumbosacral spine was employed. Based on this model, rigid fusion at L4–L5 and moderately disc degeneration at L3–L4 were simulated and used as a comparison baseline. Subsequently, Bioflex and DIAM systems were instrumented at L3–L4 segment to construct PBDSS-based and ISP-based topping-off models. Biomechanical responses of the models to bending moments and vertical vibrational excitation were computed using FE static and random response analyses, respectively.

Results.
Results from static analysis showed that at L3–L4, the response parameters including annulus stress and range of motion were decreased by 41.6% to 85.2% for PBDSS-based model and by 6.3% to 67% for ISP-based model compared with rigid fusion model. At L2–L3, these parameters were lower in ISP-based model than in PBDSS-based model. Results from random response analysis showed that topping-off instrumentation increased resonant frequency of spine system but decreased dynamic response of annulus stress at L3–L4. PBDSS-based model generated lower dynamic stress than ISP-based model at L3–L4, but the dynamic stress was higher at L2–L3 for PBDSSbased model.

Conclusion.
Under static and vibration loadings, the PBDSSbased topping-off device (Bioflex) provided a better protection for transition segment, and likelihood of degeneration of supraadjacent segment might be relatively lower when using the ISPbased topping-off device (DIAM).

Level of Evidence: 5