bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rhythmic Change of Cortical Hemodynamic Signals Associated with Ongoing Nociception in Awake and Anesthetized Individuals: An Exploratory Functional Near Infrared Spectroscopy Study
Authors: Peng Ke , Deepti Karunakaran Keerthana , Lee Arielle , Gomez-Morad Andrea , Labadie Robert , Mizrahi-Arnaud Arielle , Berry Delany , Kussman Barry , Zurakowski David , Micheli Lyle , Becerra Lino , Borsook David 
Published: October 2021

Background
Patients undergoing surgical procedures are vulnerable to repetitive evoked or ongoing nociceptive barrage. Using functional near infrared spectroscopy, the authors aimed to evaluate the cortical hemodynamic signal power changes during ongoing nociception in healthy awake volunteers and in surgical patients under general anesthesia. The authors hypothesized that ongoing nociception to heat or surgical trauma would induce reductions in the power of cortical low-frequency hemodynamic oscillations in a similar manner as previously reported using functional magnetic resonance imaging for ongoing pain.

Methods
Cortical hemodynamic signals during noxious stimuli from the fontopolar cortex were evaluated in two groups: group 1, a healthy/conscious group (n = 15, all males) where ongoing noxious and innocuous heat stimulus was induced by a contact thermode to the dorsum of left hand; and group 2, a patient/unconscious group (n = 13, 3 males) receiving general anesthesia undergoing knee surgery. The fractional power of low-frequency hemodynamic signals was compared across stimulation conditions in the healthy awake group, and between patients who received standard anesthesia and those who received standard anesthesia with additional regional nerve block.

Results
A reduction of the total fractional power in both groups—specifically, a decrease in the slow-5 frequency band (0.01 to 0.027 Hz) of oxygenated hemoglobin concentration changes over the frontopolar cortex—was observed during ongoing noxious stimuli in the healthy awake group (paired t test, P = 0.017; effect size, 0.70), and during invasive procedures in the surgery group (paired t test, P = 0.003; effect size, 2.16). The reduction was partially reversed in patients who received a regional nerve block that likely diminished afferent nociceptive activity (two-sample t test, P = 0.002; effect size, 2.34).

Conclusions
These results suggest common power changes in slow-wave cortical hemodynamic oscillations during ongoing nociceptive processing in conscious and unconscious states. The observed signal may potentially promote future development of a surrogate signal to assess ongoing nociception under general anesthesia.

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Use of Immediate Postpartum Long-Acting Reversible Contraception Before and After a State Policy Mandated Inpatient Access
Authors: Brant Ashley R. , Kollikonda Swapna , Yao Meng , Mei Lin , Emery Jonathan 
Published: October 2021

OBJECTIVE:
To assess the rate of immediate postpartum long-acting reversible contraceptive (LARC) use in a multihospital health care system 2 years before and after the policy was implemented, and to assess factors associated with LARC use and repeat pregnancy rates within 12 months after delivery.

METHODS:
We conducted a retrospective chart review of all patients giving birth at three Cleveland Clinic Ohio hospitals from July 1, 2015, to June 30, 2019. We reviewed the inpatient medication reconciliation to identify the LARC initiation rate. We compared all patients who received inpatient postpartum LARC to a 1:3 matched sample of patients who did not receive LARC, matched by delivery date and location, to identify patient characteristics associated with LARC use. The electronic medical record (Epic) was reviewed to identify new pregnancies occurring within 12 months postdelivery.

RESULTS:
We identified 17,848 deliveries prepolicy and 18,555 deliveries postpolicy. Immediate postpartum LARC was used by 0.5% (monthly range 0–2.1%) of patients prepolicy and 11.6% (monthly range 8.3–15.4%) of patients postpolicy. Levonorgestrel intrauterine devices (IUDs) were used by 56.5%, implants by 29.1%, and copper IUDs by 14.5% of LARC users. Characteristics associated with LARC use included younger age, public insurance, non-White race, Hispanic or Latina ethnicity, higher body mass index, sexually transmitted infection in pregnancy, and tobacco use. Long-acting reversible contraceptive users had a lower rate of repeat pregnancy at 12 months postpartum compared with the non-LARC group (1.9% vs 3.6%, P<.001).

CONCLUSION:
Immediate postpartum LARC use increased after a state policy change mandated universal access and was associated with decreased pregnancy rates in the first year postdelivery.
Association of Epilepsy and Severe Maternal Morbidity
Authors: Panelli Danielle M. , Leonard Stephanie A. , Kan Peiyi , Meador Kimford J. , McElrath Thomas F. , Darmawan Kelly F. , Carmichael Suzan L. , Lyell Deirdre J. , El-Sayed Yasser Y. , Druzin Maurice L. , Herrero Tiffany C. 
Published: October 2021

OBJECTIVE:
To evaluate severe maternal morbidity (SMM) among patients with epilepsy and patients without epilepsy.

METHODS:
We retrospectively examined SMM using linked birth certificate and maternal hospital discharge records in California between 2007 and 2012. Epilepsy present at delivery admission was the exposure and was subtyped into generalized, focal and other less specified, or unspecified. The outcomes were SMM and nontransfusion SMM from delivery up to 42 days’ postpartum, identified using Centers for Disease Control and Prevention indicators. Multivariable logistic regression models were used to adjust for confounders, which were selected a priori. We also estimated the association between epilepsy and SMM independent of comorbidities by using a validated obstetric comorbidity score. Severe maternal morbidity indicators were then compared using the same multivariable logistic regression models.

RESULTS:
Of 2,668,442 births, 8,145 (0.3%) were to patients with epilepsy; 637 (7.8%) had generalized, 6,250 (76.7%) had focal or other less specified, and 1,258 (15.4%) had unspecified subtypes. Compared with patients without epilepsy, patients with epilepsy had greater odds of SMM (4.3% vs 1.4%, adjusted odds ratio [aOR] 2.91, 95% CI 2.61–3.24) and nontransfusion SMM (2.9% vs 0.7%, aOR 4.16, 95% CI 3.65–4.75). Epilepsy remained significantly associated with increased SMM and nontransfusion SMM after additional adjustment for the obstetric comorbidity score, though the effects were attenuated. When grouped by organ system, all SMM indicators were significantly more common among patients with epilepsy—most notably those related to hemorrhage and transfusion.

CONCLUSION:
Severe maternal morbidity was significantly increased in patients with epilepsy, and SMM indicators across all organ systems contributed to this.
Homicide During Pregnancy and the Postpartum Period in the United States, 2018–2019
Authors: Wallace Maeve , Gillispie-Bell Veronica , Cruz Kiara , Davis Kelly , Vilda Dovile 
Published: October 2021

OBJECTIVE:
To estimate the national pregnancy-associated homicide mortality ratio, characterize pregnancy-associated homicide victims, and compare the risk of homicide in the perinatal period (pregnancy and up to 1 year postpartum) with risk among nonpregnant, nonpostpartum females aged 10–44 years.

METHODS:
Data from the National Center for Health Statistics 2018 and 2019 mortality files were used to identify all female decedents aged 10–44 in the United States. These data were used to estimate 2-year pregnancy-associated homicide mortality ratios (deaths/100,000 live births) for comparison with homicide mortality among nonpregnant, nonpostpartum females (deaths/100,000 population) and to mortality ratios for direct maternal causes of death. We compared characteristics and estimated homicide mortality rate ratios and 95% CIs between pregnant or postpartum and nonpregnant, nonpostpartum victims for the total population and with stratification by race and ethnicity and age.

RESULTS:
There were 3.62 homicides per 100,000 live births among females who were pregnant or within 1 year postpartum, 16% higher than homicide prevalence among nonpregnant and nonpostpartum females of reproductive age (3.12 deaths/100,000 population, P<.05). Homicide during pregnancy or within 42 days of the end of pregnancy exceeded all the leading causes of maternal mortality by more than twofold. Pregnancy was associated with a significantly elevated homicide risk in the Black population and among girls and younger women (age 10–24 years) across racial and ethnic subgroups.

CONCLUSION:
Homicide is a leading cause of death during pregnancy and the postpartum period in the United States. Pregnancy and the postpartum period are times of elevated risk for homicide among all females of reproductive age.
Complete Response to Combination Nivolumab and Ipilimumab in Recurrent Neuroendocrine Carcinoma of the Cervix
Authors: Paterniti Thomas A. , Dorr Katie , Ullah Asad , White Joseph , Williams Hadyn , Ghamande Sharad 
Published: October 2021

BACKGROUND:
Small cell neuroendocrine carcinoma of the cervix is a rare, aggressive tumor treated with a combination of surgery, chemotherapy, and radiation. Survival rates are poor, and innovative therapies are needed.

CASE:
A 52-year-old woman was diagnosed with small cell neuroendocrine carcinoma of the cervix. Over a 10-year period, she was treated with six different systemic therapeutic regimens, underwent planned hysterectomy with bilateral salpingo-oophorectomy, and received radiation to the pelvis and brain. After a second recurrence of disease, she was treated with a combination of nivolumab and ipilimumab and experienced a complete and durable response.

CONCLUSION:
The combination of nivolumab and ipilimumab may represent a promising new treatment option for recurrent small cell neuroendocrine carcinoma of the cervix.
Pregnant Individuals' Views on Fetal Tissue Research in the United States
Authors: Spach Natalie C. , Jaffe Elana F. , Sullivan Kristen A. , Goldfarb Ilona T. , Anderson Jean R. , Coleman Jenell , Gilbert Sappho Z. , Gross Marielle S. , Rahangdale Lisa , Faden Ruth R. , Lyerly Anne D. 
Published: October 2021

OBJECTIVE:
Fetal tissue research has driven significant medical advances but remains publicly contentious in the United States. The views of pregnant individuals in the United States regarding the donation of fetal tissue offer an important and previously unexplored perspective on this issue.

METHODS:
We conducted a secondary analysis of data from two separate, broader qualitative studies. Pregnant and recently pregnant individuals (N=79) from clinical sites at the University of North Carolina at Chapel Hill, Johns Hopkins University, and Massachusetts General Hospital were interviewed individually using a semi-structured guide addressing a range of issues related to infectious disease research and pregnancy, including the acceptability of fetal tissue research. Interviews were transcribed, coded, and analyzed for emergent themes.

RESULTS:
Among this sample of predominantly Black (61%), reproductive-aged pregnant and recently pregnant participants, the majority (72%) generally supported fetal tissue research. The following three themes were identified: choice, respect, and meaning. Respondents discussed the deeply personal nature of decisions surrounding fetal tissue research, emphasizing the importance of informed consent and respect for the person's emotional state when approaching for consent. The ways in which participants regarded how to respectfully handle fetal tissue also shaped views about the acceptability of donation, both for and against. For many participants, fetal tissue donation to research represented one way of ascribing meaning to pregnancy termination or loss.

CONCLUSION:
Among this diverse sample of pregnant and recently pregnant individuals, most were supportive of fetal tissue donation for research. A better understanding of pregnant individuals' views on this topic may lead to policies and practices that are congruent with the needs and values of people facing decisions regarding the disposition of fetal remains.
Trends in the Use of Minimally Invasive Adnexal Surgery in the United States
Authors: Dioun Shayan , Huang Yongmei , Melamed Alexander , Gockley Allison , St. Clair Caryn M. , Hou June Y. , Tergas Ana I. , Khoury-Collado Fady , Hershman Dawn L. , Wright Jason D. 
Published: October 2021

OBJECTIVE:
To examine the utilization of minimally invasive adnexal surgery, including ovarian cystectomy and oophorectomy, among women with benign gynecologic diseases and compare the associated morbidity and mortality of minimally invasive and open surgery.

METHODS:
Women with benign ovarian pathology who underwent an ovarian cystectomy or oophorectomy from 2016 through 2018 in the Nationwide Ambulatory Surgery Sample and Nationwide Inpatient Sample databases were included. Patients with a diagnosis of gynecologic malignancy or concurrent hysterectomy were excluded. Population-level weighted estimates were developed, and perioperative morbidity, mortality, and hospital charges were examined based on surgical approach for each procedure.

RESULTS:
The cohort included 351,207 women who underwent oophorectomy and 220,893 women who underwent cystectomy, when weighted representing 547,836 and 328,408 patients, respectively, nationwide. A minimally invasive surgical approach was used in 294,190 (89.6%) patients who underwent ovarian cystectomy, and in 478,402 (87.3%) of patients who underwent oophorectomy. Use of minimally invasive surgery for cystectomy increased from 88.7% in 2016 to 91.0% in 2018, and the rate of minimally invasive surgery for oophorectomy increased from 85.8% to 88.7% over the same time period (P<.001 for both). The complication rates for ovarian cystectomy were 2.7% for minimally invasive surgery and 8.8% for laparotomy (P<.001); for oophorectomy the complication rate was 3.1% for minimally invasive surgery and 22.9% for laparotomy (P<.001).

CONCLUSION:
Minimally invasive surgery is used in the majority of women who are undergoing oophorectomy and ovarian cystectomy for benign indications. Compared with laparotomy, minimally invasive surgery is associated with fewer complications.
Vocal Turn-Taking in Families With Children With and Without Hearing Loss
Authors: Kondaurova Maria V. , Zheng Qi , VanDam Mark , Kinney Kaelin 
Published: October 2021

Objective:
Vocal turn-taking is an important predictor of language development in children with and without hearing loss. Most studies have examined vocal turn-taking in mother-child dyads without considering the multitalker context in a child’s life. The present study investigates the quantity of vocal turns between deaf and hard-of-hearing children and multiple members of their social environment.

Design:
Participants were 52 families with children who used hearing aids (HA, mean age 26.3 mo) or cochlear implants (CI, mean age 63.2 mo) and 27 families with normal-hearing (NH, mean age 26.6 mo) children. The Language ENvironment Analysis system estimated the number of conversational turns per hour (CTC/hr) between all family members (i.e., adult female, adult male, target child, and other child) during full-day recordings over a period of about 1 year.

Results:
The CTC/hr was lower between the target child and the adult female or adult male in the CI compared with the HA and NH groups. Initially, CTC/hr was higher between the target child and the adult female than between the adult male or the other child. As the child’s age increased, turn-taking between the target child and the adult female increased in comparison to that between the target child and the adult male. Over time, turn-taking between the target child and the other child increased and exceeded turn-taking between the target child and the adult caregivers. The increase was observed earlier in families with siblings compared with those without.

Conclusions:
The quantity of vocal turn-taking depends on the degree of child hearing loss and the relationship between the children and the members of their social environment. Longitudinally, the positive effect of an assistive device on the quantity of turns between the children and their family members was found. The effect was stronger in families with siblings.
Impact of Intraoperative Hypothermia on Transfusion Requirements in Patients With Pelvic and Acetabular Trauma
Authors: Goel Rahul , Boissonneault Adam , Grissom Helyn , Arora Sona , Hernandez-Irizarry Roberto , Schenker Mara , Maceroli Michael 
Published: October 2021

Objectives:
To explore the association between intraoperative hypothermia and perioperative blood loss and blood transfusion requirements in patients with operative pelvic and acetabular fractures.

Design:
Retrospective review.

Setting:
Single, Level 1 trauma center in Atlanta, Georgia.

Patients/Participants:
Three hundred seventy-four patients who underwent surgical fixation of an acetabular fracture and/or pelvic ring injury at a single Level 1 trauma center during the years 2013–2017.

Main Outcome Measures:
Estimated blood loss during surgery (EBL, mL), drain output (mL) on postoperative day 1 (POD1), and rate of postoperative packed red blood cell (pRBC) transfusion (%).

Results:
A significant association was found between intraoperative hypothermia and postoperative transfusion requirement (P = 0.016). The rate of postoperative blood transfusion was 42% for patients with intraoperative hypothermia compared with 28% for controls. In a subgroup analysis of patients presenting with an admission acidosis, the rate of postoperative transfusion was significantly increased to more than 4 times as likely when intraoperative hypothermia was present, even after controlling for admission hemoglobin, Injury Severity Score, and rate of preoperative transfusion (OR 4.4; P = 0.018).

Conclusions:
For patients with pelvic trauma who present with an admission acidosis, intraoperative hypothermia is an independent risk factor for postoperative blood transfusion. This information is clinically important given the modifiable nature of intraoperative patient temperature and the known complications and sequelae associated with increased transfusion rates.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Zero Patient-controlled Analgesia is an Achievable Target for Postoperative Rapid Recovery Management of Adolescent Idiopathic Scoliosis Patients
Authors: Sarwahi Vishal , Hasan Sayyida , Liao Benita , Galina Jesse , Atlas Aaron , Lo Yungtai , Lee Andrew , Lentz Jonathon , Amaral Terry , Kars Michelle 
Published: October 2021

Study Design.
Retrospective review.

Objective.
The objective of this study was to report on one institution's use of single bolus micro-dose intrathecal morphine as part of a rapid recovery pathway during posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and its comparison to patients whose pain was controlled with patient-controlled analgesia (PCA).

Summary of Background Data.
Narcotic substance addiction has risen across all patient populations, including pediatrics. Narcotics have been historically used in complex spine surgeries as a measure of pain control, predominantly provided as PCA and additional take-home medication.

Methods.
AIS patients undergoing PSF from 2015 to 2019 were reviewed. In 2018, we instituted a standardized rapid recovery pathway for scoliosis patients undergoing PSF utilizing micro-dose intrathecal morphine (ITM-RRP). Before this, traditional protocol with PCA was used for postoperative management. Perioperative data, morphine consumption and prescription refill requests were compared.

Results.
There were 373 AIS patients total in this study, of which 250 patients were in the PCA group and 123 in the ITM-RRP Group. Preoperative Cobb angles (P = 0.195), as well as levels fused (P = 0.481) and body mass index (P = 0.075) were similar. 69.4% of ITM-RRP patients had a length of stay ≤3 days, significantly >11.6% of PCA patients (P < 0.001). ITM-RRP patients began ambulating significantly earlier with 84.6% patients out of bed by postoperative day 1 versus 8% PCA patients (P < 0.001). Additionally, ITM-RRP patients had significantly lower VAS pain scores with activity and earlier initial bowel movements (P < 0.001).
Postoperative emesis was similar (P = 0.11). No patients had pruritus, respiratory depression, or required supplemental oxygenation.

Conclusion.
This is the first study to show that a rapid recovery protocol utilizing single micro-dose ITM with oral analgesics have adequate recovery, significantly better postoperative pain control and superior perioperative outcomes to traditional protocols using PCA in the AIS population following PSF.

Level of Evidence: 3
Implant Microbial Colonization Detected by Sonication as a Cause for Spinal Device Failure
Authors: García-Pérez Daniel , Lagares Alfonso , Castaño-León Ana María , Panero Irene , Munarriz Pablo M. , Delgado-Fernández Juan , Jiménez-Roldán Luis , Pérez-Núñez Angel , Alén Jose Antonio F. , Paredes Igor 
Published: October 2021

Study Design.
A prospective single center observational study.

Objectives.
The aim of this study was to examine the potential role of sonication in the diagnosis of low-grade infections and its association with pedicle screw (PS) loosening, and to describe risk factors and radiological findings associated with spinal implant infection.

Summary of Background Data.
Although PS loosening has mainly been attributed to mechanical overload, implant colonization and biofilm formation have recently been suggested. Culturing of sonication fluid implants is promising in the field of spine instrumentation infection, but little data are available.

Methods.
We prospectively included all patients who were subjected to implant removal. PS loosening was assessed with computed tomography (CT) scan. Different clinical and radiological parameters which could serve as indicators of implant infection were studied.

Results.
Thirty-eight patients were included in the study and 11 of them (29%) had a positive sonication result. Patients with spinal implant infection were associated with screw loosening (P = 0.005). Particularly, those screws with a positive microbiological culture showed signs of screw loosening in the preoperative CT scan (P < 0.001). Our results also showed that radiological screw loosening at L1-L3 level, and loosened larger constructs were associated with screw microbial colonization. The most common isolated microorganisms were coagulase-negative staphylococci and Cutibacterium acnes. An implant-based multivariate analysis indicated that screw loosening, the absence of prophylactic cefazolin, ICU hospitalization, screw breakage, and L1-L3 spine level were independent risk factors for implant-associated infection. Our model exhibited a high predictive power with an area under the curve of 0.937.

Conclusion.
As clinical presentation of deep implant chronic infection is unspecific, consideration of these factors enables preoperative prediction and risk stratification of implant colonization, thus helping patient's management.

Level of Evidence: 3