bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Brain-derived Neurotrophic Factor From Active and Sham Transcranial Direct Current Stimulation in Older Adults With Knee Osteoarthritis
Authors: Suchting Robert , Teixeira Antonio L. , Ahn Brian , Colpo Gabriela D. , Park Juyoung , Ahn Hyochol 
Published: October 2021

Objectives:
Previous work has shown effects of transcranial direct current stimulation (tDCS) on clinical pain measures, qualitative sensory testing measures, and peripheral inflammation. The present report extends this research to investigate the effect of tDCS on brain-derived neurotrophic factor (BDNF) levels.

Materials and Methods:
This secondary analysis examined a sample of 40 older adults (50 to 70 y old) with symptomatic knee osteoarthritis randomly assigned in a 1:1 fashion to active (n=20) or sham (n=20) tDCS for 20 minutes on 5 consecutive days. BDNF was measured before the first session and after the final treatment session. Generalized linear modeling evaluated BDNF plasma levels as a function of tDCS group, adjusted for baseline. Bayesian statistical inference was used to quantify the probability that effects of the treatment exist.

Results:
Generalized linear modeling indicated a 90.4% posterior probability that the sham condition had 49.9% higher BDNF at the end of treatment, controlling for baseline. Follow-up analyses within the active TDCS group supported an association between change in BDNF and change in clinical pain, and exploratory analyses found an effect of tDCS on irisin.

Discussion:
Results indicated that tDCS could be a potential nonpharmacological treatment to decrease BDNF levels, which may in turn decrease pain. This study adds to a growing literature suggesting that tDCS affects cortical excitability, and consequentially, the neural circuits implicated in pain modulation. In addition to a direct connection to analgesia, BDNF changes may reflect tDCS-induced changes in different cortical areas and/or neural circuits.
Ultrasound-guided Multiple Nerve Blocks
Authors: Gu Jue , Wang Eerdun , Dai Shiyun , Dong Rong , Xu Fengying , Shen Zijin , Wang Zhiyuan , He Xingying 
Published: October 2021

Objectives:
The aim was to compare the feasibility of ultrasound-guided multiple nerve blocks (fascia iliaca compartment block+sacral plexus block+superior cluneal nerve block) with general anesthesia in geriatric hip fracture patients.

Methods:
Ninety-four patients were randomly divided into 2 groups: group N received ultrasound-guided multiple nerve blocks and group G received general anesthesia. Primary outcome measures included perioperative Pain Threshold Index (PTI) and Numerical Rating Scale. Secondary outcome measures comprised the following: (1) perioperative Delirium Index and Short Portable Mental Status Questionnaire; (2) perioperative Comfort Index; (3) perioperative opioid consumption (within 72 hours postoperatively); and (4) postoperative side effects (within 72 h postoperatively).

Results:
Eighty-seven patients completed the study. Baseline PTI was comparable between the groups. However, intraoperative PTI was significantly lower in group N than in group G. Preoperative and postoperative Comfort Index scores were comparable between the groups. Moderate delirium (24 to 72 h postoperatively) was significantly higher than the baseline in group G. Early moderate delirium (24 h postoperatively) was significantly higher in group G than in group N. Severe delirium was comparable between the groups and within each group. High intraoperative PTI was associated with high opioid consumption. The intravenous sufentanil dose in group G was twice of that in group N. Incidence of nausea and vomiting was similar between the groups.

Discussion:
Ultrasound-guided multiple nerve blockade may be an alternative to the common anesthetic procedures used for geriatric hip fracture patients. It provided satisfactory intraoperative pain management and reduced early postoperative cognitive disorders.
Reducing Blood Culture and Antibiotic Usage in Neonates
Authors: Romano-Clarke Giuseppina , Merrit Kamaris , Ziady Emily , Durham Cathleen , Johnson Jennifer , Morris Sarah , Nelson Brett D. 
Published: October 2021

Background:
A maternal diagnosis of chorioamnionitis, based on maternal peripartum fever of 100.4°F alone, is commonly used as an indication for blood work and antibiotic treatment in newborns. New strategies such as the Kaiser Permanente early-onset sepsis (EOS) calculator have proven effective in identifying high-risk newborns and reducing unnecessary antibiotic administration.

Purpose:
Retrospective data from October 2017 to September 2018 from 297 well-appearing newborns ≥35 weeks' gestational age (GA) with maternal chorioamnionitis showed that 93.6% had blood work and 90.2% were treated with antibiotics. This was despite no culture-positive cases of sepsis. Our aim was to reduce by 50% blood work evaluation and antibiotic treatment within a 6-month period.

Methods:
Using plan-do-study-act (PDSA) cycles, we adopted the Kaiser Permanente EOS calculator. We collected longitudinal data to track the outcomes after its implementation.

Results:
In 423 newborns with maternal chorioamnionitis triaged with the EOS calculator from October 2018 to July 2020, the rates of blood culture and antibiotic treatment decreased from 93.6% to 26.7% and 90.2% to 12.3% (P < .0001). In the larger population of 6426 newborns ≥35 weeks' GA, the rate of blood culture and antibiotic treatment decreased from 12.8% to 5.8% and 9.9% to 2.5% (P < .0001).

Implications for Practice:
The EOS calculator substantially and safely decreases blood work and antibiotic administration in asymptomatic newborns with maternal chorioamnionitis.

Implications for Research:
Our findings provide further evidence for the effectiveness and safety of the EOS calculator.

Video abstract available at
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
Use of Airway Pressure Release Ventilation in Patients With Acute Respiratory Failure Due to COVID-19: Results of a Single-Center Randomized Controlled Trial*
Authors: Ibarra-Estrada Miguel Á. , García-Salas Yessica , Mireles-Cabodevila Eduardo , López-Pulgarín José A. , Chávez-Peña Quetzalcóatl , García-Salcido Roxana , Mijangos-Méndez Julio C. , Aguirre-Avalos Guadalupe 
Published: October 2021

OBJECTIVES:
Airway pressure release ventilation is a ventilatory mode characterized by a mandatory inverse inspiratory:expiratory ratio with a very short expiratory phase, aimed to avoid derecruitment and allow spontaneous breathing. Recent basic and clinical evidence suggests that this mode could be associated with improved outcomes in patients with acute respiratory distress syndrome. The aim of this study was to compare the outcomes between airway pressure release ventilation and traditional ventilation targeting low tidal volume, in patients with severe coronavirus disease 2019.

DESIGN:
Single-center randomized controlled trial.

SETTING:
ICU of a Mexican referral center dedicated to care of patients with confirmed diagnosis of coronavirus disease 2019.

PATIENTS:
Ninety adult intubated patients with acute respiratory distress syndrome associated with severe coronavirus disease 2019.

INTERVENTIONS:
Within 48 hours after intubation, patients were randomized to either receive ventilatory management with airway pressure release ventilation or continue low tidal volume ventilation.

MEASUREMENTS AND MAIN RESULTS:
Forty-five patients in airway pressure release ventilation group and 45 in the low tidal volume group were included. Ventilator-free days were 3.7 (0–15) and 5.2 (0–19) in the airway pressure release ventilation and low tidal volume groups, respectively (p = 0.28). During the first 7 days, patients in airway pressure release ventilation had a higher Pao
2/Fio
2 (mean difference, 26 [95%CI, 13–38]; p < 0.001) and static compliance (mean difference, 3.7 mL/cm H2O [95% CI, 0.2–7.2]; p = 0.03), higher mean airway pressure (mean difference, 3.1 cm H2O [95% CI, 2.1–4.1]; p < 0.001), and higher tidal volume (mean difference, 0.76 mL/kg/predicted body weight [95% CI, 0.5–1.0]; p < 0.001). More patients in airway pressure release ventilation had transient severe hypercapnia, defined as an elevation of Pco
2 at greater than or equal to 55 along with a pH less than 7.15 (42% vs 15%; p = 0.009); other outcomes were similar. Overall mortality was 69%, with no difference between the groups (78% in airway pressure release ventilation vs 60% in low tidal volume; p = 0.07).

CONCLUSIONS:
In conclusion, when compared with low tidal volume, airway pressure release ventilation was not associated with more ventilator-free days or improvement in other relevant outcomes in patients with severe coronavirus disease 2019.
Transcatheter arterial chemoembolization followed by surgical resection for hepatocellular carcinoma: a focus on its controversies and screening of patients most likely to benefit
Authors: Wei Zhan-Qi , Zhang Yue-Wei 
Published: October 2021

Abstract
Surgical resection (SR) is recommended as a radical procedure in the treatment of hepatocellular carcinoma (HCC). However, postoperative recurrence negatively affects the long-term efficacy of SR, and preoperative adjuvant therapy has therefore become a research hotspot. Some clinicians adopt transcatheter arterial chemoembolization (TACE) as a preoperative adjuvant therapy in patients undergoing SR to increase the resection rate, reduce tumor recurrence, and improve the prognosis. However, the findings of the most relevant studies remain controversial. Some studies have confirmed that preoperative TACE cannot improve the long-term survival rate of patients with HCC and might even negatively affect the resection rate. Which factors influence the efficacy of preoperative TACE combined with SR is a topic worthy of investigation. In this review, existing clinical studies were analyzed with a particular focus on several topics: screening of the subgroups of patients most likely to benefit from preoperative TACE, exploration of the optimal treatment regimen of preoperative TACE, and determination of the extent of tumor necrosis as the deciding prognostic factor.
Highly Crosslinked Polyethylene Liners Have Negligible Wear at 10 Years: A Radiostereometric Analysis Study
Authors: Campbell David G. , Callary Stuart A. 
Published: October 2021

Abstract

Background
The introduction of crosslinked ultra-high molecular weight polyethylene (XLPE) acetabular liners has been very successful, with decreased wear and reduction in the rates of revision hip arthroplasties. XLPE is the preferred articulation for most surgeons; however, there are concerns about the long-term performance of XLPE liners created with different manufacturing processes, which may lead to time-dependent failure, including accelerated wear, after several years.

Questions/purposes
(1) What is the amount and rate of wear during the first 10 years using radiostereometric analysis (RSA) measurements of patients who had THAs that included a second-generation XLPE bearing? (2) Does the rate of wear change after 5 years in situ?

Methods
This is a brief follow-up of a previous RSA study. In that study, we prospectively enrolled 21 patients with osteoarthritis who underwent primary cementless THA with an XLPE acetabular liner (three cycles of 3Mrad annealed) and 32-mm articulation. That group represented 44% of the 48 THAs performed by the surgeon at the hospital where RSA was available; 16 had cemented hips, leaving 32 who were invited to participate in this study. Of those, 11 lived rurally and declined to participate, leaving 21 patients who were included in the initial study. Since then, three patients died, one developed dementia and could not participate, and one had revision THA for reasons other than wear, leaving 16 patients available for analysis at 10 years. Tantalum markers were inserted during surgery, and all patients had RSA radiographs taken at 1 week, 6 months, and 1, 2, 5, and 10 years postoperatively. Femoral head penetration into the acetabular component was measured with RSA, including bedding-in during the first year and annual wear thereafter.

Results
The median medial, proximal, anterior, two-dimensional (2D), and three-dimensional (3D) wear rates between 1 and 10 years were -0.001, 0.004, -0.012, 0.000, and 0.002 mm/year, respectively. No patient in this cohort had a proximal or 2D wear rate greater than 0.025 mm/year. The median proximal wear rate between 5 and 10 years (0.002 mm/year) was not greater than wear at 1 to 5 years (0.004 mm/year).

Conclusion
Femoral head penetration in this second-generation XLPE liner remained very low at 10 years and accelerated wear after 5 years in situ did not occur. Concerns about late-onset wear from oxidation of irradiated-annealed XLPE were not observed. The low level of wear remains encouraging for the future clinical performance of this material.

Level of Evidence
Level II, therapeutic study.
Changes in Children's Behavioral Health and Family Well-Being During the COVID-19 Pandemic
Authors: Hanno Emily C. , Cuartas Jorge , Miratrix Luke W. , Jones Stephanie M. , Lesaux Nonie K. 
Published: October 2021

ABSTRACT:

Objective:
The coronavirus disease 2019 pandemic and associated public health measures have influenced all aspects of life for children and families. In this study, we examine changes in children's behavioral health and families' well-being at the start of the pandemic.

Method:
We used longitudinal data on 2880 children from 1 US state collected over 3 waves to compare family and child well-being before and after a state-wide stay-at-home advisory set in March 2020. We descriptively examined levels and changes in 4 child behavioral health outcomes (externalizing, internalizing, adaptive, and dysregulated behaviors) and 4 family well-being outcomes (parental mental health, parental stress, parent-child relationship conflict, and household chaos) across the preshutdown and postshutdown periods. Fixed effects regression models were used to predict within-child and within-family differences in preshutdown and postshutdown outcomes.

Results:
Fixed effects analyses showed children's externalizing (0.09 points; 95% confidence interval [CI] 0.05–0.13), internalizing (0.04 points; 95% CI, 0.01–0.08), and dysregulated (0.11 points; 95% CI, 0.06–0.16) behaviors increased after the shutdown, whereas children's adaptive behaviors declined (−0.10 points; 95% CI, −0.15 to −0.05). Parental mental health issues (0.22 points; 95% CI, 0.17–0.27), parental stress (0.08 points; 95% CI, 0.03–0.12), parent-child relationship conflict (0.10 points; 95% CI, 0.04–0.16), and household chaos (0.10 points; 95% CI, 0.05–0.14) all increased relative to preshutdown levels.

Conclusion:
Many children experienced declines in behavioral health and many families experienced declines in well-being in the early months of the public health crisis, suggesting the need for family-focused and child-focused policies to mitigate these changes.
Implementation and Routinization of the ABCDE Bundle
Authors: Collinsworth Ashley W. , Brown Rachel , Cole Louann , Jungeblut Candice , Kouznetsova Maria , Qiu Taoran , Richter Kathleen M. , Smith Susan , Masica Andrew L. 
Published: October 2021

Background
The ABCDE (Awakening and Breathing Coordination, Delirium monitoring and management, and Early exercise/mobility) bundle has been associated with reductions in delirium incidence and improved patient outcomes but has not been widely adopted.

Objective
The objective of this study was to determine how to facilitate ABCDE bundle adoption by examining the impact of different implementation strategies on bundle adherence rates and assessing clinicians' perceptions of the bundle and implementation efforts.

Methods
This study examined the effect of 2 bundle implementation strategies on patient care in 8 adult intensive care units. The basic strategy included electronic health record (EHR) modification, whereas the enhanced strategy included EHR modification plus additional bundle training, clinical champions, and staff engagement. A total of 84 nurses, physicians, and therapists participated in interviews and a survey to assess bundle implementation.

Results
Respondents indicated bundle use resulted in “best care” through care standardization and coordination and improved patient outcomes. Intensive care units in both intervention groups had significant improvements in bundle adherence after implementation efforts, but intensive care units in the basic intervention group outperformed other sites after initiating their own implementation strategies. Successful implementation tactics included incorporating the bundle into multidisciplinary rounds and providing ongoing support, training, and routine auditing and feedback.

Discussion
The ABCDE bundle can improve quality of care and outcomes, and implementation can be accelerated through EHR tools, trainings, and performance feedback.
Development, Implementation, and Impact of a Proning Team During the COVID-19 Intensive Care Unit Surge
Authors: O'Donoghue Sharon C. , Church Meghan , Russell Kristin , Gamboa Kelly A. , Hardman Jacqueline , Sarge Jennifer , Moskowitz Ari , Hayes Margaret M. , Cocchi Michael N. , DeSanto-Madeya Susan 
Published: October 2021

Background
Prone positioning has been used as an intervention to improve oxygenation in critically ill patients with acute respiratory distress syndrome. During the COVID-19 pandemic, resources were even more limited given a surge in acute respiratory distress syndrome patients, which outstripped intensive care unit (ICU) capacity at many institutions.

Local Problem
The purpose of this article is to describe the development and implementation of a proning team during the surge in ICU patients with COVID-19 and to measure the impact of the program through surveys of staff involved.

Methods/Interventions
A proning protocol and educational plan was developed. A proning team of redeployed staff was created. A survey of ICU registered nurses and proning team members was used to evaluate the benefits and challenges of the proning team.

Results
The proning team was successful in safely performing more than 300 proning and supinating maneuvers for critically ill patients. There is overwhelming support within the institution for a proning team for future COVID-19 surges.

Discussion
The development and implementation of the proning team happened quickly to assist with the surge of patients and off-load work from ICU registered nurses. Despite the success of the proning team, more clearly defined roles and expectations, as well as additional education, are needed to further enhance teamwork and workflow.

Conclusions
Creation of the proning team was a creative use of resources that helped manage the large and medically complex patient population. This work may serve as a guide to other health care institutions.
Full-Thickness Laparoendoscopic Excision for Management of Complex Colon Polyps
Authors: Mirza Kasim L. , Wickham Carey J. , Noren Erik R. , Shin Joongho , Cologne Kyle G. , Lee Sang W. 
Published: October 2021

BACKGROUND:
Benign colon polyps are increasingly being detected because of improved colonoscopic screening and early detection of masses on the adenoma-to-carcinoma pathway. Full-thickness laparoendoscopic excision is a colon-preserving technique for endoscopically unresectable polyps consisting of endoscopically guided nonanatomic wedge colectomy.

OBJECTIVE:
This study aimed to evaluate the safety and success of full-thickness laparoendoscopic excision compared to segmental colectomy for complex polyps not amenable to endoscopic resection.

DESIGN:
This is a retrospective case-control study.

SETTINGS:
This study was conducted at a tertiary academic center.

PATIENTS:
A prospectively maintained institutional database identified 22 patients with benign complex polyps managed with full-thickness laparoendoscopic excision from 2015 to 2020. These patients were compared with 22 propensity score-matched controls from the same database that underwent laparoscopic segmental colectomy.

MAIN OUTCOME MEASURES:
Primary outcome was inpatient length of stay. Secondary outcomes included operative details and postoperative morbidities.

RESULTS:
Full-thickness laparoendoscopic excision was successful in all patients. Patients had a median age of 64 years (41–85), and 82% were men. Final pathology revealed complete excision of benign lesions in 20 of 22 patients and adenocarcinoma in 2 of 22. For the adenocarcinomas, 1 patient underwent subsequent elective colectomy without complications, and 1 patient declined surgery. Propensity score matching was successful for age, sex, BMI, ASA score, colon location, and prior abdominal surgery. Compared with controls, cases had significantly shorter operative time (89.5 minutes (46–290) vs 122 minutes (85–200), p = 0.009), length of stay (1 day (0–17) vs 3 days (1–8), p < 0.001), and reduced blood loss (5 mL (2–15) vs 25 mL (10–150), p < 0.001). Thirty-day morbidity (9.1% vs 27.3%, p = 0.240) was not significantly different. An unplanned 30-day reoperation was performed in 1 patient for suspected small-bowel obstruction. There was 1 mortality due to decompensated cirrhosis in the treatment group.

LIMITATIONS:
This study was limited by its single-institution retrospective design.

CONCLUSIONS:
Full-thickness laparoendoscopic excision is safe and successful compared with corresponding segmental colectomy for complex polyps. Favorable postoperative outcomes, including decreased operative time, length of stay, and blood loss, make it a useful approach for managing complex polyps throughout the colon.
Two-Team Lateral Pelvic Lymph Node Dissection Assisted By the Transanal Approach
Authors: Matsuda Takeru , Yamashita Kimihiro , Hasegawa Hiroshi , Urakawa Naoki , Kanaji Shingo , Oshikiri Taro , Nakamura Tetsu , Kakeji Yoshihiro 
Published: October 2021

INTRODUCTION:
Although lateral pelvic lymph node dissection is considered as a treatment option for advanced rectal cancer, it is technically demanding. Recently, the transanal approach for total mesorectal excision has become increasingly used. In this Technical Note, we describe lateral pelvic lymph node dissection using a 2-team method that was assisted by the transanal approach.

TECHNIQUE:
First, the lateral pelvic area was entered from the anal side by dissection between the S4 sacral splanchnic nerve and levator ani muscle. Then, the fatty tissues including the obturator compartment and the distal part of the internal iliac compartment were separated from the inferior and superior vesical vessels and the bladder wall. Next, the fatty tissues were separated from the lateral pelvic wall. The obturator nerve was isolated and preserved, whereas the obturator vessels were resected at their peripheral end. Then, the fatty tissues were dissected from the bottom plane. Finally, the fatty tissues were dissected from the ventral bladder wall and were completely isolated from the obturator nerve in cooperation with the transabdominal team.

RESULTS:
The 2-team method shortened the operative time dramatically and decreased mental and physical burden on the operators during lateral dissection. Assistance with the transanal approach helped with a secure and effective dissection, especially of the most distal parts, such as around the internal pudendal and inferior vesical arteries, because substantial skill is required for the transabdominal approach alone.

CONCLUSIONS:
This procedure is useful for the safe and effective performance of lateral pelvic lymph node dissection for patients with rectal cancer.