bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current Ventilator and Oxygen Management during General Anesthesia
Authors: Suzuki Satoshi , Mihara Yuko , Hikasa Yukiko , Okahara Shuji , Ishihara Takuma , Shintani Ayumi , Morimatsu Hiroshi ,   on behalf of the Okayama Research Investigation Organizing Network (ORION) investigators
Published: March 2018

Abstract

Background
Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia.

Methods
A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1 h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%).

Results
A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60).

Conclusions
Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.
Averting Opioid-induced Respiratory Depression without Affecting Analgesia
Authors: Dahan Albert , van der Schrier Rutger , Smith Terry , Aarts Leon , van Velzen Monique , Niesters Marieke 
Published: March 2018

Abstract
The ventilatory control system is highly vulnerable to exogenous administered opioid analgesics. Particularly respiratory depression is a potentially lethal complication that may occur when opioids are overdosed or consumed in combination with other depressants such as sleep medication or alcohol. Fatalities occur in acute and chronic pain patients on opioid therapy and individuals that abuse prescription or illicit opioids for their hedonistic pleasure. One important strategy to mitigate opioid-induced respiratory depression is cotreatment with nonopioid respiratory stimulants. Effective stimulants prevent respiratory depression without affecting the analgesic opioid response. Several pharmaceutical classes of nonopioid respiratory stimulants are currently under investigation. The majority acts at sites within the brainstem respiratory network including drugs that act at α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (ampakines), 5-hydroxytryptamine receptor agonists, phospodiesterase-4 inhibitors, D1-dopamine receptor agonists, the endogenous peptide glycyl-glutamine, and thyrotropin-releasing hormone. Others act peripherally at potassium channels expressed on oxygen-sensing cells of the carotid bodies, such as doxapram and GAL021 (Galleon Pharmaceuticals Corp., USA). In this review we critically appraise the efficacy of these agents. We conclude that none of the experimental drugs are adequate for therapeutic use in opioid-induced respiratory depression and all need further study of efficacy and toxicity. All discussed drugs, however, do highlight potential mechanisms of action and possible templates for further study and development.
Speech Recognition Abilities in Normal-Hearing Children 4 to 12 Years of Age in Stationary and Interrupted Noise
Authors: Koopmans Wiepke J. A. , Goverts S. Theo , Smits Cas 
Published: March 2018

Objectives:
The main purpose of this study was to examine developmental effects for speech recognition in noise abilities for normal-hearing children in several listening conditions, relevant for daily life. Our aim was to study the auditory component in these listening abilities by using a test that was designed to minimize the dependency on nonauditory factors, the digits-in-noise (DIN) test. Secondary aims were to examine the feasibility of the DIN test for children, and to establish age-dependent normative data for diotic and dichotic listening conditions in both stationary and interrupted noise.

Design:
In experiment 1, a newly designed pediatric DIN (pDIN) test was compared with the standard DIN test. Major differences with the DIN test are that the pDIN test uses 79% correct instead of 50% correct as a target point, single digits (except 0) instead of triplets, and animations in the test procedure. In this experiment, 43 normal-hearing subjects between 4 and 12 years of age and 10 adult subjects participated. The authors measured the monaural speech reception threshold for both DIN test and pDIN test using headphones. Experiment 2 used the standard DIN test to measure speech reception thresholds in noise in 112 normal-hearing children between 4 and 12 years of age and 33 adults. The DIN test was applied using headphones in stationary and interrupted noise, and in diotic and dichotic conditions, to study also binaural unmasking and the benefit of listening in the gaps.

Results:
Most children could reliably do both pDIN test and DIN test, and measurement errors for the pDIN test were comparable between children and adults. There was no significant difference between the score for the pDIN test and that of the DIN test. Speech recognition scores increase with age for all conditions tested, and performance is adult-like by 10 to 12 years of age in stationary noise but not interrupted noise. The youngest, 4-year-old children have speech reception thresholds 3 to 7 dB less favorable than adults, depending on test conditions. The authors found significant age effects on binaural unmasking and fluctuating masker benefit, even after correction for the lower baseline speech reception threshold of adults in stationary noise.

Conclusions:
Speech recognition in noise abilities develop well into adolescence, and young children need a more favorable signal-to-noise ratio than adults for all listening conditions. Speech recognition abilities in children in stationary and interrupted noise can accurately and reliably be tested using the DIN test. A pediatric version of the test was shown to be unnecessary. Normative data were established for the DIN test in stationary and fluctuating maskers, and in diotic and dichotic conditions. The DIN test can thus be used to test speech recognition abilities for normal-hearing children from the age of 4 years and older.
Neglected Tibial Pilon Fractures: Can Arthrodesis Be Avoided?
Authors: Ahmed Abdel-Salam A. , Singer Mohammed S. , El Bigawi Hossam A. 
Published: March 2018

Objectives:
To evaluate the outcomes of neglected pilon fractures treated by the Ilizarov fixator and to determine whether this technique was successful in avoiding an ankle arthrodesis.

Design:
Retrospective case series.

Setting:
Level I university trauma center.

Patients:
Between January 2003 and March 2015, 18 patients (mean age of 42.17 years) with an untreated pilon fracture with late presentation (>1 month) were evaluated. Six patients were women and 12 were men. The mean duration from trauma to management was 11.17 weeks (range: 7–15). All fractures were OTA/AO 43 type C. Four cases were open fractures.

Intervention:
Closed fracture reduction, correction of deformity, and restoration of alignment by the Ilizarov fixator.

Main Outcome Measurements:
The radiographs were evaluated for tibial alignment, quality of reduction, and development of arthrosis. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for functional assessment.

Results:
The follow-up period ranged from 18 to 168 months (mean; 38.00). The quality of reduction was excellent in 2 cases, satisfactory in 13 cases, and poor in 3 cases. The external fixator period averaged 29.06 weeks (range: 6.1–7.5 months). All fractures healed without deep infection. Ankle dorsiflexion and plantar flexion averaged 8.67 and 25.67 degrees, respectively, in 15 cases. Arthrodesis was performed for the remaining 3 cases. The mean AOFAS Ankle-Hindfoot score was 82.67. One case had mild anterior translation, and another 1 had a procurvatum of 5 degrees. Arthrosis developed in 6 ankles.

Conclusions:
A satisfactory outcome was achieved after management by the Ilizarov fixator while avoiding arthrodesis in most cases of this series of neglected pilon fractures.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
INSTRUMENTAL DIFFERENCE IN ASSESSING CHOROIDAL HYPERPERMEABILITY AND PHOTODYNAMIC THERAPY IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY
Authors: Lee Seung Min , Kwon Han Jo , Park Sung Who , Lee Ji Eun , Byon Ik Soo 
Published: March 2018

Purpose:
To investigate the difference in choroidal hyperpermeability (CH) assessed using digital fundus camera (DFC) and scanning laser ophthalmoscope (SLO) and its effect on photodynamic therapy (PDT) outcomes in chronic central serous chorioretinopathy.

Methods:
Midphase indocyanine green angiography (ICGA) images were acquired using both DFC and SLO in 38 consecutive eyes with chronic central serous chorioretinopathy in this retrospective study. Scanning laser ophthalmoscope-ICGA was taken immediately after DFC-ICGA. Photodynamic therapy was applied to the area of CH associated with subretinal fluid (CH-SRF). The main outcome measures included the areas of CH in the macula and CH-SRF, resolution of SRF, and change in the best-corrected visual acuity.

Results:
Areas of CH (5.187 ± 2.625 mm2 vs. 3.170 ± 1.661 mm2, P < 0.001) and CH-SRF (2.315 ± 1.111 mm2 vs. 1.465 ± 0.709 mm2, P < 0.001) were greater in DFC than in SLO. Sixteen eyes underwent DFC ICGA-guided PDT (DFC-PDT group) and 22 underwent SLO ICGA-guided PDT (SLO-PDT group). Subretinal fluid resolution at 12 months was 100.0% and 90.9% in the DFC-PDT and SLO-PDT groups, respectively, without statistical differences. The improvement of best-corrected visual acuity was earlier in the SLO-PDT group than in the DFC-PDT group (3 months, P = 0.002 vs. 6 months, P = 0.003), but the final best-corrected visual acuity showed no difference.

Conclusion:
In chronic central serous chorioretinopathy, larger areas of CH and CH-SRF were observed with DFC than with SLO, which caused the ophthalmologists performing ICGA-guided PDT to determine a larger laser spot. This seemed to affect the time of visual recovery, but not the final outcome.
A Drug to Prevent Pediatric Myopia—What Would it Take?
Authors: Novack Gary D. 
Published: March 2018

Abstract:
Because of the epidemic of myopia with both its short-term and long-term effects, we desperately need ways to slow myopic progression. In this study which was part of a myopia prevention symposium, the author answers the following question: Assuming that researchers did come up with a pharmacological treatment to slow myopic progression—what would it take to obtain regulatory approval from the United States Food and Drug Administration (FDA)? Previous publicly available information (a 2003 FDA advisory committee on this topic, International Conference on Harmonisation guidances on drug development, and published articles) as well as the author's experience is used. Development pathways including preclinical safety, chemistry, manufacturing and controls, and early- and late-stage clinical studies are presented. In particular, challenges for the conduct of multi-year controlled double-masked studies are presented. As any treatment would have to be chronic, prophylactic, and pediatric, there are a host of concerns as to efficacy, safety, and benefit/risk (therapeutic index). Although more challenging than some short-term indications in ophthalmology, nonetheless the pharmaceutical community is investing in seemingly equally challenging conditions such as retinal degeneration. The author looks forward to working with colleagues in academia and industry to evaluate and develop novel therapies to slow the development of myopia.
Changes in Optical Density of Postlens Fluid Reservoir During 2 Hours of Scleral Lens Wear
Authors: Schornack Muriel M. , Nau Cherie B. 
Published: March 2018

Objectives:
Debris accumulation in the postlens fluid reservoir during scleral lens wear is clinically observed. We evaluated a method to quantify increases in turbidity of the postlens fluid reservoir by assessing changes in optical density of the fluid over time and compared these changes during 2 hr of scleral lens wear using three different lens designs.

Methods:
Thirty-five patients (age, mean [SD], 29 [7] years) with no history of eye disease were enrolled in the study. Participants were fit with a 15.0-, 18.0-, and 18.2-mm scleral lens on one randomly selected eye during the enrollment examination. During each of three subsequent visits, one of three lenses selected during enrollment was placed on the eye. Scheimpflug images were acquired within 5 min of lens placement and at 20-min intervals for the ensuing 2 hr. Fluid reservoir optical density was assessed using Pentacam (Oculus Inc) analysis software.

Results:
Increases in fluid reservoir optical density were significant between each time interval with all lenses until 100 min. No significant increases in fluid reservoir optical density were noted with the 15.0- and 18.0-mm lenses between 100 and 120 min; fluid reservoir optical density increased with the 18.2-mm lens between 100 and 120 min. Optical density increased by 105% (15.0-mm lens) and 117% (18.0- and 18.2-mm lenses) at 2 hr.

Conclusions:
Optical density of the postlens fluid reservoir can be quantified during scleral lens wear. During 2 hr of wear, fluid reservoir optical density doubled with all lens designs evaluated.
A Comparative Study of Central Corneal Epithelial, Stromal, and Total Thickness in Males With and Without Primary Open-Angle Glaucoma
Authors: Batawi Hatim , Lollett Ivonne Valentina , Maliakal Cima , Wellik Sarah R. , Anderson Michael G. , Feuer William , Karp Carol L. , Galor Anat 
Published: March 2018

Purpose:
To compare the central corneal epithelial thickness (CET), stromal thickness (CST), and total thickness (CCT) in males with and without primary open-angle glaucoma and to determine the factors associated with corneal thickness.

Methods:
A case–control study was conducted to evaluate 116 male patients at the Miami Veterans Affair Medical Center. Subjects with available anterior segment optical coherence tomography images (Cirrus HD-OCT, Carl Zeiss Meditec Inc, Dublin, CA) were retrospectively classified into 2 groups by glaucoma status. CET, CST, and CCT measurements between the groups were compared. Associations between thickness and other variables of interest were also evaluated.

Results:
The 2 groups were similar with respect to race and ethnicity. Mean age of patients in the glaucoma group (70.3 ± 8.9) was higher than in the nonglaucoma group (66.0 ± 11.7), P < 0.03. Individuals who self-identified as black had lower CST (447.8 ± 29.0 μm) and CCT (503.0 ± 30.5 μm) compared with whites (CST: 470.0 ± 31.7 μm; CCT: 525.1 ± 32.4 μm), P = 0.0001 and P = 0.0002, respectively. In a similar manner, individuals with glaucoma had lower CST (453.4 ± 32.5 μm) and CCT (507.3 ± 33.8 μm) than that of those without glaucoma (CST: 465.2 ± 31.2 μm; CCT: 521.5 ± 31.5 μm), P = 0.05 and P = 0.02, respectively. CET, CST, and CCT were negatively correlated with the number of antiglaucoma medications (r = −0.2, r = −0.22, and r = −0.25, respectively), P = 0.05 for all.

Conclusions:
Individuals with glaucoma have lower CST and CCT measurements compared with individuals without glaucoma. An increased number of glaucoma medications were associated with lower thickness measurements.
Quantitative sensory testing after macroreplantation: evidence for a specific somatosensory profile
Authors: Blume Kathrin R. , Racz Juliane , Franz Marcel , Dietrich Caroline , Puta Christian , Friedel Reinhard , Hofmann Gunther O. , Miltner Wolfgang H.R. , Weiss Thomas 
Published: March 2018

Abstract
A comprehensive functional recovery is one of the criteria for successful replantation of an amputated limb. Functionality of a replanted limb is strongly dependent on its regained sensibility. In previous studies concerning the sensibility of replanted limbs, only a few somatosensory submodalities were examined in small samples. The purpose of this study is to provide a full pattern of somatosensory symptoms after replantation. Quantitative sensory testing was performed according to a standardized protocol in a sample of 15 patients who underwent replantation of their upper limb proximal to the radiocarpal joint (macroreplantation). Results indicate that most of these patients showed a specific somatosensory profile characterized by thermal and mechanical hypoesthesia and hyperalgesia in response to pressure pain, whereas no single case of hyperalgesia to heat pain occurred. This distinct profile of impaired somatosensation shares some features of the somatosensory profile of neuropathic pain syndromes. Patients' limbs that were replanted many years before the present quantitative sensory testing showed more sensory deficits than patients with more recent replantations. This knowledge might be helpful in the development of more specific and more successful rehabilitation programs with replanted patients and improves the behavioral function of the replanted limb.
Piloting a Multifaceted Interprofessional Education Program to Improve Physical Therapy and Nursing Students' Communication and Teamwork Skills
Authors: Turkelson Carman , Keiser Megan , Yorke Amy M. , Smith Leslie 
Published: March 2018

While effective interpersonal communication and teamwork skills among health care professionals are critical to patient safety, health care students have limited opportunities to learn or practice these skills. Therefore, the purpose of this pilot program was to explore the effect of a multifaceted interprofessional education program on the behaviors and perceptions of students from 3 health care professions.
Between January and April 2016, students from graduate physical therapy (n = 57), undergraduate nursing (n = 39), and graduate nursing acute care nurse practitioner (n = 6) programs participated in didactic and standardized patient simulation sessions designed to develop teamwork and communication skills. A prospective pre-/postdesign was used to examine program effectiveness using 3 scales: the Readiness for Interprofessional Learning Scale (pre-/post-simulation), the Interdisciplinary Education Perception Scale (pre/post-simulation), and the National League of Nursing Student Satisfaction and Self-Confidence in Learning Scale (postsimulation).
Statistical analysis of the pre- and postscore Readiness for Interprofessional Learning Scale and Interdisciplinary Education Perception Scale measures was performed using the Wilcoxon signed rank test. Statistically significant changes were noted pre- to posttest in the Readiness for Interprofessional Learning Scale teamwork/collaboration (P < .001) and professional identity subscales (P ≤ .001). No statistically significant changes were noted in the 4 Interdisciplinary Education Perception Scale subscales pre- and posttest. The National League of Nursing Student Satisfaction and Self-Confidence in Learning Scale results indicated that students had a high level of satisfaction and self-confidence with the knowledge and skills presented.
Preliminary findings suggest that using a multifaceted approach that includes standardized patient simulations allowed physical therapy and nursing students to gain valuable experiential knowledge and practice the teamwork behaviors required for safe, high-quality clinical practice.
Subsequent Fracture Prevention in Patients 50 Years and Older With Fragility Fractures: A Quality Improvement Initiative
Authors: Mackey Patricia A. , Rosenthal Laura D. , Mi Lanyu , Whitaker Michael D. 
Published: March 2018

ABSTRACT
Because of osteoporosis, patients older than 50 years with fragility fractures are at risk of further fractures. We developed a quality improvement initiative based on an evidence-based Fracture Liaison Service (FLS) model of care to help prevent subsequent fractures. Previous to the implemented FLS model, less than 13% of patients with fragility fractures were assessed for osteoporosis at our institution. We created a registry tool to identify patients with fractures who were older than 50 years. Our interventions focused on identifying, contacting, and educating patients; and coordinating screening tests and an outpatient follow-up visit with an endocrinologist. Identification of patients older than 50 years with fragility fractures increased from 0% to 74.5%, with implementation of the fracture registry. Of those identified, 33.9% were screened and had a follow-up visit. The fragility fracture population older than 50 years is at risk of subsequent fractures and should be identified, contacted, educated, screened, and assessed for osteoporosis to prevent subsequent fractures.
The Effects of Severe Myopia on the Properties of Sampling Units in Peripheral Retina
Authors: Nagra Manbir , Gilmartin Bernard , Logan Nicola S. , Anderson Stephen J. 
Published: March 2018

SIGNIFICANCE
Poor peripheral visual acuity in myopia may reflect, in part, photoreceptor misalignment with the exit pupil of the eye. We speculate that if such misalignment causes sufficient visual deprivation and/or disrupts retinal feedback processes, it may influence eye growth itself.

PURPOSE
It is known that myopic eyes have a reduced peripheral resolution acuity relative to emmetropic eyes, though it remains unclear how mechanical stretching of the retina in myopia impacts on peripheral visual performance. Our aim was to determine how retinal stretching affects the properties of sampling units in peripheral vision.

METHODS
Three-dimensional magnetic resonance imaging provided a depiction in vivo of ocular shape, allowing the inter-eye ratio of retinal image surface areas and the relative alignment of surfaces to be determined in our observer, who was unique in having severe myopia in the right eye (~21 D) but only modest myopia in the left (~3 D). Visual performance was assessed for the detection and direction discrimination of drifting sinusoids positioned 40° in the temporal retina. Applying the sampling theorem to our measures, we estimated the density and cut-off frequency of the underlying sampling units.

RESULTS
The retinal image surface area of the right eye was 40% larger than that of the left and was rotated 8.9° anticlockwise relative to the left eye’s image surface. In agreement with a linear stretch model of myopia, the sampling density of the right eye was reduced by approximately the same ratio as that predicted from the inter-eye MRI data, namely, 1.18. However, the cut-off frequency (cycles/mm) of the right eye was approximately half that of the left, a reduction that cannot be explained solely by a linear areal expansion of retinal sampling units.

CONCLUSIONS
Poor peripheral acuity in severe myopia may be caused, at least in part, by receptoral misalignment with the exit pupil.