bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multimodal Stepwise Approach to Reducing In-Hospital Opioid Use After Cesarean Delivery
Authors: Smith Alisha M. , Young Paul , Blosser Colleen C. , Poole Aaron T. 
Published: March 2019

OBJECTIVE:
To evaluate the association of a standardized, structured approach to in-hospital postcesarean delivery pain management with maternal opioid use after cesarean delivery.

METHODS:
We conducted a retrospective cohort study of women who underwent cesarean delivery before and after a quality improvement intervention at a single tertiary care center. A multidisciplinary task force revised electronic order sets for all patients who underwent cesarean delivery with neuraxial anesthesia. The revised order set separated acetaminophen from opioids, scheduled acetaminophen and nonsteroidal antiinflammatory drug administration, and limited opioid use to breakthrough pain. Data were collected by electronic chart review. The primary outcome was median morphine milligram equivalents per hospital stay. Secondary outcomes included median morphine milligram equivalents per day, median pain scores, time to discharge, and opioid–nonopioid pain medication use. Descriptive and bivariable analyses were performed.

RESULTS:
There were no significant differences in baseline characteristics in the preintervention (n=283) and postintervention (n=286) groups. There was a 75% reduction in median morphine milligram equivalents per stay from 120 (90–176 interquartile range) preintervention to 30 (5–68) postintervention (P<.001) and a 77% reduction in median morphine milligram equivalents per day (51 [41–60] vs 12 [2–25], P<.001). There was no difference between groups in time to discharge or median pain scores. There was no difference in ketorolac use (80% preintervention vs 75% postintervention, P=.14) or in median ibuprofen mg per day (1,391 preintervention vs 1,347 postintervention, P=.22). There was an increase in median acetaminophen mg per day (753 preintervention vs 2,340 postintervention, P<.001). There was a significant increase in patients who used no opioids during their hospital stay (6% preintervention vs 19% postintervention, P<.001).

CONCLUSION:
A multimodal stepwise approach to postcesarean delivery pain control was associated with markedly reduced opioid consumption without increasing hospital stay or median pain scores. By separating acetaminophen from opioids and limiting opioids to breakthrough pain, we were able to operationalize a tier-based approach to pain management.
Radiographic Healing of Far Cortical Locking Constructs in Distal Femur Fractures: A Comparative Study With Standard Locking Plates
Authors: Plumarom Yanin , Wilkinson Brandon G. , Marsh J. Lawrence , Willey Michael C. , An Qiang , Gao Yubo , Karam Matthew D. 
Published: March 2019

Objectives:
To investigate the radiographic healing of far cortical locking (FCL) construct fixation in distal femur fractures compared with traditional locking plate (LP) constructs.

Design:
A retrospective cohort of 143 consecutive patients with 146 distal femur fractures.

Setting:
Level I trauma center.

Patients/Participants:
After excluding patients with OTA/AO type B fractures, referred nonunion cases, patients younger than 16 years, and patients with less than 24 weeks of follow-up, 69 patients with 70 total fractures were included for analysis.

Intervention:
AP and lateral knee radiographs were blinded to type of screws and individually reviewed by 3 orthopaedic trauma surgeons.

Outcome Measurements:
The modified RUST (mRUST) score was our primary outcome measure. mRUST scores were assigned at 6, 12, and 24 weeks and final follow-up based on AP and lateral radiographs and compared between FCL and LP groups as a tool for evaluating fracture healing. Secondary outcomes compared between FCL and LP included union rate and postoperative complications.

Results:
Statistically significant differences in mRUST scores were noted between FCL and LP groups at 6 weeks (P = 0.040), 12 weeks (P = 0.034), 24 weeks (0.044), and final follow-up (P = 0.048). There was no significant difference in union or specific complication rates between the 2 groups. The union rate was 90.5% and 82.1% for the FCL and LP groups, respectively, at final follow-up.

Conclusions:
To our knowledge, this is the first comparative study between FCL and LP constructs. The FCL group was noted to have significantly higher mRUST scores at all periods indicating increased callus formation, but the differences seen were small and there were no differences in healing rates or complications between the 2 groups, thus bringing the clinical benefit of FCL into question. Further prospective study designs are needed to compare FCL with LP constructs and to investigate the role of interfragmentary motion on callus formation in distal femur fractures.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Long-Term Follow-Up of Anterior Spinal Fusion for Thoracolumbar/Lumbar Curves in Adolescent Idiopathic Scoliosis
Authors: Direito-Santos Bruno , Queirós Carlos Mesquita , Serrano Pedro , Encarnação Ângelo , Campos Armando , Oliveira António 
Published: March 2019

Study Design.
Retrospective patient series analysis with update of long-term data.

Objective.
To define the long-term prognosis of the thoracolumbar/lumbar correction after selective anterior spinal fusion (ASF) in adolescent idiopathic scoliosis (AIS).

Summary of Background Data.
The ASF is a well-described procedure for the treatment of AIS. The correction reliability over time, the consequences in adjacent spinal levels and patient's quality of life are fundamental for the characterization of AIS treatment.

Methods.
One hundred seven patients were submitted to single-rod ASF for thoracolumbar/lumbar (ThL/L) AIS between 1993 and 2016 in a single-surgeon experience. Seventy five were available for final follow-up evaluation 9 years ±4 (2–23) after surgery. A clinical and sequential radiographic evaluations were performed.

Results.
The mean age at surgery was 16 years ± 2.33 (14–20) and 94 (87%) were females. The mean final follow-up of the 75 patients available was 9 years ± 4 (2–23). Sixty-five patients had a Lenke type 5C curve and 10 had a type 6C curve. The mean values of the Scoliosis Research Society 22 (SRS-22) questionnaire in Lenke 5C was 92 ± 9 (71–109) and in Lenke 6C 90.3 ± 9 (75–107). In Lenke 5C group, the mean preoperative ThL Cobb angle was 38.4° ± 9.3 (21–60) and the postoperative was 5.9° ± 4.5 (0–18; P < 0.001) being similar at the final follow-up (P > 0.05). In Lenke 6C group, the mean preoperative ThL Cobb angle was 58.6° ± 13.9 (40–90) and the postoperative ThL Cobb was 22.6° ± 14.5 (5–48, P < 0.001) being similar at the final follow-up (P > 0.05). The mean preoperative Thoracic (Th) Cobb angle was 39° ± 7.6 (30–50), the postoperative was 30.6° ± 10.1 (14–49, P < 0.008) and in the final follow-up was 29.3° ± 10.7 (11–48, P < 0.011).

Conclusion.
ASF is a safe procedure in the treatment of ThL/L with good long-term results and high rates of satisfaction among patients with AIS Lenke type 5C. The partial correction was frequent in Lenke type 6C despite the absence of progression in the non-instrumented curves.

Level of Evidence: 4
Transport of Vancomycin and Cefepime Into Human Intervertebral Discs
Authors: Zhu Qiaoqiao , Gao Xin , Brown Mark D. , Eismont Frank , Gu Weiyong 
Published: March 2019

Study Design.
Simulation of antibiotics transport into human intervertebral disc with intravenous infusion.

Objective.
The objective of this study was to quantitatively investigate antibiotic concentrations in the disc.

Summary of Background Data.
Intravenous infusion of antibiotics is typically used to treat intervertebral disc infection in clinics. However, it is difficult to evaluate the drug concentrations within discs in vivo.

Methods.
A computational model was used in this study. The variation of drug charge with pH was considered in the model. Thirty-minute infusions of two commonly used antibiotics in clinic—vancomycin and cefepime—were numerically investigated. Spatial and temporal concentration distributions of these drugs in both nondegenerated and moderately degenerated discs were calculated.

Results.
For intravenous infusion of 1 g vancomycin and 2 g cefepime in 30 minutes repeated every 12 hours, it was predicted that vancomycin concentration in the disc fluctuated between 17.0 and 31.0 times of its minimum inhibitory concentration (1 ug/mL) and cefepime concentration fluctuated between 1.1 and 4.2 times of its minimum inhibitory concentration (i.e., 8 ug/mL) in about 2 days. It was also found that vancomycin concentration in moderately degenerated disc was lower than that in the nondegenerated disc.

Conclusion.
This study provides quantitative guidance on selecting proper dosage for treating disc infection. The method used in this study could be used to provide quantitative information on transport of other antibiotics and drugs in discs as well.

Level of Evidence: N/A
Neurologic Injury in Complex Adult Spinal Deformity Surgery
Authors: Lui Darren F. , Butler Joseph S. , Yu Hai Ming , Malhotra Karan , Selvadurai Susanne , Benton Adam , Agu Obiekezie , Molloy Sean 
Published: March 2019

Study Design.
A retrospective review of prospectively collected data.

Objective.
The aim of this study was to determine the safety of MOLIF versus PSO.

Summary of Background Data.
Complex adult spinal deformity (CASD) represents a challenging cohort of patients. The Scoli-RISK-1 study has shown a 22.18% perioperative risk of neurological injury. Restoration of sagittal parameters is associated with good outcome in ASD. Pedicle subtraction osteotomies (PSO) is an important technique for sagittal balance in ASD but is associated with significant morbidity. The multilevel oblique lumbar interbody fusion (MOLIF) is an extensile approach from L1 to S1.

Methods.
Single surgeon series from 2007 to 2015. Prospectively collected data. Scoli-RISK-1 criteria were refined to only include stiff or fused spines otherwise requiring a PSO. Roentograms were examined preoperatively and 2 year postoperatively. Primary outcome measure was the motor decline in American Spinal Injury Association (ASIA) at hospital discharge, 6 weeks, 6 months, and 2 years. Demographics, blood loss, operative time, spinopelvic parameters, and spinal cord monitoring (SCM) events.

Results.
Sixty-eight consecutive patients were included in this study, with 34 patients in each Group. Group 1 (MOLIF) had a mean age 62.9 (45–81) and Group 2 (PSO) had a mean age of 66.76 years (47–79); 64.7% female versus PSO 76.5%; Body Mass Index (BMI) Group 1 (MOLIF) 28.05 and Group 2 (PSO) 27.17. Group 1 (MOLIF) perioperative neurological injury was 2.94% at discharge but resolved by 6 weeks. Group 2 (PSO) had five neurological deficits (14.7%) with no recovery by 2 years. There were four SCM events (SCM). In Group 1 (MOLIF), there was one event (2.94%) versus three events (8.88%) in Group 2 (PSO).

Conclusion.
Staged MOLIF avoids passing neurological structures or retraction of psoas and lumbar plexus. It is safer than PSO in CASD with stiff or fused spines with a lower perioperative neurological injury profile. MOLIF have less SCM events, blood loss, and number of levels fused.

Level of Evidence: 3
Radio Peel—Synergism Between Nano-fractional Radiofrequency and 20% Trichloroacetic Acid Chemical Peeling
Authors: Artzi Ofir , Cohen Sarit , Verner Ines , Mehrabi Joseph N. , Naveh Hadas Prag , Shoshani Hadas , Nachlieli Tal 
Published: March 2019

BACKGROUND
Microneedling fractional radiofrequency (FRF) and chemical peels are widely used for skin rejuvenation.

OBJECTIVE
The authors aimed at evaluating the efficacy and safety of FRF and trichloroacetic acid 20% (TCA20%) peel in different combinations for determining the optimal treatment protocol.

METHODS
In this prospective clinical comparison of 4 protocols (FRF alone, TCA20% alone, TCA20% before FRF [TCA→FRF], and TCA20% following FRF [FRF→TCA]), the patients underwent 3.8 ± 1.2 successive treatments of one protocol at 4- to 6-week intervals. The patients and 2 dermatologists evaluated improvement of pigmentation and dyschromia, erythema and blood vessels, laxity and wrinkling, and skin imperfections using a global aesthetic improvement scale (GAIS) and a 1 to 5 scoring system. The patients rated their satisfaction and reported adverse effects and reduced activity. Skin impedance and histological changes following the different protocols were also evaluated on 3 additional volunteers.

RESULTS
Sixty-seven patients (age range 22–80 years) were studied. TCA→FRF caused skin impedance to decrease, yielding a more superficial and less-efficient penetration of FRF energy. FRF→TCA produced more significant improvement in overall facial skin appearance (GAIS) and most evaluated skin parameters. Adverse effects and satisfaction rates were similar for all approaches.

CONCLUSION
FRF→TCA had the best synergistic effect on skin rejuvenation compared with FRF or TCA20% alone and TCA→FRF.
Efficacy and Safety of Bimatoprost 0.01% for the Treatment of Eyebrow Hypotrichosis: A Randomized, Double-Blind, Vehicle-Controlled Study
Authors: Suchonwanit Poonkiat , Chanasumon Nongsak , Sriphojanart Tueboon 
Published: March 2019

BACKGROUND
Eyebrow hypotrichosis is an important dermatological problem. However, there is no standard treatment.

OBJECTIVE
To study the efficacy and safety of bimatoprost 0.01% for the treatment of eyebrow hypotrichosis.

MATERIALS AND METHODS
Although bimatoprost 0.03% has been studied previously, this is the first study to evaluate the efficacy and safety of bimatoprost 0.01% for the treatment of eyebrow hypotrichosis. A randomized, double-blinded, vehicle-controlled trial was conducted in 40 patients. All patients were randomized to receive bimatoprost 0.01% or placebo vehicle, once daily, for 6 months. The primary outcome was improvement in eyebrow density and diameter. Additional outcomes were the improvement in clinical assessments and safety evaluation.

RESULTS
Compared to the vehicle group, bimatoprost 0.01% significantly increased mean eyebrow hair density, eyebrow hair diameter, and clinical assessments (p < .001) in the drug group. Patients' satisfaction score was higher for the drug group than the vehicle group (p < .05). Adverse effects of the treatment were minimal and similar between the 2 groups.

CONCLUSION
Bimatoprost 0.01% was found to be superior to a placebo for eyebrow enhancement. Bimatoprost 0.01% can be considered effective, safe, and well-tolerated for the treatment of eyebrow hypotrichosis.
Therapeutic Drug Monitoring of Everolimus in Oncology: Evidences and Perspectives
Authors: Falkowski Sabrina , Woillard Jean-Baptiste 
Published: March 2019

Abstract:
Everolimus is a mammalian target of rapamycin (m-TOR) inhibitor that has been approved for the treatment of hormone receptor-positive advanced breast cancer, metastatic renal cancer, and neuroendocrine tumors. Although therapeutic drug monitoring (TDM) of everolimus is well established in the transplantation field, it is not currently performed in oncology. The last consensus conference about the TDM of everolimus states that for the use of everolimus in oncology, “further studies are required to determine the clinical utility of TDM for everolimus in oncology settings.” In this review, the authors will discuss the current evidences and perspectives, based on observational studies available, in favor of the TDM of everolimus in oncology focusing on (1) the management of everolimus in routine practice, (2) the prerequisites for TDM of everolimus in oncology, (3) the pharmacodynamics (including a description of the biomarker of resistance and mutations in m-TOR), and (4) a general outlook.
Conservative management for postmenopausal women with tubo-ovarian abscess
Authors: Yagur Yael , Weitzner Omer , Man-El Gili , Schonman Ron , Klein Zvi , Fishman Ami , Beiner Mario , Kadan Yfat 
Published: March 2019

AbstractObjectives:The aim of the study was to describe the experience of one institution in management and outcome of tubo-ovarian abscess (TOA) in pre- and postmenopausal women and to reassess the optimal approach for TOA in postmenopausal women.Methods:A retrospective cohort study included women diagnosed with TOA between 2003 and 2017 in a tertiary referral center. TOA was diagnosed by sonography or computerized tomography and at least one of the following criteria: temperature more than 38°C, leukocytosis more than 15,000 mm3, or surgically proven disease. Women were followed up for a mean of 7.6 years (range 6 mo to 14 y). The rates of conservative management and pelvic malignancy were evaluated.Results:The study cohort included 144 (69.23%) women who met the inclusion criteria, of which 105 (72.92%) were premenopausal and 39 (27.08%) were postmenopausal. Univariate analysis found no differences in risk factors and disease characteristics between the two groups. Among the study sample, 22 (56.4%) postmenopausal women and 48 (45.7%) premenopausal women were treated surgically (P = 0.5). None of the premenopausal women and 1 (2.6%) postmenopausal woman were diagnosed with pelvic malignancy.Conclusion:In postmenopausal women with TOA, the prevalence of concurrent pelvic malignancy was 2.6%, which is higher than in the general population, but lower than that reported in the literature; 44% were conservatively managed without any apparent cases of misdiagnoses of cancer.
The effect of a randomized 12-week soy drink intervention on everyday mood in postmenopausal women
Authors: Simpson Ellen E.A. , Furlong Orlaith N. , Parr Heather J. , Hodge Stephanie J. , Slevin Mary M. , McSorley Emeir M. , McCormack Jacqueline M. , McConville Christopher , Magee Pamela J. 
Published: March 2019

Abstract

Objective:
Dietary soy may improve menopausal symptoms, and subsequently mediate mood. This novel study examines various doses of dietary soy drink on everyday mood stability and variability in postmenopausal women.

Methods:
Community-dwelling women (n = 101), within 7 years postmenopause, consumed daily either a low (10 mg, n = 35), medium (35 mg, n = 37), or high (60 mg, n = 29) dose of isoflavones, for 12 weeks. Menopausal symptoms and repeated measures of everyday mood (positive [PA] and negative [NA] affect) (assessed at four time points per day for 4 consecutive days, using The Positive and Negative Affect Schedule) were completed at baseline and follow-up.

Results:
The dietary soy intervention had no effect on everyday mood stability (for PA [F{2,70} = 0.95, P = 0.390] and NA [F{2,70} = 0.72, P = 0.489]) or variability (for PA [F{2,70} = 0.21, P = 0.807] and for NA [F{2,70} = 0.15, P = 0.864]), or on menopausal symptoms (for vasomotor [F{2,89} = 2.83, P = 0.064], psychological [F{2,88} = 0.63, P = 0.535], somatic [F{2,89} = 0.32, P = 0.729], and total menopausal symptoms [F{2,86} = 0.79, P = 0.458]). There were between-group differences with the medium dose reporting higher PA (low, mean 24.2, SD 6; and medium, mean 29.7, SD 6) and the low dose reporting higher NA (P = 0. 048) (low, mean 11.6, SD 2; and high, mean 10.6, SD 1) in mood scores. Psychological (baseline M = 18 and follow-up M = 16.5) and vasomotor (baseline M = 4.2 and follow-up M = 3.6) scores declined from baseline to follow-up for the overall sample.

Conclusions:
Soy isoflavones had no effect on mood at any of the doses tested. Future research should focus on the menopause transition from peri to postmenopause as there may be a window of vulnerability, with fluctuating hormones and increased symptoms which may affect mood.
Periwound Challenges Improve Patient Satisfaction in Wound Care
Authors: Wongkietkachorn Apinut , Surakunprapha Palakorn , Titapun Attapol , Wongkietkachorn Nuttapone , Wongkietkachorn Supawich 
Published: March 2019

Summary:
In wound care, we usually focus nearly all of our efforts on the wound area while paying little attention to the periwound area. Although the periwound area may seem unimportant, it matters to patients. A female patient was admitted with a wound at the perianal area. Wound dressing was performed using standard wet-to-dry gauzes. The patient had several small complaints including irritant contact dermatitis, skin maceration, pain during dressing change, and fecal contamination to the wound. In this case, we ended up switching to a different method of wound dressing. We went from using wet-to-dry gauzes for the primary dressing to a hydrofiber with silver dressing and from gauze and Micropore as a secondary dressing to an adhesive sodium carboxymethylcellulose foam dressing. This resolved all complaints. The patient’s satisfaction score using visual analog scale increased from 2 to 10 (out of 10 points). This example shows how even small details can make a significant difference in wound care. Because periwound care is often neglected, therapeutic algorithm that integrates major challenges in periwound care into wound healing strategies is proposed.
Identification of Cofilin-1 and Destrin as Potential Early-warning Biomarkers for Gamma Radiation in Mouse Liver Tissues
Authors: Yi Lan , Hu Nan , Mu Hongxiang , Sun Jing , Yin Jie , Dai Keren , Xu Fanghui , Yang Nanyang , Ding Dexin 
Published: March 2019

Abstract
Gamma radiation causes cell injury and leads to an increased risk of cancer, so it is of practical significance to identify biomarkers for gamma radiation. We used proteomic analysis to identify differentially expressed proteins in liver tissues of C57BL/6J mice treated with gamma radiation from 137Cs for 360 d. We confirmed obvious pathological changes in mouse liver tissues after irradiation. Compared with the control group, 74 proteins showed a fold change of ≥1.5 in the irradiated groups. We selected 24 proteins for bioinformatics analysis and peptide mass fingerprinting and found that 20 of the identified proteins were meaningful. These proteins were associated with tumorigenesis, tumor suppression, catalysis, cell apoptosis, cytoskeleton, metabolism, gene transcription, T-cell response, and other pathways. We confirmed that both cofilin-1 and destrin were up regulated in the irradiated groups by western blot and real-time polymerase chain reaction. Our findings indicate that cofilin-1 and destrin are sensitive to gamma radiation and may be potential biomarkers for gamma radiation. Whether these proteins are involved in radiation-induced tumorigenesis requires further investigation.
MULTIPLE LATE RECURRENCES OF MACULAR HOLE AFTER VITRECTOMY AND EPISODE OF SPONTANEOUS CLOSURE IN A SINGLE EYE
Authors: Parikh Pooja D. , Day Ghafoori Shelley 
Published: March 2019

Purpose:
To report the novel finding of multiple recurrences of full-thickness macular hole in a 70-year-old woman with one episode of spontaneous closure.

Methods:
Case report of a 70-year-old woman who initially presented with a full-thickness macular hole who developed 3 subsequent recurrences of full-thickness macular hole over a duration of 4 years. Spontaneous closure was noted at the second recurrence. Institutional review board was not applicable for this case.

Results:
Combination of three recurrences of full-thickness macular hole with successful closure after vitrectomy as well as a single episode of spontaneous closure.

Conclusion:
This is a novel report in an adult patient with three recurrences of full-thickness macular hole in a previously vitrectomized eye along with an episode of spontaneous closure.