bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differential Roles of the Right and Left Toe Perfusion Index in Predicting the Incidence of Postspinal Hypotension During Cesarean Delivery
Authors: Xu Z. , Xu T. , Zhao P. , Ma R. , Zhang M. , Zheng J. 
Published: May 2018

(Anesth Analg. 2017;125(5):1560–1566)
Severe postspinal hypotension, which occurs in 70% of parturients, increases the risk of maternal and fetal complications. However, noninvasive methods used to predict spinal hypotension currently do not reflect aortocaval compression by the gravid uterus. One predictive method is the measurement of perfusion index (PI) parameters, usually measured via the finger. However, the authors of the present study speculated that measurement of toe PI may have greater predictive accuracy than finger PI and be associated with the incidence of postspinal hypotension in parturients. This is due to the fact that an underlying difference between finger and toe PI in supine parturients is the effect of direct aortocaval compression of the right iliac vessels by the gravid uterus.
Optimal Point of Insertion and Needle Angle in Neuraxial Blockade Using a Midline Approach
Authors: Vogt M. , van Gerwen D.J. , Lubbers W. , van den Dobbelsteen J.J. , Hagenaars M. 
Published: May 2018

(Reg Anesth Pain Med. 2017;42(5):600–608)
When using a midline approach to neuraxial blockade, as few attempts as possible should be made to ensure patient comfort and reduce the risk of complications. This approach can be difficult, however, due to both patient factors beyond the clinician’s control as well as equipment used, clinician experience, the positioning of the patient, and point of insertion. While there are suggested needle insertion points and angles, none are supported by clinical research. This study aimed to establish a scientific rationale for choosing the optimal insertion angle and insertion point for access to the subarachnoid space or the epidural space by using a computer algorithm to perform measurements in computed tomography (CT) scans in 52 patients at different spine levels.
The Association Between the Time From Oxytocin Cessation During Labor to Cesarean Delivery and Postpartum Blood Loss: A Retrospective Cohort Study
Authors: Tran G. , Kanczuk M. , Balki M. 
Published: May 2018

(Can J Anaesth. 2017;64(8):820–827)
Despite the use of prophylactic agents like oxytocin, the rise in postpartum hemorrhage (PPH) between 2003 and 2010 has been attributed to postpartum uterine atony. Oxytocin reduces PPH by up to 60% when used during the third stage of labor. However, oxytocin is associated with an increased risk of PPH secondary to uterine atony when used for labor augmentation that results in prolonged infusions or high doses. Myometrial oxytocin receptors (OTRs) may be less responsive to oxytocin administered to prevent PPH because the OTRs have become desensitized when exposed to oxytocin during labor augmentation. It is unclear if OTRs can become resensitized after a cessation of oxytocin. This study aimed to assess the association between blood loss and the interval of time between discontinuing oxytocin and cesarean delivery (CD).
Maternal Super Obesity and Risk for Intensive Care Unit Admission in the MFMU Cesarean Registry
Authors: Smid M.C. , Dotters-Katz S.K. , Vaught A.J. , Vladutiu C.J. , Boggess K.A. , Stamilio D.M. 
Published: May 2018

(Acta Obstet Gynecol Scand. 2017;96(8):976–983)
Obesity is considered a risk factor for intensive care unit (ICU) admission, ICU morbidity and ICU mortality in the nonpregnant population. The prevalence of maternal super obesity [body mass index (BMI) ≥50 kg/m2] is growing and is associated with increased risk of complications including cesarean section (CS), maternal morbidity, hypertensive disorders of pregnancy, gestational diabetes, and peripartum hemorrhage. This study aimed to assess the association between maternal super obesity and ICU admission in women who delivered by CS or vaginal birth after cesarean section (VBAC).
Novel Oxytocin Receptor Variants in Laboring Women Requiring High Doses of Oxytocin
Authors: Reinl E.L. , Goodwin Z.A. , Raghuraman N. , Lee G.Y. , Jo E.Y. , Gezahegn B.M. , Pillai M.K. , Cahill A.G. , de Guzman Strong C. , England S.K. 
Published: May 2018

(Am J Obstet Gynecol. 2017;217(2):214.e1–214.e8)
In the United States, oxytocin is administered to nearly half of women who give birth to either augment or induce labor. However, the required dosage of oxytocin varies widely among women, with a therapeutic window between 1 mU/min and >40 mU/min. Variations in the oxytocin receptor gene may explain some women’s requirements for high or low doses of oxytocin. This study aimed to identify variants in the oxytocin receptor gene in women in labor who had high or low dosage requirements.
Assisted Reproductive Technology and Severe Postpartum Haemorrhage: A Case-control Study
Authors: Nyfløt L.T. , Sandven I. , Oldereid N.B. , Stray-Pedersen B. , Vangen S. 
Published: May 2018

(BJOG. 2017;124:1198–1205)
Assisted reproductive technology (ART) is used in many countries as infertility occurs in ∼9% of the world population. In some European countries it has been reported that at least 3% of children were conceived via ART. Severe postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and the association between PPH and pregnancies achieved by ART is unclear. The aim of this case-control study was to determine whether an association exists between ART and severe PPH as well as to determine whether any association was affected by other risk factors for severe PPH.
Does the Addition of Active Body Warming to In-line Intravenous Fluid Warming Prevent Maternal Hypothermia During Elective Caesarean Section? A Randomized Controlled Trial
Authors: Chebbout R. , Newton R.S. , Walters M. , Wrench I.J. , Woolnough M. 
Published: May 2018

(Int J Obstet Anesth. 2017;31:37–44)
Inadvertent perioperative hypothermia (IPH), defined as a core temperature <36°C, is a common occurrence during elective cesarean section with rates as high as 50% reported. Despite IPH occurring so frequently, active body warming is not commonly used during cesarean section nor are there guidelines for its use in obstetric populations. In the United Kingdom only 16% of obstetric units routinely use active body warming. The goal of the current study was to determine if the use of active body warming, either forced air warming or conduction mattress warming, provided additional benefit during cesarean section when warming of intravenous fluids was also utilized.
Mode of First Delivery and Severe Maternal Complications in the Subsequent Pregnancy
Authors: Colmorn L.B. , Krebs L. , Klungsøyr K. , Jakobsson M. , Tapper A.M. , Gissler M. , Lindqvist P.G. , Källen K. , Gottvall K. , Bordahl P.E. , Bjarnadóttir R.I. , Langhoff-Roos J. 
Published: May 2018

(Acta Obstet Gynecol Scand. 2017;96(9):1053–1062)
Cesarean delivery rates have been rising worldwide since the 1990s despite well-known long-term maternal risks, including complications in subsequent pregnancies. In Nordic countries, intended vaginal delivery is traditionally the recommended mode of delivery after cesarean. The safety of vaginal delivery after cesarean has been called into question. This study aimed to explore the risks of severe complications at delivery following a first elective or emergency cesarean delivery and the risk of complications by the intended delivery mode.
Cesarean Risk in Obese Women at Term: A Retrospective Cohort Analysis
Authors: Nugent R. , de Costa C. , Vangaveti V. 
Published: May 2018

(Aust N Z J Obstet Gynaecol. 2017;57(4):440–445)
Obesity in pregnancy is a growing issue and has been associated with increased risk of maternal and fetal complications such as gestational diabetes and hypertensive disorders of pregnancy. While increased fetal surveillance during such pregnancies has been recommended, there is little information concerning the induction of labor (IOL) in pregnant obese women. This retrospective study aimed to compare the impact of IOL and expectant management on neonatal and maternal outcomes, hypothesizing that term IOL was not associated with an increased risk of cesarean delivery.
Predictors of Success of External Cephalic Version and Cephalic Presentation at Birth Among 1253 Women With Noncephalic Presentation Using Logistic Regression and Classification Tree Analyses
Authors: Hutton E.K. , Simioni J.C. , Thabane L. 
Published: May 2018

(Acta Obstet Gynecol Scand. 2017;96(8):1012–1020)
While external cephalic version (ECV) can reduce the likelihood of cesarean birth and noncephalic presentation, many women are not offered, or they decline ECV due to low reported success rates. Factors which predict successful ECV have been studied and identified, but further study of the outcomes for clinically relevant groupings of women are lacking. This study used classification and regression tree (CART) analyses to divide observations into subgroups based on the factor that best separates those with and without a certain outcome. This resulted in a flow chart that may be helpful to clinicians predicting factors of successful ECV.
Can 3-Dimensional Power Doppler Indices Improve the Prenatal Diagnosis of a Potentially Morbidly Adherent Placenta in Patients With Placenta Previa?
Authors: Haidar Z.A. , Papanna R. , Sibai B.M. , Tatevian N. , Viteri O.A. , Vowels P.C. , Blackwell S.C. , Moise K.J. 
Published: May 2018

(Am J Obstet Gynecol. 2017;217(2):202.e1–202.e13)
The incidence of morbidly adherent placenta (MAP), a condition that can result in life-threatening hemorrhage and other maternal morbidities, has been on the rise. Traditionally, 2-dimensional (2D) ultrasound has been used to diagnose MAP and severe MAP (increta and percreta). This diagnosis is subjective as it relies on clinician interpretation of the ultrasound examination. This study aimed to evaluate the ability of a 3D power Doppler technique to diagnose MAP and severe MAP, as compared with gray-scale 2D ultrasound.
Intravenous Dexamethasone as an Adjunct to Improve Labor Analgesia: A Randomized, Double-blinded, Placebo Controlled Clinical Trial
Authors: Dube P. , Mitra S. , Singh J. , Saroam R. , Mehra R. 
Published: May 2018

(J Clin Anesth. 2017;43:6–10)
It is well recognized that lumbar epidural analgesia using local anesthetic with or without an adjuvant is a consistently effective method of pain relief during labor. However, newer adjuvants, such as clonidine and neostigmine, are associated with adverse side effects and may be less suitable in pregnant women. A potential alternative is dexamethasone, a well-known anti-inflammatory drug. As there are limited studies regarding its intrapartum use, the authors of the present study evaluated the role of intravenous dexamethasone as an adjuvant to neuraxial analgesia for labor pain in a double-blind, prospective, randomized, placebo-controlled study.
Core Temperature Monitoring in Obstetric Spinal Anesthesia Using an Ingestible Telemetric Sensor
Authors: du Toit L. , van Dyk D. , Hofmeyr R. , Lombard C.J. , Dyer R.A. 
Published: May 2018

(Anesth Analg. 2018;126(1):190–195)
Maternal core temperature is difficult to monitor during cesarean delivery (CD) under spinal anesthesia (SA). A drop in maternal core temperature <36.0°C during the perioperative period is associated with increased risks of postoperative morbidity. Current knowledge of the thermal insult associated with obstetric SA is limited to small randomized controlled trials. In the present study, the authors used continuous core temperature recording to generate high-resolution data on thermal insult and thermal recovery associated with CD under SA.
Preemptive Analgesia for Postoperative Hysterectomy Pain Control: Systematic Review and Clinical Practice Guidelines
Authors: Steinberg A.C. , Schimpf M.O. , White A.B. , Mathews C. , Ellington D.R. , Jeppson P. , Crisp C. , Aschkenazi S.O. , Mamik M.M. , Balk E.M. , Murphy M. 
Published: May 2018

(Am J Obstet Gynecol. 2017;217(3):303–313)
Preemptive analgesia, which may include multimodal pain management, is administered before surgery and is believed to prevent central sensitization. This can include narcotic or non-narcotic medications and may be administered in many ways. This systematic review used current studies of women receiving preemptive medication for abdominal hysterectomy, with a primary outcome of pain control. The aim was to determine the best method of pain control while decreasing narcotic consumption and adverse events.
Epidural Blood Patch Treatment for Headache Caused by a Ruptured Tarlov Cyst
Authors: Qasem F. , McCallum C. , Armstrong P. 
Published: May 2018

(Can J Anaesth. 2017;64(9):983–984)
There are limited data on the management of Tarlov cysts, which are cerebrospinal fluid–containing nerve root cysts located between the endoneurium and perineurium. Patients with Tarlov cysts may be asymptomatic.
Combined Spinal Epidural in a Parturient With Tinea Versicolor
Authors: Turakhia M.B. , Bauchat J. 
Published: May 2018

(J Clin Anesth. 2017;43:63–64)
In this correspondence, the authors discussed the case of a 33-year-old parturient who presented for labor analgesia (combined spinal epidural technique) with a history of recurrent lumbar tinea versicolor, as well as a maculopapular rash from the cervical to the sacral area on physical examination. Tinea versicolor is a benign condition in which Malassezia globosa, a yeast found in normal flora, becomes pathogenic following exposure to heat and humidity in immunosuppressed individuals. Following informed consent, combined spinal epidural labor analgesia was administered with a 27-G Pencan spinal needle following sterile skin preparation and using a needle-through-needle technique. The epidural catheter remained in situ for 13 hours. The authors reported an uneventful delivery and postoperative course.
The Relationship Between the Learning and Patient Safety Climates of Clinical Departments and Residents’ Patient Safety Behaviors
Authors: Silkens Milou E.W.M. , Arah Onyebuchi A. , Wagner Cordula , Scherpbier Albert J.J.A. , Heineman Maas Jan , Lombarts Kiki M.J.M.H. 
Published: May 2018

Purpose
Improving residents’ patient safety behavior should be a priority in graduate medical education to ensure the safety of current and future patients. Supportive learning and patient safety climates may foster this behavior. This study examined the extent to which residents’ self-reported patient safety behavior can be explained by the learning climate and patient safety climate of their clinical departments.

Method
The authors collected learning climate data from clinical departments in the Netherlands that used the web-based Dutch Residency Educational Climate Test between September 2015 and October 2016. They also gathered data on those departments’ patient safety climate and on residents’ self-reported patient safety behavior. They used generalized linear mixed models and multivariate general linear models to test for associations in the data.

Results
In total, 1,006 residents evaluated 143 departments in 31 teaching hospitals. Departments’ patient safety climate was associated with residents’ overall self-reported patient safety behavior (regression coefficient [b] = 0.33; 95% confidence interval [CI] = 0.14 to 0.52). Departments’ learning climate was not associated with residents’ patient safety behavior (b = 0.01; 95% CI = −0.17 to 0.19), although it was with their patient safety climate (b = 0.73; 95% CI = 0.69 to 0.77).

Conclusions
Departments should focus on establishing a supportive patient safety climate to improve residents’ patient safety behavior. Building a supportive learning climate might help to improve the patient safety climate and, in turn, residents’ patient safety behavior.
Oncocytic Melanoma: A Study of a Rare Entity
Authors: Donner Ludvik R. , Maximo Valdemar 
Published: May 2018

Abstract:
The authors report the second case of oncocytic melanoma, one of the rarest known melanoma variants. The diagnosis was established by Fontana stain positivity, expression of S100 protein as well as gp100/HMB45, and demonstration of numerous mitochondria by ultrastructure. Because it is known that some oncocytic tumors of the thyroid gland and kidney contain point mutations and common deletions of mitochondrial DNA, the complete mitochondrial DNA of the reported oncocytic melanoma was also studied. It was normal except for 2 private separate point mutations, predicted to be not pathogenic, which do not seem to play any role in the tumor phenotype.
Transanal Total Mesorectal Excision vs Laparoscopic Total Mesorectal Excision in the Treatment of Low and Middle Rectal Cancer: A Propensity Score Matching Analysis
Authors: Persiani Roberto , Biondi Alberto , Pennestrì Francesco , Fico Valeria , De Simone Veronica , Tirelli Flavio , Santullo Francesco , D’Ugo Domenico 
Published: May 2018

BACKGROUND:
Transanal total mesorectal excision is a novel and promising technique in the treatment of low and middle rectal cancer.

OBJECTIVE:
This study aimed to compare the safety and feasibility of transanal total mesorectal excision versus laparoscopic total mesorectal excision.

DESIGN:
This was a retrospective study using propensity score matching analysis.

SETTINGS:
This study was conducted in a single high-volume university hospital.

PATIENTS:
Patients with low and middle rectal cancer who underwent total mesorectal excision with curative intent between 2007 and 2017 were recruited.

INTERVENTIONS:
Laparoscopic total mesorectal excision and transanal total mesorectal excision had been performed.

MAIN OUTCOME MEASURES:
Intraoperative, pathological, and 30-day postoperative outcomes were compared between the transanal and laparoscopic groups.

RESULTS:
Overall, 105 patients were selected from the whole sample of 316 patients with rectal cancer. After propensity score matching analysis, 46 patients for each group were compared. Laparoscopic total mesorectal excision was associated with a higher conversion rate to open surgery (19.6% vs 0%, p = 0.002). Transanal total mesorectal excision showed a longer distal resection margin (15 mm vs 25 mm; p < 0.001), and similar results regarding the completeness of mesorectal excision and circumferential resection margin involvement, compared to laparoscopy. There were no statistically significant differences between the 2 groups in terms of postoperative complications.

LIMITATIONS:
The study was limited by its retrospective design and the small size of the sample.

CONCLUSIONS:
Transanal total mesorectal excision is a safe and feasible technique that results in a high-quality rectal cancer resection specimen and favorable 30-day postoperative outcomes.
Administration of an Oral Hydration Solution Prevents Electrolyte and Fluid Disturbances and Reduces Readmissions in Patients With a Diverting Ileostomy After Colorectal Surgery: A Prospective, Randomized, Controlled Trial
Authors: Migdanis Athanasios , Koukoulis Georgios , Mamaloudis Ioannis , Baloyiannis Ioannis , Migdanis Ioannis , Kanaki Maria , Malissiova Eleni , Tzovaras Georgios 
Published: May 2018

BACKGROUND:
Patients with a newly formed ileostomy often develop electrolyte abnormalities and dehydration.

OBJECTIVE:
The study assessed the prophylactic effect of an isotonic hydration solution on dehydration and electrolyte abnormalities in patients with a newly formed ileostomy.

DESIGN:
This was a prospective, randomized, controlled trial (NCT02036346).

SETTINGS:
The study was conducted at a single surgical unit of a public university hospital.

PATIENTS:
Patients scheduled for elective rectosigmoid resection were considered for study inclusion.

INTERVENTION:
Patients in whom a diverting ileostomy was created were randomly assigned to the intervention group (n = 39), which received an oral isotonic glucose-sodium hydration solution for 40 days postdischarge and the control group (n = 41) which did not receive an intervention. The 2 groups were compared with a group of patients who underwent rectosigmoid resection without diverting ileostomy (n = 37).

MAIN OUTCOME MEASURES:
Serum electrolyte and renal function markers were assessed preoperatively and at 20 and 40 days postdischarge.

RESULTS:
At 20 days postdischarge, the serum sodium of the control group appeared lower than the serum sodium of the intervention group and the nonileostomy group (p = 0.007). At the same time point, urea and creatinine levels of the control group were higher than the urea and creatinine levels of the other 2 groups (p = 0.01 and p = 0.02). At 40 days postdischarge, mean sodium and renal function markers improved in the control group, but sodium and creatinine continued to differ in comparison with the intervention and nonileostomy groups (p = 0.01 and p = 0.04). The readmission rate for fluid and electrolyte abnormalities was higher in the control group (24%) than in the other 2 groups, where no rehospitalization for such a reason was required (p = 0.001).

LIMITATIONS:
The study was limited by its single-center design.

CONCLUSION:
An oral isotonic drink postdischarge can have a prophylactic effect on patients with a newly formed ileostomy, preventing readmission for fluid and electrolyte abnormalities. See Video Abstract at http://links.lww.com/DCR/A603.
The Chimeric Versatility of the Subscapular System Revisited: Backup Options, Coverage for Bone Transplants and Vascularized Lymph Nodes
Authors: Schoenle Philipp , Gazyakan Emre , Kremer Thomas , Harhaus Leila , Kneser Ulrich , Hirche Christoph 
Published: May 2018

Summary:
Traumatic soft tissue and bone defects are demanding challenges for the reconstructive microsurgeons. Common and safe workhorses for these reconstructions are free microvascular flaps based on the subscapular system. In this article, we want to demonstrate the versatility of the serratus anterior muscle combined with other components of the subscapular system for reconstruction of complex lower extremity defects. Three patients with traumatic soft tissue and bone defects of the lower extremity were planned for reconstruction. The defects varied in size and could be covered by 1 or 2 slips of the serratus muscle or split muscle combined with latissimus dorsi muscle flap. In 1 case, the thoracodorsal lymph node package was included for addressing severe posttraumatic lymphedema after burn injury. In another case, the serratus slips served as coverage for a free scapula bone transplant. The chimeric flaps healed without complications; no further operations were needed for reconstruction. By the use of only 1 or 2 slips of the serratus muscle, we could prevent functional impairments for the patients and reduced further scarring compared with classic latissimus dorsi—(para-) scapular combinations.