bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidural Space Identification With Loss of Resistance Technique for Epidural Analgesia During Labor: A Randomized Controlled Study Using Air or Saline: New Arguments for an Old Controversy
Authors: Brogly N. , Guasch E. , Alsina E. , García C. , Puertas L. , Dominguez A. , Diez Je , Gómez J. , Gilsanz F. 
Published: August 2018

(Anesth Analg. 2018;126:532–536)
The saline loss of resistance (SLOR) technique was established as the preferred method for epidural space identification in the 1980s, after air LOR (ALOR) was found to have a higher incidence of adverse effects. However, in review of the literature, the authors of the present study discovered that many of the studies had methodological issues. Furthermore, recent meta-analyses based on these studies have been unable to demonstrate superiority of SLOR over ALOR. Consequently, the authors assessed the effect of epidural space identification technique on the onset of anesthetic block, as well as screened for possible variables related to analgesia quality during labor and delivery, which might be affected by use of the ALOR or SLOR technique.
An Up-down Determination of the Required Seated Duration After Intrathecal Injection of Bupivacaine and Fentanyl for the Prevention of Hypotension During Cesarean Delivery
Authors: Moore A. , El-Mouallem E. , El-Bahrawy A. , Kaufman I. , Moustafa M. , Derzi S. , Hatzakorzian R. , Lipishan W. 
Published: August 2018

(Can J Anaesth 2017;64:1002–1008)
Prolonged seated time following intrathecal injection can prevent hypotension during cesarean delivery by limiting the upward spread of hyperbaric local anesthesia, but the limited studies of this technique have shown conflicting results. This study aimed to determine the median seated time for the prevention of hypotension following intrathecal injection of either 11.25 or 15 mg of hyperbaric bupivacaine with preservative-free morphine and fentanyl. The secondary aim of the study was to measure the rates of supplemental analgesia requirements for patients with who remained seated for an extended duration after spinal anesthesia administration.
Clinical Pain-related Outcomes and Inflammatory Cytokine Response to Pain Following Insomnia Improvement in Adults With Knee Osteoarthritis
Authors: Heffner Kathi L. , France Christopher R. , Ashrafioun Lisham , Quiñones Maria , Walsh Patrick , Maloney Michael D. , Giordano Brian D. , Pigeon Wilfred R. 
Published: August 2018

Objectives:
Clinical insomnia is known to affect pain, but mechanisms are unclear. Insomnia can dysregulate inflammatory pathway, and inflammation plays a mediating role in pain. It is unclear whether insomnia-related alterations in inflammation can be modified with insomnia improvement, and if such alterations parallel improvement in pain. The current study objective was to provide proof of concept for the role of insomnia in inflammation and pain by testing whether improving insomnia would reduce pain and related physical function, and, concurrently, modulate inflammatory responses.

Materials and Methods:
Thirty adults with osteoarthritis knee pain and insomnia (Insomnia Severity Index >10) provided baseline measures of osteoarthritis and laboratory pain, and serial blood samples for inflammatory biomarkers, interleukin 6, and tumor necrosis factor α, before and after pain testing. To manipulate insomnia, participants were randomly assigned to a 6-week cognitive-behavioral therapy for insomnia (n=16); or wait-list control (n=14). At 8-weeks (time 2), all measures were repeated. To directly test insomnia improvement effects, participants were grouped by insomnia status at time 2 after confirming baseline equivalency on all outcomes.

Results:
Compared with those maintaining insomnia at time 2 (Insomnia Severity Index ≥8; n=18), those whose insomnia improved at time 2 (n=12) had significantly improved physical functioning, decline in knee pain during transfer activities, and attenuated increase in interleukin 6 and less decrease in tumor necrosis factor α across the pain testing session.

Discussion:
These findings suggest further exploration of inflammatory pathways linking clinical insomnia, and its improvement, to chronic pain.
Effect of Intravenous Oxycodone in Combination With Different Doses of Dexmedetomdine on Sleep Quality and Visceral Pain in Patients After Abdominal Surgery
Authors: Jiang Zongming , Zhou Guozhong , Song Qiliang , Bao Chenying , Wang Hua , Chen Zhonghua 
Published: August 2018

Objective:
Oxycodone or dexmedetomidine (DEX) alone are widely used in clinical practice. The aim of this study was to observe the effect of 2 oxycodone and DEX combinations on postoperative sleep quality.

Methods:
This was a prospective and randomized clinical study. A total of 99 patients underwent laparoscopic-assisted operations on stomach and intestines with general anesthesia were enrolled and randomly divided into 3 groups according to postoperative analgesic protocol (n=33 each). The analgesic protocols were as follows after the surgery. In group C, 0.6 mg/kg oxycodone alone was diluted to 100 mL in 0.9% saline. In group D1 or D2, 0.6 mg/kg oxycodone combined with 2.4 μg/kg or 4.8 μg/kg DEX was diluted to 100 mL in 0.9% saline, respectively. The intravenous patient-controlled analgesia device was set up to deliver a continuous infusion of 3 mL/h and a bolus of 1 mL, with a 12-minute lockout interval. The primary outcome was the percentage of stage 2 nonrapid eye movement (stage N2) sleep. Polysomnography was performed the night before operation (PSG-night0), the first (PSG-night1) and second (PSG-night2) nights after surgery.

Results:
A total of 97 patients were included in the final analysis. Compared with group C, N2 sleep were higher in groups D1 and D2 on PSG-night1 (54±9% and 53±10%, respectively) and PSG-night2 (55±7% and 56±8%, respectively) (P<0.001 for all comparisons). No differences were observed regarding N1 and N2 sleep between groups D1 and D2 on PSG-night1 and PSG-night2 (P>0.05). Group C had higher percentage of N1 sleep on PSG-night1 (37±5%) and PSG-night2 (33±3%) when compared with groups D1 and D2 (P<0.001 for the comparisons). Groups D1 and D2 required lower rates of rescue analgesia (5% and 4.7%, respectively; P=0.012) and effective pressing times (10.7±4.8 times and 9.9±2.6 times, respectively; P<0.05) when compared with group C, whereas no statistical significance was found between groups D1 and D2. Furthermore, there were no significant difference about resting visual analogue scales at 4, 6, and 12 hours postoperatively between groups D1 and D2. In comparison with the other 2 groups, group D2 had a higher occurrence of postoperative hypotension (24.2%) (P<0.05), though without significant sinus bradycardia.

Discussion:
DEX combined with oxycodone can improve sleep quality and provide good visceral analgesia. However, larger doses of DEX does not further improve sleep but increases the risk of hypotension.
One-Step Approach to Identifying Gestational Diabetes Mellitus
Authors: Pocobelli Gaia , Yu Onchee , Fuller Sharon , Fraser James R. , Wartko Paige D , Chen Lu , Newton Katherine M. , Dimer Jane , McCulloch David K. , Warwick Susan , Dublin Sascha 
Published: August 2018

OBJECTIVE:
To compare perinatal outcomes before and after a clinical guideline change from a two-step to a one-step approach to screening for gestational diabetes mellitus (GDM).

METHODS:
We conducted a before–after cohort study of women with singleton live birth deliveries within Kaiser Permanente Washington, a mixed-model health plan in Washington state. We used Kaiser Permanente Washington electronic health data and linked birth certificates. We compared outcomes before (January 2009–March 2011) and after (April 2012–December 2014) the guideline change among women who received prenatal care from health care providers internal to Kaiser Permanente Washington (n=4,977 before, n=6,337 after). We made the same comparison among women who received prenatal care from external health care providers (not exposed to the guideline change; n=3,386 before, n=4,454 after) to control for time trends unrelated to the guideline change. Adjusted relative risks and 95% CIs were estimated using Poisson generalized estimating equations.

RESULTS:
After the guideline change, receipt of the one-step approach became widespread among women cared for by Kaiser Permanente Washington internal providers (87%), and use of insulin increased 3.7-fold from 1.2% to 4.4%. Among women cared for by Kaiser Permanente Washington internal providers, GDM increased from 6.9% to 11.4%, induction of labor from 25.2% to 28.6%, neonatal hypoglycemia from 1.3% to 2.0%, and outpatient nonstress testing from 134.6 to 157.0 test days per 100 women. After accounting for background trends in outcomes (based on the women cared for by external providers), the guideline change was associated with increased incidence of GDM (relative risk [RR] 1.41, 95% CI 1.17–1.69), labor induction (RR 1.20, 95% CI 1.09–1.32), neonatal hypoglycemia (RR 1.77, 95% CI 1.14–2.75), and nonstress testing (RR 1.12, 95% CI 1.02–1.24% per 100 women). There was no association with other outcomes including cesarean delivery or macrosomia.

CONCLUSION:
Adopting the one-step approach was associated with a 41% increase in the diagnosis of GDM without improved maternal or neonatal outcomes.
Identification and Management of Abdominal Wall Varices in Pregnancy
Authors: Wood Amber M. , Grotegut Chad A. , Ronald James , Pabon-Ramos Waleska , Pedro Christina , Knechtle Stuart J. , Wysokinska Ewa , Rubin Geoffrey D. , Brady Carla W. , Gilner Jennifer B. 
Published: August 2018

BACKGROUND:
Portal hypertension in pregnancy is associated with elevated risk of variceal hemorrhage. Ectopic varices, those located outside the esophagus or stomach, are rare but have a high risk of associated maternal morbidity or mortality.

CASE:
A 31-year-old woman, gravida 2 para 0010, with cirrhosis and portal hypertension was found to have abdominal wall ectopic varices on third-trimester obstetric ultrasonography. Computed tomography angiography confirmed these findings. Given concern for catastrophic hemorrhage during delivery, she underwent transjugular intrahepatic portosystemic shunt placement at 35 weeks of gestation, with reduction in the pressure gradient within the portosystemic circulation. She subsequently underwent an uncomplicated cesarean delivery.

CONCLUSION:
Identification of ectopic varices on obstetric ultrasonography may allow for treatment before delivery, decreasing the risk of serious maternal morbidity or mortality.
Early Hearing Detection and Intervention: Timely Diagnosis, Timely Management
Authors: Findlen Ursula M. , Hounam Gina M. , Alexy Emily , Adunka Oliver F. 
Published: August 2018

Objective:
A quality improvement study was completed to assess the impact of three clinical practice changes on the timing of diagnosis and intervention for congenital hearing loss.

Design:
A retrospective chart review was conducted for 800 infants evaluated for congenital hearing loss before and after implementing three clinical practice changes: the use of Kalman-weighted signal averaging for auditory brainstem response testing, a tone burst-prioritized testing protocol, and expediting scheduling of initial assessment. The impact of middle ear involvement on age at diagnosis and history of neonatal intensive care unit stay on age at treatment was also examined.

Results:
The use of Kalman-weighted signal averaging for auditory brainstem response testing, a tone burst-prioritized testing protocol, and expedited scheduling of initial assessment each resulted in a decrease of age at diagnosis. Ultimately, the age at initial assessment was the only significant predictor related to decreased timeline for diagnosis. Middle ear pathology significantly increased age at diagnosis, while history of time in the neonatal intensive care unit significantly increased the age at provision of amplification as a treatment for permanent hearing loss.

Conclusions:
The technology used for assessment, clinical protocol, and timing of assessment of infants can impact the timeline for diagnosis and treatment of congenital hearing impairment. Given the significant sequelae of delayed or missed diagnosis of hearing loss in infancy, implementing clinical practice changes should be considered at pediatric diagnostic centers.
Preliminary Safety and Tolerability of a Novel Subcutaneous Intrathecal Catheter System for Repeated Outpatient Dosing of Nusinersen to Children and Adults With Spinal Muscular Atrophy
Authors: Strauss Kevin A. , Carson Vincent J. , Brigatti Karlla W. , Young Millie , Robinson Donna L. , Hendrickson Christine , Fox Michael D. , Reed Robert M. , Puffenberger Erik G. , Mackenzie William , Miller Freeman 
Published: August 2018

Background:
Many patients with spinal muscular atrophy (SMA) who might benefit from intrathecal antisense oligonucleotide (nusinersen) therapy have scoliosis or spinal fusion that precludes safe drug delivery. To circumvent spinal pathology, we designed a novel subcutaneous intrathecal catheter (SIC) system by connecting an intrathecal catheter to an implantable infusion port.

Methods:
Device safety and tolerability were tested in 10 SMA patients (age, 5.4 to 30.5 y; 80% with 3 copies of SMN2); each received 3 sequential doses of nusinersen (n=30 doses). Pretreatment disease burden was evaluated using the Revised Hammersmith Scale, dynamometry, National Institutes of Health pegboard, pulmonary function testing, electromyography, and 2 health-related quality of life tools.

Results:
Device implantation took ≤2 hours and was well tolerated. All outpatient nusinersen doses were successfully administered via SIC within 20 minutes on the first attempt, and required no regional or systemic analgesia, cognitive distraction, ultrasound guidance, respiratory precautions, or sedation. Cerebrospinal fluid withdrawn from the SIC had normal levels of glucose and protein; cerebrospinal fluid white blood cells were slightly elevated in 2 (22%) of 9 specimens (median, 1 cell/µL; range, 0 to 12 cells/µL) and red blood cells were detected in 7 (78%) specimens (median, 4; range, 0 to 2930 cells/µL).

Discussion:
Preliminary observations reveal the SIC to be relatively safe and well tolerated in SMA patients with advanced disease and spinal fusion. The SIC warrants further study and, if proven effective in larger trials of longer duration, could double the number of patients able to receive nusinersen worldwide while reducing administration costs 5- to 10-fold.
Prevention of Nerve Root Thermal Injury Caused by Bipolar Cauterization Near the Nerve Roots
Authors: Ohyama Shoichiro , Takahashi Shinji , Tamai Koji , Hori Yusuke , Hirakawa Yoshihiro , Hoshino Masatoshi , Suzuki Akinobu , Nakamura Hiroaki 
Published: August 2018

Study Design.
This was a controlled, interventional animal study.

Objective.
This study aimed to investigate the thermal injury of nerve root by cauterization near the nerve root and to identify the prevention or rescue procedure of nerve root injury.

Summary of Background Data.
In spine surgery, bipolar cauterization of epidural venous plexus near the nerve root is an essential procedure to control bleeding. Although a potential risk of neurological thermal damage exists, the underlying mechanism and prevention have not been elucidated.

Methods.
Temperature measurement and histological evaluation after bipolar cauterization near the posterior branch of the nerve root were performed using a rabbit model. Subsequently, the effect of saline irrigation or changing the direction of bipolar forceps to reduce thermal elevation during bipolar cauterization was evaluated. Finally, the effectiveness of locally injected corticosteroid after bipolar cauterization was evaluated.

Results.
After bipolar cauterization, temperature of the surrounding site reached 60.9 °C, and 47.8% of the nerves were histologically injured. Using saline irrigation, thermal elevation was significantly suppressed up to 42.7 °C (P < 0.01), and no nerve was histologically injured. When bipolar cauterization was performed in the perpendicular direction, temperature of the surrounding site reached only 40.4 °C (P < 0.01). Locally injected corticosteroid reduced the incidence of nerve injury to 25.0%. However, a significant increase in nerve damage remained compared with the sham group (P < 0.01).

Conclusion.
Bipolar cauterization near the nerve roots can increase the temperature of nerve roots and cause thermal nerve root injury, despite no accidental direct nerve root injury. Using saline irrigation, or setting bipolar forceps perpendicular to nerve roots, thermal elevation could be suppressed and nerve injury could be prevented. Therefore, it is recommended that surgeons set bipolar forceps perpendicular to nerve roots or use saline irrigation for the prevention of nerve root injury.

Level of Evidence: N/A
Maternal Plasma Concentrations of Per- and Polyfluoroalkyl Substances and Breastfeeding Duration in the Norwegian Mother and Child Cohort
Authors: Rosen Emma M. , Brantsæter Anne Lise , Carroll Rachel , Haug Line S. , Singer Alison B. , Zhao Shanshan , Ferguson Kelly K. 
Published: August 2018

Background:
Per- and polyfluoroalkyl substances (PFASs) have been widely produced, many of them persist in the environment, and have been associated with various health effects. Previous studies have identified inverse associations between perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), and breastfeeding duration, but have been limited in investigation of other PFASs.

Methods:
We measured the associations between plasma concentrations of nine different PFASs and cessation of breastfeeding before 3 and 6 complete months using women from the Norwegian Mother and Child Cohort Study (MoBa). The study population includes 1716 primarily nulliparous women from two previous studies of MoBa participants, enrolled from 2003 to 2007. The association was measured using Cox proportional hazards model. Mixtures analyses were performed using Elastic net regularization to identify interactive effects and control for copollutant confounding.

Results:
Concentrations of PFASs in this population were lower than concentrations in the previous studies on this topic. We found associations between increasing concentrations of perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), and decreased breastfeeding cessation (increased duration). The strongest associations were seen between PFDA and PFUnDA and cessation before 3 months: (both hazard ratios = 0.73; 95% confidence intervals = 0.62, 0.86). In our population, the other PFASs appeared to be unassociated with breastfeeding cessation. The mixtures analyses identified meaningful interactions between PFUnDA:PFDA, perfluorohexane sulfonate (PFHXS):PFOA, and PFOA:PFOS.

Conclusions:
The identification of associations between previously unexamined PFASs concentrations and increased breastfeeding duration is novel and may be explained by differences in transplacental transfer rates.
Factors associated with age at natural menopause among elderly women in São Paulo, Brazil
Authors: Lay Alejandra Andrea Roman , Duarte Yeda Aparecida de Oliveira , Filho Alexandre Dias Porto Chiavegatto 
Published: August 2018

Abstract

Objectives:
To analyze factors associated with age at natural menopause in elderly women who are part of the Health, Well-Being and Aging Study— which is a representative sample of elderly residents of the municipality of São Paulo, Brazil.

Methods:
Multivariate Cox proportional-hazards analysis using data from a total of 1,415 women with natural menopause. We included 163 women with hysterectomy, oophorectomy, and estrogen therapy as censored data.

Results:
The median age of natural menopause was 50 years. In the multivariate Cox proportional hazards, smoking was associated with earlier age at natural menopause for the three cohorts (2000, 2006, and 2010). Current smokers had a 35% higher risk of earlier natural menopause (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.12, 1.62) and former smokers had a 27% higher risk of earlier natural menopause (HR 1.27, 95% CI 1.09, 1.50), in comparison with never-smokers. Women with 8 years or more of formal education had a 33% lower risk of earlier natural menopause (HR 0.67, 95% CI 0.50, 0.89) than women with no education, and women who were separated, widowed, or divorced had a 15% higher risk of earlier natural menopause (HR 1.15, 95% CI 1.00, 1.31) in comparison with married women. Marital status and parity were associated with later age at natural menopause only in 2006.

Conclusions:
We found significant associations of age at natural menopause with reproductive and lifestyle factors similar to some studies of women from developed countries.
Association of menopause and type 2 diabetes mellitus
Authors: Ren Yongcheng , Zhang Ming , Liu Yu , Sun Xizhuo , Wang Bingyuan , Zhao Yang , Liu Dechen , Liu Xuejiao , Zhang Dongdong , Liu Feiyan , Cheng Cheng , Liu Leilei , Chen Xu , Zhou Qionggui , Hu Dongsheng 
Published: August 2018

Abstract

Objective:
Limited information is available on the direct effect of menopause and risk of type 2 diabetes mellitus (T2DM) among women with different metabolic types. We aimed to investigate whether menopause is a direct risk factor for T2DM.

Methods:
In this population-based cross-sectional study, women were recruited from a rural area of China from July to August 2013 and July to August 2014. Multivariate logistic regression analysis yielded adjusted odds ratios (ORs) and 95% CIs. Mediation analysis was performed to examine the contribution of age to menopause status-related T2DM.

Results:
We included 8,191 women (median age 56, interquartile range 47-65). The prevalence of T2DM was 13.22%. Risk of T2DM was increased with postmenopause versus premenopause status after adjustment (adjusted OR [aOR] = 1.90, 95% CI = 1.51-2.37), with the strongest association between postmenopause status and T2DM among women with body mass index (BMI) <24.0 kg/m2 (aOR, 3.25; 95% CI, 1.98-5.32). Risk of T2DM was increased with postmenopause status interacting with BMI, hypertension, triglycerides level, and waist circumference. On mediation analysis, age partially mediated the menopause status–T2DM association (indirect effect: OR = 1.27, 95% CI = 1.13-1.46; direct effect: OR = 1.88, 95% CI = 1.49-2.36).

Conclusions:
The prevalence of T2DM is high among women, and postmenopause status might be a stable and significant risk factor for T2DM; especially, postmenopausal women with normal weight should not be ignored in addressing the risk.