bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery
Authors: Hussain Nasir , Brull Richard , McCartney Colin J. L. , Wong Patrick , Kumar Nicolas , Essandoh Michael , Sawyer Tamara , Sullivan Timothy , Abdallah Faraj W. 
Published: July 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery.

Methods
Databases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling.

Results
Fourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of −30.5 mg [−42.2, −18.8] (P < 0.00001), and in rest pain area under the curve more than 24 h, by −4.7cm · h [−5.1, −4.2] or −1.2cm [−1.3, −1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes.

Conclusions
We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.
Internal Carotid Artery Blood Flow Response to Anesthesia, Pneumoperitoneum, and Head-up Tilt during Laparoscopic Cholecystectomy
Authors: Skytioti Maria , Elstad Maja , Søvik Signe 
Published: July 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Little is known about how implementation of pneumoperitoneum and head-up tilt position contributes to general anesthesia-induced decrease in cerebral blood flow in humans. We investigated this question in patients undergoing laparoscopic cholecystectomy, hypothesizing that cardiorespiratory changes during this procedure would reduce cerebral perfusion.

Methods
In a nonrandomized, observational study of 16 patients (American Society of Anesthesiologists physical status I or II) undergoing laparoscopic cholecystectomy, internal carotid artery blood velocity was measured by Doppler ultrasound at four time points: awake, after anesthesia induction, after induction of pneumoperitoneum, and after head-up tilt. Vessel diameter was obtained each time, and internal carotid artery blood flow, the main outcome variable, was calculated. The authors recorded pulse contour estimated mean arterial blood pressure (MAP), heart rate (HR), stroke volume (SV) index, cardiac index, end-tidal carbon dioxide (ETco
2), bispectral index, and ventilator settings. Results are medians (95% CI).

Results
Internal carotid artery blood flow decreased upon anesthesia induction from 350 ml/min (273 to 410) to 213 ml/min (175 to 249; −37%, P < 0.001), and tended to decrease further with pneumoperitoneum (178 ml/min [127 to 208], −15%, P = 0.026). Tilt induced no further change (171 ml/min [134 to 205]). ETco
2 and bispectral index were unchanged after induction. MAP decreased with anesthesia, from 102 (91 to 108) to 72 (65 to 76) mmHg, and then remained unchanged (Pneumoperitoneum: 70 [63 to 75]; Tilt: 74 [66 to 78]). Cardiac index decreased with anesthesia and with pneumoperitoneum (overall from 3.2 [2.7 to 3.5] to 2.3 [1.9 to 2.5] l · min−1 · m−2); tilt induced no further change (2.1 [1.8 to 2.3]). Multiple regression analysis attributed the fall in internal carotid artery blood flow to reduced cardiac index (both HR and SV index contributing) and MAP (P < 0.001). Vessel diameter also declined (P < 0.01).

Conclusions
During laparoscopic cholecystectomy, internal carotid artery blood flow declined with anesthesia and with pneumoperitoneum, in close association with reductions in cardiac index and MAP. Head-up tilt caused no further reduction. Cardiac output independently affects human cerebral blood flow.
Long-Term Sensorineural Hearing Loss in Patients With Blast-Induced Tympanic Membrane Perforations
Authors: Littlefield Philip D. , Brungart Douglas S. 
Published: July 2019

Objective:
To describe characteristics of sensorineural hearing loss (SNHL) in patients with blast-induced tympanic membrane (TM) perforations that required surgery.

Design:
A retrospective review of hearing outcomes in those who had tympanoplasty for combat blast-induced TM perforations. These were sequential cases from one military otolaryngologist from 2007 to 2012. A total of 87 patients were reviewed, and of those, 49 who had appropriate preinjury, preoperative, and long-term audiograms were included. Those with pre-existing hearing loss were excluded. Preinjury audiograms were used to assess how sensorineural thresholds changed in the ruptured ears, and in the contralateral ear in those with unilateral perforations.

Results:
The mean time from injury to the final postoperative audiogram was 522 days. In the ears with TM perforations, 70% had SNHLs of 10 dB or less (by bone conduction pure tone averages). Meanwhile, approximately 8% had threshold shifts >30 dB, averaging 50 dB. The strongest predictor of severe or profound hearing loss was ossicular discontinuity. Thresholds also correlated with bilateral injury and perforation size. In those with unilateral perforations, the SNHL was almost always larger on the side with the perforation. Those with SNHL often had a low-to-mid frequency threshold shift and, in general, audiograms that were flatter across frequencies than those of a typical population of military personnel with similar levels of overall hearing loss.

Conclusions:
There is a bimodal distribution of hearing loss in those who experience a blast exposure severe enough to perforate at least one TM. Most ears recover close to their preinjury thresholds, but a minority experience much larger sensorineural threshold shifts. Blast exposed ears also tend to have a flatter audiogram than most service members with similar levels of hearing loss.
The Association Between Physiological Noise Levels and Speech Understanding in Noise
Authors: Stiepan Samantha , Siegel Jonathan , Lee Jungwha , Souza Pamela , Dhar Sumitrajit 
Published: July 2019

Objectives:
Traditionally, elevated hearing thresholds have been considered to be the main contributors to difficulty understanding speech in noise; yet, patients will often report difficulties with speech understanding in noise despite having audiometrically normal hearing. The purpose of this cross-sectional study was to critically evaluate the relationship of various metrics of auditory function (behavioral thresholds and otoacoustic emissions) on speech understanding in noise in a large sample of audiometrically normal-hearing individuals.

Design:
Behavioral hearing thresholds, distortion product otoacoustic emission (DPOAE) levels, stimulus-frequency otoacoustic emission levels, and physiological noise (quantified using OAE noise floors) were measured from 921 individuals between 10 and 68 years of age with normal pure-tone averages. The quick speech-in-noise (QuickSIN) test outcome, quantified as the signal-to-noise ratio (SNR) loss, was used as the metric of speech understanding in noise. Principle component analysis (PCA) and linear regression modeling were used to evaluate the relationship between the measures of auditory function and speech in noise performance.

Results:
Over 25% of participants exhibited mild or worse degree of SNR loss. PCA revealed DPOAE levels at 12.5 to 16 kHz to be significantly correlated with the variation in QuickSIN scores, although correlations were weak (R2 = 0.017). Out of all the metrics evaluated, higher levels of self-generated physiological noise accounted for the most variance in QuickSIN performance (R2 = 0.077).

Conclusions:
Higher levels of physiological noise were associated with worse QuickSIN performance in listeners with normal hearing sensitivity. We propose that elevated physiological noise levels in poorer speech in noise performers could diminish the effective SNR, thereby negatively impacting performance as seen by poorer QuickSIN scores.
Medialized Trochanteric Starting Point and Focused Lateral Endosteal Beak Reaming to Optimize Success of Intramedullary Nailing in Atypical Femur Fractures: A Technical Trick and Case Series
Authors: Berkes Marschall B. , Shaw James C. , Warner Stephen J. , Achor Timothy S. 
Published: June 2019

Summary:
Optimal intramedullary treatment of atypical femur fractures associated with bisphosphonate use requires avoidance of postoperative malreduction, particularly varus. This can be difficult to achieve, given the fracture location, errors with nail entry point, endosteal beaking, and underlying patient osteology, all of which can contribute to postoperative varus and predispose the patient to treatment failure. We present a surgical technique and clinical series of 10 patients emphasizing a medialized trochanteric nail entry point and preferential lateral endosteal reaming to secure a biologically and biomechanically favorable reduction and fixation.
Complications Associated With Minimally Invasive Anterior to the Psoas (ATP) Fusion of the Lumbosacral Spine
Authors: Tannoury Tony , Kempegowda Harish , Haddadi Kaveh , Tannoury Chadi 
Published: July 2019

Study Design.
Retrospective cohort study.

Objectives.
To analyze complications associated with minimally invasive anterolateral retroperitoneal antepsoas lumbosacral fusion (MIS-ATP).

Summary of Background Data.
MIS-ATP provides anterolateral access to the lumbar spine allowing for safe anterior lumbar interbody fusions between T12-S1. Anecdotally, many surgeons believe that ATP approach is not feasible at L5-S1 level, predisposing to catastrophic vascular injuries. This approach may help overcome limitations associated with conventional straight anterior lumbar interbody fusions, MIS lateral lumbar interbody fusion, and oblique lateral interbody fusion.

Methods.
A detailed retrospective chart review of patients who had underwent MIS-ATP approach for lumbar fusion between T12-S1 was performed. Available electronic data from surgeries performed between January 2008 and March 2017 was carefully screened for surgical patients treated for spondylolisthesis, spondylosis, stenosis, sagittal, and/or coronal deformity. Detailed review of electronic medical records including operative notes, progress notes, discharge summaries, laboratory results, imaging reports, and clinic visit notes performed by a single independent reviewer not involved in patient care for documented complications. A complication is defined as any adverse event related to the index spine procedure for which patient required specific intervention or treatment.

Results.
Nine hundred forty patients with a total of 2429 interbody fusion levels performed via MIS-ATP were identified during the study period. Sixty-seven patients (7.2%) sustained one or more complications during the perioperative period, of which 25.5% were surgical and 74.5% were medical. Overall, 78 (8.2%) surgical complications pertaining to the index procedure were noted during a postoperative period of 1 year from the date of surgery. No major vascular or direct visceral injuries were encountered.

Conclusions.
MIS-ATP approach provides a safe access to anterolateral interbody fusions between T12-S1. The ATP approach is performed by the spine surgeon, does not require neuromonitoring, and warrants minimal to no psoas muscle retraction resulting in significantly reduced postoperative thigh pain and rare neurologic injuries. Additionally, the direct and clear visualization of the retroperitoneal vasculature provided by the ATP approach minimizes the risk of inadvertent vascular injury.

Level of Evidence: 4
Hazardous air pollutants and telomere length in the Sister Study
Authors: Niehoff Nicole M. , Gammon Marilie D. , Keil Alexander P. , Nichols Hazel B. , Engel Lawrence S. , Taylor Jack A. , White Alexandra J. , Sandler Dale P. 
Published: July 2019

Background:
Telomeres are vital for genomic integrity, and telomere length has been linked to many adverse health outcomes. Some hazardous air pollutants or air toxics increase oxidative stress and inflammation, two possible determinants of shortened telomere length. No studies have examined air toxic–telomere length associations in a nonoccupational setting.

Methods:
This study included 731 Sister Study participants (enrolled 2003–2007) who were randomly selected to assess telomere length in baseline blood samples. Multiplex qPCR was used to determine telomere to single copy gene (T/S) ratios. Census tract concentration estimates of 29 air toxics from the 2005 National Air Toxics Assessment were linked to baseline residential addresses. Air toxics were classified into tertile-based categories of the exposure. Multivariable linear regression was used to estimate β coefficients and 95% confidence intervals (CIs) in single-pollutant models. Multipollutant groups were identified with regression trees.

Results:
The average T/S ratio was 1.24. Benzidine (T3 versus T1 β = −0.08; 95% CI = −0.14, −0.01) and 1,4-dioxane (T3 versus T1 β = −0.06; 95% CI = −0.13, 0.00) in particular, as well as carbon tetrachloride, chloroprene, ethylene dibromide, and propylene dichloride, were associated with shorter relative telomere length. Benzidine (P = 0.02) and 1,4-dioxane (P = 0.06) demonstrated some evidence of a monotonic trend. The regression tree identified age, BMI, physical activity, ethylene oxide, acrylonitrile, ethylidene dichloride, propylene dichloride, and styrene in multipollutant groups related to telomere length.

Conclusions:
In this first study of air toxics and telomere length in a nonoccupational setting, several air toxics, particularly 1,4-dioxane and benzidine, were associated with shorter relative telomere length.
Reading between the Lines: A Plastic Surgeon’s Guide to Evaluating the Quality of Evidence in Research Publications
Authors: Gabriel Allen , Maxwell G. Patrick 
Published: July 2019

Summary:
An important component of practicing evidence-based medicine (EBM) in plastic surgery is staying current with published research, an increasingly difficult task given the rapid growth of the literature. This article reviews the methodological aspects specific to the aesthetic surgery field that should be considered when evaluating the quality of evidence in research publications in the context of the level of evidence (LOE) grading scales that are currently used by plastic surgery journals. Reporting the LOE in a research publication can help to highlight the quality of the research and the potential for bias so that the reader may prioritize information accordingly. However, LOE classifications are not an absolute index of the quality of evidence and do not preclude careful evaluation of the study’s methods and results in the context of the authors’ conclusions. As the application of evidence-based medicine expands in the plastic surgery community, surgeons must be mindful of how to appropriately interpret research findings and assess the utility of applying results to their practice.
Femtosecond Laser-Assisted Keratolimbal Allograft Transplantation for the Treatment of Total Limbal Stem Cell Deficiency
Authors: Qi Xiaolin , Duan Fangnan , Li Xiang , Zhang Xiaoyu , Li Na , Liu Mingna , Gao Hua 
Published: June 2019

Purpose:
To investigate the surgical procedure and therapeutic efficacy of femtosecond (FS) laser-assisted keratolimbal allograft (KLAL) transplantation in the treatment of eyes with total limbal stem cell deficiency.

Methods:
Ten eyes from 10 patients who underwent FS laser-assisted KLAL transplantation were enrolled. The best-corrected visual acuity (BCVA), ocular surface stability, corneal transparency, and postoperative complications were recorded.

Results:
The keratolimbal grafts prepared using the FS laser were even in thickness and width. After the surgery, glucocorticoid and tacrolimus eye drops were administered locally to the eyes with concentration gradients, and a medium dose was prescribed for maintenance. Within the mean follow-up period of 16.8 ± 7.3 months, 9 of 10 eyes (90.0%) maintained a stable ocular surface and showed significant improvements in corneal transparency and BCVA. Persistent corneal edema only occurred in one eye because of repeated epithelial defects, and the BCVA of this eye did not improve. Confocal microscopy revealed activated dendritic cells in the Bowman membrane at the limbus, but they were always low in density with small dendritic processes. No acute immune rejection, cataracts, or elevation of intraocular pressure were detected.

Conclusions:
The FS laser-assisted KLAL technique can produce ring-shaped grafts with an even depth and width, resulting in a stable ocular surface and good visual prognosis. After surgery, glucocorticoids and potent immunosuppressive eye drops were administered locally with concentration gradients and effectively inhibited acute immune rejection.
Recurrence of Infection in Corneal Grafts After Therapeutic Penetrating Keratoplasty for Microbial Keratitis
Authors: Chatterjee Samrat , Agrawal Deepshikha 
Published: June 2019

Purpose:
To determine the factors responsible for the recurrence of infection after therapeutic penetrating keratoplasty (TPK) in severe microbial keratitis.

Methods:
This is a retrospective interventional case series that reviewed the medical records of 229 consecutive patients (2005–2017) who underwent TPK for microbial keratitis at a tertiary eye care center in Central India. The primary outcome was recurrence of the primary infection. The factors responsible for recurrence were identified by univariate and multivariate regression analysis.

Results:
The overall outcomes were clear graft in 50 (21.8%) eyes, failed graft in 139 (60.7%) eyes, evisceration in 19 (8.3%) eyes, phthisis bulbi in 14 (6.1%) eyes, repeat TPK in 2 (0.9%) eyes, and anterior staphyloma in 1 (0.4%) eye. Recurrence occurred in 63 (27.5%) eyes within 16.2 ± 13.8 (range: 2–66) days. Univariate analysis identified fungal etiology (P = 0.001), ulcer size > 60 mm2 (P = 0.001), limbal involvement (P = 0.001), endothelial exudates (P = 0.024), retro-iris exudates (P = 0.001), corneal perforation (P = 0.005), coexisting endophthalmitis (P < 0.001), and graft size ≥ 10 mm2 (P < 0.001) as significant risk factors. Multiple logistic regression identified fungal etiology (P = 0.013), retro-iris exudates (P = 0.011), coexisting endophthalmitis (P = 0.004), and graft size ≥ 10 mm2 (P = 0.058) as independent risk factors for recurrence. Presenting visual acuity of 20/200 or better was seen in 49 (21.4%) and 39 (17%) eyes, and no light perception in 11 (4.8%) and 26 (11.4%) eyes at postoperative months 1 and 3, respectively.

Conclusions:
Fungal etiology, retro-iris exudates, coexisting endophthalmitis, and larger grafts were susceptible to recurrence. Early surgery may mitigate most of these factors. Despite the risk of recurrence, TPK remains an effective treatment in severe nonresponsive keratitis.
Orbital Myositis: A Comprehensive Review and Reclassification
Authors: McNab Alan A. 
Published: July 2019

Purpose:
Orbital myositis occurs in typical and atypical forms. This review summarizes and updates the current state of knowledge of all forms of inflammation affecting extraocular muscle, excluding thyroid-associated orbitopathy.

Methods:
A comprehensive literature review of orbital myositis was performed.

Results:
Orbital myositis typically occurs in an idiopathic acute form, with painful diplopia due to inflammation in 1 or more extraocular muscles of young adult females, which usually responds to a course of oral corticosteroids. Atypical forms include idiopathic chronic or recurrent orbital myositis, and myositis related to systemic autoimmune, inflammatory, and infective conditions. The commonest associated autoimmune condition is inflammatory bowel disease. Immunoglobulin G4–related ophthalmic disease often affects extraocular muscle. Drug reactions and rarely paraneoplastic disease may also cause extraocular muscle inflammation.

Conclusions:
Orbital myositis occurs in a typical acute steroid responsive form, but atypical forms related to specific autoimmune and inflammatory conditions are increasingly recognized. Orbital myositis has many similarities to uveitis and would benefit from a systematic approach to nomenclature, diagnosis, and treatment.
Prognostic biomarkers of cervical squamous cell carcinoma identified via plasma metabolomics
Authors: Zhou Huihui , Li Qi , Wang Tong , Liang Hong , Wang Yanan , Duan Yani , Song Min , Wang Yaoxian , Jin Hong 
Published: June 2019

Abstract
Cervical cancer is the second most common female malignancy worldwide. The metabolic profile of plasma associated with the prognosis of cervical cancer remains poorly understood. In this cross-sectional study, plasma samples were collected from three groups of patients with CSCC, namely primary patients before treatment (BT group), patients with a poor prognosis (PP group, including patients with distant metastasis and local recurrence), and patients with a good prognosis within two years after the first treatment (GP group). The plasma metabolomics was conducted to detect the dynamic changes of metabolites via ultra-performance liquid chromatography with quadrupole time-of-flight mass spectrometry. Multivariate analyses, including principle component, partial least square-discriminant, and orthogonal projection to latent structure-discriminant analyses, were performed to compare each pair of the three groups. The differential metabolites were identified by comparison of the exact m/z values and mass spectrometry (MS)/MS spectra with the structural information of the metabolites obtained from the Human Metabolome Database (http://www.hmdb.ca/) and LIPID MAPS (http://www.lipidmaps.org/). To screen for potential markers, receiver operating characteristic curve analysis of the differential metabolites. Finally, thirty plasma samples were collected from each group. Multivariate analyses showed that 31 metabolites were significantly different among the 3 groups studied. Of those, the 5 metabolites phosphatidyl choline (15:0/16:0), phosphatidyl glycerol (12:0/13:0), actosylceramide (d18:1/16:0), D-Maltose, and phthalic acid, with an area under the curve above 0.75, were identified as potential biomarkers. The present findings provide evidence for biomarkers to monitor prognosis of patients with CSCC, which may help in better managing the disease.