bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Complications Associated With Periviable Birth
Authors: Rossi Robert M. , DeFranco Emily A. 
Published: June 2018

OBJECTIVE:
To quantify the rate of maternal complications associated with a periviable birth in a contemporary population of live births in the state of Ohio.

METHODS:
We conducted a population-based retrospective cohort study of all live births in Ohio (2006–2015). Maternal, obstetric, and neonatal characteristics were compared between women who delivered in the periviable period (20–25 weeks of gestation) with those who delivered preterm (26–36 weeks of gestation) and at term (greater than 36 weeks of gestation). Women were also stratified by 3-week gestational age epochs (ie, 20–22, 23–25 weeks of gestation). The primary study outcome was a composite of individual adverse maternal outcomes (chorioamnionitis, blood product transfusion, hysterectomy, unplanned operation, and intensive care unit [ICU] admission). Multivariate logistic regression estimated the relative association of periviable birth with maternal complications.

RESULTS:
Of 1,457,706 live births in Ohio during the 10-year study period, 6,085 live births (0.4%) occurred during the periviable period (20–25 weeks of gestation). The overall rate of the composite adverse outcome was 17.2%. In multivariate analysis, periviable birth was associated with an increased risk of the composite adverse maternal outcome (adjusted relative risk [RR] 5.8, CI 5.4–6.2) and individual complications including transfusion (adjusted RR 4.4, CI 3.4–5.7), unplanned operative procedure (adjusted RR 2.0, CI 1.7–2.4), unplanned hysterectomy (adjusted RR 7.8, CI 4.6–13.0), uterine rupture (adjusted RR 7.1, CI 3.8–13.4), and ICU admission (adjusted RR 9.6, CI 7.2–12.7) compared with the term cohort. Delivery between 20–22 weeks and 23–25 weeks of gestation was associated with the highest risk of composite adverse outcome. The risk of composite adverse outcome decreased with advancing gestational age stratum.

CONCLUSION:
Periviable birth is associated with significant maternal morbidity. Nearly one in five women in this cohort had a serious morbidity associated with their periviable delivery.
Changes in Surgical Volume and Outcomes Over Time for Women Undergoing Hysterectomy for Endometrial Cancer
Authors: Wright Jason D. , Ruiz Maria P. , Chen Ling , Gabor Lisa R. , Tergas Ana I. , St. Clair Caryn M. , Hou June Y. , Ananth Cande V. , Neugut Alfred I. , Hershman Dawn L. 
Published: June 2018

OBJECTIVE:
To examine changes over time in surgeon and hospital procedural volume for hysterectomy for endometrial cancer and explore the association between changes in volume and perioperative outcomes.

METHODS:
We used the Statewide Planning and Research Cooperative System database to analyze women who underwent abdominal or minimally invasive hysterectomy from 2000 to 2014. Annualized surgeon and hospital volume was estimated. The association between surgeon and hospital volume and perioperative morbidity, mortality, and resource utilization (transfusion, length of stay, hospital charges) was estimated by modeling procedural volume as a continuous and categorical variable.

RESULTS:
A total of 44,558 women treated at 218 hospitals were identified. The number of surgeons performing cases each year decreased from 845 surgeons with 2,595 patients (mean cases=3) in 2000 to 317 surgeons who operated on 3,119 patients (mean cases=10) (P<.001) in 2014, whereas the mean hospital volume rose from 14 to 32 cases over the same time period (P=.29). When stratified by surgeon volume quartiles, the morbidity rate was 14.6% among the lowest volume surgeons, 20.8% for medium–low, 15.7% for medium–high, and 14.1% for high-volume surgeons (P<.001). In multivariable models in which volume was modeled as a continuous variable, there was no association between surgeon volume and the rate of complications, whereas excessive total charges were lowest and perioperative mortality highest for the high-volume surgeons (P<.001 for both).

CONCLUSION:
Care of women with endometrial cancer has been concentrated to a smaller number of surgeons and hospitals. The association between surgeon and hospital volume for endometrial cancer is complex with an increased risk of adverse outcomes among medium-volume hospitals and surgeons but the lowest complication rates for the highest volume surgeons and centers.
Safety of Deep Sedation Without Intubation for Second-Trimester Dilation and Evacuation
Authors: Aksel Sarp , Lang Laura , Steinauer Jody E. , Drey Eleanor A. , Lederle Lauren , Sokoloff Abby , Carlisle A. Sue 
Published: June 2018

OBJECTIVE:
To estimate the incidence of pulmonary aspiration and other anesthesia-related adverse events in women undergoing dilation and evacuation (D&E) under intravenous deep sedation without tracheal intubation in an outpatient setting.

METHODS:
We reviewed all D&Es done under anesthesiologist-administered intravenous deep sedation without tracheal intubation between February 2009 and April 2013. The study's primary outcome was pulmonary aspiration; secondary outcomes included other anesthesia-related complications. We calculated the incidence of anesthesia-related adverse events as well as a 95% CI around the point estimate.

RESULTS:
During the 51-month study period, 4,481 second-trimester abortions were completed. Of these, 2,523 (56%) were done under deep sedation without tracheal intubation, 652 (26%) between 14 and 19 6/7 weeks of gestation, and 1,871 (74%) between 20 and 24 weeks of gestation. Seven cases of anesthesia-related complications were identified: two cases of pulmonary aspiration (0.08%, 95% CI 0.01–0.29%), four cases of upper airway obstruction (0.016%, 95% CI 0.04–0.41%), and one case of lingual nerve injury (0.04%, 95% CI 0.001–0.22%).

CONCLUSION:
Deep sedation without tracheal intubation for women undergoing D&E has a low incidence of anesthesia-related complications.
Hospital Readmission as a Poor Measure of Quality in Ovarian Cancer Surgery
Authors: Uppal Shitanshu , Spencer Ryan J. , Rice Laurel W. , del Carmen Marcela G. , Reynolds R. Kevin , Griggs Jennifer J. 
Published: June 2018

OBJECTIVE:
To evaluate the role of 30-day readmission rate as a quality of care metric in patients undergoing ovarian cancer surgery.

METHODS:
We performed a retrospective cohort study of women diagnosed between 2004 and 2013 with advanced-stage, high-grade, serous carcinoma who underwent primary treatment. Using the National Cancer Database, we compared the performance of hospital risk-adjusted 30-day readmission rate to other quality of care metrics (risk-adjusted 30- and 90-day mortality, rates of adherence to guideline-based care, and overall survival) within hospitals categorized by yearly case volume (10 or less, 11–20, 21–30, and 31 cases per year or more).

RESULTS:
A total of 42,931 patients met the inclusion criteria. The overall unplanned 30-day readmission rate was 6.36% (95% CI 6.13–6.59). After adjusting for comorbidity, stage, histology, and sociodemographic and treatment factors, hospitals performing 31 cases per year or more had a 24% higher likelihood of readmission (adjusted odds ratio [OR] 1.25, 95% CI 1.06–1.46) when compared with those performing 10 cases per year or less. However, hospitals performing 31 cases per year or more had a significantly lower risk-adjusted 90-day mortality (adjusted OR 0.74, 95% CI 0.60–0.91) despite higher rates of complex surgical procedures and higher rates of guideline-concordant care delivery (86% vs 77%, P<.001). In the Cox proportional hazards regression model, care at a high-volume hospital was independently predictive of lower hazard of death (adjusted hazard ratio 0.86, 95% CI 0.82–0.90).

CONCLUSION:
Hospitals with 31 cases per year or more have a lower 30- and 90-day mortality despite performing more complex surgeries, are more likely to be adherent to guideline-based care, and achieved higher overall survival.
Risk of Spontaneous Abortion After Inadvertent Human Papillomavirus Vaccination in Pregnancy
Authors: Kharbanda Elyse O. , Vazquez-Benitez Gabriela , Lipkind Heather S. , Sheth Sangini S. , Zhu Jingyi , Naleway Allison L. , Klein Nicola P. , Hechter Rulin , Daley Matthew F. , Donahue James G. , Jackson Michael L. , Kawai Alison Tse , Sukumaran Lakshmi , Nordin James D. 
Published: June 2018

OBJECTIVE:
To evaluate the risk of spontaneous abortion after quadrivalent human papillomavirus (4vHPV) vaccination before and during pregnancy across seven integrated health systems within the Vaccine Safety Datalink.

METHODS:
Within a retrospective observational cohort, we compared risks for spontaneous abortion after 4vHPV in three exposure windows: distal (16–22 weeks before the last menstrual period [LMP]), peripregnancy (within 6 weeks before the LMP), and during pregnancy (LMP through 19 weeks of gestation). Women 12–27 years of age with a pregnancy between 2008 and 2014, with continuous insurance enrollment 8 months before and through pregnancy end, and with a live birth, stillbirth, or spontaneous abortion were included. Pregnancies were identified through validated algorithms. Spontaneous abortions and stillbirths were verified by chart review with spontaneous abortions adjudicated by clinical experts. We excluded multiple gestations, spontaneous abortions before 6 weeks of gestation, and women using medications increasing risk of spontaneous abortion. Spontaneous abortion risk after 4vHPV during pregnancy was compared with distal vaccination using time-dependent covariate Cox models. Spontaneous abortion risk for peripregnancy compared with distal vaccination was evaluated with standard Cox models.

RESULTS:
We identified 2,800 pregnancies with 4vHPV exposure in specified risk windows: 919 (33%) distal, 986 (35%) peripregnancy, and 895 (32%) during pregnancy. Mean age was 22.4 years in distal and peripregnancy groups compared with 21.4 years among women vaccinated during pregnancy. Among women with distal 4vHPV exposure, 96 (10.4%) experienced a spontaneous abortion. For peripregnancy and during pregnancy exposures, spontaneous abortions occurred in 110 (11.2%) and 77 (8.6%), respectively. The risk of spontaneous abortion was not increased among women who received 4vHPV during pregnancy (adjusted hazard ratio 1.10, 95% CI 0.81–1.51) or peripregnancy 1.07 (0.81–1.41).

CONCLUSION:
Inadvertent 4vHPV exposure during or peripregnancy was not significantly associated with an increased risk of spontaneous abortion.
The Emotional Communication in Hearing Questionnaire (EMO-CHeQ): Development and Evaluation
Authors: Singh Gurjit , Liskovoi Lisa , Launer Stefan , Russo Frank 
Published: June 2018

Objectives:
The objectives of this research were to develop and evaluate a self-report questionnaire (the Emotional Communication in Hearing Questionnaire or EMO-CHeQ) designed to assess experiences of hearing and handicap when listening to signals that contain vocal emotion information.

Design:
Study 1 involved internet-based administration of a 42-item version of the EMO-CHeQ to 586 adult participants (243 with self-reported normal hearing [NH], 193 with self-reported hearing impairment but no reported use of hearing aids [HI], and 150 with self-reported hearing impairment and use of hearing aids [HA]). To better understand the factor structure of the EMO-CHeQ and eliminate redundant items, an exploratory factor analysis was conducted. Study 2 involved laboratory-based administration of a 16-item version of the EMO-CHeQ to 32 adult participants (12 normal hearing/near normal hearing (NH/nNH), 10 HI, and 10 HA). In addition, participants completed an emotion-identification task under audio and audiovisual conditions.

Results:
In study 1, the exploratory factor analysis yielded an interpretable solution with four factors emerging that explained a total of 66.3% of the variance in performance the EMO-CHeQ. Item deletion resulted in construction of the 16-item EMO-CHeQ. In study 1, both the HI and HA group reported greater vocal emotion communication handicap on the EMO-CHeQ than on the NH group, but differences in handicap were not observed between the HI and HA group. In study 2, the same pattern of reported handicap was observed in individuals with audiometrically verified hearing as was found in study 1. On the emotion-identification task, no group differences in performance were observed in the audiovisual condition, but group differences were observed in the audio alone condition. Although the HI and HA group exhibited similar emotion-identification performance, both groups performed worse than the NH/nNH group, thus suggesting the presence of behavioral deficits that parallel self-reported vocal emotion communication handicap. The EMO-CHeQ was significantly and strongly (r = −0.64) correlated with performance on the emotion-identification task for listeners with hearing impairment.

Conclusions:
The results from both studies suggest that the EMO-CHeQ appears to be a reliable and ecologically valid measure to rapidly assess experiences of hearing and handicap when listening to signals that contain vocal emotion information.
Recommendations on Collecting and Storing Samples for Genetic Studies in Hearing and Tinnitus Research
Authors: Szczepek Agnieszka J. , Frejo Lidia , Vona Barbara , Trpchevska Natalia , Cederroth Christopher R. , Caria Helena , Lopez-Escamez Jose A. 
Published: June 2018

Objectives:
Research on the genetic basis of tinnitus is still in its first steps. A group of scientists dedicated to tinnitus genetics within European Tinnitus Network (TINNET) network recognize that further progress requires multicenter collaborative efforts for defining contributing genes. The purpose of the present work is to provide instructions regarding collection, processing, storage, and shipment of samples intended for genetic studies in auditory research.

Design:
One part of the recommendations has a general character; another part is of particular importance for auditory healthcare practitioners such as otolaryngology physicians, audiologists, and general practitioners.

Results:
We provide a set of instructions and various options for obtaining samples. We give advice regarding sample processing, storage, and shipment and define the minimal and essential clinical information that should accompany the samples collected for genetic processing.

Conclusions:
These recommendations offer a basis to standardize and optimize collaborations between geneticists and healthcare practitioners specialized in tinnitus and hearing disorders.
An update on the role of type I interferons in systemic lupus erythematosus and Sjögren's syndrome
Authors: Thorlacius Gudny Ella , Wahren-Herlenius Marie , Rönnblom Lars 
Published: June 2018

Purpose of review
Systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS) share several clinical and laboratory features, including an overexpression of type I interferon (IFN) regulated genes. The genetic background to this IFN signature and the role of the type I IFN system in the disease process have been partly clarified. Here, we summarize the latest information concerning the type I IFN system in both diseases.

Recent findings
A number of gene variants in the type I IFN signalling pathways associate with an increased risk for both SLE and pSS in several ethnicities. The function of some risk gene variants has been elucidated, as well as the importance of epigenetic changes in type I IFN regulated genes. MicroRNA-451 and miR-302d have been shown to target IFN regulatory factor 8 and 9, suggesting that noncoding RNAs can control the IFN system. A prominent type I IFN activation is related to several disease manifestations, and in SLE to a more severe disease phenotype. Phase II studies in SLE suggest beneficial effects of blocking the type I IFN receptor.

Summary
The activated type I IFN system in SLE and pSS has a strong genetic component, is important in the disease etiopathogenesis and can be targeted.
Lupus and vaccinations
Authors: Mathian Alexis , Pha Micheline , Amoura Zahir 
Published: June 2018

Purpose of review
To review the latest data in the field of vaccinations in systemic lupus erythematosus (SLE), focusing on pneumococcal, seasonal influenza, herpes zoster and human papillomavirus infections.

Recent findings
Less than 40% of patients responded adequately to the 23-valent pneumococcal polysaccharide (PPS23) vaccine. A randomized controlled trial showed that sequential administration of the pneumococcal conjugate vaccine followed by the PPS23 vaccine was well tolerated but was not superior to the PPS23 vaccine alone in terms of immunogenicity. A real-life observation confirmed that annual influenza vaccination has an impact on morbidity and mortality in SLE. Three meta-analyses did not show any particular adverse effect of influenza vaccines in SLE. These vaccines are less immunogenic in SLE. A study confirmed that the quadrivalent human papillomavirus vaccine was well tolerated and highly immunogenic in SLE.

Summary
New data confirm the safety and the lower immunogenicity of pneumococcal and influenza vaccine in SLE patients. Current efforts to improve immunization coverage in SLE should focus on spreading to patients and physicians information on the safety, efficacy and usefulness of vaccines in this population.
Spondyloarthritis: new insights into clinical aspects, translational immunology and therapeutics
Authors: Bridgewood Charlie , Watad Abdulla , Cuthbert Richard J. , McGonagle Dennis 
Published: June 2018

Purpose of review
The spondyloarthopathies (SpA), which encompass related diseases that were originally viewed as autoimmune, are now known to have a strong innate immune or autoinflammatory initiation phase characterized by disease localization to tissue-specific sites based on the nuances and microanatomy and immunology of those sites. This review covers recent translational advances in the field of SpA.

Recent findings
Imaging studies in SpA continue to add support for the pivotal role of enthesitis in disease initiation and expression. Although in its infancy, there is growing evidence for microbiotal intestinal dysbiosis in ankylosing spondylitis and psoriatic arthritis. The role of cytokines beyond tumour necrosis factor (TNF) continues to grow with support for the interleukin (IL)-23/17 axis being key to disease and emergent evidence for the importance of the IL-36 pathway. The treatment of inflammatory bowel disease (IBD) with vedolizumab an α4β7-integrin blocker has been associated with arthritis flares and small molecules with Janus kinase inhibition appear to be as effective as the anti-TNFs. The disparate response of different domains in SpA points towards immunological heterogeneity even within what was considered a homogeneous disease.

Summary
The clinical aspects and translational immunology and therapeutics of SpA continue to evolve and indicate the complexity of diagnosis and treatment of these conditions.
Use of the Dedicated Orthopaedic Trauma Room for Open Tibia and Femur Fractures: Does It Make a Difference?
Authors: Steeby Shaun F. , Harvin William H. , Worley John R. , Della Rocca Gregory J. , Volgas David A. , Stannard James P. , Crist Brett D. 
Published: June 2018

Objective:
To assess the “Dedicated Orthopaedic Trauma Operating Room” (DOTOR) effect on management and outcomes of open tibia and femur fractures.

Design:
Retrospective chart review.

Location:
University Level I Trauma Center.

Methods:
Patients categorized into those managed in the DOTOR versus those managed in a standard on-call operating room (OCOR). Data collected include patient and injury characteristics, time to debridement, and patient outcomes.

Results:
A total of 297 patients with 347 open tibia and femur fractures were included; 154 patients (174 fractures) were managed in the DOTOR group and 143 patients (170 fractures) were managed in the OCOR group. The average time to debridement was significantly longer for DOTOR (12.9 hours) versus OCOR (5.4 hours). The DOTOR group was 9 times less likely to undergo debridement within 6 hours. The number of patients debrided within 24 hours was similar (90% for DOTOR vs. 96% OCOR). The rate of primary fracture union was significantly higher in the DOTOR (73.2% vs. 56.6%). OCOR patients were twice as likely to have an unplanned surgery. Rates of infection, nonunion, and amputation were similar.

Conclusion:
Despite earlier access to the Operating room for debridement in the OCOR group, there was no difference in the infection rate compared with the DOTOR group. However, patients managed in the DOTOR group were more likely to go on to uncomplicated fracture union and less likely to have an unplanned surgery.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Glove Perforation in Orthopaedics: Probability of Tearing Gloves During High-Risk Events in Trauma Surgery
Authors: Lakomkin Nikita , Cruz Aristides I. , Fabricant Peter D. , Georgiadis Andrew G. , Lawrence John Todd R. 
Published: June 2018

Objective:
To assess the risk of glove perforation during common maneuvers or events in trauma-related orthopaedic surgical procedures.

Methods:
Four investigators executed 6 high-risk maneuvers in a simulated laboratory setting. Alternative techniques were also performed for most maneuvers. Glove integrity was examined by 2 standard methods of fluid leak testing. The rates of perforation were compared between techniques using χ2 and Fisher exact tests.

Results:
Investigators were only able to identify 14.3% of perforations. Cleaning drill bit flutes by hand had the highest overall tear rate (85%). Catching a glove along the guide wire when passing a cannulated drill bit resulted in a 50% perforation rate. Catching a glove around a rotating drill shaft had a tear rate of 40%. Palpating the end of a flexible nail cut with a wire cutter had a significantly higher perforation rate than a nail cut with a proprietary, nail-specific tool (35% vs. 5%, P = 0.022). Blind digital fracture reduction had a tear rate that was not statistically different than directly visualizing the reduction (20% vs. 15%, P = 0.5). Inserting screws while stabilizing the threads with one's fingers resulted in a perforation rate of 15%.

Conclusions:
Orthopaedic surgeons should be aware that microperforation of surgical gloves often goes undetected and should consider modifying or using alternative techniques when performing certain surgical maneuvers. The results of this study can be used by orthopaedic and surgical first assist training programs to promote safe surgical practice.