bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subarachnoid Meperidine-Morphine Combination: An Effective Perioperative Analgesic Adjunct for Cesarean Delivery
Authors: Chung James H. , Sinatra Raymond S. , Sevarino Ferne B. , Fermo Leonda 
Published: March 2019

Background and ObjectivesLow-dose subarachnoid morphine provides effective perioperative analgesia but may be associated with a transient period of inadequate pain relief between the regression of local anesthetic block and the onset of morphine's analgesic effect. We hypothesized that this period of suboptimal analgesia could be avoided by adding meperidine, a rapid-acting, intermediate-duration opioid.MethodsIn a double-blind, randomized trial, 49 patients scheduled for elective cesarean delivery received subarachnoid 0.75% bupivacaine, 12 mg in 8.25% dextrose, with either meperidine 10 mg, morphine 0.15 mg, or meperidine 10 mg plus morphine 0.15 mg. Visual analog scale scores for pain and satisfaction were obtained at skin incision, delivery, uterine exteriorization, on arrival in the postanesthesia care unit, and 2, 4, 6, 12, and 24 hours after drug administration. Neonatal Apgar scores and adverse effects were also noted. Postoperative intravenous patient-controlled analgesia (PCA) requirements were recorded for 24 hours. The data were analyzed by chi-square analysis Fisher's exact test, the Wilcoxon rank sum test, and analysis of variance with Tukey's adjustment for multiple comparisons.ResultsThere were no significant differences in the incidence and severity of side effects, including nausea, vomiting, pruritus, and sedation. Respiratory depression was not observed. Patients treated with morphine alone were least comfortable (P < .006), expressed the lowest satisfaction scores at early observations (P < .002), and required more PCA meperidine (P < .001) than any other group. Patients treated with meperidine alone were comfortable at early observations but required the greatest total amount of PCA meperidine over the first 24 hours (P < .05). Patients in the meperidine-morphine combination group reported the lowest pain scores and highest satisfaction scores at 4-hour and 6-hour observations (P < .03) and required the least total amount of PCA meperidine.ConclusionThe subarachnoid combination of meperidine-morphine provided more uniform analgesia, higher satisfaction, and a lower requirement for intravenous narcotic supplementation than either morphine or meperidine alone in patients recovering from cesarean delivery.
Epidural Space as a Starling Resistor and Elevation of Inflow Resistance in a Diseased Epidural Space
Authors: Rocco Angelo G. , Philip James H. , Boas Robert A. , Scott David 
Published: March 2019

Background and ObjectivesThe origin and the presence of negative pressure in the epidural space as well as the relationship of the extent of epidural anesthesia to epidural pressure has long been a subject of controversy. To further elucidate epidural pressure and its time course, the pressure at the needle tip was continuously measured as it traversed the interspinous ligament and the ligamentum flavum.MethodsIn a group of 22 patients, fluid was infused under gravity, and in a second group of 25 patients, boluses of fluid were administered at controlled infusion rates and under gravity. The volume-pressure-flow relationship was thus measured in one of two ways, either with a manual syringe and pressure transducer or with a pressure-monitoring-computer-controlled volumetric infusion pump.ResultsNatural pressure, (i.e., pressure in the epidural space before instrumentation is applied) could be approached when the space was first entered before fluid was infused (initial pressure); or after fluid had been infused (residual pressure). Epidural pressure could be extrapolated from the upsweep of the volume-pressure-flow relationship by projecting it back to just before the first injection. The extrapolated pressure lay between the initial and residual pressures. Medicinal solution placed in the barrel of the syringe did not infuse under gravity until the syringe barrel was lifted to a certain height, at which flow began and continued at a perceptible rate, with very little or no further increase in height required to maintain flow. The pressure at which flow began was the critical opening pressure, a characteristic of a Starling resistor. Furthermore, resistance to inflow of fluid was related to the presence or absence of natural or surgical disease in the epidural space. Resistance was significantly higher in the diseased than in the surgical group, at 114 (range, 22-226) mm Hg/L/h versus 46 (range, 8-86) mm Hg/L/h. Three phases were seen in the pressure-time recordings.ConclusionsVolume-pressure-flow relationships in the epidural space can be explained by a model in which epidural and subarachnoid pressures are inextricably related with the Starling pressure, dependent on the subarachnoid pressure. This model suggests reasons why spread of anesthetics might be difficult to predict.
Bactericidal Activity of 0.5% Bupivacaine With Preservatives on Microorganisms in the Human Skin Flora
Authors: Sakuragi Tadakazu , Ishino Hiroyuki , Dan Kenjiro 
Published: March 2019

Background and ObjectivesThe bactericidal activity of 0.5% bupivacaine with preservatives at body temperature and at room temperature is not known. We studied the bactericidal activity of 0.5% bupivacaine with 0.08% methyl para-oxybenzoate and 0.02% propyl para-aminobenzoate as preservatives and of the preservatives alone at 37°C and at room temperature on two strains of methicillin-resistant Staphylococcus aureus, two strains of methicillin-susceptible S. aureus, and one strain each of Staphylococcus epidermidis and Escherichia coli. Methods. The pathogen was exposed to 0.5% bupivacaine with preservatives or to the preservatives alone for 1, 3, 6, 12, and 24 hours at 37°C and at room temperature. The inocula from these suspensions were cultured for 48 hours at 37°C after the antimicrobial activity of bupivacaine was inactivated by 1:1,000 dilution with physiological saline.ResultsThe 1- through 12-hour exposures of four strains of S. aureus to 0.5% bupivacaine with preservatives at room temperature reduced the mean colony count by 24.2%, 49.2%, 71.3%, and 89.6%, respectively, and the exposure at 37°C reduced the count by 74.1%, 95.2%, 99.9%, and 99.8%, respectively. The differences for 1- through 12-hour exposures were significant (P < .001). The percentage kill in the strains of E. coli and S. epidermidis was significantly higher than that in the strains of S. aureus at all exposure times at room temperature (E. coli, P < .001; S. epidermidis, P < .0001) and at 1- and 3-hour exposures at 37°C (E. coli, P < .001; S. epidermidis, P < .0001). The bactericidal activity of the preservatives was markedly lower that that of 0.5% bupivacaine with preservatives (P < .0001).ConclusionsThe bactericidal activity of 0.5% bupivacaine with preservatives is stronger at body temperature than at room temperature; the bactericidal activity may be due, to a large extent, to bupivacaine rather than to the preservatives; and S. aureus is more resistant to the bactericidal activity of bupivacaine than are S. epidermidis and E. coli.
Effectiveness of intravenous acetaminophen for postoperative pain management in hip and knee arthroplasties: a population-based study
Authors: Stundner Ottokar , Poeran Jashvant , Ladenhauf Hannah Noemi , Berger Marc Moritz , Levy Steven B , Zubizarreta Nicole , Mazumdar Madhu , Bekeris Janis , Liu Jiabin , Galatz Leesa M , Moucha Calin S , Memtsoudis Stavros 
Published: March 2019

Background and objectives
The significance of intravenous over oral acetaminophen (APAP) as part of multimodal analgesic protocols is contested, particularly when considering its relatively high price and use in a surgical cohort such as total hip or knee arthroplasty (THA/TKA), which generally tolerates oral medications. This study aims to elucidate APAP’s effectiveness in a large, population-based patient sample.

Methods
1 039 647 THA/TKA procedures were sampled from the Premier Healthcare claims database 2011–2016. APAP use was categorized by intravenous/oral and use on the day of surgery, postoperative day 1 and thereafter. Outcomes were opioid utilization (in oral morphine equivalents), length and cost of hospitalization, and opioid-related adverse effects (respiratory, gastrointestinal, and naloxone use as a proxy). Mixed-effects models measured the associations between intravenous/oral APAP use and outcomes. Percent (%) change and 95% CIs are reported.

Results
Overall, 23.6% (n=245 454) of patients received intravenous APAP; of these, 56.3% (n=138 180) received just one dose on the day of surgery. After adjustment for relevant covariates, particularly use of >1 dose of intravenous APAP (compared with no use) on postoperative day 1 was associated with −6.0% (CI −7.2% to −4.7%) reduced opioid utilization; this was −10.7% (CI −11.4% to -9.9%) for use of > 1 dose oral APAP on postoperative day 1. Further comparisons regarding other outcomes also favored oral (over intravenous) APAP.

Conclusions
These results do not support the routine use of intravenous APAP in patients undergoing lower joint arthroplasty, especially since oral APAP shows more beneficial outcome patterns.
Dilemmatic Resource Governance: China’s Balancing Act to Share Rivers
Authors: Xie Lei 
Published: March 2019

China itself is vulnerable to environmental threats. With its sheer size and population, China faces immense potential threats from global warming and uneven access to natural resources. At the same time, the legitimacy of the central government heavily relies on the country’s economic performance which in turn relies on the exploitation of natural resources. China is faced with growing pressure as to how it effectively manages natural resources on an international scale. This paper examines a dilemmatic situation that great powers are faced with the participation in international environmental cooperation. The formation of multi-lateral environmental agreements requires that nation states comply with environmental responsibilities when exercising sovereign rights over environmental resources. Great powers confront more pressure as they are expected to commit to greater responsibilities in international affairs. Adopting the sharing of the Mekong river basin as a case study, this paper examines the role China plays as a great power when exercising its right to appropriate natural resources. Changes are found in China’s international water policy including the establishment of the multi-lateral mechanism. This paper concludes that China’s policy developments in resource governance facilitate China to promote coordinated actions over the shared water resources. At the same time, such balancing acts serve to legitimize China’s dominance over the management of the Mekong river basin, which is embedded in the country’s Belt and Road Strategy.
High-intensity transcranial magnetic stimulation reveals differential cortical contributions to prepared responses
Authors: Smith Victoria , Maslovat Dana , Drummond Neil M. , Hajj Joëlle , Leguerrier Alexandra , Carlsen Anthony N. 
Published: March 2019

Corticospinal output pathways have typically been considered to be the primary driver for voluntary movements of the hand/forearm; however, more recently, reticulospinal drive has also been implicated in the production of these movements. Although both pathways may play a role, the reticulospinal tract is thought to have stronger connections to flexor muscles than to extensors. Similarly, movements involuntarily triggered via a startling acoustic stimulus (SAS) are believed to receive greater reticular input than voluntary movements. To investigate a differential role of reticulospinal drive depending on movement type or acoustic stimulus, corticospinal drive was transiently interrupted using high-intensity transcranial magnetic stimulation (TMS) applied during the reaction time (RT) interval. This TMS-induced suppression of cortical drive leads to RT delays that can be used to assess cortical contributions to movement. Participants completed targeted flexion and extension movements of the wrist in a simple RT paradigm in response to a control auditory go signal or SAS. Occasionally, suprathreshold TMS was applied over the motor cortical representation for the prime mover. Results revealed that TMS significantly increased RT in all conditions. There was a significantly longer TMS-induced RT delay seen in extension movements than in flexion movements and a greater RT delay in movements initiated in response to control stimuli compared with SAS. These results suggest that the contribution of reticulospinal drive is larger for wrist flexion than for extension. Similarly, movements triggered involuntarily by an SAS appear to involve greater reticulospinal drive, and relatively less corticospinal drive, than those that are voluntarily initiated.NEW & NOTEWORTHY Through the use of the transcranial magnetic stimulation-induced silent period, we provide novel evidence for a greater contribution of reticulospinal drive, and a relative decrease in corticospinal drive, to movements involuntarily triggered by a startle compared with voluntary movements. These results also provide support for the notion that both cortical and reticular structures are involved in the neural pathway underlying startle-triggered movements. Furthermore, our results indicate greater reticulospinal contribution to wrist flexion than extension movements.
Ankle muscle responses during perturbed walking with blocked ankle joints
Authors: Vlutters Mark , van Asseldonk Edwin H. F. , van der Kooij Herman 
Published: March 2019

The ankle joint muscles can contribute to balance during walking by modulating the center of pressure and ground reaction forces through an ankle moment. This is especially effective in the sagittal plane through ankle plantar- or dorsiflexion. If the ankle joints were to be physically blocked to make an ankle strategy ineffective, there would be no functional contribution of these muscles to balance during walking, nor would these muscles generate afferent output regarding ankle joint rotation. Consequently, ankle muscle activation for the purpose of balance control would be expected to disappear. We have performed an experiment in which subjects received anteroposterior pelvis perturbations during walking while their ankle joints could not contribute to the balance recovery. The latter was realized by physically blocking the ankle joints through a pair of modified ankle-foot orthoses. In this article we present the lower limb muscle activity responses in reaction to these perturbations. Of particular interest are the tibialis anterior and gastrocnemius medialis muscles, which could not contribute to the balance recovery through the ankle joint or encode muscle length changes caused by ankle joint rotation. Yet, these muscles showed long-latency responses, ~100 ms after perturbation onset. The response amplitudes were dependent on the perturbation magnitude and direction, as well as the state of the leg. The results imply that ankle muscle responses can be evoked without changes in proprioceptive information of those muscles through ankle rotation. This suggest a more centralized regulation of balance control, not strictly related to the ankle joint kinematics. NEW & NOTEWORTHY Walking human subjects received forward-backward perturbations at the pelvis while wearing “pin-shoes,” a pair of modified ankle-foot orthoses that physically blocked ankle joint movement and reduced the base of support of each foot to a single point. The lower leg muscles showed long-latency perturbation-dependent activity changes, despite having no functional contributions to balance control through the ankle joint and not having been subjected to muscle length changes through ankle joint rotation.
Unexpected Activities in Regulating Ciliation Contribute to Off-target Effects of Targeted Drugs
Authors: Kiseleva Anna A. , Korobeynikov Vladislav A. , Nikonova Anna S. , Zhang Peishan , Makhov Petr , Deneka Alexander Y. , Einarson Margret B. , Serebriiskii Ilya G. , Liu Hanqing , Peterson Jeffrey R. , Golemis Erica A. 
Published: March 2019

Abstract

Purpose:
For many tumors, signaling exchanges between cancer cells and other cells in their microenvironment influence overall tumor signaling. Some of these exchanges depend on expression of the primary cilium on nontransformed cell populations, as extracellular ligands including Sonic Hedgehog (SHH), PDGFRα, and others function through receptors spatially localized to cilia. Cell ciliation is regulated by proteins that are themselves therapeutic targets. We investigated whether kinase inhibitors of clinical interest influence ciliation and signaling by proteins with ciliary receptors in cancer and other cilia-relevant disorders, such as polycystic kidney disease (PKD).

Experimental Design:
We screened a library of clinical and preclinical kinase inhibitors, identifying drugs that either prevented or induced ciliary disassembly. Specific bioactive protein targets of the drugs were identified by mRNA depletion. Mechanism of action was defined, and activity of select compounds investigated.

Results:
We identified multiple kinase inhibitors not previously linked to control of ciliation, including sunitinib, erlotinib, and an inhibitor of the innate immune pathway kinase, IRAK4. For all compounds, activity was mediated through regulation of Aurora-A (AURKA) activity. Drugs targeting cilia influenced proximal cellular responses to SHH and PDGFRα. In vivo, sunitinib durably limited ciliation and cilia-related biological activities in renal cells, renal carcinoma cells, and PKD cysts. Extended analysis of IRAK4 defined a subset of innate immune signaling effectors potently affecting ciliation.

Conclusions:
These results suggest a paradigm by which targeted drugs may have unexpected off-target effects in heterogeneous cell populations in vivo via control of a physical platform for receipt of extracellular ligands.
A Novel Na
+
-K
+
-Cl
−
Cotransporter 1 Inhibitor STS66* Reduces Brain Damage in Mice After Ischemic Stroke
Authors: Huang Huachen , Bhuiyan Mohammad Iqbal H. , Jiang Tong , Song Shanshan , Shankar Sandhya , Taheri Taraneh , Li Eric , Schreppel Philipp , Hintersteininger Michael , Yang Sung-Sen , Lin Shih-Hua , Molyneaux Bradley J. , Zhang Zhongling , Erker Thomas , Sun Dandan 
Published: March 2019

Background and Purpose—

Inhibition of brain NKCC1 (Na
+
-K
+
-Cl
−
cotransporter 1) with bumetanide (BMT) is of interest in ischemic stroke therapy. However, its poor brain penetration limits the application. In this study, we investigated the efficacy of 2 novel NKCC1 inhibitors, a lipophilic BMT prodrug STS5 (2-(Dimethylamino)ethyl 3-(butylamino)-4-phenoxy-5-sulfamoyl-benzoate;hydrochloride) and a novel NKCC1 inhibitor STS66 (3-(Butylamino)-2-phenoxy-5-[(2,2,2-trifluoroethylamino)methyl]benzenesulfonamide), on reducing ischemic brain injury.

Methods—
Large-vessel transient ischemic stroke in normotensive C57BL/6J mice was induced with 50-min occlusion of the middle cerebral artery and reperfusion. Focal, permanent ischemic stroke in angiotensin II (Ang II)–induced hypertensive C57BL/6J mice was induced by permanent occlusion of distal branches of middle cerebral artery. A total of 206 mice were randomly assigned to receive vehicle DMSO, BMT, STS5, or STS66.

Results—
Poststroke BMT, STS5, or STS66 treatment significantly decreased infarct volume and cerebral swelling by ≈40% to 50% in normotensive mice after transient middle cerebral artery occlusion, but STS66-treated mice displayed better survival and sensorimotor functional recovery. STS5 treatment increased the mortality. Ang II–induced hypertensive mice exhibited increased phosphorylatory activation of SPAK (Ste20-related proline alanine-rich kinase) and NKCC1, as well as worsened infarct and neurological deficit after permanent distal middle cerebral artery occlusion.

Conclusions—
The novel NKCC1 inhibitor STS66 is superior to BMT and STS5 in reducing ischemic infarction, swelling, and neurological deficits in large-vessel transient ischemic stroke, as well as in permanent focal ischemic stroke with hypertension comorbidity.
Myrmeicus or Myrmecius?
Authors: Woudhuysen George 
Published: March 2019

AbstractIn this article, I examine the name of a friend and correspondent of the fourth-century poet Rufius Festus Avienius, commonly identified hitherto as Flavianus Myrmeicus. After summarising the current state of research and translating the verse epistle which he received, I argue that, for a variety of reasons, Myrmeicus cannot be his name. Instead, it should be emended to Myrmecius, which was his signum: an example of a type of nickname which many Romans of elevated status in late antiquity bore in addition to their birth names. I examine Myrmecius as a signum within the context of late-Roman supernomina more generally, in the process clarifying how and in what circumstances and combinations they were used, and suggesting several sources from which they might be derived. I then explain how Myrmecius’ signum might have been mangled in the course of transmission, and conclude by noting that while the bulk of attested signa are found on inscriptions, Myrmecius suggests that many more may currently lie concealed in literary texts.
SHG s and SHG Banking in Odisha
Authors: Nayak Akhaya Kumar , Pattnaik Binay Kumar 
Published: March 2019

Abstract
The SHG-based micro-finance programme for income generation and empowerment is extremely popular and has a wide reach in India. SHG s have been playing a key mediating role to empower a socially, economically, and politically deprived section comprising mostly women. Scholars have investigated the phenomenon of SHG, but largely from development perspectives. The present paper is an earnest and novel attempt to examine the evolution and development of the phenomenon of SHG in the eastern Indian state of Odisha from the social movement perspective. Based on both secondary and primary data, it discusses whether the phenomenon is a social movement at all and examines the applicability of resource mobilisation theory to study it.
A resident-nepotistic-tolerant dominance style in wild white-nosed coatis (Nasua narica)?
Authors: de la O Claudio , Fürtbauer Ines , King Andrew J. , Valenzuela-Galván David 
Published: March 2019

Abstract
Dominance relationships imply consistent asymmetries in social relationships. Socioecological models predict that resource distribution determines the mode of competition that animals will face and, ultimately, the nature of their social relationships. Here, we provide the first systematic investigation of dominance style in white-nosed coatis (Nasua narica). Coatis live in cohesive female-resident groups, and have a diet based on clumped (fruits) and dispersed (insects) food items, which are predicted to favour despotic and egalitarian social styles, respectively. Our results revealed moderate linearity and steepness in dominance relationships over time, with variations attributed to stages of reproductive season, rather than presumed variations in food resources. Primary social bonds and coalitions were found to mediate dominance rank. Overall, our results suggest some similarities between coatis and despotic-tolerant primate species, at least under particular ecological circumstances, and we discuss their potential for affording a deeper understanding on the sources of variation in mammal social systems.