bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brain Dynamics and Temporal Summation of Pain Predicts Neuropathic Pain Relief from Ketamine Infusion
Authors: Bosma Rachael L. , Cheng Joshua C. , Rogachov Anton , Kim Junseok A. , Hemington Kasey S. , Osborne Natalie R. , Venkat Raghavan Lakshmikumar , Bhatia Anuj , Davis Karen D. 
Published: September 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Ketamine is an N-methyl-d-aspartate receptor antagonist that reduces temporal summation of pain and modulates antinociception. Ketamine infusions can produce significant relief of neuropathic pain, but the treatment is resource intensive and can be associated with adverse effects. Thus, it is crucial to select patients who might benefit from this treatment. The authors tested the hypothesis that patients with enhanced temporal summation of pain and the capacity to modulate pain via the descending antinociceptive brain pathway are predisposed to obtain pain relief from ketamine.

Methods
Patients with refractory neuropathic pain (n = 30) and healthy controls underwent quantitative sensory testing and resting-state functional magnetic resonance imaging and then completed validated questionnaires. Patients then received outpatient intravenous ketamine (0.5 to 2 mg · kg−1 · h−1; mean dose 1.1 mg · kg−1 · h−1) for 6 h/day for 5 consecutive days. Pain was assessed 1 month later. Treatment response was defined as greater than or equal to 30% pain relief (i.e., reduction in pain scores). We determined the relationship between our primary outcome measure of pain relief with pretreatment temporal summation of pain and with brain imaging measures of dynamic functional connectivity between the default mode network and the descending antinociceptive brain pathway.

Results
Approximately 50% of patients achieved pain relief (mean ± SD; Responders, 61 ± 35%; Nonresponders, 7 ± 14%). Pretreatment temporal summation was associated with the effect of ketamine (ρ = −0.52, P = 0.003) and was significantly higher in Responders (median [25th, 75th] = 200 [100, 345]) compared with Nonresponders (44 [9, 92]; P = 0.001). Pretreatment dynamic connectivity was also associated with the clinical effect of ketamine (ρ = 0.51, P = 0.004) and was significantly higher in Responders (mean ± SD, 0.55 ± 0.05) compared with Nonresponders (0.51 ± 0.03; P = 0.006). Finally, the dynamic engagement of the descending antinociceptive system significantly mediated the relationship between pretreatment pain facilitation and pain relief (95% CI, 0.005 to 0.065).

Conclusions
These findings suggest that brain and behavioral measures have the potential to prognosticate and develop ketamine-based personalized pain therapy.
Early Intervention to Improve Sucking in Preterm Newborns
Authors: Grassi* Angela , Sgherri* Giada , Chorna Olena , Marchi Viviana , Gagliardi Luigi , Cecchi Francesca , Laschi Cecilia , Guzzetta Andrea 
Published: September 2018

Background:
Premature birth is associated with feeding difficulties due to inadequate coordination of sucking, swallowing, and breathing. Nonnutritive sucking (NNS) and oral stimulation interventions may be effective for oral feeding promotion, but the mechanisms of the intervention effects need further clarifications.

Purpose:
We reviewed preterm infant intervention studies with quantitative outcomes of sucking performance to summarize the evidence of the effect of interventions on specific components of sucking.

Methods:
PubMed, CINAHL, MEDLINE, EMBASE, and PSYCOLIST databases were searched for English language publications through August 2017. Studies were selected if they involved preterm infants, tested experimental interventions to improve sucking or oral feeding skills, and included outcome as an objective measure of sucking performance. Specific Medical Subject Headings (MeSH) terms were utilized.

Results:
Nineteen studies were included in this review: 15 randomized, 1 quasi-randomized, and 3 crossover randomized controlled trials. Intervention types were grouped into 6 categories (i) NNS, (ii) NNS with auditory reinforcement, (iii) sensorimotor stimulation, (iv) oral support, (v) combined training, and (vi) nutritive sucking. Efficiency parameters were positively influenced by most types of interventions, though appear to be less affected by trainings based on NNS alone.

Implications for Practice:
These findings may be useful in the clinical care of infants requiring support to achieve efficient sucking skills through NNS and oral stimulation interventions.

Implications for Research:
Further studies including quantitative measures of sucking performance outcome measures are needed in order to best understand the needs and provide more tailored interventions to preterm infants.
Air- and Bone-Conducted Sources of Feedback With an Active Middle Ear Implant
Authors: Banakis Hartl Renee M. , Easter James R. , Alhussaini Mohamed A. , Tollin Daniel J. , Jenkins Herman A. 
Published: September 2018

Objectives:
Active middle ear implants (AMEI) have been used to treat hearing loss in patients for whom conventional hearing aids are unsuccessful for varied biologic or personal reasons. Several studies have discussed feedback as a potential complication of AMEI usage, though the feedback pathway is not well understood. While reverse propagation of an acoustic signal through the ossicular chain and tympanic membrane constitutes an air-conducted source of feedback, the implanted nature of the device microphone near the mastoid cortex suggests that bone conduction pathways may potentially be another significant factor. This study examines the relative contributions of potential sources of feedback during stimulation with an AMEI.

Design:
Four fresh-frozen, hemi-sectioned, human cadaver specimens were prepared with a mastoid antrostomy and atticotomy to visualize the posterior incus body. A Carina active middle ear implant actuator (Cochlear Ltd., Boulder, CO) was coupled to the incus by two means: (1) a stereotactic arm mounted independently of the specimen and (2) a fixation bracket anchored directly to the mastoid cortical bone. The actuator was driven with pure-tone frequencies in 1/4 octave steps from 500 to 6000 Hz. Acoustic sound intensity in the ear canal was measured with a probe tube microphone (Bruel & Kjær, Nærum, Denmark). Bone-conducted vibration was quantified with a single-axis laser Doppler vibrometer (Polytec Inc., Irvine, CA) from both a piece of reflective tape placed on the skin overlying the mastoid and a bone-anchored titanium screw and pedestal (Cochlear Ltd., Centennial, CO) implanted in the cortical mastoid bone.

Results:
Microphone measurements revealed ear-canal pressures of 60–89 dB SPL, peaking in the frequency range below 2 kHz. Peak LDV measurements were greatest on the mastoid bone (0.32–0.79 mm/s with mounting bracket and 0.21–0.36 mm/s with the stereotactic suspension); peak measurements on the skin ranged from 0.05 to 0.15 mm/s with the bracket and 0.03 to 0.13 mm/s with stereotactic suspension.

Conclusion:
AMEI produce both air- and bone-conducted signals of adequate strength to be detected by the implanted device microphone, potentially resulting in reamplification. Understanding the relative contribution of these sources may play an important role in the development of targeted mitigation algorithms, as well as surgical techniques emphasizing acoustic isolation.
Midterm Results of the Ponseti Method for Treatment of Clubfoot in Patients With Spina Bifida
Authors: Arkin Cameron , Ihnow Stephanie , Dias Luciano , Swaroop Vineeta T. 
Published: September 2018

Background:
Clubfoot occurs in 30% to 50% of patients with spina bifida. The Ponseti casting method has changed treatment of idiopathic clubfoot to a primarily nonoperative regimen. The Ponseti method is now widely applied to clubfoot in spina bifida, however, few studies report treatment outcomes. Most available studies include heterogeneous diagnoses or short-term results. The purpose of this study is to report midterm outcomes in patients with spina bifida and clubfoot treated with the Ponseti method.

Methods:
IRB-approved retrospective chart review of 17 consecutive patients (26 feet) below 1 year of age with spina bifida and clubfoot treated with Ponseti method. Charts reviewed for age at treatment initiation, number of casts, surgeries performed, recurrence of deformity, and further treatments. Primary outcome was recurrence of deformity requiring further treatment. Data were analyzed using t tests for means and χ2 tests for categorical data.

Results:
Initial correction was achieved in 26 of 26 feet patients. A total of 23 of 26 feet patients underwent a surgical procedure for the tendo-Achilles at an average age of 105 days, 12 percutaneous tenotomies (percT) and 11 open tendonectomy (openT). At average follow-up of 5 (1.8 to 7.5) years, 11 feet (42.3%) in 8 patients were successfully treated with Ponseti method. Of the 15 feet (57.7%) with recurrence, 10 required posterior releases, 4 posterior-medial-lateral releases and 1 tendon transfers. Average age at further treatment was 1.5 years (0.9 to 3.1 y). Those with recurrence required more casts before tendon surgery (7.6 vs. 6.1, P=0.02). A total of 100% patients (12/12) with percT had recurrence of deformity, compared with 18% (2/11) of patients with openT (P<0.0005).

Conclusions:
Midterm evaluation of Ponseti method for clubfoot in spina bifida shows a successful outcome in 42.3%. Recurrence with openT was significantly lower than percT and also substantially lower than previously published recurrence rates in spina bifida (33.3% to 68%). In spina bifida, Ponseti method leads to reliable initial correction and is useful to decrease extensive soft tissue release. An open excision of the Achilles should be performed. Families should be counseled about high risk of recurrence and potential need for further treatment.

Level of Evidence:
Level III—retrospective comparative study.
Validity, Reliability, and Responsiveness of the Banff Patellar Instability Instrument (BPII) in a Adolescent Population
Authors: Lafave Mark R. , Hiemstra Laurie A. , Kerslake Sarah 
Published: September 2018

Background:
Health-related quality of life measures for the adolescent patellar instability population are limited. The Banff Patella Instability Instrument (BPII) is a disease-specific health-related quality of life that has been tested on a mixed adult and adolescent population but has not been exclusively tested with an adolescent population. The purpose of this study was to determine the validity, reliability, and responsiveness of the BPII within an adolescent population.

Methods:
Content validation was tested with 3 measures: floor and ceiling effects; the Cronbach alpha; readability grade level. Reliability was measured with an intraclass correlation coefficient (2, k) and the SEM. Responsiveness was measured using a 1-way analysis of variance comparing preoperative BPII scores to postoperative BPII scores at 6, 12, and 24 months. Eta squared was calculated to measure effect size.

Results:
The BPII demonstrated no floor or ceiling effects. The Cronbach alpha for the BPII ranged from 0.97 to 0.98 for the preoperative and postoperative time periods. The readability index was a mean grade level of 8.9. Test-retest reliability assessment demonstrated an intraclass correlation coefficient (2, k) of 0.99 indicating strong reliability. The SEM was 1.3. There was a statistically significant difference in BPII scores for the 4 different time interval measures (F
3, 176=50.04; P<0.001). Eta squared was 0.46 demonstrating a moderate to large effect.

Conclusions:
The BPII demonstrated validity, reliability, and responsiveness in an adolescent population. Furthermore, it has demonstrated an appropriate cognitive reading grade level of 8.9, commensurate with the mean age (16.08 y) of the population tested.

Level of Evidence:
Level III.
Ossification of the Proximal and Middle Phalangeal Condyles: Radiographic Aid in Phalangeal Neck Fracture Reduction
Authors: Dua Karan , O’Hara Nathan N. , Shusterman Igor , Abzug Joshua M. 
Published: September 2018

Background:
Phalangeal neck fractures are commonly dorsally displaced and angulated. Surgical treatment is often necessary to restore the retrocondylar recess. The purpose of this study was to determine whether radiographic landmarks can serve as a reference tool for assessing phalangeal neck fracture alignment based on age and sex.

Methods:
In total, 1061 lateral finger radiographs that were interpreted as “normal” by pediatric radiologists in children aged 1 to 18 years were retrospectively reviewed. The proximal and middle phalanges of each digit had a line drawn along the volar cortex [termed the volar phalangeal line (VPL)] and a second perpendicular line was drawn at the level of the phalangeal condyle. A ratio of the anterior to posterior aspects of the phalangeal condyle was determined at the intersection of these lines. Sex of the patients was noted to determine whether it influenced the temporal course of ossification. A linear regression model was utilized to determine the annual coefficient of growth for the phalangeal condyles.

Results:
There is a temporal course of ossification of the proximal and middle phalangeal condyles. As children increase in age, the VPL will intersect the phalangeal condyle more dorsally due to the eccentric ossification. In children above 9 years of age, the VPL will reliably intersect the middle one third of the phalangeal condyle. No clinically significant difference exists between the ratios of the proximal and middle phalanges. Sex was not associated with a difference in growth. The greatest growth increase was observed in the 8 to 9-year-old interval.

Conclusions:
The phalangeal condyles ossify in an eccentric manner and the VPL will intersect the phalangeal condyle more dorsally with increasing age. The VPL and knowledge of where it should intersect the phalangeal condyle can be used as a reference guide for evaluating the reduction of proximal and middle phalangeal neck fractures in children.

Level of Evidence:
Level III.
ICU Management of Trauma Patients
Authors: Tisherman Samuel A. , Stein Deborah M. 
Published: September 2018

Objectives:
To describe the current state of the art regarding management of the critically ill trauma patient with an emphasis on initial management in the ICU.

Data Sources and Study Selection:
A PubMed literature review was performed for relevant articles in English related to the management of adult humans with severe trauma. Specific topics included airway management, hemorrhagic shock, resuscitation, and specific injuries to the chest, abdomen, brain, and spinal cord.

Data Extraction and Data Synthesis:
The basic principles of initial management of the critically ill trauma patients include rapid identification and management of life-threatening injuries with the goal of restoring tissue oxygenation and controlling hemorrhage as rapidly as possible. The initial assessment of the patient is often truncated for procedures to manage life-threatening injuries. Major, open surgical procedures have often been replaced by nonoperative or less-invasive approaches, even for critically ill patients. Consequently, much of the early management has been shifted to the ICU, where the goal is to continue resuscitation to restore homeostasis while completing the initial assessment of the patient and watching closely for failure of nonoperative management, complications of procedures, and missed injuries.

Conclusions:
The initial management of critically ill trauma patients is complex. Multiple, sometimes competing, priorities need to be considered. Close collaboration between the intensivist and the surgical teams is critical for optimizing patient outcomes.
Use of Vasopressor Increases the Risk of Mortality in Traumatic Hemorrhagic Shock: A Nationwide Cohort Study in Japan
Authors: Aoki Makoto , Abe Toshikazu , Saitoh Daizoh , Hagiwara Shuichi , Oshima Kiyohiro 
Published: September 2018

Objectives:
To evaluate the possible association of vasopressor use with mortality in traumatic hemorrhagic shock patients.

Design:
Retrospective cohort study.

Setting:
Traumatic hemorrhagic shock patients at 260 emergency hospitals in Japan between 2004 and 2015.

Patients:
Three-thousand five-hundred fifty-one traumatic hemorrhagic shock patients who had systolic hypotension (< 90 mm Hg) on arrival at the emergency department and a blood transfusion received within the first 24 hours.

Interventions:
The use of vasopressor for traumatic hemorrhagic shock within the first 24 hours.

Measurements and Main Results:
Among 236,698 trauma patients, 3,551 were included in the study. Overall, 198 of 459 patients (43%) in the vasopressor+ group expired compared with 481 of 3,092 patients (16%) in the vasopressor– group. Use of vasopressor had an odds ratio of 2.172 (95% CI, 1.666–2.833) for in-hospital mortality adjusted for age, gender, year of onset, cause of injury, mechanism of injury, vital signs at the emergency department, Injury Severity Score, use of prehospital IV fluid, and volume of blood transfusion within the first 24 hours. In the propensity score-matched cohort and two subgroup analyses (massive transfusion and survivable injury models), use of vasopressor was associated with higher mortality (odds ratio, 2.168; 95% C, 1.442–3.320), (odds ratio, 2.029; 95% CI, 1.414–2.911; massive transfusion model), and (odds ratio, 1.959; 95% CI, 1.364–2.814; survivable injury model).

Conclusions:
Use of vasopressor for traumatic hemorrhagic shock was associated with mortality after controlling for biases (trauma severity; volume of fluid resuscitation).
Outcomes for Invasive Melanomas Treated With Mohs Micrographic Surgery: A Retrospective Cohort Study
Authors: Degesys Catherine A. , Powell Helen B. , Hsia Ling-Lun B. , Merritt Bradley G. 
Published: September 2018

BACKGROUND
Mohs micrographic surgery (MMS) has been used effectively to treat invasive melanoma.

OBJECTIVE
To further study the safety and efficacy of MMS in the treatment of invasive melanoma.

METHODS AND MATERIALS
A retrospective cohort study evaluated 123 melanomas excised using MMS with MART-1 immunostain. Local recurrence, metastasis, overall survival, and disease-free survival rates were calculated. These were compared with historical controls.

RESULTS
Among included patients, 78 were men (63%) and 45 were women (37%), with a mean age of 66.48 years. Mean follow-up time was 1,273 days (3.49 years). Local recurrence was identified in 2/123 (1.63%; 95% confidence interval, 0.20%–5.75%) lesions. Local recurrence was identified in 1/70 (1.43%; 95% confidence interval, 0.04%–7.70%) of head and neck cases. Tumor location was head and neck in 70 lesions (56.9%). Overall survival was 95.12% and disease-specific survival was 100%.

CONCLUSION
Mohs micrographic surgery is an effective treatment method for invasive melanoma, as evidenced by low recurrence rates and high rates of disease-free survival.
Trends in Medicare Billing Among Mohs Surgeons in the United States During 2012: A Retrospective Cohort Study
Authors: Tsai Sheena , Kooistra Laura J. , Conic Ruzica Z. , Bordeaux Jeremy S. 
Published: September 2018

BACKGROUND
It is important to understand variability in practice patterns of Mohs surgeons.

OBJECTIVE
To examine the practice patterns of physicians performing Mohs micrographic surgery (MMS) in the United States.

METHODS and Materials
This retrospective cohort study of the 2012 Medicare Physician and Other Supplier Public Use Files includes all physicians who billed Medicare for MMS.

RESULTS
The authors found 2,067 physicians who billed Medicare for MMS in 2012. American College of Mohs Surgery (ACMS) members took a significantly higher average number of head and neck (H&N) and trunk layers compared with American Society for Mohs Surgery (ASMS) members and those with no membership (p < .001). Male surgeons, surgeons with more experience (21+ years out), surgeons in private practice, and those practicing in rural populations closed a significantly greater proportion of cases with flaps or grafts, as compared to females (p < .001), those with less experience (<21 years out) (p < .001), surgeons in academic practice (p = .004), and those practicing in urban or cluster populations (p < .001), respectively.

CONCLUSION
There is significant variability in practices of Mohs surgeons in the United States.
Traffic-related Air Pollution and Pregnancy Loss
Authors: Kioumourtzoglou Marianthi-Anna , Raz Raanan , Wilson Ander , Fluss Ronen , Nirel Ronit , Broday David M. , Yuval  , Hacker Michele R. , McElrath Thomas F. , Grotto Itamar , Koutrakis Petros , Weisskopf Marc G. 
Published: September 2018

Background:
Traffic-related air pollution has been linked to multiple adverse pregnancy outcomes. However, few studies have examined pregnancy loss, targeting losses identified by hospital records, a large limitation as it does not capture events not reported to the medical system.

Methods:
We used a novel variation of the time-series design to determine the association, and identify the critical window of vulnerability, between week-to-week traffic-related air pollution and conceptions resulting in live births, using nitrogen dioxide (NO2) as a traffic emissions tracer. We used information from all live births recorded at Beth Israel Deaconess Medical Center in Boston, MA (2000–2013) and all live births in Tel Aviv District, Israel (2010–2013).

Results:
In Boston (68,969 live births), the strongest association was during the 15th week of gestation; for every 10 ppb of NO2 increase during that week, we observed a lower rate of live births (rate ratio [RR] = 0.87; 95% confidence interval [CI], 0.78, 0.97), using live birth–identified conceptions to infer pregnancy losses. In the Tel Aviv District (95,053 live births), the strongest estimate was during the 16th gestational week gestation (RR = 0.82; 95% CI, 0.76, 0.90 per 10 ppb of NO2).

Conclusions:
Using weekly conceptions ending in live birth rather than identified pregnancy losses, we comprehensively analyzed the relationship between air pollution and all pregnancy loss throughout gestation. The observed results, with remarkable similarity in two independent locations, suggest that higher traffic-related air pollution levels are associated with pregnancy loss, with strongest estimates between the 10th and 20th gestational weeks.