bluuebunny/crossref_metadata_2025_split huggingface dataset:
Repeated Intravenous Lidocaine Infusions for Patients with Fibromyalgia: Higher Doses of Lidocaine Have a Stronger and Longer-Lasting Effect on Pain Reduction
Authors: Wilderman Igor , Pugacheva Olga , Perelman Vsevolod (Sev) , Wansbrough Michael C T , Voznyak Yuri , Zolnierczyk Lukasz 
Published: September 2019

AbstractObjectivesTo determine the effect of escalating doses of lidocaine infusion with or without added magnesium on pain levels and the duration of pain relief in patients with fibromyalgia (FM).MethodsA retrospective chart review of 74 patients diagnosed with FM who underwent at least three escalating doses of intravenous (IV) lidocaine infusions (5 mg/kg of body weight, 7.5 mg/kg, and 7.5 mg/kg of lidocaine + 2.5 g of magnesium sulfate) was conducted. Each patient’s subjective impression of change in pain intensity and duration of pain relief after each treatment was recorded, along with an 11-point numeric rating scale (NRS) for pain intensity, immediately before and after each infusion.ResultsShort-term lidocaine analgesia was evaluated by the reduction in NRS pain score according to the patients reported pre- (immediately before treatment) and post-treatment (immediately after treatment) values. There was a statistical difference in the NRS score reduction between doses 5 mg/kg and 7.5 mg/kg of lidocaine (P = 0.009). Long-term analgesia was evaluated at follow-up visits by the patient’s subjective impression of change in pain intensity and duration of pain relief. There was a statistical difference in the percentage of pain relief and the mean duration of pain relief between the treatments with 5 mg/kg and 7.5 mg/kg of lidocaine (P = 0.007 and P = 0.003). Although there was a trend of greater response to magnesium sulfate as a beneficial adjunct to the lidocaine infusion, we were unable to find a statistically significant difference for any of the variables studied.ConclusionsThis study demonstrated that escalating doses of IV lidocaine to 7.5 mg/kg safely and effectively reduced the pain with prolonged effect in a significant number of patients diagnosed with fibromyalgia. Larger, prospective clinical studies are required to confirm this finding.
Exploring Variation in Police Perceptions of De-Escalation: Do Officer Characteristics Matter?
Authors: White Michael D , Mora Victor , Orosco Carlena 
Published: September 2019

Abstract
Though de-escalation has become popular in policing, there is very little research on the topic. We know virtually nothing about what it is, whether it works, or even how officers perceive de-escalation. The authors surveyed over 100 officers in the Tempe (AZ) Police Department regarding their perceptions of de-escalation, including tactics used to peacefully resolve potentially violent encounters, the frequency of use, and their perceptions of de-escalation training. We examine perceptions overall, as well as by officer race/ethnicity and sex. Findings suggest that officers view de-escalation through a lens defined by their authority and officer safety. They use certain tactics multiple times each shift. Officers are open to de-escalation training but are skeptical about its impact on citizen encounters. Lastly, minority and female officers use certain tactics more often than white male officers. The article concludes with a discussion of the implications for the larger debate on de-escalation in policing.
CHARACTERISATION AND EVALUATION OF AL2O3:C-BASED OPTICALLY STIMULATED LUMINESCENT DOSEMETER SYSTEM FOR DIAGNOSTIC X-RAYS: PERSONAL AND IN VIVO DOSIMETRY
Authors: Wong J H D , Bakhsh M , Cheah Y Y , Jong W L , Khor J S , Ng K H 
Published: September 2019

Abstract
This study characterises and evaluates an Al2O3:C-based optically stimulated luminescent dosemeter (OSLD) system, commercially known as the nanoDot™ dosemeter and the InLight® microStar reader, for personal and in vivo dose measurements in diagnostic radiology. The system characteristics, such as dose linearity, reader accuracy, reproducibility, batch homogeneity, energy dependence and signal stability, were explored. The suitability of the nanoDot™ dosemeters was evaluated by measuring the depth dose curve, in vivo dose measurement and image perturbation. The nanoDot™ dosemeters were observed to produce a linear dose with ±2.8% coefficient variation. Significant batch inhomogeneity (8.3%) was observed. A slight energy dependence (±6.1%) was observed between 60 and 140 kVp. The InLight® microStar reader demonstrated good accuracy and a reproducibility of ±2%. The depth dose curve measured using nanoDot™ dosemeters showed slightly lower responses than Monte Carlo simulation results. The total uncertainty for a single dose measurement using this system was 11%, but it could be reduced to 9.2% when energy dependence correction was applied.
A Trusts Act for New Zealand
Authors: Cone Geoffrey , Shan Claudia , Barber Simon 
Published: September 2019

Abstract
There has been a seismic overhaul of trust law in New Zealand, culminating in the Trustee Act 1956 being replaced by the Trusts Act 2019. The latter reflects modern trust practice and its key features include clarifying the powers, duties, roles and requirements of trust participants, and streamlining various processes. In this article, we focus on a number of these features, with a particular focus on practical insights on the improvements and advantages of New Zealand trust law for domestic as well as international practitioners, settlors, beneficiaries and protectors alike.
Prepregnancy Genetic Carrier Screening in Recipients of Hematopoietic Stem Cell Transplants
Authors: Aluko Ashley , Seidler Emily , Penzias Alan 
Published: September 2019

BACKGROUND:
Genetic carrier screening of individuals with a history of hematopoietic stem cell (HSC) transplant is not always straightforward.

CASE:
We present the case of a couple who underwent prepregnancy genetic screening before fertility treatment. The genetics laboratory flagged the male partner's blood sample because there was a discrepancy between the sex of the patient and the sex chromosome markers, ultimately leading to the discovery of a prior HSC transplant.

CONCLUSION:
A history of HSC transplant may confound results of serum-based genetic carrier screening. Hematopoietic stem cell transplant recipients are at risk for misinterpreted genetic carrier screening because the results of such screening may not actually be reflective of their own DNA.
Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes
Authors: Silver Robert M. , Hunter Shannon , Reddy Uma M. , Facco Francesca , Gibbins Karen J. , Grobman William A. , Mercer Brian M. , Haas David M. , Simhan Hyagriv N. , Parry Samuel , Wapner Ronald J. , Louis Judette , Chung Judith M. , Pien Grace , Schubert Frank P. , Saade George R. , Zee Phyllis , Redline Susan , Parker Corette B. ,   for the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (NuMoM2b) Study
Published: September 2019

OBJECTIVE:
To examine the relationship between prospectively assessed maternal sleep position and subsequent adverse pregnancy outcomes.

METHODS:
This was a secondary analysis of a prospective observational multicenter cohort study of nulliparous women with singleton gestations who were enrolled between October 2010 and May 2014. Participants had three study visits that were not part of clinical care. They prospectively completed in-depth sleep questionnaires between 6 0/7 and 13 6/7 weeks of gestation and 22 0/7 and 29 6/7 weeks of gestation, the first and third study visits. A subset of women also underwent level 3 home sleep tests using the Embletta Gold device. The primary outcome was a composite of adverse pregnancy outcomes such as stillbirth, a small-for-gestational-age newborn, and gestational hypertensive disorders.

RESULTS:
A total of 8,706 (of 10,038) women had data from at least one sleep questionnaire and for pregnancy outcomes, and they comprised the population for this analysis. The primary outcome occurred in 1,903 pregnancies (22%). There was no association between reported non–left lateral or supine sleep during the last week of the first visit (adjusted odds ratio [aOR] 1.00 [95% CI 0.89–1.14]) or third visit (aOR 0.99 [95% CI 0.89–1.11] and the composite or any individual outcome, except for an apparent protective effect for stillbirth at the third visit (aOR 0.27 (95% CI 0.09–0.75). Women with objectively measured supine sleep position for at least 50% of the time were no more likely than those in the supine position 50% or less of the time to have the composite adverse outcome.

CONCLUSIONS:
Going to sleep in the supine or right lateral position, as self-reported before the development of pregnancy outcome and objectively assessed through 30 weeks of gestation, was not associated with an increased risk of stillbirth, a small-for-gestational-age newborn, or gestational hypertensive disorders.
Disseminated Intravascular Coagulation and Hemorrhage After Dilation and Evacuation Abortion for Fetal Death
Authors: Kerns Jennifer L. , Ti Angeline , Aksel Sarp , Lederle Lauren , Sokoloff Abby , Steinauer Jody 
Published: September 2019

OBJECTIVE:
To examine the association between fetal death and risk of hemorrhage and disseminated intravascular coagulation (DIC) among women undergoing dilation and evacuation (D&E) procedures.

METHODS:
We conducted a retrospective cohort study of all D&Es at one academic abortion clinic in San Francisco between 2009 and 2013. We abstracted data on fetal death status, demographic characteristics, and complications including hemorrhage and DIC. We examined the risk of hemorrhage and DIC among women with fetal death compared with those without. We conducted unadjusted and adjusted analyses for the outcomes of hemorrhage, DIC, and any complication.

RESULTS:
Among 92 cases of D&E for fetal death and 4,428 cases of D&E for other reasons, hemorrhage occurred in 10% and 7%, respectively (P=.28), and DIC occurred in 2.0% and 0.2% of the fetal death and nonfetal death cohorts (P<.001). In adjusted analysis, fetal death was associated with 2.9 times higher odds of hemorrhage (95% CI 1.4–6.0). In an unadjusted analysis, fetal death was associated with 12.3 times higher odds of DIC (95% CI 2.6–58.6) and 3.0 times higher odds of any complication (95% CI 1.6–5.9).

CONCLUSION:
Women undergoing D&E for fetal death are far more likely to experience DIC and hemorrhage than are women without fetal death, yet the absolute risk is low (2%). Although D&E providers should be prepared for DIC and hemorrhage, we do not recommend any specific preoperative preparation because the vast majority of D&E abortions for fetal death are uncomplicated.
A Postpartum Remote Hypertension Monitoring Protocol Implemented at the Hospital Level
Authors: Hauspurg Alisse , Lemon Lara S. , Quinn Beth A. , Binstock Anna , Larkin Jacob , Beigi Richard H. , Watson Andrew R. , Simhan Hyagriv N. 
Published: September 2019

OBJECTIVE:
To evaluate the feasibility, acceptability, and compliance of a remote blood pressure monitoring protocol implemented as a quality improvement measure at the hospital level for management of hypertension in postpartum women after hospital discharge.

METHODS:
This is an ongoing quality improvement project that included women admitted to the postpartum unit of a single tertiary care hospital. We designed nursing call center-driven blood pressure management and treatment algorithms, which were initiated after hospital discharge until 6 weeks postpartum. Women are eligible to participate if they have a diagnosis of chronic hypertension, superimposed preeclampsia, gestational hypertension, preeclampsia, or postpartum hypertension and have access to a text messaging-enabled smartphone device. After identification by an obstetric care provider, women are enrolled into the program, which is automatically indicated in the electronic medical record. Maternal, obstetric, and sociodemographic data were obtained from the electronic medical record.

RESULTS:
Between February 2018 and January 2019, we enrolled 499 patients. Here we report on the first 409 enrolled patients. Participants include 168 (41%) with gestational hypertension, 179 (44%) with preeclampsia with no history of chronic hypertension, 49 (12%) with chronic hypertension with superimposed preeclampsia, and 13 (3%) with postpartum preeclampsia. One hundred seventy-one (42%) participants had antihypertensives initiated or titrated through the program. Three hundred forty women (83%) continued the program beyond 3 weeks postpartum, and 360 (88%) attended an in-person 6-week postpartum visit. Two hundred thirty-five out of 250 women who completed a postprogram survey (94%) reported satisfaction with the program.

CONCLUSION:
In this study, we detail results from an ongoing remote blood pressure monitoring program. We demonstrate high compliance, retention, and patient satisfaction with the program. This is a feasible, scalable remote monitoring program connected to the electronic medical record.
Recovery Process After Anterior Cervical Decompression in Patients With Cervical Spondylotic Myelopathy With Different Natural History
Authors: Li Peng , Zhang Haoping , Cheng Huijuan , Meng Fanshuai , Li Junwei 
Published: September 2019

Study Design:
An observational prospective cohort study.

Objective:
To investigate the influence of natural history on the recovery of patients with cervical spondylotic myelopathy (CSM) after anterior cervical decompression.

Summary of Background Data:
The natural history of CSM has not been clearly elucidated, it remains unclear whether the natural history of CSM is associated with the recovery process after surgical treatment.

Materials and Methods:
Patients with CSM (n=117) after anterior cervical decompression were stratified variously on the basis of natural history features. Baseline and postoperative neurological functions were rated using the Japanese Orthopaedic Association (JOA) and patient-based self-evaluation (PBSE) scores. The minimum and maximum recovery times for sensory function, and motor functions of the upper and lower extremities were analyzed separately at time points 1–60 months after surgery.

Results:
In all patients, the postoperative JOA and PBSE scores were significantly improved relative to baseline, in which sensory function recovered most quickly, followed by upper-extremity and lower-extremity motor functions. However, when compared with patients whose first symptom onset at the lower extremity, patients with the first onset at the upper extremity required less time to recover lower-extremity motor function, but more time to recover upper-extremity motor function. Patients with rapid progression had significantly lower preoperative and final JOA and PBSE scores compared with patients whose progression was steady or stepwise. Patients with preoperative symptoms ≥1 year had longer recovery time and poorer functional outcomes compared with those symptoms <1 year.

Conclusions:
In patients with CSM, the location of first symptom onset, progressive velocity of symptom, and duration of preoperative symptoms significantly influenced the recovery process after anterior cervical decompression.

Level of Evidence:
Level 2—observational prospective study.
Comparison of the Effects of Milrinone, Sodium Nitroprusside, and Nitroglycerine for Induced Hypotension in Elderly Patients Undergoing Spine Surgery
Authors: Huh Jaewon , Chung Hyewon , Hwang Wonjung 
Published: September 2019

Background:
The use of induced hypotension is limited because of concerns about hypoperfusion to major organs in elderly patients. The aim of this study was to compare the effects of milrinone with those of other vasodilating hypotensive agents on induced hypotension in elderly patients undergoing spine surgery.

Methods:
In total, 60 patients older than 60 years who underwent lumbar fusion surgeries were randomized to groups M (milrinone), S (sodium nitroprusside), and N (nitroglycerine). The study drug was infused after perivertebral muscle retraction until complete interbody fusion occurred. The infusion dose was adjusted to achieve a fall of 30% in systolic blood pressure or mean blood pressure to 60 to 65 mm Hg. Intraoperative blood loss, grade of the surgical field, and urine output were recorded.

Results:
Intraoperative blood loss per fused spine level was 288.5±94.4 mL in group M, 399.8±60.3 mL in group S, and 367.0±122.5 mL in group N (P=0.002). The grade of the surgical field was similar among the 3 groups (P=0.439). Hourly urine output was 1.4±0.5 mL in group M, 0.7±0.3 mL in group S, and 0.9±0.4 mL in group N (P<0.001).

Conclusions:
The use of milrinone for induced hypotension led to less intraoperative blood loss and higher urine output than the use of sodium nitroprusside or nitroglycerine in elderly patients undergoing spine surgery.
Patterns of Care and Survival in Elderly Patients With Locally Advanced Soft Tissue Sarcoma
Authors: Greto Daniela , Saieva Calogero , Loi Mauro , Desideri Isacco , Delli Paoli Camilla , Lo Russo Monica , Pezzulla Donato , Teriaca Maria A. , Lucidi Sara , Visani Luca , Terziani Francesca , Olmetto Emanuela , Becherini Carlotta , Bonomo Pierluigi , Francolini Giulio , Campanacci Domenico A. , Scoccianti Guido , Livi Lorenzo 
Published: September 2019

Objectives:
The aim of this study was to analyze patterns of care in elderly soft tissue sarcoma (STS) patients and their impact on clinical outcome and treatment-related toxicity.

Materials and Methods:
We retrospectively collected data of >65-year-old patients diagnosed with locally advanced STS between 1991 and 2017 in a single institution.

Results:
The study included 111 patients: 105 (94.6%) patients underwent surgery, associated with preoperative (n=19, 17.1%) or postoperative radiotherapy (n=72, 64.8%). Anthracycline-based chemotherapy was prescribed in 41.4% of patients (n=46). Acute grade ≥3 postoperative radiotherapy–related radiation dermatitis and all grades of chemotherapy-induced neutropenia were significantly correlated to age >80 years (P=0.02) and >70 years (P=0.045), respectively. The mean follow-up was 4.1 years (range, 0.1 to 17.7). Three-year and 5-year local recurrence–free survival were 80.3% and 75.7%, respectively; neither treatment-related nor patient-related characteristics affected local recurrence. Three-year and 5-year distant relapse–free survival were 59.6% and 44.6%, respectively. On multivariate Cox regression, undifferentiated pleomorphic sarcoma histology and Charlson Comorbidity Index >7 were independent factors associated with distant relapse–free survival (P=0.026 and P=0.0001). Overall survival was 62% and 46.6% at 3 and 5 years, respectively. On multivariate Cox regression, surgery and Charlson Comorbidity Index <7 were independent factors associated with overall survival (P=0.006 and P=0.0001).

Conclusions:
In this study, elderly STS patients receiving a tailored treatment encompassing surgery, radiotherapy, and/or chemotherapy obtained an improved outcome, although caution is advised because of increased toxicity in relation to age. Comorbidities should be considered to offer the best treatment option to this frail patient population.
Spectrum of Melanocytic Proliferation/Differentiation in a Large Series of Cutaneous Neurofibromas: An Under-Recognized Histopathologic Phenomenon and Potential Clue for Neurofibromatosis Type 1
Authors: Ntala Chara , Biswas Asok 
Published: September 2019

Aims:
Neurofibromas (NFs) and melanocytic nevi share a common neuroectodermal origin and may occasionally show overlapping morphological features. The objective of this study was to assess the prevalence and spectrum of melanocytic proliferation/differentiation in NFs and also to test the hypothesis whether detection of this feature could be used as a potential clue for neurofibromatosis type 1 (NF-1).

Methods:
This was a retrospective study of 229 syndromic and 239 sporadic cutaneous NFs. Each case was assessed for an associated melanocytic component, both within the tumor and the overlying epidermis. Melan A immunohistochemistry was used in selected cases to further characterize this feature, particularly in diffuse NFs.

Results:
An associated melanocytic component was detected in 77/229 syndromic and 12/239 sporadic cases (P < 0.00001). This was in the form of a junctional proliferation (lentiginous melanocytic hyperplasia or junctional nevus) or dermal differentiation (diffuse spindle cell or dermal nests of pigmented epithelioid melanocytes).

Conclusions:
Our study affirms that the spectrum of melanocytic proliferation/differentiation in NFs is broad and probably under-recognized. Awareness of this phenomenon is critical to avoid misdiagnosis of some diffuse NFs as primary melanocytic tumors, for example, desmoplastic melanomas. Given the strong link between dermal melanocytic differentiation and syndromic NFs, its detection could potentially serve as a useful clue for NF-1 in an appropriate clinical context.
Mentoplasty with Customized Guides and Plates Using 3D Technology: a More Precise and Safer Technique
Authors: Arcas Antoni , Vendrell Gerard , Cuesta Frank , Bermejo Laura 
Published: September 2019

SUMMARY:
Mentoplasty or genioplasty is a common operation to enhance function and appearance of the chin, which has major impact on character impressions and facial beauty. With the advent of new 3D technologies, the technique can be performed using customized guides and plates (with 3D planning and printing), addressing the drawbacks of the procedure, making it minimally invasive, safe, very accurate, and predictable. In this article, we describe a surgical technique using customized surgical guides and plates and performed under local anesthesia and oral sedation, with a surgical time of approximately 45 minutes. The video includes a 3D animation of customized mentoplasty and a recording of real procedures for chin augmentation using customized guides and plates, with use of a minimally invasive approach.
Immediate and Delayed Reconstruction after Excision of Axillary Hidradenitis Suppurativa Using a Propeller Flap
Authors: Elboraey Mohamed A. , Alali Ahmad B. , Alkandari Qutaibah A. 
Published: September 2019

Background:
The chronic inflammatory skin condition hidradenitis suppurativa (acne inversa), characterized by hair follicle or apocrine gland infection, causes recurrent superficial nodules and abscesses in axillary, mammary, and perianal regions. Chronic reoccurrence results in fistula formation, causing scarring and fibrosis. Surgical excision of affected skin tissue with adequate free margins is the gold standard treatment to prevent recurrence. This case series describes 6 cases of radical excision of localized axillary hidradenitis suppurativa, with immediate or delayed perforator-based propeller flap defect closure.

Methods:
All patients presenting for surgical treatment of hidradenitis suppurativa between 2016 and 2018 were identified from the hospital database. Only patients with hidradenitis suppurativa confined to the axilla were included. Patients with simple abscess incisions, recurrence after previous grafting/flap surgery, and extension of the disease outside the axilla region were excluded. Patient demographics, size of defect, complications, time of follow-up, recurrences, and level of patient satisfaction were documented.

Results:
Six patients with localized axillary hidradenitis suppurativa were identified, with 8 propeller flap surgeries performed. Defect size was assessed by pathologic examination of excised specimens, ranging from 11–18 cm × 6–14 cm × 0.5–2 cm (length × width × depth). Seven of the eight wounds healed primarily. Functional and aesthetic results were satisfactory and there were no recurrences. The only observed complication was venous congestion following 1 flap procedure.

Conclusion:
These findings confirm that the propeller flap procedure can be effective for immediate or delayed defect closure after radical excision of localized axillary hidradenitis suppurativa, providing that no perifocal signs of infection are present after debridement.