bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of intraoperative propofol-based total intravenous anesthesia on postoperative pain in spine surgery
Authors: Lin Wei-Lin , Lee Meei-Shyuan , Wong Chih-Shung , Chan Shun-Ming , Lai Hou-Chuan , Wu Zhi-Fu , Lu Chueng-He 
Published: March 2019

Abstract

Background:
As reported, patients experience less postoperative pain after propofol-based total intravenous anesthesia (TIVA). In the present study, we investigated the postoperative analgesic effects between propofol-based TIVA and desflurane anesthesia after spine surgery.

Methods:
Sixty patients were included who received (surgical time >180 minutes) lumbar spine surgery. Patients were randomly assigned to receive either TIVA (with target-controlled infusion) with propofol/fentanyl-based anesthesia (TIVA group) or desflurane/fentanyl-based anesthesia (DES group), titrated to maintain Bispectral Index values between 45 and 55. All patients received patient-controlled analgesia (PCA) with fentanyl for postoperative pain relief. Numeric pain rating scale (NRS) pain scores, postoperative fentanyl consumption, postoperative rescue tramadol use, and fentanyl-related side effects were recorded.

Results:
The TIVA group patients reported lower NRS pain scores during coughing on postoperative day 1 but not day 2 and 3 (P = .002, P = .133, P = .161, respectively). Less fentanyl consumption was observed on postoperative days 1 and 2, but not on day 3 (375 μg vs 485 μg, P = .032, 414 μg vs 572 μg, P = .033, and 421 μg vs 479 μg, P = .209, respectively), less cumulative fentanyl consumption at postoperative 48 hours (790 μg vs 1057 μg, P = .004) and 72 hours (1210 μg vs 1536 μg, P = .004), and total fentanyl consumption (1393 μg vs 1704 μg, P = .007) when compared with the DES group. No difference was found in rescue tramadol use and fentanyl-related side effects.

Conclusion:
Patients anesthetized with propofol-based TIVA reported less pain during coughing and consumed less daily and total PCA fentanyl after lumbar spine surgery.
Risk factors of postoperative acute lung injury following lobectomy for nonsmall cell lung cancer
Authors: Kim Hyun Jung , Cha Seung Ick , Kim Chang-Ho , Lee Jaehee , Cho Joon Yong , Lee Youngok , Kim Gun-Jik , Lee Deok Heon 
Published: March 2019

Abstract
Acute lung injury following lung resection surgery is not rare and often related to mortality. Although it has been a significant clinical and economic impact associated with increased intensive care unit (ICU) utilization, length of hospital stay, and associated cost, it is unpredictable. Aims of this study were to identify the modifiable risk factors of postoperative acute lung injury (PALI) following lung cancer surgery.
We retrospectively analyzed medical records of 354 cases of lung cancer surgery in the tertiary university hospital from January 2012 to December 2015. PALI was defined as bilateral diffuse pulmonary infiltration on chest radiography, oxygenation failure (PaO2/FiO2 < 300), and absence of sign of left ventricular failure within a week from operation. We classified patients into either PALI group or non-PALI group and compared clinical characteristics of two groups. Logistic regression model was fitted to evaluate the risk factor of PALI.
Among 354 cases of lung cancer surgeries, 287 lobectomies were analyzed. The overall incidence of PALI was 2.79% (8/287); four patients developed pneumonia with acute respiratory distress syndrome, and four patients developed ALI without clinical infection sign. There was no difference in baseline characteristics between PALI group and non-PALI group, but in operative parameters, a larger amount of fluid infusion was observed in PALI group. Logistic regression model showed underlying ischemic heart disease (OR 7.67, 95% CI 1.21–47.44, P = .03), interstitial lung disease (OR 30.36, 95% CI 2.30–401.52, P = .01), intravascular crystalloid fluid during surgery (OR 1.10, 95% CI 1.00–1.20, P = .04), and intraoperative transfusion (OR 56.4, 95% CI 3.53–901.39, P < .01) were risk factors of PALI. PALI increases ICU admission, use of mechanical ventilator, duration of hospital stay, and mortality.
The clinical impact of PALI is marked. Significant independent risk factors have been identified in underlying ischemic heart disease, interstitial lung disease, intravascular crystalloid fluid, and transfusion during surgery.
The effect of diabetes on the risk and mortality of acute lung injury/acute respiratory distress syndrome
Authors: Ji Mingxia , Chen Mengyan , Hong Xiaofei , Chen Tiejiang , Zhang Ning 
Published: March 2019

Abstract

Background:
The role of pre-existing diabetes in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is still controversial. This systematic review and meta-analysis of observational studies aimed to evaluate the effect of diabetes on the risk and mortality of ALI/ARDS.

Methods:
A comprehensive literature search was performed in PubMed, Scopus, Cochrane Central Register of Controlled Trails and Web of Science for their inception to September 2018. Summary risk estimates were calculated with a DerSimonian and Laird random-effects model. Heterogeneity was evaluated using Cochran chi-square test and the I2 statistic.

Results:
Ultimately, 14 studies with a total of 6613 ALI/ARDS cases were included. The risk of ALI/ARDS was not significantly reduced in diabetes patients (OR 0.82, 95% CI 0.57–1.18, P = .283), with obvious heterogeneity across studies (I2 = 72.5%, P < .001). Further analyses in the meta-analysis also showed no statistically significant associations between pre-existing diabetes and in-hospital mortality (OR 0.79, 95% CI 0.51–1.21, P = .282) or 60-day mortality of ALI/ARDS (OR 0.91, 95% CI 0.75–1.11, P = .352).

Conclusion:
This systematic review and meta-analysis of observational studies indicates that pre-existing diabetes have no effect on the risk and mortality of ALI/ARDS.
Challenges in the delivery of surgical care for head and neck cancer patients in the Hong Kong Special Administrative Region and China
Authors: Chan Jason Y.K. , Wong Eddy W.Y. , Xue Lingbin , Liang Fa Ya 
Published: March 2019

Purpose of review
This article aims to explore the ethical dilemmas faced by head and neck surgeons in the Hong Kong Special Administrative Region (HKSAR) and China in the provision of safe, oncological sound and timely care for head and neck cancer patients.

Recent findings
There is no literature, in particular, in relation to the treatment of head and neck cancer patients and priority setting in head and neck surgery. However, through examining the healthcare provision and sociocultural backgrounds of the HKSAR and China, certain aspects, such as traditional Chinese medicine and medical guan xi (Seeking medical care for personal connections) have been shown to significantly influence the provision of care in China. Medical guan xi facilitates inequity and is problematic in developing a system based on justice, equity, nonmalfeasance and beneficence. In the HKSAR, resource limitations are related to the maldistribution of healthcare between the public and private sectors, resulting in significant time constraints for surgery and oncology care of patients. There is informal application of ethical frameworks for priority setting, however, these have neither been formally supported nor enforced from an administrative level that needs to be addressed.

Summary
In the HKSAR, there needs to be a strengthening of an ethical framework for priority setting to adhere to justice for our patients and healthcare providers in treating head and neck cancer patients. In China, priority setting is largely set by sociocultural practices that are endemic, in particular, medical guan xi that is inequitable and needs to be addressed to improve the doctor–patient relationship.
Hepatic Venous Pressure Gradient Measurements in Children
Authors: Ebel Noelle H. , Carlin Kristen , Shaffer Michele L. , Shivaram Giri , Hawkins Matthew , Lane Erin R. , Cooper Kara , Lindquester Will S. , Gadodia Gaurav , Murray Karen F. 
Published: March 2019

ABSTRACTObjectives:In adults, elevated hepatic venous pressure gradients (HVPGs) are correlated with the degree of liver fibrosis on histopathology and predict worse outcomes including variceal bleeding and death. We aimed to examine the association between HVPG measurements, histopathologic findings, and clinical indicators of portal hypertension in children.Methods:Utilizing retrospective data from 2 pediatric centers between 2006 and 2015, we identified children who underwent simultaneous HVPG measurement and transjugular liver biopsy. Medical charts were reviewed for histopathology, imaging, endoscopic, and clinical data.Results:Forty‐one children (median age 11 years) were included in the analysis with diagnoses of acute hepatitis (n = 15), chronic liver disease (n = 12), hepatic noncirrhotic portal hypertension (n = 4), acute liver failure (n = 3), and nonhepatic causes of portal hypertension (n = 7). Elevated mean HVPG measurements were found in children with acute liver failure (10 mmHg, range 4–12) and chronic liver disease (7 mmHg, range 1–12). HVPG measurements did not correlate with the histological severity of fibrosis (ρ = 0.23, P = 0.14) or portal inflammation (ρ = 0.24, P = 0.29), and no difference was found in HVPG when comparing children with and without a history of variceal bleeding (P = 0.43).Conclusions:HVPG measurements do not correlate significantly with the degree of hepatic fibrosis on biopsy. Furthermore, HVPG measurements are not associated with the presence of varices or history of variceal bleeding, suggesting the possibility of intrahepatic shunting in children with advanced liver disease. Therefore, unlike in adults, HVPG measurements may not accurately predict children who are at risk of complications from portal hypertension.
A Symptom Self‐report Tool for Children With Inflammatory Bowel Disease (IBDnow)
Authors: Vernon‐Roberts Angharad , Lopez Robert N. , Frampton Chris , Gearry Richard B. , Lemberg Daniel A. , Day Andrew S. 
Published: March 2019

ABSTRACTObjectives:Clinical symptom evaluation for children with inflammatory bowel disease (IBD) is typically done using composite tools: the Pediatric Crohn's Disease Activity Index (PCDAI) and Pediatric Ulcerative Colitis Activity Index (PUCAI). Both rely on clinician interpretation of child or parent symptom recall. No universal self‐report tool has yet been developed for children with IBD to assess and report their symptoms. The research objective was to develop a self‐report tool that produced information congruent with that obtained by clinicians using the PUCAI or PCDAI.Methods:A children's symptom self‐report tool (IBDnow) was developed with picture and text Likert symptom scales. The clinician and child completed their reports during the same outpatient consultation. Agreement levels were calculated at the individual level (identical child and clinician answers), category level (symptom severity), and aggregate level (cohort scores). Internal consistency was measured with Cronbach alpha.Results:One hundred children from Christchurch (New Zealand) (n = 65), and Sydney (Australia) (n = 35) completed the study (Crohn's Disease (CD):88, ulcerative colitis (UC):12), mean age 13.9 years (±3.6). Mean individual agreement was 0.76 (±0.19). Category severity had very good or good inter‐rater reliability for 5 of the 7 symptom scales and overall severity agreement of 76%. Aggregate mean scores were significantly different between clinicians (14.9, ±18.8), and participants (21.6, ±19.4), (P <0.005, confidence interval −9.0, −4.4), but 60 pairs had scores within a 10% margin. Cronbach alpha was 0.74.Conclusions:This self‐report tool had good proportionate agreement between raters, and good crude agreement for symptom categories. Assigning PUCAI or PCDAI scores caused inter‐rater discrepancies to be misleadingly magnified. Pediatric gastroenterologists may consider utilizing IBDnow to elicit symptom self‐reports from children with IBD to enable them to communicate meaningful information on their ongoing symptom burden. This would be a positive step in helping children feel included in clinical encounters and promoting self‐management, at the same time producing valid, subjective symptom recall.
Infliximab Paradoxical Psoriasis in a Cohort of Children With Inflammatory Bowel Disease
Authors: Courbette Olivier , Aupiais Camille , Viala Jerome , Hugot Jean‐Pierre , Louveau Baptiste , Chatenoud Lucienne , Bourrat Emmanuelle , Martinez‐Vinson Christine 
Published: March 2019

ABSTRACTObjectives:In adult inflammatory bowel disease (IBD) treated by anti‐TNF antibodies, paradoxical psoriasis has an estimated prevalence of 1.6 to 22%, especially in infliximab (IFX)‐treated patients. Little is known in the pediatric IBD (PIBD) populations.Methods:All patients ages from 2 to 18 years with Crohn disease (CD) or ulcerative colitis (UC) and treated for the first time by IFX between January 2002 and March 2014, were considered for inclusion in this retrospective study performed in a tertiary PIBD centre. Paradoxical psoriasis events together with clinical and biological data were collected in all patients. Comparisons between psoriasis and control groups were performed using univariate statistical analyses.Results:One hundred and twenty‐three CD patients and 24 UC patients were treated with IFX. Twenty patients (13.6%) experienced a paradoxical psoriasis. All of them were affected by CD. Perianal CD was more frequent in the psoriasis group (P = 0.033). Fourteen patients (70%) were in remission when skin lesions occurred. Paradoxical psoriasis was diagnosed 355 days (median, interquartile range [IQR] 239; 532) after the initiation of IFX corresponding to the eighth injection (median, IQR: 6; 15). Psoriasis lesions were controlled by local steroids in all cases and no patients discontinued IFX therapy.Conclusions:13.6% of our IBD patients treated with IFX developed psoriasis during a median follow‐up of 23.9 months (IQR: 11.6; 36.5). Crohn disease patients with perianal disease were at a higher risk to develop this common side effect.
Severity and the Treatment of Depression
Authors: Zimmerman Mark 
Published: March 2019

Abstract
Severity is an important consideration in treatment decision-making for depression. Two controversies in the treatment of depression are related to the issue of severity. First, are antidepressants only effective for severely depressed patients? Second, should the severity of depression be used as the basis for recommending medication or psychotherapy as first-line treatment? More specifically, should patients with severe depression preferentially be treated with medication? A related question is whether psychotherapy is beneficial for severely depressed patients. Some controversial articles sparked coverage in the popular press related to these questions and stimulated subsequent research on the impact of depression severity on treatment efficacy. The results of three recent large pooled analyses of patient level data indicate that the efficacy of antidepressants is not limited to the narrow band of patients who score highest on symptom severity scales. A meta-analysis of 132 controlled psychotherapy studies of more than 10,000 patients found that greater mean baseline symptom severity did not predict poorer response. A pooled analysis of individual patient data from 16 studies comparing antidepressants and cognitive behavior therapy found that severity was not associated with differential treatment outcome. These results are discussed in the context of recommendations in official treatment guidelines.
Motor Action Execution in Reaction-Time Movements
Authors: Tarkka Ina M. , Hautasaari Pekka 
Published: March 2019

Objective
Reaction-time movements are internally planned in the brain. Presumably, proactive control in reaction-time movements appears as an inhibitory phase preceding movement execution. We identified the brain activity of reaction-time movements in close proximity to movement onset and compared it with similar self-paced voluntary movements without external command.

Design
We recorded 18 healthy participants performing reaction-time and self-paced fast index finger abductions with 306-sensor magnetoencephalography and electromyography. Reaction-time movements were performed as responses to cutaneous electrical stimulation delivered on the hand radial nerve area. Motor field and movement-evoked field 1 corresponding to the sensorimotor cortex activity during motor execution and afferent feedback after the movement were analyzed with Brainstorm's scouts using regions of interest analysis.

Results
Primary motor and somato sensory cortices were active before and after movement onset. During reaction-time movements, primary motor and somato sensory cortices showed higher activation compared with self-paced movements. In primary motor cortex, stronger preparatory activity was seen in self-paced than in reaction time task.

Conclusions
Both primary motor and somato sensory cortices participated in the movement execution and in the prediction of sensory consequences of movement. Cutaneous stimulation facilitated cortical activation during motor field after reaction-time movements, implying the applicability of cutaneous stimulation in motor rehabilitation.
Bone Marrow Mesenchymal Stem Cell Transplantation Enhances Nerve Regeneration in a Rat Model of Hindlimb Replantation
Authors: Abbas Ozan Luay , Özatik Orhan , Gönen Zeynep Burçin , Koçman Atacan Emre , Dağ Ilknur , Özatik Fikriye Yasemin , Bahar Dilek , Musmul Ahmet 
Published: March 2019

Background:
Successful limb replantation must be based not only on the viability of the amputated part but also on satisfactory long-term functional recovery. Once the vascular, skeletal, and soft-tissue problems have been taken care of, nerve recovery becomes the ultimate limiting factor. Unfortunately, nerve regeneration after limb replantation is impaired by several consequences. The authors tested the hypothesis that bone marrow mesenchymal stem cells could improve nerve regeneration outcomes in an experimental model of limb replantation.

Methods:
Twenty rats underwent replantation after total hindlimb amputation. Animals were subdivided into two groups: a replanted but nontreated control group and a replanted and bone marrow mesenchymal stem cell–transplanted group. Three months after surgery, nerve regeneration was assessed using functional, electrophysiologic, histomorphologic, and immunohistochemical analyses.

Results:
Bone marrow mesenchymal stem cell–treated animals showed significantly better sciatic functional index levels and higher compound muscle action potential amplitudes in comparison with the controls. Histomorphometric analysis revealed that the number of regenerating axons was approximately two-fold greater in the treated nerves. In addition, the mean g-ratio of these axons was within the optimal range. Immunohistochemical assessment revealed that expression of S-100 and myelin basic protein in the treated nerves was significantly higher than in controls. Correspondingly, the expression levels of anti–protein gene product 9.5 and vesicular acetylcholine transporter in motor endplates were also significantly higher. Finally, muscles in the bone marrow mesenchymal stem cell–transplanted group showed significantly larger average fiber areas.

Conclusion:
The authors’ findings demonstrate that it is possible to improve the degree of nerve regeneration after limb replantation by bone marrow mesenchymal stem cell transplantation.
Routine Postoperative Admission to the Intensive Care Unit Following Repair of Nonsyndromic Craniosynostosis: Is it Necessary?
Authors: Chocron Yehuda , Azzi Alain , Galli Rafael , Alnaif Nayif , Atkinson Jeffrey , Dudley Roy , Farmer Jean-Pierre , Gilardino Mirko S. 
Published: March 2019

Background:
Cranial vault surgery for craniosynostosis is generally managed postoperatively in the intensive care unit (ICU). The purpose of the present study was to examine our center's experience with the postoperative management of otherwise healthy patients with nonsyndromic craniosynostosis (NSC) without routine ICU admission.

Methods:
A retrospective cohort study of patients with NSC operated using a variety of vault reshaping techniques in our pediatric center between 2009 and 2017 was carried out. Patients with documented preexisting comorbidities that would have required admission to the ICU regardless of the surgical intervention were excluded.

Results:
A total of 102 patients were included in the study. Postoperatively, 100 patients (98%) were admitted as planned to a general surgical ward following observation in the recovery room. Two patients (2%) required ICU admission due to adverse intraoperative events. There were no patients who required transfer to the ICU from the recovery area or surgical ward. Within the surgical ward cohort, 6 patients (6%) had minor postoperative complications that were readily managed on the surgical floor. Postoperative anemia requiring transfusion was the most common complication.

Conclusion:
The results from this study suggest that otherwise healthy patients with NSC undergoing cranial vault surgery can potentially be safely managed without routine admission to the ICU postoperatively. Key elements are proper preoperative screening, access to ICU should an adverse intraoperative event occur and necessary postoperative surgical care. The authors hope that this experience will encourage other craniofacial surgeons to reconsider the dogma of routine ICU admission for this patient population.
Toothache as a Warning Sign of Subarachnoid Hemorrhage Postmortem Findings
Authors: Xingang Qiu , Wang Xian , Meichen Pan , Yuning Wang , Qian Liu 
Published: March 2019

AbstractThe symptoms of sudden severe headache and/or diminished consciousness characterize the onset of aneurysmal subarachnoid hemorrhage (SAH). However, several studies have suggested that some patients show an atypical presentation at the onset: symptoms lacking sudden headache and diminished consciousness. These atypical symptoms can easily lead to misdiagnosis. This paper reported the death cases of acute aneurysmal subarachnoid hemorrhage with toothache as the first symptom, hoping to provide clinical evidence for the general public doctors to reduce the misdiagnosis and delayed diagnosis of SAH, improve the identification ability of SAH, and prevent such death events from happening again.