bluuebunny/crossref_metadata_2025_split huggingface dataset:
NSAIDs hypersensitivity: questions not resolved
Authors: Blanca-Lopez Natalia , Somoza-Alvarez Maria L. , Bellon Teresa , Amo Gemma , Canto Gabriela , Blanca Miguel 
Published: June 2018

Purpose of reviewNSAIDs are the drugs most frequently involved in hypersensitivity reactions (HSR). These are frequently prescribed at all ages. HSR are of great concern and can affect people at any age. These drugs can induce reactions by stimulating the adaptive immune system (IgE or T cell), known as selective responders or more frequently by abnormalities in biochemical pathways related with prostaglandin metabolism. These are known as cross-intolerant. With some exceptions, skin testing and in-vitro studies are of little value in selective responders.Recent findingsIn the last years, several classifications have been provided based on clinical symptoms, time interval between drug intake and appearance of symptoms, response to other nonchemically related NSAIDs and the underlying disease. Based on this classification, several well differentiated categories within each group of entities cross-intolerant and selective responders are now recognized. The most complex groups for evaluation are cross-intolerant in which three major groups exist: NSAIDs exacerbated respiratory disease, NSAIDs exacerbated cutaneous disease and NSAIDs-induced urticaria/angioedema in the absence of chronic spontaneous urticaria. Within the selective responders, there are two mechanisms involved: drug-specific IgE or T-cell effector responses. New entities have been added to this classification like mixed reactions within the cross-intolerant category, that must manifest as anaphylaxis and multiple immediate selective reactions.SummaryThe precise evaluation of patients with NSAIDs hypersensitivity following established guidelines will improve not only our understanding but also the management of these entities. As the number of patients affected with NSAIDs is important, further studies are warranted.
Dexmedetomidine Prevents Excessive γ-Aminobutyric Acid Type A Receptor Function after Anesthesia
Authors: Wang Dian-Shi , Kaneshwaran Kirusanthy , Lei Gang , Mostafa Fariya , Wang Junhui , Lecker Irene , Avramescu Sinziana , Xie Yu-Feng , Chan Nathan K. , Fernandez-Escobar Alejandro , Woo Junsung , Chan Darren , Ramsey Amy J. , Sivak Jeremy M. , Lee C. Justin , Bonin Robert P. , Orser Beverley A. 
Published: June 2018

Abstract

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Postoperative delirium is associated with poor long-term outcomes and increased mortality. General anesthetic drugs may contribute to delirium because they increase cell-surface expression and function of α5 subunit-containing γ-aminobutyric acid type A receptors, an effect that persists long after the drugs have been eliminated. Dexmedetomidine, an α2 adrenergic receptor agonist, prevents delirium in patients and reduces cognitive deficits in animals. Thus, it was postulated that dexmedetomidine prevents excessive function of α5 γ-aminobutyric acid type A receptors.

Methods
Injectable (etomidate) and inhaled (sevoflurane) anesthetic drugs were studied using cultured murine hippocampal neurons, cultured murine and human cortical astrocytes, and ex vivo murine hippocampal slices. γ-Aminobutyric acid type A receptor function and cell-signaling pathways were studied using electrophysiologic and biochemical methods. Memory and problem-solving behaviors were also studied.

Results
The etomidate-induced sustained increase in α5 γ-aminobutyric acid type A receptor cell-surface expression was reduced by dexmedetomidine (mean ± SD, etomidate: 146.4 ± 51.6% vs. etomidate + dexmedetomidine: 118.4 ± 39.1% of control, n = 8 each). Dexmedetomidine also reduced the persistent increase in tonic inhibitory current in hippocampal neurons (etomidate: 1.44 ± 0.33 pA/pF, n = 10; etomidate + dexmedetomidine: 1.01 ± 0.45 pA/pF, n = 9). Similarly, dexmedetomidine prevented a sevoflurane-induced increase in the tonic current. Dexmedetomidine stimulated astrocytes to release brain-derived neurotrophic factor, which acted as a paracrine factor to reduce excessive α5 γ-aminobutyric acid type A receptor function in neurons. Finally, dexmedetomidine attenuated memory and problem-solving deficits after anesthesia.

Conclusions
Dexmedetomidine prevented excessive α5 γ-aminobutyric acid type A receptor function after anesthesia. This novel α2 adrenergic receptor- and brain-derived neurotrophic factor-dependent pathway may be targeted to prevent delirium.
Antegrade Percutaneous Intramedullary Fixation Technique for Metacarpal Fractures: Prospective Study on 150 Cases
Authors: Rocchi Lorenzo , Merendi Gianfranco , Mingarelli Luigi , Fanfani Francesco 
Published: June 2018

Objectives:
The aim of our study was to assess the results of antegrade percutaneous intramedullary Kirschner wire (K-wire) fixation, for the treatment of unstable displaced metacarpal fractures in a large number of cases, in order to support the usage of this mini-invasive technique in the largest variety of fractures as possible.

Material and Methods:
Every patient meeting the inclusion criteria was treated with closed reduction and antegrade intramedullary fixation with 1 or 2 K-wire from January 2013. A total of 150 patients with 165 metacarpal fractures were evaluated until February 2016. Average follow-up duration was 10 weeks. The clinical outcome was assessed by the total active motion of the digit, presence of rotational deformity, Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and Patient-Rated Wrist/Hand Evaluation (PRWHE) score. The radiographic outcome was assessed by evaluating the dorsal angulation and shortening of the metacarpal, comparing the postoperative radiography and the first radiography showing fracture healing.

Results:
Comparing the injured and contralateral digit average total active motion after 10 weeks from surgery, no statistical significance emerged. No patient developed extensor tendon irritation, so that there was no need to perform tenolysis, ever. The average Quick Disabilities of the Arm, Shoulder, and Hand score was 12.3 (range, 0 to 37). The average Patient-Rated Wrist/Hand Evaluation score was 19 (range, 0 to 41). Fracture union was steadily achieved. Radiographic assessment showed a nonsignificant postoperative loss of reduction.

Conclusions:
Antegrade intramedullary K-wire fixation technique is valid, reproducible, cheap, and perfectly suited to the treatment of metacarpal fractures requiring surgery, providing immediate mobilization and excellent outcomes for a very wide variety of fractures.
Robotic Platform for an IPAA
Authors: Lightner Amy L. , Kelley Scott R. , Larson David W. 
Published: June 2018

INTRODUCTION:
An IPAA is the preferred operative approach for restoration of intestinal continuity in patients with ulcerative colitis and familial adenomatous polyposis. As minimally invasive approaches have become more widely adopted, their use in IPAA has also become increasingly commonplace. Laparoscopy has the same limitations during the proctectomy portion as seen in operations for rectal cancer, including dissection in the mid-to-lower rectum attributed to angles created by bony confines of the deep pelvis and lack of visibility when constructing the anastomosis. Robotic surgery provides improved 3-dimensional and high-definition visualization of the pelvis and multiple degrees of freedom, which greatly enhance performance during the proctectomy and construction of the anastomosis.

TECHNIQUE:
In the setting of a previous subtotal colectomy, the ileostomy site is taken down and stapled across. A 15-mm balloon trocar is placed in the site to achieve insufflation, and the robotic ports are placed horizontally just above the umbilicus. The lateral mesenteric attachments are mobilized laparoscopically, then the J-pouch is constructed through the ostomy site. The J-pouch is placed back into the abdomen with the anvil in place, and the proctectomy is performed after docking the robot. The rectum is stapled with the robotic stapler and exteriorized from the ileostomy site, and the anastomosis is constructed under direct robotic visualization.

RESULTS:
In addition to the potential ergonomic advantages, the maneuverability and visualization in the pelvis during the proctectomy and construction of the anastomosis are reported by many surgeons to be improved as compared with laparoscopy, especially in male or obese patients.

CONCLUSIONS:
A robotic approach during the proctectomy and IPAA offers significant advantages to a laparoscopic approach, expanding our armamentarium of minimally invasive surgical techniques to IPAA.
Exposure to Community Violence and Self-harm in California
Authors: Matthay Ellicott C. , Farkas Kriszta , Skeem Jennifer , Ahern Jennifer 
Published: June 2018

Background:
Self-harm is a leading cause of morbidity and mortality. Exposure to community violence is an important and potentially modifiable feature of the social environment that may affect self-harm, but studies to date are limited in the samples and outcomes examined.

Methods:
We conducted a population-based, nested case–control study. Cases were all deaths and hospital visits due to self-harm in California, 2006–2013. We frequency-matched California resident population-based controls from the American Community Survey to cases on age, gender, race/ethnicity, and year of survey/injury. We assessed past-year community violence using deaths and hospital visits due to interpersonal violence in the community of residence. We estimated risk difference parameters that were defined to avoid extrapolation and to capture associations between changes in the distribution of community violence and the population-level risk of self-harm.

Results:
After adjustment for confounders, setting past-year community violence to the lowest monthly levels observed within each community over the study period was associated with a 30.1 (95% confidence interval = 29.6, 30.5) per 100,000 persons per year lower risk of nonfatal self-harm but no difference in the risk of fatal self-harm. Associations for a parameter corresponding to a hypothetical violence prevention intervention targeting high-violence communities indicated a 5% decrease in nonfatal self-harm at the population level. In sensitivity analyses, results were robust.

Conclusions:
This study strengthens evidence on the relationship between community violence and self-harm. Future research should investigate reasons for differential associations by age and gender and whether community violence prevention programs have meaningful impacts on self-harm.
Impact of POR and CYP3A5 Polymorphisms on Trough Concentration to Dose Ratio of Tacrolimus in the Early Post-operative Period Following Kidney Transplantation
Authors: Phupradit Annop , Vadcharavivad Somratai , Ingsathit Atiporn , Kantachuvesiri Surasak , Areepium Nutthada , Sra-ium Supasil , Auamnoy Titinun , Sukasem Chonlaphat , Sumethkul Vasant , Kitiyakara Chagriya 
Published: June 2018

Background:
Tacrolimus, a critical dose drug, is widely used in transplantation. Knowing the contribution of genetic factors, which significantly influence tacrolimus variability, is beneficial in the personalization of its starting dose. The significant impact of CYP3A5*3 polymorphisms on tacrolimus exposure has been reported. Conflicting results of the additional influence of POR*28 polymorphisms on tacrolimus pharmacokinetic interindividual variability have been observed among different populations. The objective of this study was to explore the interaction between POR*28 and CYP3A5*3 polymorphisms and their main effects on tacrolimus trough concentration to dose ratios on day 7 after kidney transplantation.

Methods:
Two hundred sixteen adult kidney transplant recipients participated in this retrospective study. All participants received a twice daily tacrolimus regimen. Blood samples and data were collected on day 7 after transplantation. A 2-way analysis of covariance was performed. Tested covariates were age, hemoglobin, serum albumin, and prednisolone dose.

Results:
A 2 × 2 analysis of covariance revealed that the interaction between CYP3A5 polymorphisms (CYP3A5 expresser and CYP3A5 nonexpresser) and POR polymorphisms (POR*28 carrier and POR*28 noncarrier) was not significant (F(1, 209) = 2.473, P = 0.117,

JOURNAL/thdm/04.03/00007691-201810000-00003/inline-formula1/v/2023-08-14T203421Z/r/image-tiff

= 0.012). The predicted main effect of CYP3A5 and POR polymorphisms was significant (F(1, 209) = 105.565, P < 0.001,

JOURNAL/thdm/04.03/00007691-201810000-00003/inline-formula2/v/2023-08-14T203421Z/r/image-tiff

= 0.336 and F(1, 209) = 4.007, P = 0.047,

JOURNAL/thdm/04.03/00007691-201810000-00003/inline-formula3/v/2023-08-14T203421Z/r/image-tiff

= 0.019, respectively). Hemoglobin, age, and steroid dose influenced log C0/dose of tacrolimus (F(1, 209) = 20.612, P < 0.001,

JOURNAL/thdm/04.03/00007691-201810000-00003/inline-formula4/v/2023-08-14T203421Z/r/image-tiff

= 0.090; F(1, 209) = 14.360, P < 0.001,

JOURNAL/thdm/04.03/00007691-201810000-00003/inline-formula5/v/2023-08-14T203421Z/r/image-tiff

= 0.064; and F(1, 209) = 5.512, P = 0.020,

JOURNAL/thdm/04.03/00007691-201810000-00003/inline-formula6/v/2023-08-14T203421Z/r/image-tiff

= 0.026, respectively).

Conclusions:
After adjusting for the influences of hemoglobin, age, and prednisolone dose, significant impacts of the CYP3A5 and POR polymorphisms on tacrolimus exposure were found. The effect of POR*28 and CYP3A5*3 polymorphisms during the very early period after kidney transplantation is independent of each other.
Privately practicing nurse practitioner services in Australia and patient access to care: Results from realist interviews
Authors: Currie Jane , Chiarella Mary , Buckley Thomas 
Published: June 2018

ABSTRACT

Background:
To facilitate the expansion of nurse practitioners working in community and primary health settings, legislative changes were enacted in 2010. These led to privately practicing nurse practitioners (PPNPs) being enabled to provide care subsidized through the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. Little is known about the impact of this legislation on patient access to care in Australia.

Purpose:
To explore how, why and in which contexts PPNP services in Australia impact on patient access to care.

Methods:
Semistructured interviews using realist evaluation were undertaken with 20 participants, selected through stratified sampling using geographic criteria (State/territory in which practicing) and dividing the sample representatively between those who worked solely in private practice and those who worked in both private and public practice. Thematic analysis of qualitative data was undertaken.

Conclusion:
Findings suggest that PPNPs have increased access to care for patients, predominantly in community and primary health settings.

Implications for practice:
In increasing access to care, PPNPs have the potential to reduce hospital and general practitioner attendance, thereby potentially reducing the ever-increasing demand for health care.
Nipple-Sparing Mastectomy Incisions for Cancer Extirpation Prospective Cohort Trial: Perfusion, Complications, and Patient Outcomes
Authors: Odom Elizabeth B. , Parikh Rajiv P. , Um Grace , Kantola Simone W. , Cyr Amy E. , Margenthaler Julie A. , Tenenbaum Marissa M. , Myckatyn Terence M. 
Published: June 2018

Background:
Nipple-sparing mastectomy offers several advantages for women seeking postmastectomy breast reconstruction, but compromised skin and nipple perfusion may lead to skin and nipple necrosis. It is unclear whether the incisional approach contributes to these complications; therefore, the purpose of this study was to compare the impact of incision type on outcomes in patients undergoing nipple-sparing mastectomy.

Methods:
This is a prospective cohort study of patients undergoing nipple-sparing mastectomy with prosthetic breast reconstruction through an inframammary fold versus a lateral radial incision. Skin and nipple perfusion as represented by fluorescence intensity, mammometric parameters, patient-reported outcomes, and clinical outcomes were analyzed and compared for the two cohorts, and multivariable logistic regression models were performed to evaluate the effects of covariates on outcomes.

Results:
Seventy-nine patients were studied: 55 in the inframammary fold cohort and 24 in the lateral radial cohort. The inframammary fold group had significantly less fluorescence intensity to the inferior (21.9 percent versus 36.9 percent; p = 0.001) and lateral portions of breast skin (23.1 percent versus 40.7 percent; p = 0.003) after reconstruction. Decreased fluorescence intensity was associated with smoking, decreased mean arterial pressure, and greater specimen weight. Postreconstruction breast volumes were increased over preoperative volumes in the inframammary fold group (38.3 percent) versus the lateral radial (31.2 percent) group; however, patients with a lateral radial incision had a greater increase in satisfaction with their breasts and psychosocial well-being.

Conclusions:
There are significant differences in patient-reported outcomes and final breast volumes based on the incisional approach to nipple-sparing mastectomy. These data can be used to guide providers and counsel patients considering nipple-sparing mastectomy with prosthetic reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Opioid Use following Outpatient Breast Surgery: Are Physicians Part of the Problem?
Authors: Hart Alexandra M. , Broecker Justine S. , Kao Leslieann , Losken Albert 
Published: June 2018

Background:
The increasing rate of opioid abuse warrants standardization of postoperative pain management. The purpose of this study was to analyze the use of opioids in pain control and patient satisfaction following ambulatory breast surgery.

Methods:
This was a prospective study of a consecutive series of patients undergoing secondary breast reconstruction (n = 60) or breast reduction (n = 35). All patients were given a pain questionnaire preoperatively. Postoperatively, women received 30 tablets of oxycodone 5.0 mg/acetaminophen 325 mg. Patients were contacted three times: postoperative days 3 to 5, 8 to 10, and 30 or higher. All patients were queried on narcotic use, pain level (0 to 10), and satisfaction with pain control. Patients with allergies or taking narcotics preoperatively were excluded.

Results:
Most in the secondary breast reconstruction group (61.5 percent) had stopped taking opioids by postoperative day 5. Patients consumed a mean of 11.4 tablets following secondary breast reconstruction and a mean of 17.5 tablets after breast reduction. A majority reported feeling satisfied with their pain management. At postoperative day greater than 30, most experienced very mild pain, with an improvement of 3.74 points following breast reduction. There were 18.6 and 12.5 tablets per patient left over for secondary breast reconstruction and breast reduction, respectively. A total of 1551 unused tablets were left over for the entire cohort at postoperative day greater than 30. There was no significant difference in average pain scores or interference with enjoyment or activity between those who did or did not take pain medication.

Conclusions:
This commonly prescribed pain regimen provides adequate pain relief and satisfaction for breast surgery, with a substantial number of leftover tablets. Physicians as prescribers should be aware of discrepancies. Prescription of 30 opioid tablets after outpatient breast surgery appears unnecessary and excessive.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Report of 736 High-Definition Lipoabdominoplasties Performed in Conjunction with Circumferential VASER Liposuction
Authors: Hoyos Alfredo , Perez Mauricio E. , Guarin David E. , Montenegro Alvaro 
Published: June 2018

Background:
Several innovations and modifications to the abdominal lipectomy procedure have been performed through the years. Despite recent improvements, the lack of natural results, including high scars, navel deformities, and “tense” abdomen, are still challenging. The objective of this study is to present an alternative technique of combined 360-degree truncal liposuction with abdominal definition, abdominoplasty, and neoumbilicoplasty.

Methods:
From January of 2005 to June of 2017, 736 VASER-assisted lipoabdominoplasties were performed. Only healthy women with a body mass index below 33 were included. A three-step procedure was performed: (1) truncal liposculpture, (2) dermolipectomy and plication of the rectus abdominis muscle, and (3) neoumbilicoplasty through a butterfly technique. The follow-up included photographs and medical assessment with a mean of 2 years (up to 5 years). A nonstandardized survey was performed to self-evaluate the results.

Results:
Six hundred seventy patients answered the survey (91 percent). Six hundred fifteen patients were satisfied with the procedure (91.79 percent). Minor complications were reported: seroma in 7.3 percent, prolonged bruising in 10 percent, and swelling in 18 percent. Neither flap necrosis nor infections were reported. Neoumbilicoplasty was performed in all patients. Additional procedures were required in 4.6 percent.

Conclusions:
Ultrasound-assisted lipoabdominoplasty is an alternative lipectomy technique that prevents stigmata of the procedure. The abdominal definition improves the shape and recreates the superficial anatomy. Neoumbilicoplasty shape, form, and choice of its position over the abdominal wall provide significant improvements in results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Use of Bone Dust to Correct the Open Roof Deformity in Rhinoplasty
Authors: Taş Süleyman 
Published: June 2018

Background:
Hump removal frequently results in an open roof during rhinoplasty, which is conventionally closed with lateral osteotomies. However, if the patient has a narrow bony vault, lateral osteotomies are problematic. In this article, the author presents a new and practical approach to fix the open roof deformity.

Methods:
A total of 240 patients (female, n = 187; male, n = 53) were enrolled and operated on with the presented technique. This approach has four steps, as follows: complete submembranous dissection, preparation of spreader flaps, harvesting of bone dust from the bony hump, and placement of the bone dust. The patient’s nasal dorsum was evaluated by ultrasonography. During the follow-up period, all patients were photographed postoperatively from standard views using a digital camera. Photographs were inspected by two independent plastic surgeons. A palpation test for the nasal dorsum was conducted by a senior surgeon to identify any irregularities. A rhinoplasty outcomes evaluation questionnaire was administered to all patients at a 1-year follow-up visit. Functional improvement was assessed with self-evaluation of nasal patency. The chi-square test was used for statistical analysis.

Results:
Of the 240 patients, 182 completed the 1-year follow-up period and rhinoplasty outcomes evaluation questionnaire. Thirty-seven patients were evaluated by ultrasonography at 1 year postoperatively. During the follow-up period, no resorption or displacement was detected. High patient satisfaction was achieved, and no complications were encountered.

Conclusion:
The presented four-step surgical concept was useful for rhinoplasty surgeons to successfully manage open roof deformity in selected patients.