bluuebunny/crossref_metadata_2025_split huggingface dataset:
Succinylcholine and Intracranial Pressure
Authors: Cottrell James E. 
Published: September 2018

Abstract
Intracranial and Hemodynamic Changes after Succinylcholine Administration in Cats. By Cottrell JE, Hartung J, Giffin JP, and Shwiry B. Anesthesia & Analgesia 1983; 62:1006–9. Reprinted with permission.
Bolus injections of succinylcholine (1.5 mg/kg) significantly increased intracranial pressure (ICP) in cats under normal conditions from control levels of 8 +/- 1 mmHg to 16 +/- 3 mmHg (+/- SEM, P less than 0.01), and in the presence of artificially increased ICP from control levels of 27 +/- 1 mmHg to 47 +/- 4 mmHg (P less than 0.01). These approximately 100% increases in ICP were accompanied by a transitory decrease in mean arterial pressure (approximately 10 s), followed by a 15 to 20% increase (P less than 0.05). Pulmonary arterial pressure increased 20 to 30% (P less than 0.05). These results, when considered in conjunction with results previously obtained in humans, suggest that succinylcholine may be contraindicated in neurosurgical patients.
Intrauterine Device Expulsion After Postpartum Placement
Authors: Jatlaoui Tara C. , Whiteman Maura K. , Jeng Gary , Tepper Naomi K. , Berry-Bibee Erin , Jamieson Denise J. , Marchbanks Polly A. , Curtis Kathryn M. 
Published: September 2018

OBJECTIVE:
To estimate expulsion rates among women with postpartum intrauterine device (IUD) placement by timing of insertion, IUD type, and delivery method.

DATA SOURCES:
We searched PubMed, Cochrane Library, and ClinicalTrials.gov from 1974 to May 2018.

METHODS OF STUDY SELECTION:
We searched databases for any published studies that examined postpartum placement of a copper IUD or levonorgestrel intrauterine system and reported counts of expulsions. We assessed study quality using the U.S. Preventive Services Task Force evidence grading system. We calculated pooled absolute rates of IUD expulsion and estimated adjusted relative risks (RRs) for timing of postpartum placement, delivery method, and IUD type using log-binomial multivariable regression model.

TABULATION, INTEGRATION, AND RESULTS:
We identified 48 level I to II-3 studies of poor to good quality. Pooled rates of expulsion varied by timing of IUD placement, ranging from 1.9% with interval placements (4 weeks postpartum or greater), 10.0% for immediate placements (10 minutes or less after placental delivery), and 29.7% for early placements (greater than 10 minutes to less than 4 weeks postpartum). Immediate and early postpartum placements were associated with increased risk of expulsion compared with interval placement (adjusted RR 7.63, 95% CI 4.31–13.51; adjusted RR 6.17, 95% CI 3.19–11.93, respectively). Postpartum placement less than 4 weeks after vaginal delivery was associated with an increased risk of expulsion compared with cesarean delivery (adjusted RR 5.19, 95% CI 3.85–6.99). Analysis of expulsion rates at less than 4 weeks postpartum also indicated that the levonorgestrel intrauterine system was associated with a higher risk of expulsion (adjusted RR 1.91, 95% CI 1.50–2.43) compared with CuT380A.

CONCLUSION:
Postpartum IUD expulsion rates vary by timing of placement, delivery method, and IUD type. These results can aid in counseling women to make an informed choice about when to initiate their IUD and to help institutions implement postpartum contraception programs.
Trends and Outcomes Associated With Using Long-Acting Opioids During Delivery Hospitalizations
Authors: Duffy Cassandra R. , Wright Jason D. , Landau Ruth , Mourad Mirella J. , Siddiq Zainab , Kern-Goldberger Adina R. , D’Alton Mary E. , Friedman Alexander M. 
Published: September 2018

OBJECTIVE:
To assess trends in use of long-acting opioids during delivery hospitalizations.

METHODS:
The Perspective database, an administrative inpatient database that includes medication receipt, was analyzed to evaluate patterns of long-acting opioid use during delivery hospitalizations from January 2006 through March 2015. Medications evaluated included methadone, formulations including buprenorphine and extended-release formulations of oxycodone, morphine, fentanyl, and other opioids. Temporal trends in use of these medications were determined. Unadjusted and adjusted models evaluating the role of demographic and hospital factors were created evaluating both use of these medications and risk for severe morbidity. Risk for severe morbidity was determined based on Centers for Disease Control and Prevention criteria.

RESULTS:
Our analysis included 2,994,630 delivery hospitalizations meeting study criteria. Over the entire study period, use of long-acting opioids increased significantly from 457 to 844 per 100,000 deliveries. Although buprenorphine and methadone use increased, use of other long-acting opioids decreased. In 2006, methadone and buprenorphine accounted for less than one third of all long-acting opioids used during delivery hospitalizations. By 2015, buprenorphine and methadone represented 73.5% of long-acting opioids used. In adjusted and unadjusted models, risk for severe morbidity was significantly lower with buprenorphine or methadone compared with other long-acting opioids. Restricting the cohort to only women with drug abuse or dependence, risk for severe morbidity was lower with methadone and buprenorphine than without any long-acting opioids.

CONCLUSION:
Increased use of methadone and buprenorphine in this study supports the feasibility of use of these medications during pregnancy and uptake of clinical recommendations for women with opioid use disorder. Use of methadone and buprenorphine is associated with decreased maternal morbidity, although causation cannot be presumed from this study model.
Choice of Prophylactic Antibiotics and Surgical Site Infections After Cesarean Delivery
Authors: Kawakita Tetsuya , Huang Chun-Chih , Landy Helain J. 
Published: September 2018

OBJECTIVE:
To examine the rate of surgical site infection according to the choice of antibiotics in women undergoing cesarean delivery.

METHODS:
We conducted a retrospective cohort study of women undergoing cesarean delivery (labored, unlabored, and scheduled) from 2012 to 2017. Women with chorioamnionitis and those who did not receive any antibiotics were excluded. Our primary outcome was defined a priori as a composite of cellulitis, endometritis, deep wound infection, abdominopelvic abscess, and sepsis. Outcomes were examined according to the choice of antibiotics: cefazolin, a standard alternative (both clindamycin and gentamicin), and inappropriate alternatives (such as clindamycin only). A multivariable logistic regression model was used to calculate the propensity score for each observation, which was the probability of receiving a particular antibiotic regimen. The propensity score-adjusted logistic regression models were conducted to calculate adjusted odds ratios (ORs) and 95% CIs. Firth's penalized likelihood approach was applied to address issues of rare events.

RESULTS:
Among 6,584 selected women, 6,163 (93.6%), 274 (4.2%), and 147 (2.2%) received cefazolin, a standard alternative, and inappropriate alternatives, respectively. Use of standard alternative antibiotics compared with cefazolin was not associated with increased odds of the primary outcome (crude OR 1.50 [0.92–2.46]; adjusted OR 1.63 [0.97–2.60]) but was associated with increased odds of cellulitis (crude OR 2.07 [1.16–3.70]; adjusted OR 1.93 [1.03–3.31]). Use of inappropriate alternative antibiotics compared with cefazolin was associated with increased odds of the primary outcome (crude OR 4.37 [2.80–6.83]; adjusted OR 4.13 [2.59–6.36]) as well as some components of the composite outcome such as endometritis before discharge (crude OR 6.85 [3.94–11.90]; adjusted OR 6.68 [3.69–11.44]) and cellulitis (crude OR 3.36 [1.78–6.34]; adjusted OR 3.23 [1.63–5.81]).

CONCLUSION:
Both standard alternative and inappropriate alternatives were associated with increased odds of surgical site infections compared with cefazolin.
Use of Kratom, an Opioid-like Traditional Herb, in Pregnancy
Authors: Smid Marcela C. , Charles Jasmin E. , Gordon Adam J. , Wright Tricia E. 
Published: September 2018

BACKGROUND:
Kratom (Mitragyna speciosa) is an herbal preparation with opioid-like effects made from a tree native to Southeast Asia and the Pacific Islands. Increasingly, kratom is used for self-treatment of opioid use disorder and recently has been associated with a multistate outbreak of salmonellosis. Few data are available on the clinical outcomes of kratom use in pregnancy.

CASES:
We present two cases of pregnant women presenting with kratom dependence. Both women presented with symptoms consistent with opioid withdrawal. Both women were initiated on opioid replacement, with successful treatment of symptoms.

CONCLUSIONS:
Kratom is an emerging self-treatment for opioid use disorder in the obstetric population. Obstetric care providers should be aware of kratom and consider opioid replacement for pregnant women with kratom dependence.
Intrawound Vancomycin Powder Reduces Bacterial Load in Contaminated Open Fracture Model
Authors: Caroom Cyrus , Moore Dustin , Mudaliar Nithya , Winkler Craig , Murphree Jefferson , Ratheal Ian , Fry Michael , Jenkins Mark , Tullar Jessica , Hamood Abdul 
Published: September 2018

Objectives:
To compare the effectiveness of both vancomycin powder and antibiotic bead placement to irrigation and debridement alone in prevention of infection in a contaminated open fracture model in rats.

Methods:
In a previously described model of contaminated open fractures, 45 rats had simulated open fractures created, stabilized, and contaminated with Staphylococcus aureus. They were then treated 6 hours later with 3 interventions: irrigation and debridement alone (control group) or in combination with placement of polymethyl methacrylate beads containing vancomycin and tobramycin powders (antibiotic bead group) or placement of 10 mg of intrawound vancomycin powder (powder group). Rats were allowed to recover and then killed 14 days later for harvest of femurs and plates. Femurs and plates were both incubated overnight, and bacterial colonies were counted in each group for comparison.

Results:
Quantitative counts of bacteria in bone showed significantly reduced growth in both bead and powder groups when compared with control group (P < 0.0001). Quantitative counts of bacteria in plates showed significantly reduced growth in both bead and powder groups when compared with control group (P < 0.0003; 0.029). No significant differences were seen in bacterial growth between bead and powder groups for either bones (P = 0.13) or plates (P = 0.065).

Conclusions:
When compared with irrigation and debridement alone, placement of intrawound vancomycin powder significantly decreased bacterial load in a contaminated open fracture model in rats similar to placing antibiotic beads. This may provide an additional adjuvant treatment that does not require a secondary surgery for bead removal.
Validation of Neck-Shaft Angle Correction After Cephalomedullary Nail Fixation
Authors: Parry Joshua A. , Barrett Ian , Schoch Bradley , Cross William , Yuan Brandon 
Published: September 2018

Objectives:
To validate a neck-shaft angle (NSA) correction formula using the known angle between the medullary nail and lag screw of an indwelling cephalomedullary nail (CMN).

Methods:
Pertrochanteric femur fractures were created in 7 synthetic femurs and reconstructed with a CMN. Anteroposterior x-rays were taken with the proximal femur in 0, 15, 30, and 45 degrees of internal/external rotation and 10 and 20 degrees of flexion with neutral rotation. The femoral NSA and the nail angle were measured on anteroposterior x-rays. The corrected NSA was obtained by multiplying the known nail angle by the quotient of the measured NSA over the measured nail angle.

Results:
With increasing degrees of internal or external rotation, the difference between the actual and the measured NSA increased. After correction using the known angle of the nail, the measured NSA was reduced to within 3 degrees of the actual NSA over all degrees of rotation. At neutral rotation, 15 degrees of external rotation, and 10 and 20 degrees of hip flexion, there was minimal difference between the actual NSA and the measured NSA, negating the effect of the correction formula.

Conclusions:
The measured NSA after CMN of intertrochanteric fractures is altered by hip rotation. This study validates the correction formula, which determines this difference by using the known angle between the lag screw and the nail.
Clinical Research Course for International Orthopaedic Surgeons: 2-Year Outcomes
Authors: Wu Hao-Hua , Ibrahim John , Conway Devin , Liu Max , Morshed Saam , Miclau Theodore , Coughlin Ralph Richard , Shearer David W. 
Published: September 2018

Background:
Although orthopaedic trauma occurs at higher rates in low- and middle-income countries (LMICs), most research on this topic is conducted in high-resource settings. Few initiatives exist to promote local research in LMICs. Investigators created the Institute for Global Orthopaedics and Traumatology (IGOT) International Research Symposium to promote local research initiatives by surgeons practicing in low-resource environments. The purpose of this study is to determine the efficacy of this symposium in teaching orthopaedic surgeons practicing in LMICs how to conduct clinical research.

Methods:
In this prospective observational study, orthopaedic surgeons from LMICs with no formal research training were recruited to attend the 1-day IGOT International Research Symposium in San Francisco. A survey was administered immediately before and after the symposium to inquire about the participants' confidence in different aspects related to research using a 1–5 Likert scale. A second survey, conducted 2 years later, recorded the attendees' research productivity after the workshop.

Results:
Forty-three participants representing 10 different LMICs from Africa and Asia attended the 2013 course. At 2 year postcourse, participants reported starting 25 research projects, authored 7 “accepted or published manuscripts” (vs. 1 before the course; P < 0.01), and were selected for 12 podium or poster presentations (vs. 3 before the course; P < 0.01). Two research symposium attendees received “Top International Forum Paper” at the 2015 Orthopaedic Trauma Association Annual Meeting.

Discussion:
A 1-day research course resulted in increased participant confidence in conducting research. This was associated with greater research productivity by participants 2 years later. These results suggest that the IGOT International Research Symposium can improve the number of initiated research projects by surgeons in LMICs.
Orthopaedic Trauma in the Developing World: Where Are the Gaps in Research and What Can Be Done?
Authors: Challa Sravya , Wu Hao-Hua , Cunningham Brian P. , Liu Max , Patel Kushal , Shearer David W. , Morshed Saam , Miclau Theodore 
Published: September 2018

Purpose:
There are an estimated 1.2 million deaths from road traffic injuries annually, disproportionately affecting patients in low-resource settings. The purpose of this scoping review is to identify knowledge gaps in global orthopaedic trauma in an effort to help prioritize future research.

Methods:
Using the 6-stage Arksey and O'Malley framework for conducting a scoping review, orthopaedic trauma literature was reviewed over a ten-year period from 2004 to 2014. Studies from low-resource settings were included and categorized by geographic location, anatomic region, study type, and level of evidence.

Results:
Of 548 included studies, 51.4% were from low- and middle-income countries in South Asia and 33.7% were from sub-Saharan Africa. Therapeutic (53.3%), epidemiologic (26.4%), and qualitative (8.9%) studies were most common. Only 10.2% of the studies were considered high level of evidence, whereas the vast majority (89.8%) was level 3 or below. Overall, lower extremity injuries were much more frequently represented in the literature compared with upper extremity injuries (233 vs. 78). Pelvic and acetabular fractures were the least studied anatomic region of the lower extremity (3.4%).

Conclusions:
Our study identified a lack of cost-effectiveness analyses pertaining to injury and intervention, paucity of high-quality research, and under-representation of pelvic, acetabular, and upper extremity injuries. Improved and prioritized research in low- and middle-income countries may help optimize care and inform policy makers of how to reduce the global burden of musculoskeletal trauma.
The Effect of Preoperative Symptom Duration on Postoperative Outcomes After a Tubular Lumbar Microdiscectomy
Authors: Basques Bryce A. , Haws Brittany E. , Khechen Benjamin , Louie Philip K. , Patel Dil V. , Bawa Mundeep S. , Movassaghi Kamran , Cardinal Kaitlyn L. , Guntin Jordan A. , Singh Kern 
Published: September 2018

Study Design:
This is a retrospective cohort study.

Objective:
This study aims to characterize the effect of preoperative symptom duration on postoperative outcomes after minimally invasive lumbar microdiscectomy (MIS LD).

Summary of Background Data:
It is unknown whether extended nonoperative treatment before MIS LD has implications for long-term clinical outcomes even after surgery is performed.

Materials and Methods:
A prospectively maintained surgical registry of patients undergoing MIS LD by a single surgeon between 2013 and 2017 was reviewed. Preoperative symptom duration was dichotomized into 2 groups (≤6 and >6 mo). Only patients with full clinical data at 6 months postoperative follow-up were included in the study. Clinical outcomes were assessed at 6, 12 weeks, and 6 months after surgery. The number of patients obtaining a minimum clinically important difference was assessed. Groups were compared with the χ2 analysis and the student t tests for categorical and continuous data, respectively.

Results:
In total, 94 patients were identified. A total of 45 patients (47.9%) had symptom duration ≤6 months. No differences in baseline characteristics were found (P>0.05). Patients with shorter symptom duration had significantly greater improvement in Oswestry Disability Index scores at 6 weeks (P=0.004), 12 weeks (P=0.022), and 6 months (P=0.005). Patients with shorter duration of symptoms also obtained minimum clinically important difference for Oswestry Disability Index at a greater rate than those with longer duration of symptoms (P=0.015).

Conclusions:
Although patients who underwent MIS LD within 6 months of symptom onset had similar baseline characteristics compared with patients who underwent surgery after 6 months of symptoms, the patients with longer preoperative symptom duration had worse functional outcomes at 6 months after surgery. These results suggest that earlier MIS lumbar microdiscectomy may provide a functional benefit for patients. Further studies should therefore evaluate the efficacy of nonoperative treatment in the setting of lumbar herniated nucleus pulposus, as prolonged conservative management may potentially impair functional recovery after surgery.
Computer-Based Video Instruction for Training Medical Students on Skin Biopsies
Authors: Cervantes Jose , Costello Collin M. , Maarouf Melody , Kurtzman Drew J.B. , Shi Vivian Y. 
Published: September 2018

BACKGROUND
The development of procedural skills is necessary for medical students. Computer-based video instruction (CBVI) increases knowledge and procedural skills.

OBJECTIVE
This pilot study's aim was to investigate the usefulness of CBVI in dermatologic procedure training for medical students and secondarily assess students' overall perception of the field of dermatology.

METHODS
Twenty-nine first- and second-year medical students were randomly assigned to the CVBI group or control group, in addition to in-person instructor demonstration of shave and punch biopsies using fresh cadaver tissue. Blinded evaluators graded student performances using a five-point Likert scale immediately after demonstration, and 1 week later to assess knowledge retention.

RESULTS
In overall performance, the CBVI group demonstrated higher scores both in shave (3.54 vs 2.59, p = .01) and punch biopsies (3.63 vs 2.88, p = .01) at immediate recall and knowledge retention (3.68 vs 2.67, p = .01; 4.00 vs 2.99, p < .001, respectively). Approximately 33.3% of the students stated that the experience increased their interest in the field of dermatology.

CONCLUSION
Incorporation of CBVI into the dermatology curriculum augments medical students' procedural skills. The CBVI group performed significantly better in all 7 grading categories for shave biopsy and in 5 of 7 categories for punch biopsy. Integration of procedural laboratory tests raises students' interest in dermatology.
Epidermolysis Bullosa Patients' Perception of Surgical Wound and Scar Healing
Authors: Harris Adam G. , Saikal Samra L. , Murrell Dedee F. 
Published: September 2018

BACKGROUND
There is limited evidence to suggest patients with epidermolysis bullosa (EB) have more postoperative wound complications than the general population. Despite this, the authors have noted reluctance among some surgeons to operate on these patients.

OBJECTIVE
A cross-sectional study was designed to investigate postoperative wound and scar healing outcomes in patients with EB.

METHODS
Patients were asked to complete the “Surgical Wound and Scar Healing in EB” questionnaire, and data gathered were analyzed.

RESULTS
Forty-six patients completed the questionnaire for a total of 94 different surgical procedures. Five patients reported blistering at the surgical wound site. All 5 had generalized forms of EB. Four patients reported wound infections, and 1 patient reported wound dehiscence. The postoperative scar healed with keloid or hypertrophic scarring after 26% of the reported surgical procedures.

CONCLUSION
Blistering at the postoperative site seems to be uncommon and particularly unlikely to occur in localized forms of EB. Postoperative wound infections and dehiscence are uncommon. Patients with EB may have a propensity to develop keloid or hypertrophic scarring. With these data, the authors hope clinicians have greater confidence in referring patients with EB for surgery, and surgeons more reassured about postoperative wound healing.
Short-term Efficacy and Safety of a Latanoprost/Carteolol Fixed Combination Switched From Concomitant Therapy to in Patients With Primary Open-angle Glaucoma or Ocular Hypertension
Authors: Inoue Kenji , Shiokawa Minako , Iwasa Mayumi , Ishida Kyoko , Tomita Goji 
Published: September 2018

Purpose:
We prospectively investigated the efficacy and safety of switching from concomitant latanoprost and carteolol hydrochloride (CH) to a latanoprost/carteolol fixed combination (LCFC) in patients with primary open-angle glaucoma or ocular hypertension.

Patients and Methods:
A total of 43 patients (43 eyes) who were using latanoprost (once daily in the evening) and CH (once daily in the morning) concomitantly were switched to LCFC (once daily in the morning) with no washout interval. The primary efficacy endpoint was change in intraocular pressure (IOP) between baseline (before switching) and 1 and 3 months after switching. Systemic blood pressure and pulse rate, corneal epithelial defects, and tear film break-up time (TBUT) were also compared before and 1 and 3 months after switching. A questionnaire was administered 1 month after switching to investigate ocular comfort and treatment preferences. Adverse reactions and dropouts were recorded.

Results:
There was no significant difference in IOP after switching to LCFC (15.0±2.6, 15.1±2.4, and 15.0±2.4 mm Hg at baseline and at 1 and 3 months, respectively). There was a significant decrease in corneal epithelial defects and significant increase in TBUT, without significant changes in systemic blood pressure or pulse rate. Three patients (7.3%) preferred concomitant latanoprost and CH; 33 (80.5%) preferred the LCFC. One patient each (9.3%) discontinued treatment because of foreign body sensation, blepharitis, increased IOP, or loss to follow-up.

Conclusions:
Switching from concomitant latanoprost and CH to LCFC led to similar IOP control with good safety and patient acceptance, at least in the short term.