bluuebunny/crossref_metadata_2025_split huggingface dataset:
I. ALTERNATIVE METHODS OF ANALGESIA Preoperative Cesarean Delivery Intravenous Acetaminophen Treatment for Postoperative Pain Control: A Randomized Double-blinded Placebo Control Trial
Authors: Towers C.V. , Shelton S. , van Nes J. , Gregory E. , Liske E. , Smalley A. , Mobley E. , Faircloth B. , Fortner K.B. 
Published: November 2018

(Am J Obstet Gynecol. 2018;218:353.e1–353.e4)
Most patients first encounter opioid medications after surgery or during an acute pain episode. The ongoing opioid use disorder epidemic in the United States has prompted research to minimize opioid treatment in the postsurgical setting. Nonobstetrical studies have reported improved pain scores and decreased opioid use after surgery with the preoperative administration of intravenous (IV) acetaminophen. The primary outcome in the current study was to examine if maternal opioid use was significantly less in the postoperative period when preoperative IV acetaminophen was given. Secondary outcomes included hospital length of stay, pain scores, and cord blood acetaminophen levels.
II. REGIONAL ANALGESIA Dose-Response Curves for Intrathecal Bupivacaine, Levobupivacaine and Ropivacaine Given for Labor Analgesia in Nulliparous Women
Authors: Ngan Kee W.D. , Ng F.F. , Khaw K.S. , Tang S.P.Y. , Koo A.G.P. 
Published: November 2018

(Reg Anesth Pain Med. 2017;42(6):788–792)
As part of the combined spinal-epidural (CSE) technique, bupivacaine, levobupivacaine and ropivacaine are often administered intrathecally to establish labor analgesia with a rapid onset of action. Data on the dose-response relationships of bupivacaine, levobupivacaine and ropivacaine for this purpose are limited. This double-blind, random allocation, graded dose-response study aimed to describe dose-response curves for the intrathecal use of these drugs.
Pharmacokinetics of Levobupivacaine With Epinephrine in Transversus Abdominis Plane Block for Postoperative Analgesia After Caesarean Section
Authors: Lacassie H.J. , Rolle A. , Cortínez L.I. , Solari S. , Corvetto M.A. , Altermatt F.R. 
Published: November 2018

(Br J Anaesth. 2018;121:469–475)
Transversus abdominis plane (TAP) block is a technique that provides postcesarean section analgesia and serves as a reasonable alternative for patients who are unable to receive neuraxial morphine. However, it often requires large volumes of local anesthetic, such as levobupivacaine, which has raised concerns about local anesthetic toxicity. Currently, there is a scarcity of information on levobupivacaine pharmacokinetics (PK) after TAP block in pregnant patients. The authors of the present study thus generated a PK model derived with data from pregnant patients after cesarean section and in healthy volunteers and compared levobupivacaine with epinephrine disposition after TAP block in both populations.
Tobacco use results in inferior outcomes after anatomic total shoulder arthroplasty
Authors: Walters Jordan D. , George L. Watson , Wan Jim Y. , Brolin Tyler J. , Azar Frederick M. , Throckmorton Thomas W. 
Published: November 2018

Background:
This study examined the effect of tobacco use on outcomes of primary anatomic total shoulder arthroplasty (TSA).

Methods:
A retrospective search identified 59 nonsmokers, 29 former smokers, and 14 current smokers with primary anatomic TSA and at least 2 yr of follow-up. At mean follow-up of 3 yr, patients were assessed with a visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores and range-of-motion testing.

Results:
Smokers were significantly younger than nonsmokers or former smokers; there were no other statistically significant differences. VAS scores were significantly higher in current smokers and ASES scores were significantly lower. Complication rates were 36% in current smokers, 15% in nonsmokers, and 7% in former smokers (P = 0.05).

Conclusions:
Current smokers had significantly worse pain and functional scores and more complications. Former smokers had results similar to nonsmokers, suggesting improved outcomes are possible in patients who quit smoking preoperatively.
Operative Reduction for Developmental Dysplasia of the Hip: Epidemiology Over 16 Years
Authors: Nelson Susan E. , DeFrancesco Christopher J. , Sankar Wudbhav N. 
Published: November 2018

Background:
The burden of surgical treatment for infantile developmental dysplasia of the hip (DDH) is unknown. We aimed to investigate the epidemiology of operative DDH reductions in the United States and identify potential at-risk populations.

Methods:
The Healthcare Utilization Project Kids’ Inpatient Database (1997 to 2012) were analyzed. International Classification of Diseases (ICD-9) codes identified inpatient hospitalizations for DDH reductions excluding neuromuscular cases. Hospital variables and patient demographics were captured. Weighted population-level counts were calculated to allow for national estimates.

Results:
An estimated 5525 (95% confidence interval, 4907.8-6142.2) operative reductions were performed. In total, 73.3% were open with a mean age at the reduction of 2.3 years (95% confidence interval, 2.1-2.5). In total, 70.0% were female and 42.3% were white. Regional distribution varied: 36.4% of reductions occurred in the West, 22.8% in the South, 21.9% in the Midwest, and 18.9% in the Northeast. Operative reductions decreased over time; open reductions decreased by 5.6% and closed by 53.4%. Mean age at treatment increased from 1.6 to 3.7 years (P<0.001). On multivariate analysis, age (P<0.001) and geographic location (P<0.05) were associated with open reduction. Patients in the West had increased odds of being Hispanic or Asian/Pacific Islander [odds ratio (OR), 4.9, P<0.001 and OR, 2.8; P=0.008]. In the South and Midwest, the highest income quartile was protective (OR, 0.4; P=0.001 and OR, 0.5; P=0.018).

Conclusions:
The frequency of closed reductions decreased more over time compared with open reductions. However, the mean age of children undergoing reductions increased suggesting a possible delay in diagnosis. The data suggests that there is room for improvement in screening. Targeted research in identified populations may reduce the burden of surgical disease in infantile DDH.

Level of Evidence:
Level III.
The Spatial Order of Physeal Maturation in the Normal Human Knee Using Magnetic Resonance Imaging
Authors: Margalit Adam , Cottrill Ethan , Nhan Derek , Yu Lingjia , Tang Xin , Fritz Jan , Lee R. Jay 
Published: November 2018

Background:
The spatial order of physeal maturation around the distal tibia has been shown to place adolescent patients at risk for certain transitional injuries, such as Tillaux or triplane fractures. Less is known about physeal maturation around the knee. The purpose of this study was to establish the spatial order of physeal maturation in the normal human knee using magnetic resonance imaging (MRI).

Methods:
We retrospectively collected all knee MRI scans from patients presenting to our institution from January 2004 to January 2014. Patients who were suspected on the basis of clinical or radiographic findings of having abnormal knee physeal development or injury were excluded. We then applied a previously described MRI staging system of knee physeal maturation to the MRI scans of the remaining patients at 8 defined knee locations. Associations between the stage of maturation and mean chronological age were then evaluated across the 8 knee locations. Interrater and intrarater reliabilities were assessed.

Results:
A total of 165 knee MRI scans (from 98 boys, 67 girls) met the inclusion criteria. Significant differences were found between each stage of physeal maturation and the mean chronological ages at all 8 knee locations for both boys and girls (each, P<0.001). Interestingly, within each stage of physeal maturation, no significant difference was found in the mean chronological ages at any of the 8 knee locations, suggesting that physeal development occurs uniformly in the normal human knee for both boys and girls. Interrater and intrarater reliability were nearly perfect at all locations.

Conclusions:
The spatial order of physeal maturation in the normal human knee was uniform across 8 knee locations for both boys and girls. This uniformity may help to explain why transitional injuries do not follow a recognizable pattern in the knee. Furthermore, the uniformity aids with surgical decision making, because minimal growth modulation or disturbance is likely when early physeal closure is present in a portion of the physis.

Level of Evidence:
Level III.
High Correlation Between Achieved and Expected Distraction Using Magnetically Controlled Growth Rods (MCGR) With Rib to Pelvis Fixation in Pediatric Spine Deformity
Authors: Lorenz Heiko M. , Braunschweig Lena , Badwan Batoul , Groenefeld Katharina , Hecker Marina M. , Tsaknakis Konstantinos , Grote Jasmin , Hell Anna K. 
Published: November 2018

Purpose:
Magnetically controlled implant systems have been established to treat severe progressive spinal deformity in children. The purpose of this study was to evaluate (1) the ratio between achieved and expected distraction length, (2) the complication rate and its risk factors as well as (3) the correlation of the distraction length and the length of the spine.

Methods:
A total of 40 patients with an average follow-up of 34 (14 to 57) months were prospectively included in the study. Children underwent lengthening procedures every three months. The ratio between the distraction lengths was determined by comparing the measured distraction length of the rod on radiographs with the distraction length displayed on the external remote controller for the magnetically controlled growing rod (MCGR). Age, weight, height, and complications were repeatedly recorded.

Results:
The analysis of 746 procedures showed the actual distraction to be 94.4% of the expected one. No difference between implants on the concave and convex spinal side was observed. The overall complication rate was 4.6% mainly because of failure of the implant or lack of implant extension, which was directly related to an increased BMI. There was also a strong correlation between achieved implant distraction length and gain in spinal length.

Conclusions:
Our study demonstrates a high ratio (0.94) between achieved and expected distraction length of magnetically controlled spinal rods. The complication rate was low (4.6%) and correlated to a high BMI. The correlation between the achieved implant distraction length and spinal length indicates the efficiency of the MCGR therapy.

Level of Evidence:
Therapeutic Level IV.
A Classification System for Spinal Cord Compression and its Association With Neurological Deficit in Spinal Epidural Abscess
Authors: Shah Akash A. , Yang Huiliang , Harris Mitchel B. , Schwab Joseph H. 
Published: November 2018

Study Design:
This was a retrospective case-control study.

Objective:
We aim to describe a novel 5-point grading system to determine the degree and severity of spinal cord compression secondary to a spinal epidural abscess (SEA). Secondarily, we aim to correlate the degree of compression with clinical presentation and outcomes.

Summary of Background Data:
Mechanical compression plays an important role in the pathophysiology of neurological dysfunction in SEA. Unfortunately, no standardized classification system for describing the degree of spinal cord compression exists. The lack of a validated grading system makes it challenging to study and consistently report the relationship between cord compression and clinical presentation/outcomes in SEA.

Materials and Methods:
Patients 18 years and older admitted to our hospital system with a diagnosis of SEA located above the conus medullaris between 1993 and 2016 were included. Using pretreatment axial magnetic resonance images, we developed a 5-point classification scale to determine the degree of spinal cord compression. After assigning a compression grade to each abscess, we investigated the relationship between the degree of compression and presenting neurological symptoms. Furthermore, we assessed the association between compression grade and clinical outcomes.

Results:
Three hundred thirty-nine patients were included in the study. Patients with high-grade cord compression (grades 4 and 5) were significantly more likely to present with pretreatment motor deficit, sensory changes, and bowel/bladder incontinence. With respect to clinical outcomes, increasing degree of compression was not associated with failure of nonoperative management, residual motor deficit, or 90-day mortality.

Conclusions:
We report a novel grading system for spinal cord compression in SEA with 5 progressively increasing grades of compression. High-grade abscesses with cord compression were significantly associated with neurological deficit at presentation but not with poor outcomes. We hope that this classification system will allow for greater consistency in reporting the association between cord compression and neurological deficit in SEA.
Accelerated Hypofractionated Radiation Therapy for Elderly Frail Bladder Cancer Patients Unfit for Surgery or Chemotherapy
Authors: Hammer Liat , Laufer Menahem , Dotan Zohar , Leibowitz-Amit Raya , Berger Raanan , Felder Shira , Weiss Ilana , Lawrence Yaacov Richard , Symon Zvi 
Published: November 2018

Purpose/Objectives:
The main purpose of this study was to report treatment outcomes of definitive image-guided accelerated hypofractionated radiation therapy for elderly patients with muscle-invasive bladder cancer unsuitable for surgery or trimodality therapy.

Materials and Methods:
Patients with confirmed muscle-invasive or high-risk T1 transitional cell carcinoma of the bladder, stage T1-T4aN0M0, who underwent transurethral resection of bladder tumor were irradiated with 45 Gy in 15 fractions. Comorbidity was assessed by Charlson Comorbidity Index. Cystoscopy, cytology, and computerised tomography imaging were used to evaluate treatment outcomes.

Results:
Seventeen patients with a median age of 87 (range, 81 to 95) years and age-adjusted Charlson Comorbidity Index ≥3 were included. Transurethral resection of bladder tumor was incomplete in 65%. Radiation technique evolved from 3-dimensional conformal radiotherapy (3D CRT, 47%) to volumetric modulated arc therapy (VMAT, 53%). Ninety-four percent completed radiotherapy, with a median time of 20 days. The median follow-up was 65.3 months. Complete local response at 3-month cystoscopy was 69%. Six patients developed a local recurrence (35%), and 2 patients developed distant metastases (11.7%). Overall survival at 1 year was 47% and 23% at 2 years. Cancer-specific survival at 1 and 2 years were 85% and 63%, respectively. Acute grade 3 gastrointestinal or genitourinary toxicities were 6% and 24%, respectively. No grade 4 toxicity was documented. Diarrhea of any grade occurred in 35% of patients treated with 3D CRT, but in none of the patients treated with VMAT (P=0.002).

Conclusions:
Accelerated hypofractionated radiotherapy alone provides good local control in elderly patients unfit for chemoradiotherapy. Contemporary radiation techniques such as VMAT were associated with reduced bowel toxicity compared with 3D CRT.
A Qualitative Comparison of Caregiver and Youth with Autism Perceptions of Sexuality and Relationship Experiences
Authors: Teti Michelle , Cheak-Zamora Nancy , Bauerband L. A. , Maurer-Batjer Anna 
Published: November 2018

ABSTRACT:

Objectives:
Caregivers play a critical role in educating their youth with autism about sex and relationships; yet, we know little about caregivers' ability to deliver this support, youth's perspectives, or the congruence of youth and caregiver experiences. To help fill this gap, we explored and compared the perspectives of caregivers and their youth with autism spectrum disorder about and interactions regarding sex and relationships.

Methods:
We conducted qualitative one-on-one interviews with youth (n = 27) and focus groups with their caregivers (n = 29). A semi-structured guide elicited information from both the groups about the youth's physical, emotional, and social transition to adulthood. Thematic analysis, including coding and analytical memos, identified key themes within and across youth and caregiver discussions about sex and relationships.

Results:
Thematic analysis of interviews revealed overarching themes about companionship, interest and experience, and access to sexual information across both the groups. Themes included different nuances among caregivers and youth, however. Caregivers expressed more future-oriented concerns than youth and overestimated their knowledge of their youth's interest and experience with sex and comfort confiding in caregivers. Youth described relationships and information sources of which their caregivers were unaware.

Conclusion:
Interventions for both caregivers and youth can support healthy and safe intimate relationships among youth with autism spectrum disorder. By comparing youth and caregiver dialogues, this study adds to what we know, and it can be used to develop a blueprint for improving communication patterns that not only include but also extend well beyond sexual health.
Accuracy of Anal Cytology for Diagnostic of Precursor Lesions of Anal Cancer: Systematic Review and Meta-analysis
Authors: Gonçalves João Carlos N. , Macedo Ana C. L. , Madeira Kristian , Bavaresco Daniela Vicente , Dondossola Eduardo Ronconi , Grande Antônio José , da Rosa Maria Inês 
Published: November 2018

BACKGROUND:
Anal canal carcinoma is relevant because it commonly occurs in high-risk groups, and its incidence has been increasing.

OBJECTIVE:
This study evaluated the accuracy of anal cytology in the screening of precursor lesions of anal cancer, compared with histopathologic examination as the reference, in all subjects and in men who have sex with men, HIV-infected men and women, and men who have sex with men and HIV-infected subgroups.

DATA SOURCES:
The data included studies identified in the MEDLINE, Latin American and Caribbean Health Sciences, Cochrane Library, and Embase electronic databases, as well as in the grey literature. The search terms included anal cancer, anal dysplasia, anal intraepithelial neoplasia, screening, and anal cytology.

STUDY SELECTION:
After excluding studies with no histopathological data and those with duplicate and missing data, 34 primary studies were included.

INTERVENTION:
Cytology of anal smears was studied.

MAIN OUTCOME MEASURES:
Sensitivity, specificity, diagnostic OR, and area under the curve were measured.

RESULTS:
A total of 5093 patients were included. The pooled sensitivity of anal cytology was 85.0% (95% CI, 82.0%–87.0%) and pooled specificity was 43.2% (95% CI, 41.4%–45.1%) for the detection of anal intraepithelial neoplasia grade 2 or worse versus anal intraepithelial neoplasia grade 1 and normal when measuring all subjects. The accuracy of anal cytology was higher in the men who have sex with men and HIV-infected and men who have sex with men only subgroups.

LIMITATIONS:
This study was limited by its specificity.

CONCLUSIONS:
The study results support the hypothesis that cytology is a good test for the screening of anal cancer.
Conditional Probability of Survival After Neoadjuvant Chemoradiation and Proctectomy for Rectal Cancer: What Matters and When
Authors: Karagkounis Georgios , Liska David , Kalady Matthew F. 
Published: November 2018

BACKGROUND:
Disease-free survival estimated from the time of surgery does not account for the changing likelihood of survival based on time already accrued. Conditional disease-free survival is defined as the probability of remaining disease free after reaching a specific time point without recurrence.

OBJECTIVE:
The purpose of this study was to evaluate conditional disease-free survival for patients with rectal cancer who were treated by proctectomy after neoadjuvant chemoradiation.

DESIGN:
Demographics, tumor characteristics, and tumor regression scores were assessed. Three-year conditional disease-free survival was estimated at x year after surgery based on the formula cDFS3 = DFS(x+3)/DFS(x), where DFS is disease-free survival and cDFS is conditional disease-free survival. Analyses were performed using Cox proportional hazards models.

SETTING:
The study was conducted at a single tertiary referral center.

PATIENTS:
A total of 545 patients with rectal cancer who were treated by neoadjuvant chemoradiation and curative intent surgery between 1992 and 2012 were included.

MAIN OUTCOME MEASURES:
Disease-free survival and conditional disease-free survival were measured.

RESULTS:
The median patient age was 57.5 years, and 28.4% were women. Median follow-up was 5.9 years. Disease-free survival at 1, 3, and 5 years was 89%, 71%, and 63%. The probability of remaining disease free for an additional 3 years for patients disease free at 1, 3, and 5 years was 75%, 83%, and 82%. Tumor regression, pathologic stage, margin status, differentiation, and procedure (low anterior versus abdominoperineal resection) were associated with disease-free survival on multivariable analysis (p < 0.05), but their relevance varied over time. R1 resection and differentiation were initially significant but not at 5 years. In contrast, tumor regression after neoadjuvant chemoradiation had a long-lasting impact on survival (at 5 y, conditional disease-free survival for an additional 3 y: 91%, 85%, 76%, and 71% for regression scores 0, 1, 2, and 3; p = 0.002).

LIMITATIONS:
This was a retrospective study over 20 years, with evolution in adjuvant therapies during this time.

CONCLUSIONS:
Conditional disease-free survival estimates improved over time, confirming that most patients will see a recurrence within the first few years. The impact of specific prognostic factors evolves variably over time. This information is useful to patients and providers and can help guide counseling and surveillance. See Video Abstract at http://links.lww.com/DCR/A771.