bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ondansetron Does Not Reduce Withdrawal in Patients With Physical Dependence on Chronic Opioid Therapy
Authors: Chu Larry F. , Sun John , Clemenson Anna , Erlendson Matthew J. , Rico Tom , Cornell Erika , Obasi Hannah , Sayyid Zahra N. , Encisco Ellen M. , Yu Jeff , Gamble Jamison G. , Carroll Ian , Clark J. David 
Published: May 2017

Objectives:
Individuals taking opioids for an extended period of time may become physically dependent, and will therefore experience opioid withdrawal should they stop taking the medication. Previous work in animal and human models has shown that the serotonin (5-HT3) receptor may be implicated in opioid withdrawal. In this study, we investigated if ondansetron, a 5-HT3-receptor antagonist, could reduce the symptoms of opioid withdrawal after chronic opioid exposure in humans.

Methods:
In this double-blinded, randomized, crossover study, 33 chronic back pain patients (N = 33) were titrated onto sustained-release oral morphine for 30 days. After titration, participants attended 2 study sessions, 1 week apart, in which opioid withdrawal was induced with intravenous naloxone, with or without 8 mg intravenous ondansetron pretreatment. Opioid withdrawal symptoms were assessed by a blinded research assistant (objective opioid withdrawal score [OOWS]) and by the research participant (subjective opioid withdrawal score [SOWS]).

Results:
Clinically significant signs of withdrawal were observed during both the ondansetron (ΔOOWS = 3.58 ± 2.22, P < 0.0001; ΔSOWS = 12.48 ± 11.18, P < 0.0001) and placebo sessions (ΔOOWS = 3.55 ± 2.39, P < 0.0001; ΔSOWS = 12.21 ± 10.72, P < 0.0001), but no significant differences were seen between the treatment sessions in either the OOWS or SOWS scores.

Conclusion:
We hypothesized that ondansetron would reduce opioid withdrawal symptoms in human subjects, but found no difference in withdrawal severity between ondansetron and placebo sessions. These findings suggest that more investigation may be necessary to determine if 5-HT3-receptor antagonists are suitable treatment options for opioid withdrawal.
Phrenic Nerve Palsy and Regional Anesthesia for Shoulder Surgery
Authors: El-Boghdadly Kariem , Chin Ki Jinn , Chan Vincent W. S. 
Published: May 2017

Abstract
Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5–C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.
Associations Between Parental Factors and Child Diabetes-Management–Related Behaviors
Authors: Lohan Aditi , Morawska Alina , Mitchell Amy 
Published: May 2017

ABSTRACT:

Objective:
Adherence to diabetes-management regimens in children requires teamwork and consistency from both parents and children. This study investigated a mediational model developed to understand the relationship between different modifiable parent factors influencing child diabetes-related behaviors.

Methods:
We recruited 186 parents of children aged 2 to 10 years with Type 1 diabetes to complete self-report questionnaires on child diabetes behavior, parental self-efficacy with managing the child's behavior, parent diabetes self-efficacy, parent adjustment, condition management effort, parent perception of their diabetes knowledge, and parenting behavior. We used structural equation modeling in AMOS to test our hypothesized model of interrelationships between variables associated with child diabetes behavior.

Results:
The hypothesized model provided good fit to the data. We found that parent perception of low levels of diabetes knowledge and higher levels of condition management effort, and parent adjustment difficulties were associated with lower parental self-efficacy with diabetes management. This was further linked with lower levels of parental self-efficacy with managing their child's diabetes behavior, and consequently, higher extent of child diabetes behavior problems. Contrary to our expectations, we did not find a significant effect of parenting behavior on child diabetes behavior problems, either directly or indirectly via parent self-efficacy for managing child's behavior.

Conclusion:
Our findings shed light on the mechanisms through which different parenting factors interact and are associated with diabetes behavior in children. These factors can be targeted through parenting interventions to improve child's cooperation with diabetes-management tasks and reduce barriers to effective management.
Challenges for Detecting Valproic Acid in a Nontargeted Urine Drug Screening Method
Authors: Pope Jeffrey D. , Black Marion J. , Drummer Olaf H. , Schneider Hans G. 
Published: May 2017

Background:
Valproic acid (VPA) is a widely prescribed medicine, and acute toxicity is possible. As such, it should be included in any nontargeted urine drug screening method. In many published liquid chromatography–electrospray ionization–mass spectrometry (LC–ESI–MS/MS) methods, VPA is usually measured using a pseudo-multiple reaction monitoring (MRM) transition. We investigate a simple ultra-high-performance liquid chromatography–quadrupole time-of-flight (QTof) approach to detect the presence of VPA with more confidence.

Methods:
Three commercially sourced VPA metabolites were characterized and added to a nontargeted high-resolution MS urine drug screening method. All analyses were performed on a Waters Xevo G2-XS LC-QTof in negative electrospray ionization mode. The mass detector was operated in MSE mode, and data were processed with UNIFI software. Sixty-eight patient urine samples, which were previously identified by a well-established gas chromatography–MS method as containing VPA, were analyzed on the Waters Xevo G2-XS LC-QTof, to validate this approach.

Results:
VPA metabolite standards were characterized, and their detection data were added to the broad drug screening library. VPA metabolites were readily detectable in the urine of patients taking VPA.

Conclusions:
The inclusion of characterized VPA metabolites provides a simple and reliable method enabling the detection of VPA in nontargeted urine drug screening.
The role of simulation and warm-up in minimally invasive gynecologic surgery
Authors: Moulder Janelle K. , Louie Michelle , Toubia Tarek , Schiff Lauren D. , Siedhoff Matthew T. 
Published: May 2017

Purpose of review
The purpose of the review is to update the reader on the current literature and recent studies evaluating the role of simulation and warm-up as part of surgical education and training, and maintenance of surgical skills.

Recent findings
Laparoscopic and hysteroscopic simulation may improve psychomotor skills, particularly for early-stage learners. However, data are mixed as to whether simulation education is directly transferable to surgical skill. Data are insufficient to determine if simulation can improve clinical outcomes. Similarly, performance of surgical warm-up exercises can improve performance of novice and expert surgeons in a simulated environment, but the extent to which this is transferable to intraoperative performance is unknown. Surgical coaching, however, can facilitate improvements in performance that are directly reflected in operative outcomes.

Summary
Simulation-based curricula may be a useful adjunct to residency training, whereas warm-up and surgical coaching may allow for maintenance of skill throughout a surgeon's career. These experiences may represent a strategy for maintaining quality and value in a lower volume surgical setting.
Decreased Visual Acuity by an Irregular Corneal Posterior Surface After Repeat Descemet Stripping Automated Endothelial Keratoplasty
Authors: Yazu Hiroyuki , Yamaguchi Takefumi , Dogru Murat , Satake Yoshiyuki , Tsubota Kazuo , Shimazaki Jun 
Published: May 2017

Purpose:
To investigate the impact of higher-order aberrations (HOAs) on visual acuity after repeat Descemet stripping automated endothelial keratoplasty (DSAEK) in the same eyes.

Methods:
This retrospective comparative case series includes 23 patients who underwent DSAEK twice in the same eyes (46 DSAEK in total). We evaluated the HOAs of the anterior and posterior corneal surfaces, and total cornea using the Fourier analysis data from anterior segment optical coherence tomography. Eyes were divided into one of the following groups, based on the improvement and decline in the best-corrected visual acuity (BCVA) after repeat DSAEK; group A: 12 eyes with an improvement ≥ 2 lines, group B: 12 eyes with a decline ≤ 2 lines, and group C: 11 eyes with no change or change within 1 line.

Results:
The HOAs of the posterior surface in group B were significantly greater than those of group A (P=0.028), whereas there were no significant differences in the anterior surface and total corneal HOAs between groups A and B (P=0.12 and 0.08). There were no significant differences in the anterior and posterior surface as well as total cornea HOAs between initial DSAEK and repeat DSAEK in group C (P=0.87, 0.65, and 0.42). The postoperative BCVA had a significant correlation with the HOAs of the anterior and posterior surfaces as well as the total cornea (R=0.40, 0.46, and 0.53; P=0.01, 0.002, and 0.001).

Conclusions:
Posterior corneal HOAs can have a negative influence on the visual acuity after endothelial keratoplasty.
Sentinel Lymph Node Technique in Endometrial Cancer
Authors: Staley Allison , Sullivan Stephanie A. , Rossi Emma C. 
Published: May 2017

Importance
Endometrial cancer (EMCA) is the most common gynecologic malignancy, with an estimated 54,000 new cases and 10,000 deaths in the United States in 2015. Lymph node metastasis is the most significant prognostic factor in EMCA. Sentinel lymph node (SLN) mapping has become a well-accepted procedure in surgical oncology and may strike a balance between the risks and benefits of lymphadenectomy.

Objective
The aim of this study was to review the current literature regarding the history, techniques, and clinical application of SLN mapping in EMCA.

Evidence Acquisition
Evidence was obtained through systematic literature review through PubMed and ClinicalTrials.gov.

Conclusions
Sentinel lymph node biopsy for EMCA is an accepted approach to the staging of this cancer; however, a consensus approach to the SLN biopsy technique and pathologic assessment is needed. Surgeons newly adopting the technique should proceed with caution and care to monitor outcomes.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After completing this activity, the learner should be better able to describe the importance of lymph node metastasis in EMCA prognosis, recognize the various techniques for SLN biopsy, describe the history of the SLN, and recognize the potential clinical application for SLN biopsy in the treatment of EMCA.
Gonadotropin-Releasing Hormone–Agonist Triggering and a Freeze-All Approach: The Final Step in Eliminating Ovarian Hyperstimulation Syndrome?
Authors: Davenport Marcus J. , Vollenhoven Beverley , Talmor Alon J. 
Published: May 2017

Importance
In vitro fertilization (IVF) has evolved dramatically in recent decades; however, clinical practices have been slow to adopt these advancements, particularly regarding final oocyte maturation and the timing of embryo transfer. Concerns still exist over the ability of gonadotropin-releasing hormone (GnRH) agonists and elective embryo cryopreservation to reduce the risk of ovarian hyperstimulation syndrome (OHSS) without compromising pregnancy outcomes.

Objective
This review investigates IVF outcomes associated with GnRH-agonist triggering and elective embryo cryopreservation. The safety and efficacy of GnRH-agonist triggering are compared with conventional human chorionic gonadotropin triggering, and frozen embryo transfers are weighed against fresh transfers.

Evidence Acquisition
A literature search was conducted using OVID (MEDLINE) and PubMed databases. The search strategy included keywords such as “ovarian hyperstimulation syndrome or OHSS,” “GnRH-agonist triggering,” “cryopreservation or freeze-all,” and “IVF outcomes.” A total of 214 articles were considered for review.

Results
Gonadotropin-releasing hormone agonist triggering reduces OHSS incidence without compromising oocyte retrieval and fertilization rates in donor and autologous cycles. However, GnRH-agonist triggering causes a luteal phase deficiency in autologous cycles, deleteriously compromising pregnancy rates. Elective embryo cryopreservation overcomes this deficiency, reducing the risk of OHSS and may improve neonatal and obstetric outcomes.

Conclusions
Gonadotropin-releasing hormone agonist triggering should be considered in all donor cycles. It should also be selectively considered in autologous cycles in combination with elective cryopreservation of all viable embryos.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to (1) outline the pathogenesis and prevention of OHSS; (2) select patients who are at high risk of OHSS; (3) compare therapeutic options for oocyte triggering and the outcomes associated with fresh and frozen transfers; and (4) explain and rationalize the routine use of GnRH-agonist triggering and elective embryo cryopreservation in everyday practice.
Evaluation of Microscopic Hematuria and Risk of Urologic Cancer in Female Patients
Authors: Lippmann Quinn K. , Slezak Jeff M. , Menefee Shawn A. , Ng Casey K. , Whitcomb Emily L. , Loo Ronald K. 
Published: May 2017

(Abstracted from Am J Obstet Gynecol 2017;216:146.e1–146.e7)
Microscopic hematuria (MH) is common in men and women, but its prevalence is higher in women probably because of benign conditions. Although urologic cancer has a lower prevalence in women than men, there is no difference in the recommended evaluation for women and men with MH.
Repealing the ACA Without a Replacement—The Risks to American Health Care
Authors: Obama Barack H. 
Published: May 2017

(Abstracted from N Engl J Med 2017;376:297–299)
In this article, former American president Barack Obama outlines how and why repealing the Affordable Care Act (ACA) without a proper substitute in place will harm US health care. He reviews the progress made as a result of the ACA while also acknowledging the work still to be done.
Effects of local and spinal administrations of mu-opioids on postoperative pain in aged vs adult mice
Authors: Mecklenburg Jennifer , Patil Mayur J. , Koek Wouter , Akopian Armen N. 
Published: May 2017

Abstract

Introduction:
Suboptimal management of postoperative pain leads to increased risk of chronic opioid therapy, especially in elderly patients.

Objectives:
Although this age-dependent phenomenon has been observed clinically, basic mechanisms including baseline nociception, postoperative hypersensitivity, and mu-opioid efficiency in aged animals have never been evaluated.

Methods:
We tested these criteria using incision model on adult (3–6 months) and aged (24 months) mice to assess translatability of postoperative animal studies to clinical observations.

Results:
Thermal and mechanical testing revealed lower baseline nociception in aged vs adult mice, while behavioral assays after hind paw plantar incision showed similar hypersensitivity levels for both age groups. Efficiency of local and spinal mu-opioid injections on postoperative pain was assessed next. DAMGO, a pure mu-opioid, was effective in reducing postoperative hypersensitivity in aged and adult mice, although adult mice displayed increased sensitivity to higher doses (50 μg local; 1–15 μg spinal). Buprenorphine, a mixed mu-opioid agonist, produced dose-dependent antihypersensitivity with adult mice more sensitive to lower doses (0.1 μg local; 0.02 μg spinal), and aged mice more sensitive to higher doses (1, 10 μg local; 0.1, 1 μg spinal). Finally, exploratory locomotor activity was used to evaluate the suppression of incision-induced spontaneous pain by DAMGO. Spinal and systemic (intraperitoneal) DAMGO inhibited ongoing pain more in adults compared with aged mice.

Conclusion:
As in humans, baseline nociception was lower in aged vs adult mice, while postoperative hypersensitivity magnitudes were comparable between groups. Unlike in humans, adult mice were more sensitive to mu-opioids, although higher doses of mixed mu-opioids were more effective for postoperative antihypersensitivity in aged mice.
Δ9-Tetrahydrocannabinol Suppresses Secretion of IFNα by Plasmacytoid Dendritic Cells From Healthy and HIV-Infected Individuals
Authors: Henriquez Joseph E. , Rizzo Michael D. , Schulz Matthias A. , Crawford Robert B. , Gulick Peter , Kaminski Norbert E. 
Published: May 2017

Abstract:
Plasmacytoid dendritic cells (pDCs) play a crucial role in host antiviral immune response through secretion of type I interferon. Interferon alpha (IFNα), a type I IFN, is critical for mounting the initial response to viral pathogens. A consequence of Human Immunodeficiency Virus-1 (HIV) infection is a decrease in both pDC number and function, but prolonged pDC activity has been linked with progression from HIV infection to the development of AIDS. Patients with HIV in the United States routinely use cannabinoid-based therapies to combat the side effects of HIV infection and antiretroviral therapy. However, cannabinoids, including Δ9-tetrahydrocannabinol (THC), are well-characterized immunosuppressants. Here, we report that THC suppressed secretion of IFNα by pDC from both healthy and HIV+ donors through a mechanism involving impaired phosphorylation of interferon regulatory factor 7. These results suggest that THC can suppress pDC function during the early host antiviral response by dampening pDC activation.
The Effectiveness and Feasibility of Endoscopic Ultrasound-guided Transgastric Drainage of Postoperative Fluid Collections Early After Pancreatic Surgery
Authors: Futagawa Yasuro , Imazu Hiroo , Mori Naoki , Kanazawa Keisuke , Chiba Masafumi , Furukawa Kenei , Sakamoto Taro , Shiba Hiroaki , Yanaga Katsuhiko 
Published: May 2017

Purposes:
To assess the feasibility and usefulness of endoscopic ultrasound-guided transgastric drainage (EUS-GD) in patients who required early postoperative drainage of peripancreatic fluid collection or postoperative pancreatic fistulas after pancreatic surgery.

Patients and Methods:
Between May 2012 and January 2016, 33 patients who developed peripancreatic fluid collection or postoperative pancreatic fistulas after pancreatic resection underwent EUS-GD or percutaneous drainage (PTD). Outcomes were compared retrospectively.

Results:
The drainage procedures were performed on postoperative day 4 to 71 (median, 12) in the EUS-GD group, and 7 to 35 (median, 14) in the PTD group. Technical and clinical success rates reached 92% (11/12) in the EUS-GD group, and 100% (21/21) in the PTD group with no complications or mortality. The duration of hospital stay after drainage was 10 to 44 (median, 15) days for EUS-GD, compared with 10 to 39 (median, 21) days for PTD.

Conclusions:
EUS-GD is a safe and useful method for early drainage, which could be a good alternative to PTD.
A Systematic Review and Meta-Analysis of Laparoscopic and Open Distal Pancreatectomy of Nonductal Adenocarcinomatous Pancreatic Tumor (NDACPT) in the Pancreatic Body and Tail
Authors: Yi Xiaojiang , Chen Sile , Wang Wei , Zou Liaonan , Diao Dechang , Zheng Yansheng , He Yaobin , Li Hongming , Luo Lijie , Xiong Wenjun , Wan Jin 
Published: May 2017

Background:
Currently, laparoscopic distal pancreatectomy is regarded as a safe and effective surgical approach for lesions in the body and tail of the pancreas. This review examined the evidence from published data of comparative studies of laparoscopic versus open distal pancreatectomy of nonductal adenocarcinomatous pancreatic tumor in pancreatic body and tail.

Methods:
A systematic review of the studies comparing laparoscopic and open distal pancreatectomy was conducted. Comparative studies published between January 1996 and June 2016 were included. Studies were selected on the basis of specific inclusion and exclusion criteria. These 2 techniques were compared regarding several outcomes of interest, which were divided into preoperative, operative, postoperative, and pathologic characteristics, postoperative biomarker, and hospital stay cost. Sensitivity and subgroup analysis partially confirmed the robustness of these data.

Results:
Ten comparative case-control studies involving 712 patients (53.7% laparoscopic and 46.3% open), who underwent a distal pancreatectomy were included. The results favored laparoscopy with regard to intraoperative blood loss (P=0.0001), the rate of blood transfusion (P=0.02), total hospital stay (P=0.004), postoperative hospital stay (P<0.0001), overall morbidity (P=0.0002), the rate of wound infection (P=0.05), time to initial feeds (P<0.0001), first flatus time (P=0.008), duration of pain-killer intake (P=0.0003), and C-reactive protein on postoperative day 1 (P=<0.0001). In the subgroup analysis, excluding western country studies, operation time changed to have a statistically significant difference between these 2 groups (P=0.02).

Conclusions:
Laparoscopic resection results in improved operative and postoperative outcomes compared with open surgery according to the results of the present meta-analysis. It may be a safe and feasible option for nonductal adenocarcinomatous pancreatic tumor patients in pancreatic body and tail. However, randomized controlled trials should be undertaken to confirm the relevance of these findings.
Putting the waste out: a proposed mechanism for transmission of the mycoparasite
Escovopsis
between leafcutter ant colonies
Authors: Augustin Juliana O. , Simões Talitta G. , Dijksterhuis Jan , Elliot Simon L. , Evans Harry C. 
Published: May 2017

The attine ant system is a remarkable example of symbiosis. An antagonistic partner within this system is the fungal parasite
Escovopsis
, a genus specific to the fungal gardens of the Attini.
Escovopsis
parasitizes the
Leucoagaricus
symbiont that leaf-cutting ants (
Acromyrmex
,
Atta
) have been farming over the past 8–12 Myr. However, it has been a puzzle how
Escovopsis
reaches its host. During a seasonal survey of nests of
Acromyrmex subterraneus subterraneus
in Atlantic rainforest in Brazil,
Escovopsis
was detected in all the sampled fungal garden waste tips or middens (
n
= 111). Middens were built strategically; always below the nest entrances. Here, we report the first evidence of a putative mechanism for horizontal transmission of
Escovopsis
between attine colonies. It is posited that leaf-cutting ants pick up the spores from soil and litter during foraging and vector the mycoparasite between attine colonies. Field and laboratory experiments, using
At. laevigata
and
Ac. subterraneus subterraneus
, confirm that
Escovopsis
spores are phoretic, and have an inbuilt dormancy, broken by the presence of their
Leucoagaricus
host. However, in the coevolutionary arms race,
Atta
ants may lose out—despite most species in the genus investing in a more advanced waste disposal system—due to the insanitary habits of their
Acromyrmex
neighbours.