bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Transcutaneous Electrical Acupoint Stimulation on the Stress Response During Extubation After General Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy: A Prospective Randomized Controlled Trial
Authors: Bai Wen-Ya , Yang Yan-Chao , Teng Xiu-Fei , Wan Yu-Xiao , Wei Wei , Zhu Jun-Chao 
Published: October 2017

Background:
Elderly patients have an increased risk of a stress response during extubation after general anesthesia. In this study, we aimed to investigate whether transcutaneous electrical acupoint stimulation (TEAS) might decrease the stress response and improve the quality of recovery in elderly patients after elective supratentorial craniotomy.

Materials and Methods:
In this prospective randomized controlled study, patients were randomly assigned to either a TEAS group (n=37) or a control group (n=38). The primary outcomes were the hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol. The secondary outcome included the consumption of remifentanil and propofol, time to extubation and reorientation, extubation quality score, postoperative quality of recovery, and postoperative complications.

Results:
Compared with the control group, hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol during extubation were decreased in the TEAS group. TEAS reduced the consumption of remifentanil (P<0.01), as well as incidence of postoperative complications. The extubation quality score was lower (P<0.01) and the quality of recovery score was higher (P<0.01) in the TEAS group than in the control group. However, the time to extubation and reorientation, and the consumption of propofol were not significantly different between the 2 groups.

Conclusions:
TEAS may decrease the stress response during extubation, improve quality of postoperative recovery, and decrease incidence of postoperative complications in elderly patients undergoing elective supratentorial craniotomy.
Radiographic Predictors of Difficult Laryngoscopy in Acromegaly Patients
Authors: Lee Hyung-Chul , Kim Min-Kyung , Kim Yong Hwy , Park Hee-Pyoung 
Published: October 2017

Background:
Patients with acromegaly have a high risk of difficult laryngoscopy. However, clinical predictors, such as upper lip bite test or modified Mallampati class, show limited predictive performance for difficult laryngoscopy in such patients. In this retrospective study, we evaluated radiographic indices obtained from skull lateral x-ray and ostiomeatal unit computed tomography images to predict difficult laryngoscopy in acromegaly patients.

Materials and Methods:
Data on demographics, preoperative serum levels of pituitary hormones, and radiographic indices were collected from 90 acromegaly patients that underwent transsphenoidal removal for pituitary tumor from January 2010 to December 2016. Difficult laryngoscopy was defined as Cormack-Lehane grade ≥III.

Results:
Difficult laryngoscopy occurred in 21 (23%) patients. In univariate analysis, age and radiographic indices indicating tongue size, such as tongue area (TA) on ostiomeatal unit computed tomography, linear distance from the alveolar line of the mandible to the hyoid bone, and linear distance from the interior border of the mandible to the hyoid bone on skull lateral x-ray, were associated with difficult laryngoscopy. In multivariate analysis, age (odds ratio [95% confidence interval], 1.084 [1.037-1.190]; P=0.002) and TA (1.002 [1.000-1.003], P=0.014) were independent risk factors for difficult laryngoscopy. The area under the curve of the combined model of age and TA was 0.80.

Conclusions:
Old age and radiographic predictors indicating large tongue size (large TA, long alveolar line of the mandible to the hyoid bone and mandible to the hyoid bone) were associated with an increased rate of difficult laryngoscopy in acromegaly patients. Preoperative radiographic measurements of tongue size can be helpful for safe airway management in such patients.
Association of High-Volume Surgeons Working in High-Volume Hospitals with Cost of Free Flap Surgeries
Authors: Mahmoudi Elham , Lu Yiwen , Chang Shu-Chen , Lin Chia-Yu , Wang Yi-Chun , Chang Chee Jen , Cheng Ming-Huei , Chung Kevin C. 
Published: October 2017

Background:
We examined the associations of surgeon and hospital volume with total cost, length of stay (LOS), and cost per day for free tissue transfer (FTT) surgeries. Evidence demonstrates a higher likelihood of success for FTT in higher volume hospitals. Little, however, is known about volume-outcome associations for surgical costs and LOS. We hypothesized that higher provider volume is associated with lower cost and shorter LOS.

Methods:
Using Taiwan’s national data (2001–2012), we conducted a retrospective cohort study of all adults 18–64 years of age who underwent FTT during the study period. We used hierarchical regression modeling for our analyses. Our 3 outcome variables were total cost of FTT surgery, LOS in hospital, and cost per day.

Results:
Except for functional muscle flap, in which LOS was 12 days shorter in high-volume compared with low-volume hospitals (P = 0.017), no association between hospital volume and LOS was found. Contrary to our hypothesis, our results for all FTT cases demonstrate positive associations of medium-volume hospitals (OR = 1.31; CI, 1.11–1.55) and high-volume surgeons (OR = 1.16; CI,1.03–1.32) with total cost and cost per day, respectively. The interactions of hospital volume and surgeon volume show that in medium- and high-volume hospitals, surgeons with the highest volume had the lowest predicted cost per day among hospitals in that category; but all differences in cost were small.

Conclusions:
There were no substantial variations based on different hospital or surgeon volume in LOS, total cost, or cost per day for FTT operations performed in Taiwan.
Strategies for Reducing Fatal Complications in Liposuction
Authors: Cárdenas-Camarena Lázaro , Andrés Gerardo Lozano-Peña , Durán Héctor , Bayter-Marin Jorge Enrique 
Published: October 2017

Background:
Liposuction has become one of the most common cosmetic surgical procedures, and severe complications secondary to this procedure have also increased significantly. That is why we carry out a research work to know the most frequent severe complications reported in the scientific literature to indicate criteria for prevention.

Methods:
English-language scientific publications about liposuction and its complications were analyzed using the PubMed.gov, from the beginning of PubMed's history through June 10, 2017. Five terms were used to define liposuction and its complications: "liposuction," "liposuction AND complications," liposuction AND major complications," "liposuction AND complications AND death," and "liposuction AND death." The quantities of results for the 5 phrases were analyzed, along with their contents.

Results:
One thousand sixty-three results were obtained from 1973 through June 10, 2017 for the phrase "Liposuction and Complications" in humans; for "Liposuction and Major Complications," 153 articles were found; for "Liposuction and Deaths," 89 articles were found; and 42 articles were obtained with the terms "Liposuction and Major Complications and Deaths." After final depuration, all those that were not specific to severe liposuction complications were eliminated, leaving a total of 39 articles that were included in our study. Five problems proved to be the most serious complications when performing liposuction: Thromboembolic disease, fat embolism, pulmonary edema, lidocaine intoxication, and intraabdominal visceral lesion.

Conclusions:
The 5 most important complications that can cause death in liposuction are easily preventable using simple measures and proper safety protocols that are described in this work.
Intravenous Access in Infants Undergoing Bilateral Sural Nerve Grafts for Primary Brachial Plexus Exploration
Authors: Al-Qattan Mohammad M. , El-Sayed Amel A. F. 
Published: October 2017

Background:
Intravenous access (IVA) in infants undergoing primary brachial plexus exploration may be difficult. Both lower limbs are prepared and draped for sural nerve graft harvesting. The injured upper limb is also prepared and draped and is not available for IVA. In difficult IVA from the remaining upper limb, we have been using one of the feet for IVA. The infection rate and problems of intravenous infusions in this setting have never been studied in the literature. This study documents the infection rate and problems of intravenous infusions in these infants when a foot (within the sterile field) is used for IVA.

Methods:
This is a retrospective study of 63 consecutive infants undergoing primary brachial plexus exploration, and in whom IVA was obtained from one of the feet. Infection rate and problems of intravenous infusions were recorded.

Results:
No surgical wound infection and no infection of the IVA site were noted. There were no instances of accidental dislodgement of the intravenous cannula and no instances of extravasation.

Conclusion:
The use of one of the feet (within the sterile filed) for IVA is safe and acceptable in infants undergoing primary brachial plexus exploration and bilateral sural nerve grafting.
Phenotypic Characterization of Corneal Endothelial Dystrophy in German Shorthaired and Wirehaired Pointers Using In Vivo Advanced Corneal Imaging and Histopathology
Authors: Shull Olivia R. , Reilly Christopher M. , Davis Lola B. , Murphy Christopher J. , Thomasy Sara M. 
Published: October 2017

Purpose:
To evaluate corneal morphology using ultrasonic pachymetry (USP), Fourier-domain optical coherence tomography (FD-OCT), and in vivo confocal microscopy (IVCM) in 2 related canine breeds—German shorthaired pointers (GSHPs) and German wirehaired pointers (GWHPs)—with and without corneal endothelial dystrophy (CED). This condition is characterized by premature endothelial cell degeneration leading to concomitant corneal edema and is similar to Fuchs endothelial corneal dystrophy.

Methods:
Corneas of 10 CED-affected (4 GSHP and 6 GWHP) and 19 unaffected, age-matched (15 GSHP and 4 GWHP) dogs were examined using USP, FD-OCT, and IVCM. A 2-sample t test or Mann–Whitney rank-sum test was used to statistically compare parameters between both groups. Data are presented as mean ± SD or median (range).

Results:
Central corneal thickness determined using USP was significantly greater in CED-affected than in unaffected dogs at 1179 (953–1959) and 646 (497–737) μm, respectively (P < 0.001). Central epithelial thickness was found to be significantly decreased in CED-affected versus unaffected dogs at 47 ± 7.1 and 55 ± 7.1 μm, respectively (P = 0.011), using FD-OCT. With IVCM, corneal endothelial density was significantly less (P < 0.001) in 5 dogs with CED versus 19 unaffected controls at 499 ± 315 versus 1805 ± 298 cells/mm2, respectively. CED-affected dogs exhibited endothelial pleomorphism and polymegethism, whereas CED-unaffected dogs had regular hexagonal arrangement of cells.

Conclusions:
GSHPs and GWHPs with CED exhibit marked differences in corneal morphology when compared with age-matched control dogs. These 2 CED-affected breeds represent spontaneous, large animal models for human Fuchs endothelial corneal dystrophy.
Brain-derived neurotrophic factor–mediated projection-specific regulation of depressive-like and nociceptive behaviors in the mesolimbic reward circuitry
Authors: Liu Di , Tang Qian-Qian , Yin Cui , Song Yu , Liu Yan , Yang Jun-Xia , Liu He , Zhang Yue-Man , Wu Si-Yin , Song Ying , Juarez Barbara , Ding Hai-Lei , Han Ming-Hu , Zhang Hongxing , Cao Jun-Li 
Published: October 2017

Abstract
Increasing evidence suggests that the mesolimbic reward system plays critical roles in the regulation of depression and nociception; however, its circuitry and cellular mechanisms remain unclear. In this study, we investigated the output-specific regulatory roles of dopaminergic (DA) neurons within the ventral tegmental area (VTA) in depressive-like and nociceptive behaviors in mice subjected to unpredictable chronic mild stress (CMS), using the projection-specific electrophysiological recording, pharmacological manipulation, behavioral test, and molecular biology technologies. We demonstrated that CMS decreased the firing activity in VTA projecting to medial prefrontal cortex (VTA → mPFC), but not in VTA to nucleus accumbens (VTA → NAc), DA neurons. However, both VTA → mPFC and VTA → NAc DA neurons showed increased firing activity in response to morphine perfusion in CMS mice. Behavioral results showed that intra-VTA microinjection of morphine (25.5 ng/0.15 μL) relieved depressive-like behaviors, intriguingly, accompanied by a thermal hyperalgesia. Furthermore, the relief of depressive-like behaviors induced by intra-VTA injection of morphine in CMS mice could be prevented by blocking brain-derived neurotrophic factor (BDNF) signaling and mimicked by the administration of exogenous BDNF in mPFC rather than in NAc shell. Nociceptive responses induced by the activation of VTA DA neurons with morphine in CMS mice could be prevented by blocking BDNF signaling or mimicked by administration of exogenous BDNF in NAc shell, but not in mPFC. These results reveal projection-specific regulatory mechanisms of depression and nociception in the mesolimbic reward circuitry and provide new insights into the neural circuits involved in the processing of depressive and nociceptive information.
Vigilance-related attention systems subserve the discrimination of relative intensity differences between painful stimuli
Authors: Yang Sung-Ling , Wu Ting-Wei , Tseng Ming-Tsung 
Published: October 2017

Abstract
Humans require the ability to discriminate intensities of noxious stimuli to avoid future harm. This discrimination process seems to be biased by an individual's attention to pain and involves modulation of the relative intensity differences between stimuli (ie, Weber fraction). Here, we ask whether attention networks in the brain modulate the discrimination process and investigate the neural correlates reflecting the Weber fraction for pain intensity. In a delayed discrimination task, participants differentiated the intensity of 2 sequentially applied stimuli after a delay interval. Compared with nonpain discrimination, pain discrimination performance was modulated by participants' vigilance to pain, which was reflected by the functional connectivity between the left inferior parietal lobule and the right thalamus. Of note, this vigilance-related functional coupling specifically predicted participants' behavioral ability to differentiate pain intensities. Moreover, unique to pain discrimination tasks, the response in the right superior frontal gyrus linearly represented the Weber fraction for pain intensity, which significantly biased participants' pain discriminability. These findings suggest that pain intensity discrimination in humans relies on vigilance-related enhancement in the parieto-thalamic attention network, thereby allowing the prefrontal cortex to estimate the relative intensity differences between noxious stimuli.
The Effects of Traumatic and Multiple Loss on Psychopathology, Disability, and Quality of Life in Iraqi Asylum Seekers in the Netherlands
Authors: Hengst Sophie M.C. , Smid Geert E. , Laban Cornelis J. 
Published: October 2017

Abstract
Emerging evidence suggests that the loss of loved ones under traumatic circumstances is highly prevalent among refugees and asylum seekers. We evaluated the effects of traumatic and multiple losses of family members and friends on psychopathology, disability, and quality of life in Iraqi asylum seekers in the Netherlands, and investigated mediation of these effects through psychopathology. Respondents (N = 294) completed structured Arabic interviews. Data were analyzed using structural equation modeling. The loss of a loved one was reported by 87.6% of the sample. Traumatic and multiple losses of family members independently predicted psychopathology, taking the effects of other traumatic events, postmigration stressors, and sociodemographic characteristics into account. Effects of traumatic and multiple losses on quality of life and disability were either partially or fully mediated by psychopathology. These findings highlight the need to evaluate and treat the effects of the loss of loved ones when working with asylum seekers and refugees as well as to incorporate grief-related psychopathology in diagnostic classifications.
Knowledge and Preferences Regarding Antidepressant Medication Among Depressed Latino Patients in Primary Care
Authors: Green Bonnie L. , Watson Maria Rosa , Kaltman Stacey I. , Serrano Adriana , Talisman Nicholas , Kirkpatrick Laura , Campoli Marcela 
Published: October 2017

Abstract
US Latinos are less likely to utilize mental health services than non-Latino whites and to take antidepressant medications. This mixed-method study followed a subset (N = 28) of a research sample of depressed Latino immigrant primary care patients, who took depression medication, with a telephone interview to study their knowledge about and experiences with antidepressant medications. Most (82%) reported taking medication for 2 months or more, and 75% reported feeling better, whereas more than half reported side effects. Most (61%) agreed that antidepressants are generally safe and helpful in treating depression (68%); however, many believed they could be addictive (39%). Fifty percent of patients who discontinued their medication did not inform their providers. Twelve of the 28 patients also participated in focus groups about interactions with providers and made suggestions for conveying information about antidepressants. Patients suggested videos as a format to disseminate medication information because they do not require written comprehension. Other patient recommendations are presented.
Nerve Transfer versus Interpositional Nerve Graft Reconstruction for Posttraumatic, Isolated Axillary Nerve Injuries: A Systematic Review
Authors: Koshy John C. , Agrawal Nikhil A. , Seruya Mitchel 
Published: October 2017

Background:
The purpose of this study was to compare functional outcomes between nerve grafting and nerve transfer procedures in the setting of isolated, posttraumatic axillary nerve injuries.

Methods:
A systematic review was performed using the PubMed, Scopus, and Cochrane databases to identify all cases of isolated, posttraumatic axillary nerve injuries in patients aged 18 years or older. Patients who underwent axillary nerve reconstruction were included and categorized by technique: graft or transfer. Demographics were recorded, including age, time to operation, and presence of concomitant injuries. Functional outcomes were evaluated, including British Medical Research Council strength and range of motion for shoulder abduction.

Results:
Ten retrospective studies met criteria, for a total of 66 patients (20 nerve grafts and 46 nerve transfers). Median time from injury to operation was equivalent across the nerve graft and nerve transfer groups (8.0 months versus 7.0 months; p = 0.41). Postoperative follow-up was 24.0 months for nerve grafting versus 18.5 months for nerve transfer (p = 0.13). Clinically useful shoulder abduction, defined as British Medical Research Council grade M3 or greater, was obtained in 100 percent of nerve graft patients versus 87 percent of nerve transfer patients (p = 0.09). Grade M4 or better strength was obtained in 85 percent of nerve graft patients and 73.9 percent of nerve transfer patients (p = 0.32).

Conclusions:
Significant differences in functional outcomes between nerve graft and transfer procedures for posttraumatic axillary nerve injuries are not apparent at this time. Prospective outcomes studies are needed to better elucidate whether functional differences do exist.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear
Authors: Saito Taichi , Malay Sunitha , Chung Kevin C. 
Published: October 2017

Background:
Evidence regarding the effectiveness of arthroscopic débridement for a triangular fibrocartilage complex tear is uncertain. The purpose of this study was to conduct a systematic review of outcomes to evaluate the effectiveness of débridement for triangular fibrocartilage complex tears.

Methods:
The authors searched all available literature in the PubMed, Embase, and MEDLINE (Ovid) databases for articles reporting on triangular fibrocartilage complex tear débridement. Data collection included arc of motion, grip strength, patient-reported outcomes, and complications.

Results:
A total of 1723 unique studies were identified, of which 18 studies met the authors’ criteria. The mean before and after arc of wrist extension/flexion motion values were 120 and 146 degrees (six studies). The mean before and after grip strength values were 65 percent and 91 percent of the contralateral side (10 studies). Disabilities of the Arm, Shoulder, and Hand scores (six studies) and pain visual analogue scale scores (seven studies) improved from 39 to 18, and from 7 to 3, respectively. The mean pain visual analogue scale score after débridement was 1.9 in the ulnar-positive group and 2.4 in the ulnar-neutral and ulnar-negative groups. Eighty-seven percent of patients returned to their original work.

Conclusions:
Patients reported reduced pain and improved functional and patient-reported outcomes after débridement of triangular fibrocartilage complex tears. Most patients after débridement returned to previous work, with few complications. Although some of these cases may require secondary procedures, simple débridement can be performed with suitable satisfactory outcomes for cases with any type of ulnar variance.
Watch Out for Wild Animals: A Systematic Review of Upper Extremity Injuries Caused by Uncommon Species
Authors: Israel Jacqueline S. , McCarthy James E. , Rose Katherine R. , Rao Venkat K. 
Published: October 2017

Background:Across the world, many species of nondomesticated animals dwell among humans in metropolitan areas. Rare animal bites pose a dilemma for hand surgeons, as they often result in operative injuries and recalcitrant infections. The authors treated an 85-year-old man who experienced severe cellulitis of the index finger following an opossum bite. This case prompted a systematic review of upper extremity injuries caused by species other than dogs, cats, snakes, and insects.Methods:The authors conducted a systematic review of PubMed and Scopus databases to identify relevant articles published between 1980 and 2016. Two reviewers critically appraised the studies that met inclusion and exclusion criteria.Results:The hand infection in the man who sustained an opossum bite at the authors’ institution was successfully treated with targeted antibiotic therapy, hand elevation, and splinting. Seventy-one articles met inclusion criteria for and were included in this systematic review. The vast majority of existing articles represent level IV and level V evidence. The relevant literature suggests that the majority of hand infections attributable to animal bites and stings are polymicrobial.Conclusions:Injuries secondary to aquatic animals appear to be the most frequently described in the literature, and hot water immersion should be used for the majority of envenomation attributable to aquatic species. Infections can often be treated with an aminopenicillin antibiotic combined with a beta-lactamase inhibitor. Given the variability in presentation and potential for sequelae such as soft-tissue necrosis and systemic reactions, hand surgeons should approach such upper extremity injuries with a high degree of caution.