bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhanced Thalamic Spillover Inhibition during Non–rapid-eye-movement Sleep Triggers an Electrocortical Signature of Anesthetic Hypnosis
Authors: Mesbah-Oskui Lia , Horner Richard L. 
Published: August 2016

AbstractBackgroundAlterations in thalamic γ-aminobutyric acid–mediated signaling are thought to underlie the increased frontal α-β frequency electrocortical activity that signals anesthetic-induced loss of consciousness with γ-aminobutyric acid receptor type A (GABAAR)–targeting general anesthetics. The general anesthetic etomidate elicits phasic extrasynaptic GABAAR activation (“spillover” inhibition) at thalamocortical neurons in vitro. We hypothesize that this action of etomidate at the thalamus is sufficient to trigger an increase in frontal α-β frequency electrocortical activity and that this effect of etomidate is fully recapitulated by enhanced thalamic spillover inhibition in vivo.MethodsWe recorded electrocortical activity and sleep–wake behavior in freely behaving wild-type (n = 33) and extrasynaptic δ-subunit–containing GABAAR knockout mice (n = 9) during bilateral microperfusion of the thalamus with etomidate and/or other pharmacologic agents that influence GABAAR or T-type Ca2+ channel activity.ResultsMicroperfusion of etomidate into the thalamus elicited an increase in α-β frequency electrocortical activity that occurred only during non–rapid-eye-movement (REM) sleep (11.0 ± 11.8% and 16.0 ± 14.2% greater 8 to 12- and 12 to 30-Hz power, respectively; mean ± SD; both P &lt; 0.031) and was not affected by blockade of thalamic T-type Ca2+ channels. Etomidate at the thalamus also increased spindle-like oscillations during non-REM sleep (4.5 ± 2.4 spindle per minute with etomidate vs. 3.2 ± 1.7 at baseline; P = 0.002). These effects of etomidate were fully recapitulated by enhanced thalamic extrasynaptic GABAAR-mediated spillover inhibition.ConclusionsThese findings identify how a prototypic GABAAR-targeting general anesthetic agent can elicit the characteristic brain wave pattern associated with anesthetic hypnosis when acting at the thalamus by promoting spillover inhibition and the necessity of a preexisting non-REM mode of activity in the thalamus to generate this effect.
Sites Related to Crawford Williamson Long in Georgia
Authors: Roddy Katie J. , Starnes Vicki , Desai Sukumar P. 
Published: August 2016

Abstract

Background
Crawford Williamson Long (1815 to 1878) was the first to use ether as an inhaled anesthetic for surgical operations. By not publishing his discovery for 7 yr, his pioneering work was largely overshadowed by that of Horace Wells (1815 to 1848), Charles Thomas Jackson (1805 to 1880), and William Thomas Green Morton (1819 to 1868). As a result, sites commemorating Long’s discovery are not offered the same recognition as those affiliated with Wells or Morton.

Methods
We highlight sites in Athens, Danielsville, and Jefferson, Georgia, that honor the first man to regularly use ether as an anesthetic agent. Extensive site visits, examination of museum artifacts, and genealogical research were used to obtain information being presented.

Results
Historic Oconee Hill Cemetery in Athens is where Long and members of his family are buried. Established in 1856, it is closely linked to the history of Athens and the University of Georgia (Athens, Georgia). The main site we describe is the Crawford W. Long Museum, located in Jefferson, Georgia, which opened to the public in 1957. It has undergone extensive renovations and holds an expansive collection of Long’s family heirlooms and personal artifacts. In addition, it displays an impressive art collection, depicting Long, surgical procedures, members of Long’s family, and homes associated with him. Visitors to the museum may also enjoy a walking audio tour that highlights the life of Long and his contribution to medicine.

Conclusions
We provide information on sites and artifacts that honor Georgia’s most celebrated physician. Much of this has not been published before, and it is our hope that Crawford Williamson Long’s legacy receives the attention it richly deserves.
C-arm Positioning Is a Significant Source of Radiation in Spine Surgery
Authors: Reiser Elizabeth W. , Desai Rupen , Byrd Sarah A. , Farber Harrison , Chi Deborah , Idler Cary S. , Isaacs Robert E. 
Published: August 2016

Study Design.
Prospective chart review.

Objective.
It is well-known that radiation exposure during minimally invasive spine procedures can be substantial. Less interest has focused on setup radiation exposure before incision, including preoperative images used for surgical approach. The present study seeks to better quantify the significance of setup radiation in the total radiation exposure of minimally invasive spine surgery.

Summary of Background Data.
Radiographic localization is necessary in minimally invasive spine procedures to visualize anatomy, but increased radiation exposure is associated with health risks. Preoperative imaging for anatomical localization has not been previously analyzed as an appreciable source of radiation.

Methods.
From an institutional review board–approved database of more than 1100 procedures, the minimally invasive spine cases with recorded set-up radiation were extracted. The total radiation, set-up radiation, and procedure type data were evaluated. Statistics were generated using a chi-squared analysis.

Results.
Set-up and total radiation data were collected for 270 spine surgeries performed by four surgeons at two locations. There were 30 thoracic and 240 thoracolumbar/lumbar cases; 78 anterior and 192 posterior cases. Average total radiation (set-up and intraoperative) was 8.04 rad, and average setup radiation was 1.90 rad (28%, std 2.97 rad) across all cases. On average for the thoracolumbar/lumbar cases, set-up radiation accounted for almost 25% of total radiation with 1.76 rad from setup out of 8.16 rad total. Thoracic-only cases often necessitated even more images for localization, generating an average set-up/total percentage of 52%. Across all procedures, set-up radiation significantly increased the total radiation exposure because it accounted for more than 25% of the total procedure.

Conclusion.
Radiation exposure during preoperative localization can be substantial. Operating room personnel should recognize the high percentage of radiation that occurs during set-up, and merit should be given to techniques and technologies that can limit unnecessary radiation exposure during this portion of the procedure.

Level of Evidence: 2
Stagnant Physical Therapy Referral Rates Alongside Rising Opioid Prescription Rates in Patients With Low Back Pain in the United States 1997–2010
Authors: Zheng Patricia , Kao Ming-Chih , Karayannis Nicholas V. , Smuck Matthew 
Published: August 2016

Study Design.
A cross-sectional observational study utilizing the National Ambulatory and National Hospital Ambulatory Medical Care Surveys between 1997 and 2010.

Objective.
The aim of this study was to characterize national physical therapy (PT) referral trends during primary care provider (PCP) visits in the United States.

Summary of Background Data.
Despite guidelines recommending PT for the initial management of low back pain (LBP), national PT referral rates remain low.

Methods.
Race, ethnicity, age, payer type, and PT referral rates were collected for patients aged 16 to 90 years who were visiting their PCPs. Associations among demographic variables and PT referral were determined using logistic regression.

Results.
Between 1997 and 2010, we estimated 170 million visits for LBP leading to 17.1 million PT referrals. Average proportion of PCP visits associated with PT referrals remained stable at about 10.1% [odds ratio (OR) 1.00, 95% confidence interval (95% CI) 0.96–1.04)], despite our prior finding of increasing number of visits associated with opioid prescriptions in the same timeframe.
Lower PT referral rates were observed among visits by patients who were insured by Medicaid (OR 0.48, 95% CI 0.33–0.69) and Medicare (OR 0.50, 95% CI 0.35–0.72). Furthermore, visits not associated with PT referrals were more likely to be associated with opioid prescriptions (OR 1.69, 95% CI 1.22–2.35).

Conclusion.
Although therapies delivered by PTs are promoted as a first-line treatment for LBP, PT referral rates remain low. There also exist disparately lower referral rates in populations with more restrictive health plans and simultaneous opioid prescription. Our findings provide a broad overview to PT prescription trend and isolate concerning associations requiring further explorations.

Level of Evidence: 3
Surgical and Functional Outcomes After Multilevel Cervical Fusion for Degenerative Disc Disease Compared With Fusion for Radiculopathy
Authors: Faour Mhamad , Anderson Joshua T. , Haas Arnold R. , Percy Rick , Woods Stephen T. , Ahn Uri M. , Ahn Nicholas U. 
Published: August 2016

Study Design.
Retrospective cohort comparative study.

Objective.
To evaluate presurgical and surgical factors that affect return to work (RTW) status after multilevel cervical fusion, and to compare outcomes after multilevel cervical fusion for degenerative disc disease (DDD) versus radiculopathy.

Summary of Background Data.
Cervical fusion provides more than 90% of symptomatic relief for radiculopathy and myelopathy. However, cervical fusion for DDD without radiculopathy is considered controversial. In addition, multilevel fusion is associated with poorer surgical outcomes with increased levels fused.

Methods.
Data of cervical comorbidities was collected from Ohio Bureau of Workers’ Compensation for subjects with work-related injuries. The study population included subjects who underwent multilevel cervical fusion. Patients with radiculopathy or DDD were identified. Multivariate logistic regression was performed to identify factors that affect RTW status. Surgical and functional outcomes were compared between groups.

Results.
Stable RTW status within 3 years after multilevel cervical fusion was negatively affected by: fusion for DDD, age > 55 years, preoperative opioid use, initial psychological evaluation before surgery, injury-to-surgery > 2 years and instrumentation.
DDD group had lower rate of achieving stable RTW status (P= 0.0001) and RTW within 1 year of surgery (P= 0.0003) compared with radiculopathy group. DDD patients were less likely to have a stable RTW status [odds ratio, OR = 0.63 (0.50–0.79)] or RTW within 1 year after surgery [OR = 0.65 (0.52–0.82)].
DDD group had higher rate of opioid use (P= 0.001), and higher rate of disability after surgery (P= 0.002).

Conclusion.
Multiple detriments affect stable RTW status after multilevel cervical fusion including DDD. DDD without radiculopathy was associated with lower RTW rates, less likelihood to return to work, higher disability, and higher opioid use after surgery. Multilevel cervical fusion for DDD may be counterproductive. Future studies should investigate further treatment options of DDD, and optimize patient selection criteria for surgical intervention.

Level of Evidence: 3
Do Patients With Chronic Low Back Pain Benefit From Early Intervention Regarding Absence From Work?
Authors: Norbye Anja Davis , Omdal Aina Vedvik , Nygaard Marit Eikrem , Romild Ulla , Eldøen Guttorm , Midgard Rune 
Published: August 2016

Study Design.
A randomized, controlled, single-center pilot study.

Objective.
The aim of this study was to investigate the feasibility of running a trial to explore if early intervention in individuals with chronic low back pain (CLBP) would lead to an early return to work (RTW) and reduce sick leave during 12 months of follow-up compared with patients on a 3-month waiting list.

Summary of Background Data.
Back pain is the reason for numerous absent days from work. In Norway, the government initiated a priority program, Earlier Return to Work (ERTW), to reduce work absences through early intervention. However, no proper evaluation has been performed on populations with CLBP. There is no consensus on how RTW should be measured. Only a few studies have examined how waiting time affects RTW.

Methods.
Fifty-eight patients were included in the study. The group with early intervention was examined within 2 weeks, and the group on the waiting list was examined after 12 weeks. The intervention was identical in both groups and consisted of an outpatient, intensive back school. The data were obtained by questionnaire after 3, 6, and 12 months. The primary outcome was absence from work.

Results.
The sample size in a full-scale study must comprise at least 382 patients on the basis of the assumptions in the pilot. In the pilot study, early intervention directly compared with an ordinary waiting list did not significantly affect the number of sick leave days after 12 months of follow-up.

Conclusion.
A prerequisite for launching a full-scale clinical trial is a redesign of the intervention, an improvement of procedures concerning inclusion and randomization, and finally a more precise definition of RTW.

Level of Evidence: 3
Mini-Open Achilles Tendon Rupture Repair
Authors: Hsu Andrew R. , Anderson Robert B. 
Published: August 2016

Acute midsubstance Achilles tendon ruptures are an increasingly common athletic injury that can result in significant pain, functional limitation, and decreased quality of life. In recent years, mini-open Achilles tendon repair techniques have been developed to optimize the functional benefits of surgery while reducing the incidence of postoperative complications associated with traditional open repair. The percutaneous Achilles repair system is a modern mini-open technique that has been shown to help improve time to return to baseline activities and lower the rate of postoperative wound complications compared with traditional open repair.
Level of Evidence: Diagnostic Level V, Expert Opinion. See Instructions for Authors for a complete description of levels of evidence.
Human Immunoglobulin Versus Plasmapheresis in Guillain–Barre Syndrome and Myasthenia Gravis: A Meta-Analysis
Authors: Ortiz-Salas Paola , Velez-Van-Meerbeke Alberto , Galvis-Gomez Camilo Alberto , Rodriguez Q Jesús H. 
Published: August 2016

Abstract

Objectives:
To evaluate the efficacy and safety over a short time period of human intravenous immunoglobulin versus plasma exchange (PE) in the management of some autoimmune neurologic diseases. In addition, length of hospital stay and duration of ventilator support were compared.

Methods:
Randomized controlled trials and analytical observational studies of more than 10 cases were reviewed. Cochrane Neuromuscular Disease Group trials, MEDLINE, EMBASE, HINARI, and Ovid, were searched as data source. Reference lists were examined for further relevant articles. A random-effect model was used to derive a pooled risk ratio.

Results:
A total of 552 articles were found and 24 met the criteria for a studied population of 4657 cases: 14 articles were about Guillain–Barré syndrome and 10 of myasthenia gravis. No evidence was found to suggest that PE or intravenous immunoglobulin differed in terms of efficacy or safety to treat any of the 2 diseases. Hospital stay length and ventilatory support time are different in each illness; however, we found no statistical difference in either of the 2 treatments.

Conclusions:
There is no evidence for superiority in the efficacy or safety of immunoglobulin or plasmapheresis in the management of Guillain–Barré syndrome and myasthenia gravis. However, caution should be exercised in the interpretation of these results given the limitations in the quality of the evidence and the heterogeneity of the studies.
Small Fiber Neuropathy Following Vaccination
Authors: Kafaie Jafar , Kim Minsoo , Krause Erik 
Published: August 2016

Abstract

Objective:
To identify clinical and quantitative relationship between vaccinations and small fiber neuropathy (SFN). SFN refers to damaged unmyelinated or thinly myelinated sensory and/or autonomic fibers. Diagnosis is primarily based on clinical presentation. Intraepidermal nerve fiber density can provide diagnostic confirmation with a sensitivity of 88% and a specificity of 91%. However, the possible association between vaccination and small fiber polyneuropathy is not well defined.

Methods:
Case study.

Results:
Fourteen-year-old white adolescent girl presented with intractable generalized pain for 1.5 years. Burning dysesthetic pain began in the lower back and progressed to all extremities 9 days following human papillomavirus vaccination. The pain persisted despite various pain medications. Examination was significant for allodynia of right scapula (T4–T6) and decreased pinprick sensation in feet. MRI Brain with and without contrast, MR Face, Orbit with and without contrast, and MR Cervical, Lumbar spines with and without contrast were all normal. Nerve Conduction Studies/Electromyogram studies were unremarkable, and skin biopsy of the right thigh and foot showed low intraepidermal nerve fiber density with normal sweat gland nerve fiber density.

Conclusions:
This case report describes an acute onset of non–length-dependent SFN potentially related to human papillomavirus vaccine administration. Literature review includes several similar case studies, and various pathological processes have been proposed for vaccine-associated polyneuropathies. Some theories describe immune-mediated hypersensitivity to the solvents/adjuvants and/or invasion of nervous system through a prolonged, less virulent infection. However, the lack requires that evidence must be carefully reviewed.
Evaluation of the potential antidepressant effects of soybean isoflavones
Authors: Messina Mark , Gleason Carey 
Published: August 2016

Abstract

Objective:
The aim of the study was to determine whether isoflavones affect depressive symptoms in women.

Methods:
Literature searches were conducted to identify clinical and epidemiologic studies that evaluated the impact of soy intake and isoflavone exposure on depressive symptoms. References from identified studies were also evaluated to identify eligible studies.

Results:
Only limited epidemiologic research has evaluated the impact of soy or isoflavone intake on depression although several studies from China and Japan did find soy product intake was inversely related to risk of depression. Often times, soy was, however, evaluated only as a component of a summative dietary pattern (eg, a “Japanese” or “Healthy” diet). Of the 20 intervention studies identified, roughly half found statistically significant reductions in depressive symptoms in response to isoflavones although several had design weakness. Of those studies reporting a lack of antidepressant effects of isoflavones, design limitations likely contributed to the lack of efficacy. In all but two trials, assessment of depression was, however, a secondary outcome. It is notable that both trials in which depression was a primary outcome found isoflavones significantly improved symptoms.

Conclusions:
Although the data are inconsistent and limited, the clinical and epidemiologic evidence suggests that isoflavones may offer a safe, well-tolerated option for management of depression. Furthermore, the intervention doses used in the clinical studies fall well within the dietary range. The extant literature reveals key design features for future studies, which based upon the results of this review, are clearly warranted.
Sexual and reproductive healthcare utilization among women aged 40 to 49 in rural China
Authors: Sun Xiaoming , Sun Yu , Zong Zhanhong , Shu Xingyu , Mao Jingshu , Hearst Norman 
Published: August 2016

Abstract

Objective:
China's national family planning system is mainly directed toward women of early reproductive ages. Most studies of service provision focused on younger women, who almost all receive regular examinations. Little is known about service-seeking behavior among women of late reproductive ages.

Methods:
This cross-sectional household survey interviewed 1,811 rural women aged 40 to 49 in seven provinces. We examined sexual and reproductive health, utilization of sexual and reproductive health services, and predictors of receiving a free gynecological examination in the past 2 years.

Results:
Educational levels were not high, and most women were rural farmers or housewives. More than one-fourth had migrated for work to big cities when they were younger. The mean frequency of sex in the last month was 3.6 times. Approximately 22.7% of women had not received a gynecological examination and 31.2% had not received any health education during the past 2 years. The first choice for where to seek services was township medical facilities (58.4%). On multivariate regression, age, education, migrant working experience, awareness of the need for intrauterine device removal after menopause, health education received, and attitude toward health examinations were significantly associated with receiving a gynecological examination in the past 2 years.

Conclusions:
Women of late reproductive age in rural China are not receiving as regular care as younger women. This study identifies sociodemographic and health service correlates for service-seeking behavior, many of which are modifiable. Health services should pay greater attention to this group, including community-based efforts to encourage routine examinations and appropriate use of health services.
EFFECT OF PLASMAPHERESIS AND PASSAGE OF ANTI-RETINAL ANTIBODIES THROUGH THE PLACENTA IN A CASE OF NON-PARANEOPLASTIC AUTOIMMUNE RETINOPATHY
Authors: Sierpina David I. , Skale David M. , Fan Joseph T. 
Published: August 2016

Purpose:
To present a case of nonparaneoplastic autoimmune retinopathy in association with myasthenia gravis in a young woman, and to report the effect of plasmapheresis as well as passage of antiretinal antibodies through the placenta.

Methods:
Case report.

Results:
A 31-year-old woman presented with a history of myasthenia gravis and rapidly progressive vision loss at the age of 23. Funduscopic appearance and fluorescein angiographic findings on presentation were consistent with an autoimmune retinopathy. Paraneoplastic etiology was ruled out, and antiretinal antibody testing revealed positivity for autoantibodies against GAPDH, aldolase, enolase, arrestin, as well as unnamed 48-kDa and 60-kDa proteins. ARA Western Blot and immunohistochemistry profiles were unchanged by either plasmapheresis therapy or passage of serum through the maternal placenta. However, the patient's 6-month and 8-year-old daughters appeared unaffected.

Conclusion:
This is the first report of nonparaneoplastic autoimmune retinopathy associated with myasthenia gravis, although a strong history of autoimmune disorders is a known risk factor. Our patient's antiretinal antibody panel was unaffected immediately after plasmapheresis treatment. Antibodies to GAPDH and unnamed 38-kDa and 86-kDa proteins were able to pass through the placenta into the fetal circulation, although their effect on the growing fetus is not clear.
CHEMOTHERAPEUTIC NADIR-ASSOCIATED RETINOPATHY
Authors: Rivera-De La Parra David , Graue-Hernandez Enrique O. 
Published: August 2016

Purpose:
To describe subinternal limiting membrane hemorrhage as a retinal complication of chemotherapy nadir in a patient with leukemia.

Methods:
Case report.

Results:
A 23-year-old man presented with bilateral subinternal limiting membrane hemorrhages in both eyes as a manifestation of thrombocytopenia secondary to chemotherapy treatment for acute myeloid leukemia.

Conclusion:
Chemotherapeutic nadir-associated retinopathy may present with sub-internal limiting membrane hemorrhages most probably secondary to thrombocytopenia.