bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidural analgesia in patients with traumatic rib fractures: a systematic review of randomised controlled trials
Authors: DUCH P. , MØLLER M. H. 
Published: February 2015

BackgroundTraumatic rib fractures are a common condition associated with considerable morbidity and mortality. Observational studies have suggested improved outcome in patients receiving continuous epidural analgesia (CEA). The aim of the present systematic review of randomised controlled trials (RCTs) was to assess the benefit and harm of CEA compared with other analgesic interventions in patients with traumatic rib fractures.MethodsWe performed a systematic review with meta‐analysis and trial sequential analysis (TSA). Eligible trials were RCTs comparing CEA with other analgesic interventions in patients with traumatic rib fractures. Cumulative relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated, and risk of systematic and random errors was assessed. The predefined primary outcome measures were mortality, pneumonia and duration of mechanical ventilation.ResultsA total of six trials (n = 223) were included; all were judged as having a high risk of bias. In the conventional meta‐analyses, there was no statistically significant difference in mortality (RR 2.18, 95% CI 0.21–22.42; P = 0.51; I2 = 0%), duration of mechanical ventilation (MD −7.53, 95% CI −16.32 to 1.26; P = 0.09; I2 = 91%) or pneumonia (RR 0.49, 95% CI 0.19–1.25; P = 0.13; I2 = 0%) between CEA and other analgesic interventions. Subgroup analyses and sensitivity analyses, including TSA confirmed the results.ConclusionThe quality and quantity of evidence for the use of CEA in patients with traumatic rib fractures is low, and there is no firm evidence for benefit or harm of CEA compared with other analgesic interventions. Well‐powered RCTs with low risk of bias reporting clinically relevant patient‐centred outcome measures are needed.
The evidence of neuraxial administration of analgesics for cancer‐related pain: a systematic review
Authors: Kurita G. P. , Benthien K. S. , Nordly M. , Mercadante S. , Klepstad P. , Sjøgren P. ,   the European Palliative Care Research Collaborative (EPCRC)
Published: February 2015

BackgroundThe present systematic review analysed the existing evidence of analgesic efficacy and side effects of opioids without and with adjuvant analgesics delivered by neuraxial route (epidural and subarachnoid) in adult patients with cancer.MethodsSearch strategy was elaborated with words related to cancer, pain, neuraxial route, analgesic and side effects. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. Studies were analysed according to methods, results, quality of evidence, and strength of recommendation.ResultsThe number of abstracts retrieved was 2147, and 84 articles were selected for full reading. The final selection comprised nine articles regarding randomised controlled trials (RCTs) divided in four groups: neuraxial combinations of opioid and adjuvant analgesic compared with neuraxial administration of opioid alone (n = 4); single neuraxial drug in bolus compared with continuous administration (n = 2); single neuraxial drug compared with neuraxial placebo (n = 1); and neuraxial opioid combined with or without adjuvant analgesic compared with other comprehensive medical management than neuraxial analgesics (n = 2). The RCTs presented clinical and methodological diversity that precluded a meta‐analysis. They also presented several limitations, which reduced study internal validity. However, they demonstrated better pain control for all interventions analysed. Side effects were described, but there were few significant differences in favour of the tested interventions.ConclusionHeterogeneous characteristics and several methodological limitations of the studies resulted in evidence of low quality and a weak recommendation for neuraxial administration of opioids with or without adjuvant analgesics in adult patients with cancer.
Central venous pressure: we need to bring clinical use into physiological context
Authors: SONDERGAARD S. , PARKIN G. , ANEMAN A. 
Published: February 2015

BackgroundThe place of central venous pressure (CVP) measurement in acute care has been questioned during the past decade. We reviewed its physiological importance, utility and clinical use among anaesthetists and intensivists.MethodsA literature search using the PubMed, Cochrane, Scopus and Web of Science databases was performed in regard to details of the physiology, measurement and interpretation of CVP. A questionnaire was conducted among members of the European Society of Intensive Care Medicine concerning knowledge and uses of CVP.ResultsAligning pressure transducers to the phlebostatic axis was handled inadequately. The unsuitability of CVP to assess the intravascular volume state was generally recognised by clinicians. Still, many used CVP to guide volume resuscitation in the absence of a cardiac output monitor, while the literature positioned CVP as a useful haemodynamic variable only in the expanded context of being one determinant of the driving pressure for venous return and hence cardiac output.ConclusionThe correct measurement of CVP is pivotal to its proper clinical application. This relates to defining the pressure gradient for venous return and heart efficiency. The clinical appreciation of CVP should be restored by educational efforts of its physiological context.
Deep neuromuscular block reduces intra‐abdominal pressure requirements during laparoscopic cholecystectomy: a prospective observational study
Authors: VAN WIJK R. M. , WATTS R. W. , LEDOWSKI T. , TROCHSLER M. , MORAN J. L. , ARENAS G. W. N. 
Published: February 2015

BackgroundLaparoscopic surgery causes specific post‐operative discomfort and intraoperative cardiovascular, pulmonary, and splanchnic changes. The CO2 pneumoperitoneum‐related intra‐abdominal pressure (IAP) remains one of the main drivers of these changes. We investigated the influence of deep neuromuscular blockade (NMB) on IAP and surgical conditions.MethodsThis is an open prospective single‐subject design study in 20 patients (14 female/6 male) undergoing laparoscopic cholecystectomy. Inclusion criteria were 18 years or older, and American Society of Anesthesiologists classification 1 to 3. Under a standardised anaesthesia, lowest IAP providing adequate surgical conditions was assessed without NMB and with deep NMB [post‐tetanic count (PTC) < 2] with rocuronium. The differences between IAP allowing for an adequate surgical field before and after administration of rocuronium were determined, as were effects of patient gender, age, and body mass index.ResultsMean IAP without NMB was 12.75 (standard deviation 4.49) mmHg. Immediately after achieving a deep NMB, this was 7.20 (2.51). This pressure difference of 5.55 mmHg (5.08, P < 0.001) dropped to 3.00 mmHg (4.30, P < 0.01) after 15 min. Higher IAP differences were found in women compared with men. A modest inverse relationship was found between pressure difference and age.ConclusionsWe found an almost 25% lower IAP after a deep NMB compared with no block in laparoscopic cholecystectomy. Younger and female patients appear to benefit more from deep neuromuscular blockade to reduce IAP.
Sipping, Drinking, and Early Adolescent Alcohol Consumption: A Cautionary Note
Authors: Wadolowski Monika , Bruno Raimondo , Aiken Alexandra , Stone Chiara , Najman Jake , Kypri Kypros , Slade Tim , Hutchinson Delyse , McBride Nyanda , Mattick Richard P. 
Published: February 2015

BackgroundEpidemiological studies report markedly varying rates of adolescent alcohol involvement. Despite being a common adolescent behavior, a potential cause of this variation is that consumption of sips is either not measured or not distinguished from consumption of whole beverages.MethodsParticipants were 1,843 grade 7 adolescents recruited across 49 Australian secondary schools (M age = 12.4, SD = 0.5). Quantity and frequency of lifetime and past 6‐month consumption were assessed, distinguishing between sipping and drinking. For comparison with international population surveys, quantity was reported as any consumption, sipping only, and drinking only.ResultsCombining sipping and drinking into a single category, lifetime consumption was reported by 67.3% of the present sample. Distinguishing lifetime consumption by sipping and drinking: only 7.8% of adolescents had consumed a whole beverage; the remaining 59.6% had only sipped. Consumption of whole beverages was mostly limited to 1 to 2 drinks (84.2% of drinkers). Sipping and drinking were also infrequent: 78.2% of sipping and 60.4% of drinking, occurred less than monthly. Heavy episodic consumption was uncommon (1.2% of the sample). When other population studies were inspected, a clear trend for higher drinking rates were found in those studies where sipping was counted as drinking and vice versa.ConclusionsConsumption of whole beverages appears infrequent in early adolescence, as sipping, but not drinking, was common in our sample. Comparing the present data with international population consumption measures highlights the need to more precisely measure and report adolescent consumption, particularly in relation to sipping.
Genetic Absence of nNOS Worsens Fetal Alcohol Effects in Mice. I: Behavioral Deficits
Authors: Karacay Bahri , Bonthius Nancy E. , Plume Jeffrey , Bonthius Daniel J. 
Published: February 2015

BackgroundAlcohol abuse during pregnancy often induces neuropsychological problems in the offspring, including learning disorders, attention deficits, and behavior problems, all of which are prominent components of fetal alcohol spectrum disorders (FASD). However, not all children who were exposed to alcohol in utero are equally affected by it. While some children have major deficits, others are spared. This unequal vulnerability is likely due largely to differences in fetal genetics. Some fetuses appear to have certain genotypes that make them much more prone to FASD. However, to date, no gene has been identified that worsens alcohol‐induced brain dysfunction. Nitric oxide (NO) is a gaseous molecule that can protect developing neurons against alcohol‐induced death. In the brain, NO is produced by neuronal nitric oxide synthase (nNOS). In this study, we examined whether homozygous mutation of the nNOS gene in mice worsens the behavioral deficits of developmental alcohol exposure.MethodsWild‐type and nNOS−/− mice received alcohol (0.0, 2.2, or 4.4 mg/g) daily over postnatal days (PDs) 4 to 9. Beginning on PD 85, the mice underwent a series of behavioral tests, including open field activity, the Morris water maze, and paired pulse inhibition.ResultsFor the wild‐type mice, alcohol impaired performance only in the water maze. In contrast, for the nNOS−/− mice, alcohol impaired performance on all 3 tasks. Furthermore, the nNOS−/− mice were substantially more impaired than wild‐type mice in their performance on all 3 of the behavioral tests and at both the low (2.2) and high (4.4) doses of alcohol.ConclusionsTargeted disruption of the nNOS gene worsens the behavioral impact of developmental alcohol exposure and allows alcohol‐induced learning problems to emerge that are not seen in wild type. This is the first demonstration that a specific genotype can interact with alcohol to worsen functional brain deficits in an animal model of FASD.
Prenatal Alcohol Exposure Alters Steady‐State and Activated Gene Expression in the Adult Rat Brain
Authors: Lussier Alexandre A. , Stepien Katarzyna A. , Neumann Sarah M. , Pavlidis Paul , Kobor Michael S. , Weinberg Joanne 
Published: February 2015

BackgroundPrenatal alcohol exposure (PAE) is associated with alterations in numerous physiological systems, including the stress and immune systems. We have previously shown that PAE increases the course and severity of arthritis in an adjuvant‐induced arthritis (AA) model. While the molecular mechanisms underlying these effects are not fully known, changes in neural gene expression are emerging as important factors in the etiology of PAE effects. As the prefrontal cortex (PFC) and hippocampus (HPC) play key roles in neuroimmune function, PAE‐induced alterations to their transcriptome may underlie abnormal steady‐state functions and responses to immune challenge. This study examined brains from adult PAE and control females from our recent AA study to determine whether PAE causes long‐term alterations in gene expression and whether these mediate the altered severity and course of arthritis in PAE females.MethodsAdult females from PAE, pair‐fed (PF), and ad libitum‐fed control (C) groups were injected with either saline or complete Freund's adjuvant. Animals were terminated at the peak of inflammation or during resolution (Days 16 and 39 postinjection, respectively); cohorts of saline‐injected PAE, PF, and C females were terminated in parallel. Gene expression was analyzed in the PFC and HPC using whole‐genome mRNA expression microarrays.ResultsSignificant changes in gene expression in both the PFC and HPC were found in PAE compared to controls in response to ethanol exposure alone (saline‐injected females), including genes involved in neurodevelopment, apoptosis, and energy metabolism. Moreover, in response to inflammation (adjuvant‐injected females), PAE animals showed unique expression patterns, while failing to exhibit the activation of genes and regulators involved in the immune response observed in control and pair‐fed animals.ConclusionsThese results support the hypothesis that PAE affects neuroimmune function at the level of gene expression, demonstrating long‐term effects of PAE on the central nervous system response under steady‐state conditions and following an inflammatory insult.
Personalized Feedback Based on a Drink‐Pouring Exercise May Improve Knowledge of, and Adherence to, Government Guidelines for Alcohol Consumption
Authors: de Visser Richard O. 
Published: February 2015

BackgroundAlthough most people are aware of government guidelines for alcohol consumption, few have accurate knowledge of these and fewer still use these guidelines to monitor their drinking. Most people also lack accurate knowledge of the alcohol content of the drinks they consume. The aim of the study reported here was to examine whether or not personalized feedback on alcohol consumption based on performance in a drink‐pouring task and self‐reported alcohol intake would improve university students’ knowledge of alcohol consumption guidelines and reduce their alcohol intake.MethodsA quasi‐randomized control trial with a 2‐month follow‐up was conducted with 200 students aged 18 to 37 in the south of England. Participants were allocated to a “pour + feedback” group that completed a drink‐pouring task and received personalized feedback, a “pour only” group that completed the drink‐pouring task but did not receive feedback, and a control group.ResultsAt follow‐up, participants in the “pour + feedback” group had significantly better knowledge of government guidelines, and significantly lower weekly alcohol intake when compared to the “control” and “pour only” groups.ConclusionsFurther refinement of the drink‐pouring intervention and feedback is reported in this paper, and assessment of their impact in various populations may lead to better understanding of which elements of personalized feedback have the greatest influence on young people's alcohol use.
Association Study of the SLC6A3 VNTR (DAT) and DRD2/ANKK1 Taq1A Polymorphisms with Alcohol Dependence in a Population from Northeastern Brazil
Authors: Vasconcelos Any Carolina C. G. , Neto Edmilson de Souza R. , Pinto Giovanny R. , Yoshioka France Keiko N. , Motta Fábio José N. , Vasconcelos Daniel Fernando P. , Canalle Renata 
Published: February 2015

BackgroundAlcohol dependence (AD) is a complex psychiatric disorder, affecting 5.4% of the general population lifetime, characterized by excessive alcohol consumption influenced by environmental risk factors and genetic factors. Genetic alterations in dopaminergic system are involved in the treatment and etiology of AD. The aim of this search was to test the association of the SLC6A3 40 bp‐VNTR and DRD2/ANKK1 Taq1A single nucleotide polymorphism (SNP), a transporter and receptor of the dopaminergic system, with AD through a study in a population of northeastern Brazil.MethodsThe study design was a case–control that included 227 males of northeastern Brazil (113 alcoholics and 114 controls). Alcoholics were classified according to the DSM‐IV criteria for AD and controls were subjects who had nonalcohol problems or who never drank. Genotyping was detected through polymerase chain reaction (PCR) for SLC6A3 40 bp‐VNTR and RFLP‐PCR for DRD2/ANKK1 Taq1A, and subsequent electrophoresis on a 2% agarose gel. The distribution of allele and genotype frequencies and association of polymorphisms with AD were assessed by chi‐square, Fisher's exact test, and odds ratio (OR) with a confidence interval of 95% and significance p < 0.05. Data were analyzed on BioEstat 5.3 software.ResultsThe SLC6A3 40 bp‐VNTR was associated with AD, allelic, and genotypic frequencies were significantly different, respectively (A9 vs. A10: OR = 1.88; p = 0.01; A9/A9 vs. A10/A10: OR = 6.25; p = 0.02; A9/A9 vs. A9/A10 + A10A10: OR = 5.44; p = 0.03). However, there was no statistically significant difference when the allelic (p = 0.10) and genotypic (p > 0.05) frequencies for DRD2/ANKK1 Taq1A were compared.ConclusionsThese findings suggest that A9 allele and A9/A9 genotype of the SLC6A3 40 bp‐VNTR are involved in the vulnerability to AD in the population studied. However, for the DRD2/ANKK1 SNP does not present contributions to the development of AD.
Gender Effects in Alcohol Dependence: An fMRI Pilot Study Examining Affective Processing
Authors: Padula Claudia B. , Anthenelli Robert M. , Eliassen James C. , Nelson Erik , Lisdahl Krista M. 
Published: February 2015

BackgroundAlcohol dependence (AD) has global effects on brain structure and function, including frontolimbic regions regulating affective processing. Preliminary evidence suggests alcohol blunts limbic response to negative affective stimuli and increases activation to positive affective stimuli. Subtle gender differences are also evident during affective processing.MethodsFourteen abstinent AD individuals (8 F, 6 M) and 14 healthy controls (9 F, 5 M), ages 23 to 60, were included in this facial affective processing functional magnetic resonance imaging pilot study. Whole‐brain linear regression analyses were performed, and follow‐up analyses examined whether AD status significantly predicted depressive symptoms and/or coping.ResultsFearful Condition—The AD group demonstrated reduced activation in the right medial frontal gyrus, compared with controls. Gender moderated the effects of AD in bilateral inferior frontal gyri. Happy Condition—AD individuals had increased activation in the right thalamus. Gender moderated the effects of AD in the left caudate, right middle frontal gyrus, left paracentral lobule, and right lingual gyrus. Interactive AD and gender effects for fearful and happy faces were such that AD men activated more than control men, but AD women activated less than control women. Enhanced coping was associated with greater activation in right medial frontal gyrus during fearful condition in AD individuals.ConclusionsAbnormal affective processing in AD may be a marker of alcoholism risk or a consequence of chronic alcoholism. Subtle gender differences were observed, and gender moderated the effects of AD on neural substrates of affective processing. AD individuals with enhanced coping had brain activation patterns more similar to controls. Results help elucidate the effects of alcohol, gender, and their interaction on affective processing.
Heavy Drinking Trajectories Among Men Who Have Sex with Men: A Longitudinal, Group‐Based Analysis
Authors: Marshall Brandon D. L. , Shoveller Jean A. , Kahler Christopher W. , Koblin Beryl A. , Mayer Kenneth H. , Mimiaga Matthew J. , van den Berg Jacob J. , Zaller Nickolas D. , Operario Don 
Published: February 2015

BackgroundHeavy episodic drinking (HED) is associated with sexual risk behavior and HIV seroconversion among men who have sex with men (MSM), yet few studies have examined heavy drinking typologies in this population.MethodsWe analyzed data from 4,075 HIV‐uninfected MSM (aged 16 to 88) participating in EXPLORE, a 48‐month behavioral intervention trial, to determine the patterns and predictors of HED trajectories. HED was defined as the number of days in which ≥5 alcohol drinks were consumed in the past 6 months. Longitudinal group‐based mixture models were used to identify HED trajectories, and multinomial logistic regression was used to determine correlates of membership in each group.ResultsWe identified 5 distinct HED trajectories: nonheavy drinkers (31.9%); infrequent heavy drinkers (i.e., <10 heavy drinking days per 6‐month period, 54.3%); regular heavy drinkers (30 to 45 heavy drinking days per 6 months, 8.4%); drinkers who increased HED over time (average 33 days in the past 6 months to 77 days at end of follow‐up, 3.6%); and very frequent heavy drinkers (>100 days per 6 months, 1.7%). Intervention arm did not predict drinking trajectory patterns. Younger age, self‐identifying as white, lower educational attainment, depressive symptoms, and stimulant use were associated with reporting heavier drinking trajectories. Compared to nonheavy drinkers, participants who increased HED more often experienced a history of childhood sexual abuse (CSA). Over the study period, depressive symptomatology increased significantly among very frequent heavy drinkers.ConclusionsSocioeconomic factors, substance use, depression, and CSA were associated with heavier drinking patterns among MSM. Multicomponent interventions to reduce HED should seek to mitigate the adverse impacts of low educational attainment, depression, and early traumatic life events on the initiation, continuation, or escalation of frequent HED among MSM.
Delay Discounting for Sucrose in Alcohol‐Preferring and Nonpreferring Rats Using a Sipper Tube Within‐Sessions Task
Authors: Perkel Jessica K. , Bentzley Brandon S. , Andrzejewski Matthew E. , Martinetti Margaret P. 
Published: February 2015

BackgroundDelay discounting (DD) is a measure of impulsivity that quantifies preference for a small reward delivered immediately over a large reward delivered after a delay. It has been hypothesized that impulsivity is an endophenotype associated with increased risk for development of alcohol use disorders (AUDs); however, a causal role of impulsivity is difficult to determine with human studies. We tested this hypothesis by assessing the degree of DD present in alcohol‐naïve rats selectively bred for either high‐ or low‐alcohol preference.MethodsA novel adaptation of a within‐sessions DD procedure was used to compare impulsivity differences between male alcohol‐preferring (P) and nonpreferring (NP) rat lines (n = 6 per line) using a 5% sucrose reward. Animals chose between 2 options: 2‐second sipper tube access delivered immediately (small reward) or 8‐second access after a variable delay (large reward). Each 50‐minute session consisted of 5 blocks of ten 60‐second trials. Within each session, the delay to the large reward increased in each block of trials. Delays were gradually increased over 3 sets to attain a final delay set of 3, 8, 15, 18, and 25 seconds.ResultsPrior to starting delays, there were no significant differences between lines in sucrose consumption or percent choice for the large reward, and both lines exhibited a clear preference for the large reward. After delays were initiated, choice for the large reward decreased as the delay to its presentation increased. Although discounting of the large, delayed reward was observed for both lines, the degree of discounting, or “impulsivity,” was greater for P rats compared with NP rats.ConclusionsP rats are more impulsive for sucrose rewards before exposure to alcohol compared with NP rats. Thus, individuals genetically predisposed toward developing AUDs may be more likely to engage in impulsive decision making prior to alcohol exposure.