bluuebunny/crossref_metadata_2025_split huggingface dataset:
Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal
Authors: Young L.W. , Ounpraseuth S.T. , Merhar S.L. , Hu Z. , Devlin L.A. ,   et al
Published: November 2023

(N Engl J Med. 2023; 388:2326–2337)
The diagnosis of neonatal opioid withdrawal syndrome is a frequent occurrence within US hospitals. Most often neonates are evaluated for withdrawal-related symptoms with the Finnegan Neonatal Abstinence Scoring Tool and the associated modifications, however this approach may lead to overuse of pharmacologic agents such as morphine. These authors sought to evaluate whether the Eat, Sleep, Console approach could reduce length of hospital stays experienced by neonates without compromising their safety.
Biomarkers and the Risk of Preeclampsia
Authors: Emeruwa U.N. , Gyamfi-Bannerman C. , Laurent L.C. 
Published: November 2023

(JAMA. 2023;329:539–541)
Though maternal and fetal deaths due to preeclampsia and other hypertensive disorders of pregnancy have decreased in recent years, the incidence of preeclampsia has risen. Current clinical practice for preventing preeclampsia includes initiating a low-dose aspirin treatment at the end of the first trimester of pregnancy; it has been shown to largely mitigate the effects of preeclampsia and reduce incidence. One recent study by Mendoza et al examined the effect of discontinuation of aspirin treatment between 24 and 28 weeks of gestation and found discontinuation is non-inferior to continuation of treatment to 36 weeks. This study had some important findings and implications, but is hard to generalize to the United States, as there are some fundamental differences in the aspirin treatment regimen; the dosage in the United States is 81 mg rather than 150 mg, and there is no recommendation to stop treatment at 36 weeks of gestation. Diagnostically, the United States also does not use molecular biomarkers (the sFlt-1:PlGF ratio) but rather clinical factors to determine risk of preeclampsia. Implementing the methods proposed in this recent study would be a major overhaul of current clinical practice in the United States.
Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal Birth
Authors: Tita A.T.N. , Carlo W.A. , McClure E.M. , Mwenechanya M. , Koso-Thomas E. M. ,   et al,   of the A-PLUS Trial Group
Published: November 2023

(N Engl J Med. 2023;388:1161–1170)
Sepsis and other maternal infections are responsible for 10% of maternal deaths. Sepsis is among the top 3 most common maternal deaths globally. Preeclampsia and hemorrhage are the 2 leading causes of maternal death above infection; however, the rates of preeclampsia and hemorrhage have remained stable over the years while the rates of infection and sepsis have increased. This study aimed to determine whether maternal and neonatal mortality and sepsis could be reduced using the Azithromycin Prevention in Labor Use Study (A-PLUS).
Nitrous Oxide: Primum Non Nocere
Authors: Seiler F.A. 
Published: November 2023

(Anesth Analg. 2023;136:613–615)
The use of nitrous oxide (N2O) for labor analgesia is increasing across the world. N2O is being commonly used as an analgesic in Europe, Australia, New Zealand, Canada, the United Kingdom, Finland, and Sweden. Although its use is common in many areas N2O has not been proven effective and is harmful to the environment. The use of N2O for labor analgesia has increased in hundreds of health care facilities across the United States since 2012.
Randomized Assessment of the Optimal Time Interval Between Programmed Intermittent Epidural Boluses When Combined With the Dural Puncture Epidural Technique for Labor Analgesia
Authors: Yao H.Q. , Huang J.Y. , Deng J.L. , Liu L. , Ai L. , Kee W.D.N. , Xiao F. 
Published: November 2023

(Anesth Analg. 2023;136:532–539)
Neuraxial labor analgesia has advanced to include the dural puncture epidural (DPE) and the programmed intermittent epidural bolus (PIEB) techniques. This study aimed to test the appropriate interval for effective analgesia when the DPE technique is followed by the PIEB technique. This study used fixed volumes of PIEB at 10 mL of ropivacaine 0.1% and 0.5 mg/mL of sufentanil.
Direct Comparison of Peak Bulk Flow Rate of Programmable Intermittent Epidural Bolus and Manual Epidural Bolus Using a Closed-End Multiorifice Catheter: An Experimental Study
Authors: Younger J.D. , Faryami A. , Prasad M. , Viar D. , Menkara A. , Tang A. , Harris C.A. 
Published: November 2023

(Anesth Analg. 2023;136:1198–1205)
Labor analgesia is a popular and widespread technique for pain management during labor and delivery, with many facilities adopting an administration method of programmable intermittent epidural bolus (PIEB). Previous research has studied both advantages and disadvantages of PIEB, with a consensus that advantages outweigh disadvantages. Many institutions also give access to a manual epidural bolus for breakthrough pain and/or for underperforming epidural analgesia, and studies have shown that this combination tends to lead to greater patient satisfaction, greater sensory blockade and improved pain control. Though studies have analyzed the effects of these methods, knowledge is lacking for the comparison of flow rate between PIEB and manual bolus. Understanding any differences could be beneficial to current understanding of mechanisms of pain management during labor and delivery.
General Anesthesia for Cesarean Delivery for Thrombocytopenia in Hypertensive Disorders of Pregnancy: Findings From the Obstetric Airway Management Registry
Authors: Seymour L.M. , Fernandes N.L. , Dyer R.A. , Smit M.I. , van Dyk D. , Hofmeyr R. 
Published: November 2023

(Anesth Analg. 2023;136:992–998)
In Africa, maternal morality following cesarean delivery is 50× more likely compared to morality rates in high-income countries, and spinal anesthesia (SA) is the preferred anesthetic method during cesarean delivery. For parturient patients with hypertensive disorders (ie, preeclampsia, eclampsia, or gestational hypertension), there is an increased risk for adverse outcomes, including spinal epidural hematoma following SA, so thrombocytopenia should be excluded before neuraxial blockade. An accurate platelet count is necessary before SA in emergent situations of fetal distress, which can be complicated when laboratory services are unavailable or off-site. The primary aim of this study was to determine which patients received general anesthesia (GA) when the presence of thrombocytopenia was known versus suspected. The secondary aim was perioperative platelet counts of patients with suspected thrombocytopenia to determine how often GA may have been avoided in favor of SA if platelet count was known.
A Newborn Girl With Hypoglycemia
Authors: Sen S. , Westra S.J. , Matute J.D. , Sherwood J.S. , High F.A. , Kwan M.C. 
Published: November 2023

(N Engl J Med. 2022;387:1218–1226)
A newborn female patient was admitted to the neonatal intensive care unit (ICU) due to hypoglycemia.
Five-Year Follow-Up of a Slowly Resorbable Biosynthetic P4HB Mesh (Phasix) in VHWG Grade 3 Incisional Hernia Repair
Authors: Van den Dop L. M. , Van Rooijen M. M. J. , Tollens T. , Jørgensen L. N. , De Vries-Reilingh T. S. , Piessen G. , Köckerling F. , Miserez M. , Dean M. , Berrevoet F. , Dousset B. , Van Westreenen H. L. , Gossetti F. , Tetteroo G. W. M. , Koch A. , Boomsma M. F. , Lange J. F. , Jeekel J. 
Published: November 2023

Objective:
To assess the 5-year recurrence rate of incisional hernia repair in Ventral Hernia Working Group (VHWG) 3 hernia with a slowly resorbable mesh.

Summary Background Data:
Incisional hernia recurs frequently after initial repair. In potentially contaminated hernia, recurrences rise to 40%. Recently, the biosynthetic Phasix mesh has been developed that is resorbed in 12–18 months. Resorbable meshes might be a solution for incisional hernia repair to decrease short- and long-term (mesh) complications. However, long-term outcomes after resorption are scarce.

Methods:
Patients with VHWG grade 3 incisional midline hernia, who participated in the Phasix trial (Clinilcaltrials.gov: NCT02720042) were included by means of physical examination and computed tomography (CT). Primary outcome was hernia recurrence; secondary outcomes comprised of long-term mesh complications, reoperations, and abdominal wall pain [visual analogue score (VAS): 0–10].

Results:
In total, 61/84 (72.6%) patients were seen. Median follow-up time was 60.0 [interquartile range (IQR): 55–64] months. CT scan was made in 39 patients (68.4%). A recurrence rate of 15.9% (95% confidence interval: 6.9–24.8) was calculated after 5 years. Four new recurrences (6.6%) were found between 2 and 5 years. Two were asymptomatic. In total, 13/84 recurrences were found. No long-term mesh complications and/or interventions occurred. VAS scores were 0 (IQR: 0–2).

Conclusions:
Hernia repair with Phasix mesh in high-risk patients (VHWG 3, body mass index >28) demonstrated a recurrence rate of 15.9%, low pain scores, no mesh-related complications or reoperations for chronic pain between the 2- and 5-year follow-up. Four new recurrences occurred, 2 were asymptomatic. The poly-4-hydroxybutyrate mesh is a safe mesh for hernia repair in VHWG 3 patients, which avoids long-term mesh complications like pain and mesh infection.
Clinical and Radiographic Outcomes of Repair of Spondylolitic Spondylolisthesis Through Direct Pars Repair
Authors: Nagata Kosei , Dimar John R. , Smith Nolan Sledge , Puno Rolando M. , Glassman Steven D. , Djurasovic Mladen , Carreon Leah Y. 
Published: November 2023

Study Design.
A retrospective chart review.

Objective.
The objective of this study is to investigate whether direct pars repair achieves bone healing and symptom relief in patients with spondylolitic spondylolisthesis.

Summary of Background Data.
While most cases of spondylolysis can be managed nonoperatively, a small percentage of patients require surgical intervention. The outcome of direct pars repair through a standard pedicle-screw with wiring technique is controversial in patients with lumbar spondylolitic spondylolisthesis.

Materials and Methods.
Medical records of patients who had undergone an open surgical pars repair were retrospectively reviewed. Standard demographic and surgical parameters were collected. All patients underwent a primary repair of the pars with an autograft or bone morphogenetic protein and instrumentation using a pedicle-screw with spinous process wiring. At 6 to 12 months after the surgery, patient’s pain symptoms, and postoperative computed tomography (CT) scans were independently reviewed to assess healing; which was graded as nonunion, partial union, or solid union.

Results.
There were 68 patients identified (33 male and 35 female), with an average age of 18.6 years. The mean estimated blood loss was 139 ml, and the mean length of hospital stay was 3.7 days. CT evaluation revealed 35 (52%) solid unions, 21 (31%) partial unions, and 12 (18%) nonunions requiring revisions. Thirty-four (50%) patients had no postoperative pain, 24 (35%) had mild pain, and 10 (15%) had persistent pain. The majority of patients with nonunions on CT had mild or persistent pain. Patients with no or mild pain tended to be younger than those with persistent pain (17.5 vs. 24.6 yr, P=0.163).

Conclusion.
This study demonstrated a partial or complete union rate of 82% and a postoperative persistent pain rate of 15%. These figures are comparable to the previous study, and this pedicle-screw with wiring technique can be worth trying before interbody fusion for spondylolytic spondylolisthesis to preserve anatomical lumbar motion.
Learning from patients
Authors: Nembhard Ingrid M. , Matta Sasmira , Shaller Dale , Lee Yuna S. H. , Grob Rachel , Schlesinger Mark 
Published: November 2023

Background
Enthusiasm has grown about using patients’ narratives—stories about care experiences in patients’ own words—to advance organizations’ learning about the care that they deliver and how to improve it, but studies confirming association have not been published.

Purpose
We assessed whether primary care clinics that frequently share patients’ narratives with their staff have higher patient experience survey scores.

Approach
We conducted a 1-year study of 5,545 adult patients and 276 staff affiliated with nine clinics in one health system. We used multilevel models to analyze survey data from patients about their experiences and from staff about exposure to useful narratives. We examined staff confidence in own knowledge as a moderator because confidence can influence use of new information sources.

Results
Frequency of sharing useful narratives with staff was associated with patient experience scores for all measures, conditional on staff confidence in own knowledge (p < .01). For operational measures (e.g., care coordination), increased sharing correlated with subsequently higher performance for more confident staff and lower performance or no difference for less confident staff, depending on measure. For relational measures (e.g., patient–provider communication), increased sharing correlated with higher scores for less confident staff and lower scores for more confident staff.

Conclusion
Sharing narratives with staff frequently is associated with better patient experience survey scores, conditional on confidence in knowledge.

Practice Implications
Frequently sharing useful patient narratives should be encouraged as an organizational improvement strategy. However, organizations need to address how narrative feedback interacts with their staff’s confidence to realize higher experience scores across domains.
IATROGENIC MACULAR HOLE BECAUSE OF NEODYMIUM:YTTRIUM-ALUMINUM-GARNET-SELECTIVE LASER TRABECULOPLASTY LASER: CASE REPORT AND MANAGEMENT
Authors: Saleem Zara , Scoles Drew , Capone Antonio , Mahmoud Tamer H. 
Published: November 2023

Purpose:
To report a case of a patient who suffered a full-thickness macular hole because of the accidental utilization of the selective laser trabeculoplasty mode of a dual mode laser.

Method:
Case report.

Results:
A 69-year-old woman experienced vision loss in her left eye immediately after undergoing attempted neodymium:yttrium-aluminum-garnet capsulotomy using a neodymium:yttrium-aluminum-garnet-selective laser trabeculoplasty laser system. Postinjury visual acuity was 20/25 and 20/800 in the right and left eyes, respectively. Ophthalmic examination and multimodal imaging revealed multiple macular hemorrhages and an irregular full-thickness macular hole. The patient required multiple surgeries including an autologous retinal transplant to achieve hole closure.

Conclusion:
Macular hole formation is a devastating consequence of inadvertent use of the selective laser trabeculoplasty mode when performing a neodymium:yttrium-aluminum-garnet laser capsulotomy with a neodymium:yttrium-aluminum-garnet-selective laser trabeculoplasty laser system. The authors emphasize the importance of ensuring the correct mode is selected for treatment to minimize the risk of retinal damage and permanent vision loss.
Effect of Silica in the Manufacture of Autologous Serum Eye Drops on Corneal Stromal Cells
Authors: Kim Sangyoon , Lee Ji Eun 
Published: November 2023

Purpose:
The aim of this study was to evaluate the effect of serum clot activator, silica (SiO2), which may be used for making autologous serum eye drops, on human corneal fibroblasts.

Methods:
Cultured human corneal fibroblasts were exposed to 10%, 20%, and 30% silica for 1, 6, and 24 hours; methyl thiazolyl tetrazolium–based colorimetric assay was performed to determine the survival rate of fibroblasts and lactate dehydrogenase leakage assay to assess the cytotoxicity. The apoptotic response was evaluated by flow cytometric analysis and fluorescence staining with Annexin V and propidium iodide. Cellular morphology was evaluated by inverted phase-contrast light microscopy and electron microscopy.

Results:
The survival rate of human corneal fibroblasts and cytotoxicity showed both dose-dependent and time-dependent responses. The fluorescent micrograph and flow cytometry showed that as the exposure time increased, more cells underwent apoptosis or necrosis after treatment with 30% silica. When observed with light and electron microscopy, the number of corneal fibroblasts decreased and they were more detached from the dish. In addition, damaged corneal fibroblasts showed degenerative changes after exposure to 30% silica.

Conclusions:
Silica showed dose-dependent and time-dependent toxicity in human corneal fibroblasts. It is safer to keep the blood in tubes without a clot activator when manufacturing autologous serum eye drops to prevent possible corneal cytotoxicity.
Central Toxic Keratopathy After Collagen Cross-Linking: A Case Series
Authors: Dongre Pankaj , Bevara Akhil , Deshmukh Rashmi , Vaddavalli Pravin K. 
Published: November 2023

Purpose:The aim of this study was to report a case series of central toxic keratopathy (CTK) after collagen cross-linking (CXL) in keratoconus.Methods:This is a retrospective case series between January 2020 and September 2021. In this period, CXL was performed for progressive keratoconus in 964 eyes. CXL was performed using the epithelium-off accelerated protocol in all patients with a riboflavin soak time of 20 minutes and a UVA light exposure of 9 mW for 10 minutes using the Avedro KXL (Glaukos Inc, Aliso Viejo, CA) cross-linking system.Results:Twelve of 964 eyes (1.2%) developed CTK within 1 week of CXL. All patients presented with well-circumscribed, central disciform haze that was broader in the anterior stroma and narrower in the posterior stroma. We noted initial flattening in keratometry up to 3 months post-CXL in these patients, which gradually steepened over 12 months, but did not reach preoperative levels. We also noted exuberant flattening in pachymetry in the first 3 months, which improved over 12 months. There was a statistically significant decrease in pachymetry in patients who developed CTK at 3 and 12 months postoperatively when compared to patients who underwent CXL but did not develop CTK.Conclusions:Several reports of CTK postrefractive surgery have been described previously. However, the association of CXL in the development of CTK has not been described previously. Here, we elucidated the clinical features of CTK after CXL and how it differs from corneal scarring or haze that occurs post-CXL.
Systematic Review of Intracochlear Measurements and Effect on Postoperative Auditory Outcomes after Cochlear Implant Surgery
Authors: Hasan Zubair , Key Seraphina , Lee Michael , Da Cruz Melville 
Published: November 2023

ObjectiveQuality and adequacy of the electrode neuron interface (ENI) is postulated to be a determining factor in affecting auditory outcomes after cochlear implantation. This study aims to review radiological parameters affecting ENI, including angular insertion (AngI), wrapping factor (WF), scalar translocation (ScaT), and electrode–modiolar distance (EMD) and their effect on auditory outcomes.Databases ReviewedPubMed, MEDLINE, Embase, Scopus, OpenGrey, and Google Scholar from inception to 01 September 2022.MethodsInclusion criteria were (i) all humans with any cochlear implant (CI); (ii) postoperative cross-sectional imaging with electrode position factors of AngI, ScaT, EMD, and/or WF; and (iii) associated auditory outcomes. Search was restricted to English-language literature. Two independent reviewers performed title and abstract screening, data extraction, and ROBINS-I risk of bias assessment. Formal statistical analysis not performed due to data heterogeneity. PROSPERO (CRD42022359198).ResultsThirty-one studies (n = 2,887 patients, 3,091 electrodes) underwent qualitative synthesis. Higher AngI (n = 1921 patients) demonstrated positive correlation in 11 studies, no correlation in eight studies, and negative correlation in four studies. ScaT (n = 2,115 patients) demonstrated negative correlation in 12 studies, none in six studies, and one unclear correlation. Larger EMD (n = 240 patients) showed negative correlation in two studies, no correlation in one, and unclear correlation in one study. Smaller WF (n = 369 patients) demonstrated no correlation in three studies and positive correlation in one study.ConclusionsOur study finds variable reported relationship between AngI and auditory outcomes. CI electrodes with a ScaT or larger EMD are more likely to exhibit poorer outcomes, and WF does not correlate with outcomes.
Facial-onset sensory and motor neuronopathy with myasthenia gravis: A case report
Authors: Pan Chengyu , Yang Xiangrong , Tai Zhenzhen , Zhou Zhiwei , Hao Renfang , Wang Jin , Liang Tao 
Published: November 2023

Rationale:
Facial-onset sensory and motor neuronopathy (FOSMN) is a greatly rare disease, so far, autopsy evidence that is associated with neurodegenerative. Myasthenia gravis (MG) is an antibody-mediated and complement-involved acquired autoimmune disorder of the post-synaptic neuromuscular junction. There have been few reports about if there is related between the 2. In this study, we present the case of a man who was diagnosed as FOSMN with MG in continuity.

Patient concerns:
The patient chief complaints were right-side facial numbness and right-eyelid incomplete closure, followed by slurred speech and dysphagia, and the symptoms gradually progressed. The patient serum was positive for anti-AchR and anti-Titin antibodies.

Diagnoses:
The patient was diagnosed FOSMN with MG.

Interventions:
The patient symptoms were relieved after pyridostigmine bromide and prednisolone treatment.

Outcomes:
Symptoms have improved.

Lessons:
Facial-onset sensory and motor neuronopathy and MG have disparate clinical features. Therefore, we reported a rare case in which the 2 conditions concurrently existed. Immune dysfunction might be the pathogenesis of this association, while there is no definite evidence to support it, further studies are needed.
A neonatal case report of branchiooculofacial syndrome caused by a novel mutation in the TFAP2A gene and literature review
Authors: Luo Fangmei , Lu Meiling , Zhao Lu , Zhou Ping 
Published: November 2023

Rationale:
Branchiooculofacial syndrome (BOFS) is a rare autosomal dominant disorder with a diverse clinical phenotype. To summarise the clinical characteristics and genetic variations of neonatal-onset BOFS through a case study and literature review.

Patient concerns:
A preterm neonate with a very low birth weight, born at a gestational age of 29+3 weeks, exhibited cosmetic abnormalities at a postmenstrual age of 34+6 weeks, including microcleft lip, high arched palate, curved upper lip, low ear position, and ocular hypertelorism. Hence, a genetic test on peripheral blood was carried out.

Diagnoses:
The genetic testing showed a heterozygous variant of c.724G > A (p.Glu242Lys) in the exon 4 region of the TFAP2A (transcription factor AP-2-α) gene in the short arm of chromosome 6. BOFS was confirmed based on clinical appearance and the genetic result.

Interventions:
The patient underwent solely cleft lip repair at the age of 6 months with no further intervention.

Outcomes:
The infant shows normal growth and development at 1 year of age and subsequent follow-up.

Lessons:
The characteristic facial features, branchial skin defects, and ocular anomalies are the main clinical manifestations of BOFS with neonatal onset, but the diverse clinical phenotype and variable genetic variants pose certain challenges for clinical diagnosis.