bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia
Authors: Schubert Ann-Kristin , Seneviratne Vera , Stolz Jessica , Wiesmann Thomas , Wulf Hinnerk , Eberhart Leopold , Dinges Hanns-Christian 
Published: June 2023

BACKGROUNDPeripheral regional anaesthesia is frequently used for upper extremity surgery. To prolong the duration of analgesia, adjuvants can be added to single-injection local anaesthetics. Despite attempts to compare several adjuvants in pairwise meta-analyses, a comprehensive comparison is still missing.OBJECTIVEThe objective of this network meta-analysis was to determine the effectiveness of adjuvants in upper extremity peripheral nerve blocks.DESIGNA systematic review of randomised controlled trials with network meta-analyses.DATA SOURCESA literature search in Embase, CENTRAL, MEDLINE and Web of Science was performed up to March 2023.ELIGIBILITY CRITERIARandomised trials comparing different adjuvants injected perineurally in peripheral upper extremity nerve blocks were eligible. Frequentist network meta-analysis was conducted using a random effects model with physiological saline as the comparator. The primary endpoint was the ratio of means (ROM) of the duration of analgesia.RESULTSThe review included 242 randomised controlled trials with a total of 17 391 patients. Twenty-eight adjuvants were compared in the largest networks. Most network estimations consisted of a high proportion of direct evidence. Fourteen adjuvants increased the duration of analgesia significantly by the following factors, ROM [95% confidence interval (CI)]: dexamethasone 1.95 (1.79 to 2.13), buprenorphine 1.83 (1.51 to 2.24), butorphanol 1.84 (1.41 to 2.39), potassium chloride 1.89 (1.15 to 3.11), dexmedetomidine 1.70 (1.59 to 1.81), sufentanil 1.70 (1.27 to 2.29), ketorolac 1.68 (1.24 to 2.27), midazolam 1.55 (1.24 to 1.94), tramadol 1.52 (1.32 to 1.75), nalbuphine 1.50 (1.30 to 1.72), morphine 1.43 (1.09 to 1.88), magnesium sulfate 1.42 (1.20 to 1.67), clonidine 1.36 (1.24 to 1.50) and fentanyl 1.23 (1.08 to 1.40). Inconsistency in network meta-analysis was substantial. Overall side effect rates were low with all adjuvants.CONCLUSIONThe best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam. There are general concerns about the quality of underlying studies and the risk of publication bias.TRIAL REGISTRATIONPROSPERO 2018 CRD42018115722
Correlates of serum estradiol concentration among postmenopausal women in Ilorin, North-Central Nigeria
Authors: Odeigah Louis Okebunor , Obalowu Ismaila Aberi , Alabi Anthonia Nkechi , Mohammed Abdulkadir , Ademola Christy Olanike , Oyeleke Oyeronke Adekemi 
Published: June 2023

Abstract

Objectives
There are limited data on the associated factors of circulating endogenous estradiol among Nigerian postmenopausal women. The main objective of this study is to assess the relationship between serum estradiol levels and some menstrual, clinical, and sociodemographic factors in postmenopausal women attending a family medicine clinic in Nigeria.

Methods
This was a hospital-based cross-sectional study involving 372 postmenopausal women. Sociodemographic, menstrual, and clinical data of the participants were collected, and their serum estradiol concentrations were assayed. The collected data were analyzed using IBM SPSS version 21 statistical software. A χ
2 test of association and logistic regression analysis were done to identify significant correlates of serum estradiol concentration among the participants.

Results
The mean ages at menarche and menopause among the participants were 15.6 and 48.1 years respectively. Approximately half of them (51.1%) were receiving chronic medical care for systemic hypertension and/or diabetes. The mean estradiol concentration of the participants in the study was 20.69 pg/mL. The participants' marital status and clinical presentation pattern (chronic vs others) were found to have statistically significant associations with their serum estradiol concentration; P = 0.048 and P = 0.001, respectively. Logistic regression analysis revealed that only the clinical presentation pattern had a significant relationship with serum estradiol concentration among the participants (P = 0.002).

Conclusion
Of all the studied factors, the only significant correlate of low serum estradiol concentration found in this study was chronic medical care presentation for hypertension and/or diabetes.
Efficacy and safety of lemborexant in midlife women with insomnia disorder
Authors: Terauchi Masakazu , Cheng Jocelyn Y. , Yardley Jane , Pinner Kate , Moline Margaret , Malhotra Manoj , Inabe Kanako , Nishida Maika , Pappadopulos Elizabeth 
Published: June 2023

Abstract

Objective
Insomnia is common in midlife women. The efficacy and safety of lemborexant (LEM), a competitive dual orexin receptor antagonist, was assessed for 12 months in a subgroup of midlife women (age, 40-58 y) from Study E2006-G000-303 (Study 303; SUNRISE-2).

Methods
This was a randomized, double-blind, placebo (PBO)-controlled (first 6 mo) study of adults with insomnia disorder (N = 949). During treatment period 1 (TP1), participants received PBO or LEM 5 mg (LEM5) or 10 mg (LEM10). During TP2 (second 6 mo), LEM participants continued their assigned dose; PBO participants were rerandomized to LEM5 or LEM10. Assessments included patient-reported sleep- and fatigue-related measures and treatment-emergent adverse events.

Results
The midlife female subgroup comprised 280 of 949 participants (TP1: PBO, n = 90 of 318 [28.3%]; LEM5, n = 82 of 316 [25.9%]; LEM10, n = 108 of 315 [34.3%]). At 6 months, median changes from baseline in subjective sleep-onset latency (in minutes) were −17.9, −20.7, and − 30.4 for PBO, LEM5, and LEM10 (vs PBO: LEM5, P = not significant; LEM10, P = 0.0310). At 6 months, mean changes from baseline in subjective wake after sleep onset (in minutes) were −37.0 (59.6), −50.1 (74.5), and −54.5 (65.4) for PBO, LEM5, and LEM10 (vs PBO: LEM5 and LEM10, P = not significant), with benefits sustained through 12 months. Greater decreases from baseline (improvement) in Insomnia Severity Index total score and Fatigue Severity Scale total score were seen with LEM versus PBO at 6 months; benefits continued through 12 months. Most treatment-emergent adverse events were mild to moderate in severity.

Conclusions
Consistent with the total population, subjective sleep parameters improved, and improvement was sustained over time in midlife women. LEM was well tolerated, suggesting that LEM may be a potential treatment option for midlife women with insomnia.
Factors Affecting C5 Viability and Demographic Variability in Two Brachial Plexus Centers
Authors: Zelenski Nicole A. , Joslyn Nichole A. , Lee Ying Hsuan , Chuang David Chwei-Chin , Lu Johnny Chuieng-Yi , Chang Tommy Nai-Jen , Spinner Robert J. , Bishop Allen T. , Shin Alexander Y. 
Published: June 2023

Background:
Complete brachial plexus injuries are devastating injuries. A viable C5 spinal nerve can offer additional sources of axons and alter surgical treatment. We aimed to determine factors that portend C5 nerve root avulsion.

Methods:
A retrospective study of 200 consecutive patients with complete brachial plexus injuries at two international centers (Mayo Clinic in the United States and Chang Gung Memorial Hospital in Taiwan) was performed. Demographic information, concomitant injuries, mechanism, and details of the injury were determined, and kinetic energy (KE) and Injury Severity Score were calculated. C5 nerve root was evaluated by preoperative imaging, intraoperative exploration, and/or intraoperative neuromonitoring. A spinal nerve was considered viable if it was grafted during surgery.

Results:
Complete five-nerve root avulsions of the brachial plexus were present in 62% of US and 43% of Taiwanese patients, which was significantly different. Increasing age, the time from injury to surgery, weight, body mass index of patient, motor vehicle accident, KE, Injury Severity Score, and presence of vascular injury significantly increased the risk of C5 avulsion. Motorcycle (≤150cc) or bicycle accident decreased the risk of avulsion. Significant differences were found between demographic variables between the two institutions: age of injury, body mass index, time to surgery, vehicle type, speed of injury, KE, Injury Severity Score, and presence of vascular injury.

Conclusions:
The rate of complete avulsion injury was high in both centers. Although there are a number of demographic differences between the United States and Taiwan, overall the KE of the accident increased the risk of C5 avulsion.
Assessment and role of artery-vein complex in myopic choroidal neovascularization using Optical Coherence Tomography Angiography.
Authors: Ruiz-Medrano Jorge , Almazán-Alonso Elena , Puertas Mariluz , Flores-Moreno Ignacio , García-Zamora María , Kudsieh Bachar , Ruiz-Moreno José M 
Published: June 2023

Abstract

Objective:
To analyze the presence of an artery-vein complex (AVC) underneath myopic choroidal neovascularization (mCNV) and to determine its relationship with neovascular activity.

Patients and methods:
Retrospective analysis of 681 eyes from 362 patients with high myopia defined by an axial length (AL) of >26mm using optical coherence tomography (OCT) and OCT angiography (OCTa) imaging. Patients with clinical diagnosis of mCNV and good quality OCTa images were then selected. An AVC was defined by the identification of both perforating scleral vessels (PSV) and dilated choroidal veins (DCV) under or in contact with the mCNV in the same case. Swept-source OCT (SS-OCT) and SS-OCT angiography images (TRITON; Topcon Corporation, Japan) were reviewed to detect AVC in the mCNV area.

Results:
Results: 50 eyes of 49 highly myopic patients with mCNV were analyzed. Eyes with AVC were statistically older (69.95±13.53 vs. 60.83±10.47 years-old; p<0.01), needed less intravitreal injections/year along the follow-up period (0.80±0.62 vs. 1.92±0.17; p<0.01) and showed less relapses/year (0.58±0.75 vs. 0.46±0.42; p<0.05) when compared to eyes without AVC. Moreover, eyes with AVC were less likely to relapse during the first year from mCNV activation (n=5/14 vs. n=14/16; p<0.01; p<0.01). No significant differences were found regarding either AL (30.55±2.31 vs. 29.65±2.24, p>0.05) or BCVA (0.4±0.5 vs. 0.4±0.5 logMAR, p>0.05) between groups.

Conclusions:
AVC complex has an influence over myopic choroidal neovascularization activity resulting in less aggressive neovascular lesions than those with PSVs only.
Drug Repurposing for the Treatment of Mycobacterium abscessus Infections
Authors: Baker Emily J. , Molloy Antonia , Cox Jonathan A. G. 
Published: June 2023

Abstract
With the ever-increasing burden of antimicrobial resistance, the demand to introduce countermeasures becomes increasingly critical. The urgency of this need is intensified by the void in antibiotic discovery, with the identification of novel compounds declining with time. Of increasing concern is Mycobacterium abscessus, which displays high levels of intrinsic resistance that lead to poor success rates, even after lengthy drug regimens. Research tackling these issues is now focused on the repurposing of preexisting drugs for antimycobacterial use, facilitating the discovery of antimicrobial compounds amidst a crisis where novel antibiotics are sparse. Part of this includes the use of combination treatments, whereby coadministration of synergistic compounds can reduce dose requirements and slow the progression of antimicrobial resistance in the long term. In this review, we will introduce the current therapeutic options for M. abscessus and provide insight into why treatment is so burdensome. We will also compile the current updates within drug repurposing for this pathogen, including the use of unconventional agents such as antimalarial drugs, the repositioning of antituberculosis candidates and the repurposing of preexisting antibiotics, including the application of combination regimens. In addition, the in vitro drug screening platforms used in their discovery will be appraised, with the view of highlighting potential future perspectives that may help increase physiological relevance. This review provides a timely appraisal of the future of M. abscessus treatment.
Buffered Versus Nonbuffered Local Anesthetics and Local Pain Scores in Upper Eyelid Blepharoplasty: Randomized Controlled Trial
Authors: Vasović Dolika D. , Karamarković Miodrag , Stojičić Milan , Jovanović Milan , Savić Vujović Katarina , Rašić Dejan , Colić Milan , Musić Nikola 
Published: June 2023

Purpose:
This split-face study aimed to see whether different types of local anesthetics or their buffered/nonbuffered combinations produce lower pain scores in upper eyelid blepharoplasty.

Methods:
The study involved 288 patients, randomly divided into 9 groups: 1) 2% lidocaine with epinephrine—Lid + Epi; 2) 2% lidocaine with epinephrine and 0.5% bupivacaine (1:1)—Lid + Epi + Bupi; 3) 2% lidocaine with 0.5% bupivacaine (1:1)—Lid + Bupi; 4) 0.5% bupivacaine—Bupi; 5) 2% lidocaine—Lid; 6) 4% articaine hydrochloride with epinephrine—Art + Epi; 7) buffered 2% lidocaine/epinephrine with sodium bicarbonate (SB) in a 3:1 ratio—Lid + Epi + SB; 8) buffered 2% lidocaine with SB in a 3:1 ratio—Lid + SB; 9) buffered 4% articaine hydrochloride/epinephrine with SB in a 3:1 ratio—Art + Epi + SB. Following the injection of the first eyelid and a 5-minute period of soft pressure on the injection site, patients were asked to rate their pain level on the Wong-Baker Face Pain Rating Visual Analogue Scale. Rating of the pain level was repeated 15 and 30 minutes following anesthetic administration.

Results:
The lowest pain scores at the first time point were observed in Lid + SB when compared with all of the other groups (p < 0.05). At the final time point, significantly lower scores were also observed in Lid + SB, Lid + Epi + SB, and Art + Epi + SB when compared with the Lid + Epi group (p < 0.05).

Conclusion:
These findings could help surgeons select an appropriate combination of local anesthetics, particularly in patients with lower pain threshold and tolerance because buffered combinations of local anesthetics produce significantly lower pain scores compared with nonbuffered solutions.
Cardiogenic shock: a major challenge for the clinical trialist
Authors: Sarma Dhruv , Jentzer Jacob C. , Soussi Sabri 
Published: June 2023

Purpose of review
Cardiogenic shock (CS) results in persistently high short-term mortality and a lack of evidence-based therapies. Several trials of novel interventions have failed to show an improvement in clinical outcomes despite promising preclinical and physiologic principles. In this review, we highlight the challenges of CS trials and provide suggestions for the optimization and harmonization of their design.

Recent findings
CS clinical trials have been plagued by slow or incomplete enrolment, heterogeneous or nonrepresentative patient cohorts, and neutral results. To achieve meaningful, practice-changing results in CS clinical trials, an accurate CS definition, a pragmatic staging of its severity for appropriate patient selection, an improvement in informed consent process, and the use of patient-centered outcomes are required. Future optimizations include the use of predictive enrichment using host response biomarkers to unravel the biological heterogeneity of the CS syndrome and identify subphenotypes most likely to benefit from individualized treatment to allow a personalized medicine approach.

Summary
Accurate characterization of CS severity and its pathophysiology are crucial to unravel heterogeneity and identify the patients most likely to benefit from a tested treatment. Implementation of biomarker-stratified adaptive clinical trial designs (i.e., biomarker or subphenotype-based therapy) might provide important insights into treatment effects.
Increasing Antibiotic-Resistant Infections With Inpatient Endoscopic Retrograde Cholangioscopies (ERCP) Is Associated With Higher Mortality in the United States
Authors: Chang Patrick W. , Bui Aileen , Zhou Selena , Sahakian Ara B. , Buxbaum James L. , Phan Jennifer 
Published: June 2023

Goals:
This study aims to investigate associated mortality with inpatient endoscopic retrograde cholangiopancreatography (ERCP) with and without resistant infections. The co-primary objective compares frequencies of inpatient ERCP with resistant infections to overall hospitalizations with resistant infections.

Background:
The risks of inpatient antibiotic-resistant organisms are known, but the associated mortality for inpatient ERCP is unknown. We aim to use a national database of hospitalizations and procedures to understand trends and mortality for patients with antibiotic-resistant infections during inpatient ERCP.

Study:
The largest publicly available all-payer inpatient database in the United States (National Inpatient Sample) was used to identify hospitalizations associated with ERCPs and antibiotic-resistant infections for MRSA, VRE, ESBL, and MDRO. National estimates were generated, frequencies were compared across years, and multivariate regression for mortality was performed.

Results:
From 2017 to 2020, national weighted estimates of 835,540 inpatient ERCPs were generated, and 11,440 ERCPs had coincident resistant infections. Overall resistant infection, MRSA, VRE, and MDRO identified at the same hospitalization of inpatient ERCPs were associated with higher mortality (OR CI(95%): Overall: 2.2(1.77–2.88), MRSA: 1.90 (1.34–2.69), VRE: 3.53 (2.16–5.76), and MDRO: 2.52 (1.39–4.55)). While overall hospitalizations with resistant infections have been decreasing annually, there has been a yearly increase in admissions requiring ERCPs with simultaneous resistant infections (P=0.001–0.013), as well as infections with VRE, ESBL, and MDRO (P=0.001–0.016). Required Research Practices for Studies Using the NIS scoring was 0, or the most optimal.

Conclusions:
Inpatient ERCPs have increasing coincident resistant infections and are associated with higher mortality. These rising infections during ERCP highlight the importance of endoscopy suite protocols and endoscopic infection control devices.
Equity in liver transplantation: are we any closer?
Authors: Ogundolie Moronke , Chan Norine , McElroy Lisa M. 
Published: June 2023

Purpose of review
As policies governing liver transplantation (LT) continue to change and influence clinical practice, it is important to monitor trends in equitable access and outcomes amongst patients. The purpose of this review is to closely examine recent advances and findings in health equity research in LT over the last 2 years; specifically evaluating inequities at the different stages of LT (referral, evaluation, listing, waitlist outcomes and post-LT outcomes).

Recent findings
Advancements in geospatial analysis have enabled investigators to identify and begin to study the role of community level factors (such as neighborhood poverty, increased community capital/urbanicity score) in driving LT disparities. There has also been a shift in investigating center specific characteristics that contributes to disparities in waitlist access. Modification to the current model for end stage liver disease (MELD) score policy accounting for height differences is also crucial to eradicating the disparity in LT amongst sexes. Lastly, Black pediatric patients have been shown to have higher rates of death and worse posttransplant outcome after transitioning to adult healthcare.

Summary
Although, there have been some advances in methodology and policies, inequities in waitlist access, waitlist outcomes and posttransplant outcomes continue to be pervasive in the field of LT. Future directions include expansion of social determinants of health measures, inclusion of multicenter designs, MELD score modification and investigation into drivers of worse posttransplant outcomes in Black patients.
Efficacy of vestibular rehabilitation in vestibular neuritis: a systematic review and meta-analysis
Authors: Huang Hsiao-Han , Chen Chih-Chung , Lee Hsun-Hua , Chen Hung-Chou , Lee Ting-yi , Tam Ka-Wai , Kuan Yi-Chun 
Published: June 2023

Abstract

Objective
This study aimed to evaluate the efficacy of vestibular rehabilitation in vestibular neuritis (VN).

Design
RCTs was collected from MEDLINE, EMBASE, Cochrane Library, PEDro, LILACS, and Google Scholar before May 2023.

Results
This study included 12 RCTs involving 536 patients with VN. Vestibular rehabilitation was comparable to steroids in dizziness handicap inventory (DHI) score at the 1st, 6th, and 12th months (pooled mean differences [MDs]: −4.00, −0.21, and − 0.31, respectively); caloric lateralization at the 3rd, 6th, and 12th months (pooled MD: 1.10, 4.76, and − 0.31, respectively); and abnormal numbers of vestibular-evoked myogenic potentials (VEMPs) at the 1st, 6th and 12th months. Patients receiving a combination of rehabilitation and steroid exhibited significant improvement in DHI score at the 1st, 3rd, and 12th months (MD: −14.86, pooled MD: −4.63, MD: −9.50, respectively); caloric lateralization at the 1st and 3rd months (pooled MD: −10.28, pooled MD: −8.12, respectively); and numbers of VEMPs at the 1st and 3rd months (risk ratios: 0.66 and 0.60, respectively) than did those receiving steroids alone.

Conclusion
Vestibular rehabilitation is recommended for patients with VN. A combination of vestibular rehabilitation and steroids is more effective than steroids alone in the treatment of patients with VN.
Refinements in Extended Alar Contour Grafts: Retrograde Approach in Conjunction with Alar Base Surgery
Authors: Rohrich Rod J. , Sherif Rami D. , Cason Roger W. , Novak Matthew , Trost Jeffrey G. 
Published: June 2023

Summary:
Alar contour grafts are an excellent adjunct in both primary and revision rhinoplasty for correction and prevention of alar rim irregularities. They are traditionally placed at the conclusion of a rhinoplasty through a vestibular incision along the underside of the alar rim. Alternatively, alar base resection provides an opportunity for precise retrograde placement of alar contour grafts. The purpose of this article is to describe an efficient, five-step technique for retrograde placement of alar contour grafts in the setting of concomitant alar base surgery.
The Blocking Points: The Keys to Consistent Success in Preservation Rhinoplasty
Authors: Goksel Abdulkadir , Cason Roger W. , Tran Khanh Ngoc , Rohrich Rod J. 
Published: June 2023

SUMMARY:
Preservation rhinoplasty is a growing area of interest amongst rhinoplasty surgeons. Dorsal preservation—a tenet of preservation rhinoplasty—is predicated on maintaining the integrity of the nasal midvault and effecting aesthetic change through alterations to the bony nasal pyramid and underlying septum. A challenge that is unique to dorsal preservation is the phenomenon of hump recurrence, owing to the existence of anatomical blocking points. Blocking points are resistant tensile forces that either impede dorsal lowering intraoperatively or push the dorsum back to its native convexity over time. Five anatomical blocking points have previously been described, which the authors expand upon and include an additional two. The seven anatomical blocking points are: the cartilaginous septum, perpendicular plate of the ethmoid, lateral osteotomy site, Webster’s triangle, internal mucoperiosteum of the maxillary bone, medial canthal ligament, and the lateral keystone area. It is critical that the surgeon be aware of the particular blocking points relevant to his or her chosen technique, and to appropriately and methodically address them to ensure consistent long-term results.