bluuebunny/crossref_metadata_2025_split huggingface dataset:
Individualised flow-controlled ventilation versus pressure-controlled ventilation in a porcine model of thoracic surgery requiring one-lung ventilation
Authors: Spraider Patrick , Martini Judith , Abram Julia , Putzer Gabriel , Ranalter Manuela , Mathis Simon , Hell Tobias , Barnes Tom , Enk Dietmar 
Published: September 2022

BACKGROUND
Flow-controlled ventilation (FCV) enables precise determination of dynamic compliance due to a continuous flow coupled with direct tracheal pressure measurement. Thus, pressure settings can be adjusted accordingly in an individualised approach.

OBJECTIVE
The aim of this study was to compare gas exchange of individualised FCV to pressure-controlled ventilation (PCV) in a porcine model of simulated thoracic surgery requiring one-lung ventilation (OLV).

DESIGN
Controlled interventional trial conducted on 16 domestic pigs.

SETTING
Animal operating facility at the Medical University of Innsbruck.

INTERVENTIONS
Thoracic surgery was simulated with left-sided thoracotomy and subsequent collapse of the lung over a period of three hours. When using FCV, ventilation was performed with compliance-guided pressure settings. When using PCV, end-expiratory pressure was adapted to achieve best compliance with peak pressure adjusted to achieve a tidal volume of 6 ml kg−1 during OLV.

MAIN OUTCOME MEASURES
Gas exchange was assessed by the Horowitz index (= PaO2/FIO2) and CO2 removal by the PaCO2 value in relation to required respiratory minute volume.

RESULTS
In the FCV group (n = 8) normocapnia could be maintained throughout the OLV trial despite a significantly lower respiratory minute volume compared to the PCV group (n = 8) (8.0 vs. 11.6, 95% confidence interval, CI -4.5 to -2.7 l min−1; P < 0.001), whereas permissive hypercapnia had to be accepted in PCV (PaCO2 5.68 vs. 6.89, 95% CI -1.7 to -0.7 kPa; P < 0.001). The Horowitz index was comparable in both groups but calculated mechanical power was significantly lower in FCV (7.5 vs. 22.0, 95% CI -17.2 to -11.8 J min−1; P < 0.001).

CONCLUSIONS
In this porcine study FCV maintained normocapnia during OLV, whereas permissive hypercapnia had to be accepted in PCV despite a substantially higher minute volume. Reducing exposure of the lungs to mechanical power applied by the ventilator in FCV offers a possible advantage for this mode of ventilation in terms of lung protection.
Predicting personalised remifentanil effect site concentration for surgical incision using the nociception level index
Authors: Perrin Laurent , Bisdorff Max , Saxena Sarah , Tabolcea Ionut , Huybrechts Isabelle , Van Obbergh Luc , Engelman Edgard , Barvais Luc , Coeckelenbergh Sean 
Published: September 2022

BACKGROUND
Inadequate antinociception can cause haemodynamic instability. The nociception level (NOL) index measures response to noxious stimuli, but its capacity to predict optimal antinociception is unknown.

OBJECTIVE
To determine if NOL index change to a tetanic stimulus in cardiac and noncardiac surgery patients could predict the required remifentanil concentration for haemodynamic stability at skin incision.

DESIGN
A prospective two-phase cohort study.

SETTING
University hospital.

PATIENTS
Patients undergoing remifentanil-propofol target controlled infusion (TCI) anaesthesia.

INTERVENTIONS
During the calibration phase, investigators evaluated the tetanic stimulus induced NOL index change under standardised TCI remifentanil-propofol anaesthesia during a no-touch period [bispectral index (BIS) between 40 and 60, NOL index under 15]. If the NOL index change was 20 or greater following tetanic stimulation, investigators repeated the tetanus at higher remifentanil concentrations until the response was blunted. Surgeons incised the skin at this remifentanil concentration. The investigators derived a prediction model and in the validation phase calculated, using the NOL response to a single tetanus, the required incision remifentanil concentration for the start of surgery.

MAIN OUTCOME
Haemodynamic stability at incision [i.e. maximum heart rate (HR) < 20% increase from baseline, minimum HR (40 bpm) and mean arterial pressure (MAP) ± <20% of baseline].

RESULTS
During the calibration phase, no patient had hypertension. Two patients had a HR increase slightly greater than 20% (25.4 and 26.7%) within the first 2 min of surgery, but neither of these two patients had a HR above 76 bpm. Two patients were slightly hypotensive after incision (MAP 64 and 73 mmHg). During the validation phase, neither tachycardia nor hypotension occurred, but MAP increased to 21.5% above baseline for one patient.

CONCLUSION
During a no-touch period in patients under steady-state general anaesthesia [propofol effect site concentration (Ce) required for BIS between 40 and 60], the NOL index response to a tetanic stimulus under remifentanil antinociception can be used to personalise remifentanil Ce for the start of surgery and ensure stable haemodynamics.

TRIAL REGISTRATION
ClinicalTrials.gov: NCT03324269
Harvesting the Entire Seventh Costal Cartilage for Secondary Rhinoplasty
Authors: Jung Dong-Woo , Lee Myung Ju 
Published: September 2022

Background:
As rhinoplasty is becoming increasingly common, the number of revision cases is also increasing. These cases require more cartilage, and costal cartilage is considered a good material. We introduce a method of harvesting the entire seventh costal cartilage.

Methods:
This study was performed from April 2019 to March 2020. The seventh costal cartilage was harvested from 156 patients. The incision was placed at the inframammary fold in women and directly above the cartilage in men. The length of incision was approximately 3.5 cm. After skin incision, we found a muscle fascia plane, and wide dissection was performed. We opened the muscle fascia and split the rectus abdominis muscles. Then, the seventh costal cartilage was exposed. Careful subperichondrial dissection was continued circumferentially. After the posterior aspect of the cartilage was exposed, the costochondral junction was cut and dislocated. The remaining perichondral dissection was performed under direct vision to avoid violating the perichondrium. Then, we dislocated the synchondrosis between the sixth and seventh cartilages and the seventh and eighth cartilages in turn. Finally, we cut the sternocostal area while protecting the underlying perichondrium and removed the cartilage. We checked for pneumothorax and then closed the wound layer by layer using 2-0 and 3-0 Vicryl sutures. Skin closure was performed with Steri-Strips.

Results:
The mean time for cartilage harvesting was 52 minutes. The average length of the cartilage was 9.33 mm. No cases of pneumothorax or postoperative morbidities were noted.

Conclusion:
We used sufficient amounts of cartilage to perform satisfactory rhinoplasty.
Chronic obstructive pulmonary disease and obstructive sleep apnoea overlap: co-existence, co-morbidity, or causality?
Authors: O’Neill Emily , Ryan Silke , McNicholas Walter T. 
Published: September 2022

Purpose of review
The chronic obstructive pulmonary disease and obstructive sleep apnoea overlap syndrome is associated with higher morbidity and mortality rates than either disease alone. There is evidence of a bidirectional relationship between the two conditions, with the overlap syndrome encompassing a spectrum of clinical phenotypes.

Recent findings
This review examines the evidence for the various factors that determine the overlap syndrome, the impact overlap syndrome has on co-morbidities, and implications for diagnosis and treatment.

Summary
The accurate diagnosis of the overlap syndrome is critical given its implications for treatment optimisation and reduction in healthcare utilisation and costs.
Veterans’ Use of Telehealth for Veterans Health Administration Community Care Urgent Care During the Early COVID-19 Pandemic
Authors: Cordasco Kristina M. , Yuan Anita H. , Rollman Jeffrey E. , Moreau Jessica L. , Edwards Lisa K. , Gable Alicia R. , Hsiao Jonie J. , Ganz David A. , Vashi Anita A. , Mehta Paril A. , Jackson Nicholas J. 
Published: September 2022

Background:
Since the onset of the COVID-19 pandemic, telehealth has been an option for Veterans receiving urgent care through Veterans Health Administration Community Care (CC).

Objective:
We assessed use, arrangements, Veteran decision-making, and experiences with CC urgent care delivered via telehealth.

Design:
Convergent parallel mixed methods, combining multivariable regression analyses of claims data with semistructured Veteran interviews.

Subjects:
Veterans residing in the Western United States and Hawaii, with CC urgent care claims March 1 to September 30, 2020.

Key Results:
In comparison to having in-person only visits, having a telehealth-only visit was more likely for Veterans who were non-Hispanic Black, were urban-dwelling, lived further from the clinic used, had a COVID-related visit, and did not require an in-person procedure. Predictors of having both telehealth and in-person (compared with in-person only) visits were other (non-White, non-Black) non-Hispanic race/ethnicity, urban-dwelling status, living further from the clinic used, and having had a COVID-related visit. Care arrangements varied widely; telephone-only care was common. Veteran decisions about using telehealth were driven by limitations in in-person care availability and COVID-related concerns. Veterans receiving care via telehealth generally reported high satisfaction.

Conclusions:
CC urgent care via telehealth played an important role in providing Veterans with care access early in the COVID-19 pandemic. Use of telehealth differed by Veteran characteristics; lack of in-person care availability was a driver. Future work should assess for changes in telehealth use with pandemic progression, geographic differences, and impact on care quality, care coordination, outcomes, and costs to ensure Veterans’ optimal and equitable access to care.
Thick Placenta in Pregnancy: A Review
Authors: Strebeck Ryan , Jensen Brooke , Magann Everett F. 
Published: September 2022

Importance
A thickened placenta is easily identified on ultrasound and provides insight into maternal and fetal wellbeing as well as underlying structural and physiologic anomalies.

Objectives
The aim of this study was to review the literature to clarify what classifies a placenta as “thickened” and to review the associated incidence, maternal and fetal comorbidities, and management during pregnancy.

Evidence Acquisition
Electronic databases (PubMed and Web of Science) were searched from 2000 to 2020 in the English language. Studies were selected that examined associations between placental thickness, potential etiologies, and obstetric outcomes.

Results
There were 140 abstracts identified. After reviewing the articles, 60 were used in this review. Routine assessment of the placenta in the prenatal period is an easy and inexpensive way to assess the maternal and fetal patients. The criteria for a “thickened placenta” vary between studies based on gestational age, placental location, measurement technique, and maternal or fetal factors. Whereas most suggest thickness exceeding 4 cm is pathologic, a review had a threshold of 6 cm in the third trimester to classify placentomegaly. Several maternal and fetal conditions have been associated with a thickened placenta, such as obesity, parity, anemia, diabetes, preeclampsia, cardiac dysfunction, infection, assisted reproductive technology, multiple pregnancy, sacrococcygeal teratomas, and Beckwith-Wiedemann syndrome. A thickened placenta in pregnancy is associated with a higher incidence of adverse pregnancy outcomes and neonatal morbidity and mortality.

Conclusions
The literature is clear that early evaluation of the placenta using ultrasound should be a standard practice. A thickened placenta found on routine imaging should prompt a more thorough investigation to determine the etiology of the placentomegaly. At the time of this literature review, there are no recommendations regarding modality or frequency of antenatal surveillance in pregnancies complicated by a thickened placenta. However, serial ultrasounds and weekly antenatal testing in the third trimester should be considered.

Relevance
A thickened placenta has been associated with a variety of maternal and fetal conditions and increases the risk of adverse pregnancy outcomes and neonatal morbidity and mortality.

Target Audience
Obstetricians, nurse midwives, pediatricians, family physicians

Learning Objectives
After completion of this article, the reader should be able to classify the diagnostic criteria of thickened placenta in pregnancy; identify associated maternal and fetal conditions in the setting of a thickened placenta; and predict the adverse outcomes of pregnancy related to a thickened placenta.
Sural nerve biopsy as a standardized baseline clinical model for the translational evaluation of bioengineered nerve guides: A single-blinded randomized controlled prospective study
Authors: Dastagir Khaled , Radtke Christine , Dastagir Nadjib , Bucan Vesna , Strauß Sarah , Jokuszies Andreas , Vogt Peter Maria 
Published: September 2022

Objective:
Autologous nerve transplantation is accepted as the clinical gold standard for reconstruction of peripheral nerve defects. A high number of bioengineered nerve guides as an alternative to the autologous nerve transplantation has been described in previous studies and several different types are commercially available. The implementation of these devices in the clinical setting is the most important step to proof their applicability in reconstructive nerve surgery.

Patients and Methods:
We examined in a single- blinded randomized controlled prospective study 34 patients undergoing diagnostic nerve biopsy (2 cm). The biopsy-induced nerve gap was interposed using a segment of the lesser saphenous vein in 16 patients. 18 patients had no nerve reconstruction as control group. Further 10 participants were included as healthy cohort. Nerve regeneration was assessed using von Frey filaments preoperatively and 1 day, 3, 6, 9 and 12 months postoperatively.

Results:
The result of this study revealed that patients, who received a defect bridging of the sural nerve with a venous graft, showed a better regeneration of the lateral foot sensitivity than patients without venous graft.

Conclusion:
The distal sural nerve biopsy model can serve as a preliminary nature of the injuries or baseline nerve lesion model. In a subsequent step, newly developed nerve guides could be tested in more unpredictable and challenging clinical peripheral nerve lesions.
Laughter, play faces and mimicry in animals: evolution and social functions
Authors: Davila-Ross Marina , Palagi Elisabetta 
Published: September 2022

Human laughter and laugh faces show similarities in morphology and function with animal playful expressions. To better understand primordial uses and effects of human laughter and laugh faces, it is important to examine these positive expressions in animals from both homologous and analogous systems. Phylogenetic research on hominids provided empirical evidence on shared ancestry across these emotional expressions, including human laughter and laugh faces. In addition, playful expressions of animals, in general, arguably have a key role in the development of social cognitive skills, a role that may help explain their polyphyletic history. The present work examines the evolution and function of playful expressions in primates and other animals. As part of this effort, we also coded for muscle activations of six carnivore taxa with regard to their open-mouth faces of play; our findings provide evidence that these carnivore expressions are homologues of primate open-mouth faces of play. Furthermore, our work discusses how the expressions of animal play may communicate positive emotions to conspecifics and how the motor resonance of these expressions increases affiliation and bonding between the subjects, resembling in a number of ways the important social–emotional effects that laughter and laugh faces have in humans.
This article is part of the theme issue ‘Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience’.
Laughter and culture
Authors: Bryant Gregory A. , Bainbridge Constance M. 
Published: September 2022

Like most human non-verbal vocalizations, laughter is produced by speakers of all languages, across all known societies. But despite this obvious fact (or perhaps because of it), there is little comparative research examining the structural and functional similarity of laughter across speakers from different cultures. Here, we describe existing research examining (i) the perception of laughter across disparate cultures, (ii) conversation analysis examining how laughter manifests itself during discourse across different languages, and (iii) computational methods developed for automatically detecting laughter in spoken language databases. Together, these three areas of investigation provide clues regarding universals and cultural variations in laughter production and perception, and offer methodological tools that can be useful for future large-scale cross-cultural studies. We conclude by providing suggestions for areas of research and predictions of what we should expect to discover. Overall, we highlight how important questions regarding human vocal communication across cultures can be addressed through the examination of spontaneous and volitional laughter.This article is part of the theme issue ‘Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience’.
When laughter arrests speech: fMRI-based evidence
Authors: Westermann B. , Lotze M. , Varra L. , Versteeg N. , Domin M. , Nicolet L. , Obrist M. , Klepzig K. , Marbot L. , Lämmler L. , Fiedler K. , Wattendorf E. 
Published: September 2022

Who has not experienced that sensation of losing the power of speech owing to an involuntary bout of laughter? An investigation of this phenomenon affords an insight into the neuronal processes that underlie laughter. In our functional magnetic resonance imaging study, participants were made to laugh by tickling in a first condition; in a second one they were requested to produce vocal utterances under the provocation of laughter by tickling. This investigation reveals increased neuronal activity in the sensorimotor cortex, the anterior cingulate gyrus, the insula, the nucleus accumbens, the hypothalamus and the periaqueductal grey for both conditions, thereby replicating the results of previous studies on ticklish laughter. However, further analysis indicates the activity in the emotion-associated regions to be lower when tickling is accompanied by voluntary vocalization. Here, a typical pattern of activation is identified, including the primary sensory cortex, a ventral area of the anterior insula and the ventral tegmental field, to which belongs to the nucleus ambiguus, namely, the common effector organ for voluntary and involuntary vocalizations. During the conflictual voluntary-vocalization versus laughter experience, the laughter-triggering network appears to rely heavily on a sensory and a deep interoceptive analysis, as well as on motor effectors in the brainstem.This article is part of the theme issue ‘Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience’.
Who's laughing? Play, tickling and ultrasonic vocalizations in rats
Authors: Burke C. J. , Pellis S. M. , Achterberg E. J. M. 
Published: September 2022

Social play in rats is a highly rewarding, energetic form of social interaction and important for development of the brain and social skills. The 50 kHz ultrasonic vocalizations (USV) emitted during social play are thought to be an expression of a positive affective state (laughter), which in some situations may also function as communication signals. Heterospecific play, ‘tickling’ by an experimenter, is thought to simulate conspecific play, and has been used to improve welfare and to study the neurobiology of positive affect. Given that tickling evokes substantial amounts of USV, we investigated whether heterospecific play is simulating conspecific play by comparing USV-behaviour associations in both contexts. If the 50 kHz calls are merely an expression of ‘laughter’ then the pattern and type of emission in both contexts should be similar. By contrast, as playing with a conspecific involves a two-way exchange of signalling, the additional demands on communication should lead to a different pattern of calling. While calling was prevalent in both types of play, how the different types of 50 kHz calls are used in the two contexts differed markedly. The findings suggest that while conspecific and heterospecific play are positive experiences, tickling is not the equivalent of conspecific play.
This article is part of the theme issue ‘Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience’.
The human tickle response and mechanisms of self-tickle suppression
Authors: Proelss Sandra , Ishiyama Shimpei , Maier Eduard , Schultze-Kraft Matthias , Brecht Michael 
Published: September 2022

A tickle is a complex sensation: it occurs in response to touch but not unequivocally so, and makes us laugh albeit not when we self-tickle. We quantified human ticklishness by means of physiological, visual and acoustic measures alongside subjective reports, and assessed mechanisms of self-tickle suppression. Tickle responses arose faster than previously reported as changes in thoracic circumference and joyous facial expressions co-emerge approximately 300 ms after tickle onset and are followed by vocalizations starting after an additional 200 ms. The timing and acoustic properties of vocalizations tightly correlated with subjective reports: the faster, louder and higher-pitched participants laughed, the stronger they rated the experienced ticklishness. Externally evoked ticklishness is reduced by simultaneous self-tickling, whereby self-touch evokes stronger suppression than sole self-tickle movement without touch. We suggest that self-tickle suppression can be understood as broad attenuation of sensory temporally coincident inputs. Our study provides new insight on the nature of human ticklishness and the attenuating effects of self-tickling.
This article is part of the theme issue ‘Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience’.
The cingulo-opercular network is composed of two distinct sub-systems
Authors: Gratton Caterina , Dworetsky Ally , Adeyemo Babatunde , Seitzman Benjamin A. , Smith Derek M. , Petersen Steven E. , Neta Maital 
Published: September 2022

ABSTRACTThe cingulo-opercular (CO) network and its two best studied regions – the dorsal anterior cingulate and anterior insula – have been linked to task control, but also implicated in many additional processes across cognitive, social, and emotional domains. However, most prior work investigating the CO network has used a group-average approach, which may mix signals across nearby regions that vary across individuals. Here, we reevaluate the CO network’s role in task control with both task and rest fMRI, using regions with a high probability of CO network agreement across individuals. Hierarchical clustering analyses suggest heterogeneity in the CO network’s task response properties, with one sub-system (CO1) showing consistency with prior task control characterizations while another sub-system (CO2) has weak task control responses, but preserved ties to pain and motor functions. Resting-state connectivity confirms subtle differences in the architecture of these two sub-systems. This evidence suggests that, when individual variation in network locations is addressed, the CO network includes (at least) two linked sub-systems with differential roles in task control and other cognitive/motor/interoceptive responses, which may help explain varied accounts of its functions. We propose that this fractionation may reflect expansion of primary CO body-oriented control functions to broader domain-general contexts.