bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of regional analgesia to prevent the conversion from acute to chronic pain
Authors: Geradon Pierre , Lavand’homme Patricia 
Published: August 2022

Purpose of review
Chronic post-surgical pain (CPSP) prevalence has not changed over the past decades what questions the efficacy of preventive strategies. Regional analgesia is used to control acute pain, but preventive effect on CPSP remains debated. Failures and future application of regional analgesia to prevent transition from acute to chronic pain will be discussed.

Recent findings
After thoracotomy, perioperative regional analgesia does not seem to prevent CPSP. After breast cancer surgery, paravertebral block might prevent CPSP intensity and impact on daily life up to 12 months, particularly in high catastrophizing patients. In knee arthroplasty, perioperative regional analgesia or preoperative genicular nerve neuroablation do not prevent CPSP, although current studies present several bias. The protective role of effective regional analgesia and early pain relief in trauma patients deserves further studies.

Summary
Regional analgesia failure to prevent CPSP development should prompt us to reconsider its perioperative utilization. Patients’ stratification, for example high-pain responders, might help to target those who will most benefit of regional analgesia. The impact of regional analgesia on secondary pain-related outcomes such as intensity and neuropathic character despite no difference on CPSP incidence requires more studies. Finally, the preventive effect of regional analgesia targeted interventions on CPSP in patients suffering from severe subacute pain deserves to be assessed.
Regional anesthesia global health collaborations- a scoping review of current intervention methods
Authors: Dohlman Lena E. , Thakkar Niharika , Jivanelli Bridget , Pakala Swetha , Brouillette Mark A. 
Published: August 2022

Purpose of review
Perioperative anesthesia-related mortality is significantly higher in low-resource compared to high-resource countries. Regional anesthesia techniques can provide safety, cost, and access benefits when compared to general anesthesia in these settings but is underutilized primarily due to a lack of experienced educators and training opportunities. Academic institutions and international organizations are attempting to fill this educational gap through collaborations, but these efforts need examination for best practices going forward.

Recent findings
Most collaborative anesthesia interactions between high and low resource areas have occurred between North America or Europe, and Africa or Asia and a majority have involved an educational intervention. Only 7% of the studies used a recognized framework to evaluate the intervention used in their research, such as the Kirkpatrick, REAIM or CFIR method. All recent studies reviewed reported a positive impact from educational collaborations. Only 7% of interventions have had a primary focus on regional anesthesia and most were reported between 2016 and 2022.

Summary
Robust reports on international collaborations providing capacity enhancing educational interventions in regional anesthesia have increased in recent years but are still rare and should be encouraged going forward. Short courses supported by high-resource countries can be effective in low-resource areas when partnerships produce curricula that are well designed.
Hyperlactatemia and other perioperative metabolic disturbances in neuroanesthesia
Authors: Klimek Markus , de Smalen Peter , Janssen Joost 
Published: August 2022

Purpose of review
The concept of ‘brain-body cross-talking’ has gained growing interest in the last years. The understanding of the metabolic disturbances (e.g., hypernatraemia/hyponatraemia and hyperlactatemia) in neurosurgical patients has improved during the last years.

Recent findings
The impact of elevated lactate without acidosis in neurosurgical patients remains controversial. The pathophysiology of inappropriate secretion of antidiuretic hormone (SIADH) has become clearer, whereas the diagnosis of cerebral salt wasting should be used more carefully.

Summary
These findings will contribute to a better understanding of the pathophysiology involved and enable better prevention and therapy where possible in clinical practice.
Erector spinae block: beyond the torso
Authors: Campbell Sinead , Chin Ki Jinn 
Published: August 2022

Purpose of review
This article aims to summarize the current literature describing the application of erector spinae plane (ESP) blocks for regional anesthesia of upper and lower limbs and to discuss the advantages and limitations.

Recent findings
Investigations are still at an early stage but results are promising. High thoracic ESP blockade can relieve acute and chronic shoulder pain through local anesthetic diffusion to cervical nerve roots, although it may not be as effective as direct local anesthetic injection around the brachial plexus. It does, however, preserve motor and phrenic nerve function to a greater extent. It will also block the T2 innervation of the axilla which can be a source of pain in complex arthroscopic shoulder surgery. Lumbar ESP blocks provide effective analgesia following hip arthroplasty and arthroscopy, and appear comparable to lumbar plexus, quadratus lumborum, and fascia iliaca blocks. Unlike the latter, they are motor-sparing and are associated with improved postoperative ambulation.

Summary
High thoracic and lumbar ESP blocks have the potential to provide adequate analgesia of the upper and lower limbs respectively, without causing significant motor block. They are thus alternative methods of regional anesthesia when other techniques are not feasible or have undesirable adverse effects.
Etiology, Comorbidities, and Health Service Use in a Clinical Cohort of Children With Hearing Loss
Authors: Olivier Nadia , Shepherd Daisy A. , Smith Libby , Carew Peter , Paxton Georgia A. , Downie Lilian , Rose Elizabeth , Dawes Kathryn , Sung Valerie 
Published: August 2022

Objective:
To examine etiology, comorbidities, and health service use in a cohort of children with permanent hearing loss. Receiving an etiological diagnosis can inform reproductive planning, rehabilitation outcomes, predict additional disabilities, and direct intervention or management decisions.

Design:
Retrospective audit of 518 deaf/hard-of-hearing children attending a tertiary pediatric outpatient clinic (2016–2019) using descriptive statistics. We used linear regression to investigate the relationship between degree of hearing loss, comorbidities, and health service use.

Results:
Of the 518 children who attended the clinic, 481 (92.9%) proceeded with testing for etiology. Most children (399/518, 77.0%) were diagnosed with hearing loss by 3 mo of age. Of the children tested, the cause of hearing loss was confirmed in 234/481 (48.6%), suspected in 113/481 (23.5%), and unknown in 134/481 (27.9%); 17/341 (5.0%) had congenital cytomegalovirus (CMV), 17/320 (5.3%) had enlarged vestibular aqueducts, 67/213 (31.5%) of children with bilateral hearing loss had connexin mutation, and 25/72 (34.7%) of children with unilateral loss had hypoplastic/absent cochlear nerve on imaging. The odds of having a definitive/suspected diagnosis were twice as likely for indivduals with profound hearing loss than mild hearing loss (OR 2.1; 95% CI, 1.2–3.9; P = 0.02). The majority (348/518, 67.2%) of children had medical comorbidities, and most children attended otolaryngology (453/518, 87.5%), early intervention (358/518, 69.1%), and genetic (287/518, 55.4%) services.

Conclusions:
Children with hearing loss have diverse etiologies, most have comorbidities, and attend multiple services. Most families elected to proceed with diagnostic testing for etiology. Current guidelines and expanded access to genetic testing identified a confirmed/suspected etiological diagnosis in 72.1% of children tested. The number of comorbidities correlated with service use, regardless of hearing loss severity.
Intensive Training of Spatial Hearing Promotes Auditory Abilities of Bilateral Cochlear Implant Adults: A Pilot Study
Authors: Coudert Aurélie , Verdelet Grégoire , Reilly Karen T. , Truy Eric , Gaveau Valérie 
Published: August 2022

Objective:
The aim of this study was to evaluate the feasibility of a virtual reality-based spatial hearing training protocol in bilateral cochlear implant (CI) users and to provide pilot data on the impact of this training on different qualities of hearing.

Design:
Twelve bilateral CI adults aged between 19 and 69 followed an intensive 10-week rehabilitation program comprised eight virtual reality training sessions (two per week) interspersed with several evaluation sessions (2 weeks before training started, after four and eight training sessions, and 1 month after the end of training). During each 45-minute training session, participants localized a sound source whose position varied in azimuth and/or in elevation. At the start of each trial, CI users received no information about sound location, but after each response, feedback was given to enable error correction. Participants were divided into two groups: a multisensory feedback group (audiovisual spatial cue) and an unisensory group (visual spatial cue) who only received feedback in a wholly intact sensory modality. Training benefits were measured at each evaluation point using three tests: 3D sound localization in virtual reality, the French Matrix test, and the Speech, Spatial and other Qualities of Hearing questionnaire.

Results:
The training was well accepted and all participants attended the whole rehabilitation program. Four training sessions spread across 2 weeks were insufficient to induce significant performance changes, whereas performance on all three tests improved after eight training sessions. Front-back confusions decreased from 32% to 14.1% (p = 0.017); speech recognition threshold score from 1.5 dB to −0.7 dB signal-to-noise ratio (p = 0.029) and eight CI users successfully achieved a negative signal-to-noise ratio. One month after the end of structured training, these performance improvements were still present, and quality of life was significantly improved for both self-reports of sound localization (from 5.3 to 6.7, p = 0.015) and speech understanding (from 5.2 to 5.9, p = 0.048).

Conclusions:
This pilot study shows the feasibility and potential clinical relevance of this type of intervention involving a sensorial immersive environment and could pave the way for more systematic rehabilitation programs after cochlear implantation.
Open Fractures in Pediatric Orthopaedics—Can Pathways Improve Care? A 1-Year Pre and Postimplementation Analysis
Authors: Makarewich Christopher A. , McNeely Lia W. , Gohel Shivani , Baldwin Keith D. 
Published: August 2022

Background:
In the care of open fractures, time to antibiotic administration has been shown to be a critical factor in preventing infection. To help improve outcomes at our institution we designed and implemented an open fracture pathway with the goal of reducing the time from emergency department (ED) arrival to antibiotic administration. Here we evaluate the success of this pathway, propose improvements in the protocol, and provide a framework for initiation at other institutions.

Methods:
We compared a retrospective prepathway cohort with a prospective postpathway cohort for 1-year pre and postpathway implementation. First, we analyzed the number of patients from outside facilities who had received antibiotics before transfer. For patients who had not received antibiotics before arriving at our institution, we reviewed pathway metrics including time from ED arrival to the ordering and administration of antibiotics, whether the correct antibiotic type was selected, and time to surgical debridement.

Results:
There were 50 patients in the prepathway cohort and 29 in the postpathway cohort. Prepathway 60.5% of transfers (23 of 38) received antibiotics before transfer, whereas post-pathway 90.0% of transfers (18 of 20) received antibiotics (P=0.032). For patients who had not received antibiotics before arriving at our institution and were included in pathway metric analysis, there were no differences in demographics or fracture characteristics. Time from ED arrival to antibiotic order decreased from 115.3 to 63.5 minutes (P=0.016). Time from antibiotic order to administration was similar between groups (48.0 vs. 35.7 min, P=0.191), but the overall time from ED arrival to antibiotic administration decreased from 163.3 to 99.2 minutes (P=0.004). There were no significant differences in whether the correct antibiotic type was chosen (P=0.354) or time from ED arrival to surgery (P=0.783).

Conclusions:
This study provides evidence that for pediatric patients presenting with open fractures, a care pathway can successfully decrease the time from ED arrival to antibiotic administration.

Level of Evidence:
Therapeutic level III—retrospective comparative study.
Trends in the Utilization of Implants in Index Procedures for Early Onset Scoliosis From the Pediatric Spine Study Group
Authors: Murphy Robert F. , Neel Garret B. , Barfield William R. , Anari Jason B. , St Hilaire Tricia , Thompson George , Emans John , Akbarnia Behrooz , Smith John ,   Pediatric Spine Study Group, Mooney James F. 
Published: August 2022

Introduction:Because of the relative rarity of Early Onset Scoliosis (EOS) cases, patient registries were developed to combine clinical information from multiple institutions to maximize patient care and outcomes. This study examines the history and trends regarding the use of growth-friendly devices for index surgical procedures in EOS patients within the Pediatric Spine Study Group database.Methods:All index growth-friendly implants were queried from registry inception until October 2020. EOS etiology, device/implant type, and geographic area/institution for each procedure were recorded.Results:From 1994 to 2020, 2786 patients underwent index surgery at a mean age of 6.2±2.9 years. There were 908 traditional growing rods (TGR) (32.3%), 922 vertical expandable prosthetic titanium rib devices (VEPTR) (33.1%), 5 hybrid VEPTR/TGR (0.18%), and 951 magnetically controlled growing rods (MCGR) (34.2%) index implants. Fifty-six different institutions reported an index implant, and 5 accounted for 823 (30%) of the cases during the study period. Institutions in the Northeast accounted for more index implants than other regions of the United States. There was a 40% increase in index implant insertions annually when comparing 1994 (3 implants/1 center) to 2018 (234 implants/56 centers), (P<0.001). Beginning in 2009, there was a 90.9% decrease in the number of TGR/VEPTR procedures (2009: 156 implants/32 centers; 2019: 22 implants/49 centersP=0.001), and a 479% increase in MCGR (2009: 1 implant/1 center; 2018: 197 implants/34 centers (P=0.005). The overall number of growth-friendly index procedures performed in 2019 (150/49 centers) decreased 34.5% when compared to 2018 (234/48 centers).Conclusion:The number of growth-friendly implants reported in the Pediatric Spine Study Group registry as the initial surgical management of EOS increased markedly over the past 20 years. MCGR is currently the predominant type of device utilized for index surgical procedures by group members, surpassing the use of VEPTR and TGR in 2014. There was a significant decrease in index growth-friendly procedures in 2019 compared to 2018.Level of Evidence:Level IV
Sex-based Difference in Response to Recombinant Human Bone Morphogenetic Protein-2 in a rat Posterolateral Fusion Model
Authors: Foley James P. , Fred Elianna J. , Minardi Silvia , Yamaguchi Jonathan T. , Greene Allison C. , Furman Andrew A. , Lyons Joseph G. , Paul Jonathan T. , Nandurkar Tejas S. , Blank Kenneth R. , Havey Robert M. , Muriuki Muturi , Patwardhan Avinash G. , Hsu Wellington K , Stock Stuart R. , Hsu Erin L. 
Published: August 2022

Study Design.
Pre-Clinical

Objective.
Evaluate sex-dependent differences in the bone healing response to rhBMP-2 in a rat posterolateral spinal fusion model.

Summary of Background Data.
Minimal and conflicting data exist concerning potential sex-dependent differences in recombinant human bone morphogenetic protein-2 (rhBMP-2)-mediated bone regeneration in the context of spinal fusion.

Methods.
Forty-eight female and male Sprague-Dawley rats (N=24/group), underwent L4-L5 posterolateral fusion with bilateral placement of an absorbable collagen sponge, each loaded with 5 µg of BMP-2 (10 µg/animal). At 8 weeks post-operative, 10 specimens of each sex were tested in flexion-extension with quantification of range of motion (ROM) and stiffness. The remaining specimens were evaluated for new bone growth and successful fusion via radiography, blinded manual palpation and microcomputed tomography (microCT). Laboratory microCT quantified bone microarchitecture, and synchrotron microCT examined bone microstructure at the one micrometer level.

Results.
Manual palpation scores differed significantly between sexes, with mean fusion scores of 2.4±0.4 in females versus 3.1±0.6 in males, P<0.001. Biomechanical stiffness did not differ between sexes, but ROM was significantly greater and more variable for females versus males (3.7°±5.6° vs. 0.27°±0.15°, P<0.005, respectively). Laboratory microCT showed significantly smaller volumes of fusion masses in females versus males (262±87 mm3 vs. 732±238 mm3, respectively, P<0.001) but significantly higher bone volume fraction (0.27±0.08 vs. 0.12±0.05, respectively, P<0.001). Mean trabecular thickness was not different, but trabecular number was significantly greater in females (3.1±0.5 mm−1 vs. 1.5±0.4 mm−1, respectively, P<0.001). Synchrotron microCT showed fine bone structures developing in both sexes at the eight-week time point.

Conclusions.
This study demonstrates sex-dependent differences in bone regeneration induced by rhBMP-2. Further investigation is needed to uncover the extent of and mechanisms underlying these sex differences, particularly at different doses of rhBMP-2.
Treatment of Osteochondritis Dissecans of the Capitellum Using BioCartilage in Adolescent Athletes Results in Safe and Timely Return to Play
Authors: Blickenstaff Baylor , Torres LeeAnne , Giangarra Charles 
Published: August 2022

Objectives:
Osteochondritis dissecans (OCD) is a condition affecting the capitellum in adolescent overhead athletes causing separation of articular cartilage from the subchondral bone. Multiple treatment strategies addressing these lesions have been described. The purpose of this study was to report a novel technique using BioCartilage® (Arthrex, Naples, FL) to augment microfracture of OCD lesions of the capitellum in adolescent athletes with the prediction that this would lead to favorable clinical outcomes.

Methods:
A retrospective review was performed of 5 patients with OCD lesions of the capitellum who underwent open surgical intervention with BioCartilage implantation through a lateral approach to the elbow. There were 4 female patients and 1 male patient. The mean age was 13 years. The average follow-up was 55.8 months.

Results:
Each patient returned to their original sport at 6 months with a painless range of motion and full strength. American Shoulder and Elbow Scores and Mayo Elbow Performance Scales postoperatively were 100, and Visual Analog Scales were 0/10 for each patient. There were no complications or reoperations. Radiographs obtained at 6 to 8 months postoperatively showed healing of the lesions with no further evidence of an osseous defect.

Conclusion:
Our technique shows promising mid-term results. A safe and timely return to play was achieved in each case. This technique offers advantages by providing an excellent range of motion and return to sport using a familiar open approach.
Novel treatment approaches for HER2 positive solid tumors (excluding breast cancer)
Authors: Gaye Elisabeth , Penel Nicolas , Lebellec Loïc 
Published: August 2022

Purpose of review
Human epidermal growth factor 2 (HER2) alterations (protein overexpression, gene amplification and mutation) play a key role in oncogenesis and are more likely correlated to poorer outcome in solid tumors. We reviewed recently published studies in the last 18 months on novel treatment approaches for HER2 positive solid tumors (excluding breast cancer).

Recent findings
Results of clinical studies assessing anti-HER2 therapies have been recently issued.
One of the most promising drugs is transtuzumab deruxtecan, an antibody–drug conjugate which demonstrated clinically meaningful activity in gastric or gastroesophageal junction cancer and colorectal cancers.
Small molecules such as poziotinib, pyrotinib, neratinib, which target both epidermal growth factor receptor (EGFR) and HER2 also showed promising activity, especially in heavily pretreated ERRB2-mutated non-small cell lung cancer (NSCLC) cancer patients. Yet, these findings need to be confirmed in confirmatory randomized trials with larger cohorts.
Trastuzumab-based combinations with chemotherapy or immune checkpoint inhibitors are under development with promising results, but not in all HER2 tumors. Emerging adverse events with anti-HER2 are interstitial pneumopathy and diarrhea.

Summary
Tyrosine kinase inhibitors, antibody drug conjugate in monotherapy and combinations are emerging strategies in many HER2-positive cancers; HER2 therapies are now part of standard of care of HER2-amplified gastric or gastroesophageal junction cancer. Data are pending on several unmet medical needs.
Less is more in endometrial cancer (SLN, conservative treatment, radical hysterectomy, molecular classification)
Authors: Parpex Guillaume , Lieng Chloé , Koskas Martin 
Published: August 2022

Purpose of review
The management of endometrial cancer has known many evolutions within the last decades. In this review, we aim to summarize recent evolutions (mainly toward less aggressive management) that have occurred in the management of endometrial cancer.

Recent findings
Enhanced by molecular classification, the determination of lymph node status, in young women, in case of cervical invasion, the treatment is evolving toward a less aggressive strategy.

Summary
The predictive value and the safety of sentinel lymph node biopsy explain why most societies propose to abandon systematic pelvic and para aortic lymphadenectomy. For young women, the safety of fertility preservation is now well established and efficient protocols have been validated. In stage II endometrial cancer (stromal cervical invasion), radical hysterectomy appears excessive. The Cancer Genome Atlas classification increases prognostic evaluation in association with the traditional pathological classification and permits to tailor adjuvant treatment more accurately.