bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Continuous Peripheral Nerve Blocks Decrease Home Opioid Use Following Anterior Cruciate Ligament Reconstruction in Children and Adolescents? The Envelope Please
Authors: Schlechter John A. , Gornick Bryn R. , Harrah Tanner , Sherman Benjamin 
Published: February 2022

Background:
Levels of opioid misuse and addiction among children and adolescents have reached alarming proportions. Exposure to opioids after surgery for anterior cruciate ligament reconstruction (ACLR), which is commonly performed in young athletes, increases this risk. This study was designed to evaluate whether continuous peripheral nerve block (CPNB) with placement of an elastomeric reservoir ball, compared with single-shot peripheral nerve block (SPNB), would decrease the need for home opioid analgesia and improve pain control after ACLR in children and adolescents.

Methods:
Prospectively collected data from a consecutive cohort that underwent ACLR by a single surgeon were retrospectively reviewed. Patients who received ACLR with 72-hour CPNB were assigned to Group 1. Patients who received ACLR with SPNB were assigned to Group 2. Postoperative pain management included cryotherapy, oral acetaminophen, and ibuprofen. A prescription for 10 doses of hydrocodone/acetaminophen (5/325 mg) was provided in a sealed envelope with instructions that the prescription should only be used in the case of uncontrolled pain. Reports of no opioid use were corroborated by the unopened envelope and unfilled prescription.

Results:
One hundred and ninety-six patients were enrolled in the study (SPNB=114 patients, CPNB=82 patients). Average age was 15±1.5 years (115 female). A total of 138 patients (70%) did not need home opioid analgesia after surgery. Of the 58 patients (30%) that did there were 35 (30.7%) in the SPNB group and 23 (28.0%) in the CPNB group (P=0.659). There were no differences between groups in demographics, operative data, or visual analog scale scores on any postoperative day.

Conclusion:
The findings of this study demonstrate equivalent pain control and opioid consumption in children and adolescents undergoing ACLR treated with either a CPNB or a SPNB. At-home opioid analgesia use can be negated after ACLR in 70% of children and adolescents. For the patients in this study who required opioids, average use was only 2 pills of 5 mg hydrocodone/325 mg acetaminophen, with no child using more than 10 pills.

Level of Evidence:
Level II—therapeutic.
Factors Associated With Brain Tissue Oxygenation Changes After RBC Transfusion in Acute Brain Injury Patients
Authors: Gouvêa Bogossian Elisa , Rass Verena , Lindner Anna , Iaquaniello Carolina , Miroz John Paul , Cavalcante dos Santos Elaine , Njimi Hassane , Creteur Jacques , Oddo Mauro , Helbok Raimund , Taccone Fabio Silvio 
Published: February 2022

OBJECTIVES:
Anemia is common after acute brain injury and can be associated with brain tissue hypoxia. RBC transfusion (RBCT) can improve brain oxygenation; however, predictors of such improvement remain unknown. We aimed to identify the factors associated with PbtO2 increase (greater than 20% from baseline value) after RBCT, using a generalized mixed model.

DESIGN:
This is a multicentric retrospective cohort study (2012–2020).

SETTING:
This study was conducted in three European ICUs of University Hospitals located in Belgium, Switzerland, and Austria.

PATIENTS:
All patients with acute brain injury who were monitored with brain tissue oxygenation (PbtO2) catheters and received at least one RBCT.

INTERVENTION:
Patients received at least one RBCT. PbtO2 was recorded before, 1 hour, and 2 hours after RBCT.

MEASUREMENTS AND MAIN RESULTS:
We included 69 patients receiving a total of 109 RBCTs after a median of 9 days (5–13 d) after injury. Baseline hemoglobin (Hb) and PbtO2 were 7.9 g/dL [7.3–8.7 g/dL] and 21 mm Hg (16–26 mm Hg), respectively; 2 hours after RBCT, the median absolute Hb and PbtO2 increases from baseline were 1.2 g/dL [0.8–1.8 g/dL] (p = 0.001) and 3 mm Hg (0–6 mm Hg) (p = 0.001). A 20% increase in PbtO2 after RBCT was observed in 45 transfusions (41%). High heart rate (HR) and low PbtO2 at baseline were independently associated with a 20% increase in PbtO2 after RBCT. Baseline PbtO2 had an area under receiver operator characteristic of 0.73 (95% CI, 0.64–0.83) to predict PbtO2 increase; a PbtO2 of 20 mm Hg had a sensitivity of 58% and a specificity of 73% to predict PbtO2 increase after RBCT.

CONCLUSIONS:
Lower PbtO2 values and high HR at baseline could predict a significant increase in brain oxygenation after RBCT.
Relative Hypoglycemia and Lower Hemoglobin A1c-Adjusted Time in Band Are Strongly Associated With Increased Mortality in Critically Ill Patients
Authors: Krinsley James S. , Rule Peter R. , Roberts Gregory W. , Brownlee Michael , Preiser Jean-Charles , Chaudry Sherose , Dionne Krista D. , Heluey Camilla , Umpierrez Guillermo E. , Hirsch Irl B. 
Published: February 2022

Objectives:
To determine the associations of relative hypoglycemia and hemoglobin A1c-adjusted time in blood glucose (BG) band (HA-TIB) with mortality in critically ill patients.

Design:
Retrospective cohort investigation.

Setting:
University-affiliated adult medical-surgical ICU.

Patients:
Three thousand six hundred fifty-five patients with at least four BG tests and hemoglobin A1c (HbA1c) level admitted between September 14, 2014, and November 30, 2019.

Interventions:
None.

Measurements and Main Results:
Patients were stratified for HbA1c bands of <6.5%; 6.5–7.9%; greater than or equal to 8.0% with optimal affiliated glucose target ranges of 70–140, 140–180, and 180–250 mg/dL, respectively. HA-TIB, a new glycemic metric, defined the HbA1c-adjusted time in band. Relative hypoglycemia was defined as BG 70–110 mg/dL for patients with HbA1c ≥ 8.0%. Further stratification included diabetes status-no diabetes (NO-DM, n = 2,616) and preadmission treatment with or without insulin (DM-INS, n = 352; DM-No-INS, n = 687, respectively). Severity-adjusted mortality was calculated as the observed:expected mortality ratio (O:EMR), using the Acute Physiology and Chronic Health Evaluation IV prediction of mortality. Among NO-DM, mortality and O:EMR, decreased with higher TIB 70–140 mg/dL (p < 0.0001) and were lowest with TIB 90–100%. O:EMR was lower for HA-TIB greater than or equal to 50% than less than 50% and among all DM-No-INS but for DM-INS only those with HbA1 greater than or equal to 8.0%.
Among all patients with hba1c greater than or equal to 8.0% And no bg less than 70 mg/dl, mortality was 18.0% For patients with relative hypoglycemia (bg, 70–110 mg/dl) (p < 0.0001) And was 0.0%, 12.9%, 13.0%, And 34.8% For patients with 0, 0.1–2.9, 3.0–11.9, And greater than or equal to 12.0 Hours of relative hypoglycemia (p < 0.0001).

Conclusions:
These findings have considerable bearing on interpretation of previous trials of intensive insulin therapy in the critically ill. Moreover, they suggest that BG values in the 70–110 range may be deleterious for patients with HbA1c greater than or equal to 8.0% and that the appropriate target for BG should be individualized to HbA1c levels. These conclusions need to be tested in randomized trials.
Knowledge, Confidence, and Perception Toward Therapeutic Drug Monitoring Among Physicians and Pharmacists in Kuwait
Authors: Albassam Abdullah , Alghanem Sarah S. , Alawadhi Farah , Alsulaimani Zainab 
Published: February 2022

Background:
Therapeutic drug monitoring (TDM) helps ensure an efficient and safe therapeutic outcome. This study assessed physicians' and pharmacists' knowledge, confidence, and perception regarding clinical pharmacokinetics and TDM.

Methods:
A cross-sectional survey that used a self-administered questionnaire was used. A stratified random sample of 322 physicians and pharmacists across 3 Kuwait public hospitals was surveyed. Descriptive and comparative statistical analyses were performed during data analysis. A multivariate logistic regression model was used to identify factors associated with low levels of knowledge and confidence and negative perceptions among the subjects.

Results:
The response rate was 88%. Overall, the respondents' mean total knowledge score percentage was low (50.3%), with no significant difference between the physicians' and pharmacists' scores (P > 0.5); 60.4% of the participants (95% confidence interval: 54.9–65.6) felt confident when using TDM in their practice. Most participants expressed positive perceptions (90.1%; 95% confidence interval: 86.3–92.9) toward TDM. There was high agreement internally that pharmacists require some knowledge of TDM, should be asked by physicians in general for recommendations on the appropriate use of TDM, and should be able to provide relevant information regarding the appropriate use of TDM.

Conclusions:
Physicians and pharmacists in this study had high confidence in—and the positive perceptions of—TDM and its clinical implications. The present study's findings indicate an urgent need for professional education and training in clinical pharmacokinetics and TDM and its clinical implications through continuous professional development programs and its integration within the curricula of medical and pharmacy schools.
Patterns of mental health symptoms among women living with HIV ages 45-60 in England: associations with demographic and clinical factors
Authors: Haag Katharina , Tariq Shema , Dhairyawan Rageshri , Sabin Caroline , Okhai Hajra , Gilson Richard , Burns Fiona , Sherr Lorraine 
Published: February 2022

Abstract

Objective:
We aimed to describe the prevalence of various mental health symptoms according to menopausal status (pre, peri, post) among women living with HIV ages 45-60 in England, and to identify groups of women with similar general and menopause-related mental health symptoms. We then investigated demographic predictors of group-membership and group differences in HIV-related care outcomes (antiretroviral therapy adherence, HIV clinic attendance, CD4-count, and last HIV viral load).

Methods:
An analysis of cross-sectional data from the Positive Transitions through Menopause study, an observational study of the health and well-being impacts of menopause on 869 women with HIV aged 45-60 years. Self-reported data on eight mental health indicators were collected from women in pre-, peri- and post-menopausal state using validated measures. Groups (termed “classes”) of women with similar mental health symptoms were derived via latent class analysis. Class membership was linked to demographic factors using nominal logistic regression, and to clinical outcomes using Wald tests.

Results:
We identified five classes: 1) few mental health symptoms (n = 501, 57.8%); 2) high current anxiety/depression (n = 120, 13.8%); 3) history of depression, with elevated current substance use (n = 40, 4.6%); 4) history of depression with current psychological menopause symptoms (n = 81, 9.3%); and 5) high previous and concurrent mental health problems (n = 125, 14.4%). University attendance, ethnicity, and longer time since HIV diagnosis predicted class membership. Antiretroviral therapy adherence was lower in classes 3 (11%), 4 (19%) and 5 (24%) compared to class 1 (4%; all P<0.001). Members of class 5 were more likely to have missed ≥1 HIV clinic appointment in the past year than those in class 1 (34% vs 17%, P = 0.005).

Conclusions:
Women with a history of depression, current anxiety/depression, and current menopause-related mental health symptoms were more likely to have poorer clinical outcomes. Although we cannot comment on causality, our findings highlight the importance of assessing and managing menopausal symptoms and mental health to improve well-being and engagement in HIV care.
Higher SBP in female patients with mitochondrial disease
Authors: Viering Daan H.H.M. , van Borselen Marjolein D. , Deinum Jaap , Bindels Rene J.M. , de Baaij Jeroen H.F. , Janssen Mirian C.H. 
Published: February 2022

Background:
Previous research suggests that hypertension is more prevalent among patients with mitochondrial diseases. Blood pressure (BP) is linearly related to increased cardiovascular risk, and this relationship is strongest for SBP; nevertheless, studies on SBP and DBP in mitochondrial diseases have not yet been performed.

Method:
In a retrospective case–control study design, BP in mitochondrial disease patients was compared with BP in a population cohort. Secondly, using multiple linear regression, we examined blood pressure differences in various genetic mitochondrial diseases. Lastly, we explored additional predictors of BP in a subgroup with the m.3243A > G variant.

Results:
Two hundred and eighty-six genetically confirmed mitochondrial disease patients were included. One hundred and eighty of these patients carried the m.3243A>G mitochondrial DNA variant. SBP was 9 mmHg higher in female mitochondrial disease patients than in the general female population (95% CI: 4.4–13.3 mmHg, P
< 0.001), whereas male patients had similar BP compared with controls. BP was not significantly different in patients with m.8344A>G and m.8363G>A, a mtDNA deletion or a nuclear mutation compared with m.3243A>G patients. Higher SBP was a predictor for left ventricular hypertrophy in the m.3243A>G subgroup (P
= 0.04).

Conclusion:
Novel aspects of the role of mitochondrial dysfunction in blood pressure regulation are exposed in this study. Compared with the general population, female mitochondrial disease patients have a higher SBP. Left ventricular hypertrophy is more prevalent in patients with higher SBP. Clinicians should be aware of this to prevent hypertensive complications in mitochondrial disease patients.
Long-term clinical impact of low-density lipoprotein cholesterol target attainment according to lesion complexity after percutaneous coronary intervention
Authors: Kim Byung-Jun , Lee Jung-Hee , Park Jong-Il , Nam Jong-Ho , Lee Chan-Hee , Son Jang-Won , Kim Ung , Shin Dong-Gu , Park Jong-Seon 
Published: February 2022

Objective
Long-term clinical outcomes of low-density lipoprotein cholesterol (LDL-C) target attainment according to coronary lesion complexity are limited. We investigated the clinical outcomes of LDL-C target attainment after percutaneous coronary intervention (PCI) according to coronary lesion complexity.

Methods
A total of 1285 patients who underwent PCI was categorized by LDL-C target attainment at 1 year and lesion complexity: LDL-C levels less than or equal to 70 mg/dl (n = 179) and greater than 70 mg/dl (n = 308) in complex PCI; LDL-C levels less than or equal to 70 mg/dl (n = 315) and greater than 70 mg/dl (n = 483) in noncomplex PCI. The primary endpoint was major adverse cardiovascular events (MACEs) and defined as cardiac death, nonfatal myocardial infarction, and target vessel revascularization.

Results
At 8-year follow-up, comparison of patients with 1-year LDL-C levels less than or equal to 70 mg/dl and 1-year LDL-C levels greater than 70 mg/dl showed similar MACE incidence in the noncomplex PCI group (8.3% vs. 11.6%; P = 0.074) and significantly lower MACE incidence in the complex PCI group (11.7% vs. 19.2%; P = 0.023). After IPTW adjustment, 1-year LDL-C levels less than or equal to 70 mg/dl was associated with reduced MACE rate in both complex PCI and noncomplex PCI groups.

Conclusion
Although the attainment of LDL-C levels less than or equal to 70 mg/dl was associated with reduced MACE rate in both complex PCI and noncomplex PCI groups, long-term clinical benefits were prominent in the complex PCI group.
Coronary Endothelial Dysfunction in People Living With HIV Is Related to Body Fat Distribution
Authors: Goerlich Erin , Schär Michael , Bagchi Shashwatee , Soleimani-Fard Alborz , Brown Todd T. , Sarkar Sudipa , Bonanno Gabriele , Streeb Valerie , Gerstenblith Gary , Barditch-Crovo Patricia , Weiss Robert G. , Hays Allison G. 
Published: February 2022

Background:
People living with HIV (PLWH) on antiretroviral therapy (ART) are at increased risk of atherosclerotic disease. Abnormal adipose distribution is common in PLWH and may contribute to atherosclerosis. Because coronary artery endothelial function (CEF) is impaired in early atherosclerosis, predicts future cardiovascular events, and is reduced in PLWH, we investigated associations between body fat distribution and CEF in PLWH.

Setting:
Prospective cohort study.

Methods:
PLWH on stable ART underwent MRI to quantify CEF, measured as change in coronary cross-sectional area from rest to that during isometric handgrip exercise, an endothelial-dependent stressor. Abdominal visceral and subcutaneous fat area (axial L4 level) and liver fat fraction were quantified using MRI. Linear regression was used to determine associations between CEF and independent variables.

Results:
Among 84 PLWH (52 ± 11 years; 33% women), mean cross-sectional area change was 0.74 ± 11.7%, indicating impaired CEF. On univariable regression analysis, CEF was inversely related to waist circumference (R = −0.31, P = 0.014), hip circumference (R = −0.27, P = 0.037), and subcutaneous fat area (R = −0.25, P = 0.031). We did not observe significant relationships between CEF and liver fat fraction, waist/hip ratio, or visceral fat area. On multivariable regression adjusted for age, sex, and race, CEF was associated with waist circumference, hip circumference, subcutaneous fat, and liver fat fraction.

Conclusion:
Waist and hip circumference and subcutaneous fat area are associated with impaired CEF, an established metric of abnormal vascular health in PLWH on stable ART, and may contribute to the increased rate of heart disease in this population.
Technical Variations in the Management of the Medial Crural Reduction According to the Settlement of the Angulation Deformities Over Hypertrophic Lower Lateral Cartilages
Authors: Çerçi Özkan Aret , Kozanoğlu Erol 
Published: February 2022

Background:
Medial crural (MC) overlay is reliable method used in tip deprojection. Most cases with lower lateral cartilage (LLC) hypertrophy present by variations of MC and dome shapes needing specific technical maneuvers.

Methods:
Thirteen hundred fourteen primary rhinoplasties were performed between 2018 and 2021. Patients with LLC hypertrophy who underwent MC deprojection were analyzed. Three variations in LLC hypertrophy were recognized. In type I, tip-defining points (TDP) were localized at the median plane with no angulation deformities at the LLC, which was managed by horizontal cuts of the lobular segments 4 to 6 mm below the domes. The cut fragments overlapped for 2 to 5 mm. In type II, TDP was lateralized due to widened divergence angles at the columellalobular junctions, which were managed by horizontal cuts over columellalobular junctions. The cut fragments overlapped 4 to 6 mm. In type III, TDP was localized at the median plane, there were dense angulations at the medial genu, which was managed with symmetrical removal of 4 to 5 mm cartilage from lobular segments. The domes were sutured over the medial segments.

Results:
Nineteen patients with LLC hypertrophy were included in the study among 314 patients. Twelve patients were female and 7 patients were male. The mean age was 32 years (25–42). Type I, II, and III LLC hypertrophies were detected in 10, 3, and 6 patients, respectively. A harmonious relationship between dorsum and tip and satisfactory tip stability was reached in all patients.

Conclusions:
By classification of variations of MC and domal shapes, LLC hypertrophies may be managed with proper technical maneuvers specific to each type.
Enhanced Recovery After Surgery for Pediatric Cleft Repair: A Systematic Review and Meta-Analysis
Authors: Shin Max , Wagner Connor , Prasad Aman , Barrette Louis-Xavier , Chorath Kevin , Moreira Alvaro , Rajasekaran Karthik 
Published: February 2022

Objective:
Perform a systematic review assessing the efficacy of enhanced recovery after surgery (ERAS) protocols for cleft palate repair. Primary outcomes included hospital length of stay, readmission rates, and postoperative narcotic use. Secondary outcomes included complications, time to initial postoperative oral intake, and pain scores.

Data Sources:
Cohort and randomized studies of ERAS protocols pertaining to cleft palate repair were identified by systematic review of Medline, Scopus, Embase, and grey literature.

Review Methods:
Data extracted included patient demographics, clinical care protocols, complication rates, postoperative narcotic use, time to initial postoperative oral intake, hospital length of stay, family satisfaction, and 30-day readmission. Meta-analysis was used to compare outcomes between patients enrolled in ERAS protocols versus those in conventional care pathways.

Results:
Eight hundred sixty-five articles were screened, and 5 studies met full inclusion criteria. A total of 425 patients were included. Patients in ERAS protocols saw a mean reduction of – 23.96 hours in length of stay compared to controls (95% confidence interval [CI]: – 26.4, – 20.6). Patients in ERAS protocols also had decreased total morphine consumption (mean difference [MD]: – 3.88 mg; CI: – 4.31, – 3.45), and decreased time to first initial feed compared to controls (MD: – 3.88 hours; CI: – 4.3, – 3.5). There was no difference in readmission rates or complication rates between ERAS and control groups.

Conclusions:
ERAS protocols have seen limited use in pediatric patients. The present study sought to assess the impact of ERAS protocols following primary palatoplasty. Our results indicate decreased hospital length of stay, postoperative opioid consumption, and time to feeding, without increasing readmission rates or complication rates.
Morphometric Analysis of the Cranial Fossae in Scaphocephalic Patients: An Anatomical Basis
Authors: Bisetty Vensuya , Lazarus Lelika , Harrichandparsad Rohen , Madaree Anil 
Published: February 2022

Abstract:
Scaphocephaly is the morphological consequence of premature sagittal suture fusion. Morphologic and morphometric studies on the cranial vault in scaphocephaly flourish in the literature. However, few studies are available on the cranial base in a scaphocephalic population, let alone the morphometry of its fossae. Therefore, this study aimed to analyze and compare the morphometry of the anterior, middle, and posterior cranial fossae (ACF, MCF, and PCF) in patients with scaphocephaly.
The length and width of the ACF, MCF, and PCF were measured using fixed anatomical landmarks on the two-dimensional computed tomography scans of 24 consecutive patients diagnosed with isolated sagittal synostosis between 2014 and 2020, and 14 controls.
A comparison of the results between patients with scaphocephaly and the controls showed that the ACF and PCF lengths increased significantly (P = 0.041 and P = 0.018) in patients with scaphocephaly. No differences in the MCF lengths were observed (P = 0.278; 0.774). When compared by the degree of severity, the ACF and PCF lengths were significantly increased ( analysis of variance [ANOVAI, P = 0.033; post-hoc, P = 0.013 and ANOVA, P = 0.015; post-hoc, P = 0.036) in scaphocephalic patients within the severe group as opposed to the control group.
The morphometric data obtained indicate a preponderance of deformity in the ACF and PCF with elongation along the anteroposterior plane (lengths) in scaphocephalic patients. Minimal changes were observed in the transverse plane (widths) in scaphocephaly versus controls. This data could aid craniofacial surgeons in understanding the affectation of the cranial fossae and influencing the decision on the most suitable method of corrective modality.