bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetal Outcomes With and Without the Use of Sugammadex in Pregnant Patients Undergoing Nonobstetric Surgery: A Multicenter Retrospective Study
Authors: Noguchi S. , Iwasaki H. , Shiko Y. , Kawasaki Y. , Ishida Y. , Shinomiya S. , Ono Uokawa R. , Mazda Y.
Published: November 2023

(Int J Obstet Anesth. 2023;53:103620)

Sugammadex (SGX) quickly and reliably reverses neuromuscular blockade. It also is known to bind progesterone and maintaining proper progesterone levels is critical during pregnancy, especially during the first trimester. Little is known about the impact of SGX exposure during pregnancy on pregnancy and fetal outcomes. This study aimed to compare fetal outcomes in pregnant patients who underwent nonobstetric surgery who were and were not exposed to SGX.
Buprenorphine-naloxone, Buprenorphine, and Methadone Throughout Pregnancy in Maternal Opioid Use Disorder
Authors: Kanervo Minna M. , Tupola Sarimari J. , Nikkola Eeva M. , Rantakari Krista M. , Kahila Hanna K.
Published: November 2023

(Acta Obstet Gynecol Scand. 2023;102:313–322)

Maternal opioid use disorder (MOUD) is a global concern. It poses many complications and risk factors for mothers, fetuses, and infants. Mothers are at risk of experiencing negative effects on the nervous system, increased infection risk, and poor nutrition. Children are at risk for neonatal opioid withdrawal syndrome (NOWS) and other long-term health conditions. It is recommended that mothers obtain opioid maintenance treatment (OMT) to reduce these risks. This study aimed to compare the effects of buprenorphine-naloxone, buprenorphine, and methadone treatment plans on outcomes for pregnant women.
Perinatal Mortality and Neonatal and Maternal Outcome Per Gestational Week in Term Pregnancies: A Registry-based Study
Authors: Cornette J. , van der Stok C.J. , Reiss I.K.M. , Kornelisse R.F. , van der Wilk E. , Franx A. , Jacquemyn Y. , Steegers E.A.P. , Bertens L.C.M.
Published: November 2023

(Acta Obstet Gynecol Scand. 2023;102:82–91)

The risks of maternal, fetal and neonatal adverse outcomes have a wide variance within the window of full-term gestation, 37+0/7 to 41+6/7 weeks. For uncomplicated pregnancies, the prevalence of complications is generally low. However, the optimal timing of delivery especially for pregnancies with added risk factors is open to debate. The strategy of expectant management has been challenged by studies showing increased favorable outcomes (fewer occurrences of stillbirth, adverse neonatal outcomes, cesarean deliveries, hypertensive events, and increased maternal satisfaction) when elective induction was employed between 39 and 41 weeks. This study examined the relationship between per week gestational age and adverse perinatal, neonatal and maternal outcomes, with regard to balancing risks and benefits of expectant management versus interventions at term.
Adverse Pregnancy Outcomes and Long-term Risk of Ischemic Heart Disease in Mothers: National Cohort and Co-sibling Study
Authors: Crump C. , Sundquist J. , McLaughlin M.A. , Dolan S.M. , Govindarajulu U. , Sieh W. , Sundquist K.
Published: November 2023

(BMJ. 2023;380:e072112)

The leading cause of mortality among women globally is cardiovascular disease, and adverse perinatal outcomes have been associated with an increased risk of cardiovascular disease later in life. Despite this association, adverse perinatal outcomes are often overlooked as cardiovascular risk factors in women. The aim of this study is to determine associations between adverse pregnancy outcomes (ie, gestational diabetes, pre-eclampsia, preterm delivery, small for gestational age, and other hypertensive disorders of pregnancy) and the long-term risk of ischemic heart disease.
Prophylactic Antibiotics for Vaginal Delivery: Benefits and Possible Harms
Authors: Sheffield Jeanne S.
Published: November 2023

(N Engl J Med. 2023;388:1221–1223)

Antiseptic techniques were discovered by Ignaz Semmelweis. Semmelweis was a physician in Hungary in the 1860s. His discovery wasn’t popular at the time he published his work, but it is now a standard practice in today’s modern healthcare facilities with procedures such as basic handwashing being used in everyday life outside of the hospital setting. Although this is now standard practice, maternal death is still often caused by infection. Infection during delivery is the third most leading cause of death among mothers, following hemorrhage and hypertension. It was reported that 810 individuals die during or following delivery every day from diseases that could be prevented by following simple antiseptic techniques. Ninety-four percent of these deaths occur in low and middle-income areas, such as Africa and Asia, with 10.7% of these deaths being directly related to infection or sepsis. The Global Maternal and Neonatal Sepsis Initiative was created by the WHO to reduce the overall rate of maternal mortality by the year 2030.
Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage
Authors: Gallos I. , Devall A. , Martin J. , Middleton L. , Beeson L. , Coomarasamy A. ,   et al
Published: November 2023

(N Engl J Med. 2023;389:11–21)

Postpartum hemorrhage (PPH) remains the leading cause of maternal death worldwide despite published recommendations from the World Health Organization (WHO) on prevention and treatment. There are challenges in implementing the PPH recommendations. Delay in detection as well as delay in treatment of PPH are 2 reasons the maternal death rate is high. One reason for the delay in detection is due to the ongoing use of visual estimation of blood loss, which often inaccurately underestimates the amount of lost blood. More aggressive interventions for PPH may be delayed until earlier approaches have failed in stopping the blood loss. In some cases, no effective treatment is administered at all. Finally, although the WHO has given these recommendations, not all hospitals and/or medical professionals are implementing them. This study sought to understand whether a treatment bundle referred to as E-MOTIVE could improve early detection and treatment of PPH in patients with a vaginal birth.
Early Detection and Bundled Treatment for Postpartum Hemorrhage
Authors: Boatin A. , Ngonzi J.
Published: November 2023

(N Engl J Med. 2023;389;3)

It is a common complication after a woman has given birth, to have varying degrees of postpartum hemorrhage (PPH). Bleeding after birth is the leading cause of maternal death in many developing regions, accounting for more than 20% of postpartum deaths worldwide. Postpartum hemorrhage is defined as when more than 500 mL of blood loss occurs. Though highly preventable, a patient can escalate rapidly from moderate to severe in a matter of minutes if precautions and monitoring are not in place.
Testing Equivalence of Two Doses of Intravenous Iron to Treat Iron Deficiency in Pregnancy: A Randomized Controlled Trial
Authors: Froessler B. , Schubert K.O. , Palm P. , Church R. , Aboustate N. , Kelly T.L. , Dekker G.A. , Hodyl N.A.
Published: November 2023

(BJOG. 2023;130:15–23)

The most common nutritional disorder worldwide is iron deficiency (ID). Iron is vital for many bodily functions, so when women who are pregnant suffer from ID they are more likely to experience complications during pregnancy as well as deliver babies at risk for neonatal complications. It is estimated that about 47% of women suffer from ID during pregnancy even though it is a treatable disorder. Intravenous iron (IVI) has been proven to help pregnant women who are nonresponsive to oral iron intake. This study compared the effects of 2 different doses of IVI in pregnant women.
Maternal mRNA COVID-19 Vaccination During Pregnancy and Delta or Omicron Infection or Hospital Admission in Infants: Test Negative Design Study
Authors: Jorgensen S.C.J. , Hernandez A. , Fell D.B. , Austin P.C. , D'Souza R. , Guttmann A. , Brown K.A. , Buchan S.A. , Gubbay J.B. , Nasreen S. , Schwartz K.L. , Tadrous M. , Wilson K. , Kwong J.C. ,   Canadian Immunization Research Network (CIRN) Provincial Collaborative Network (PCN) Investigators
Published: November 2023

(BMJ. 2023;380:e074035)

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) rates are higher in infants than in older children. Passive immunity has been shown to help prevent other infections, such as pertussis, in infants through the transfer of maternal antibodies following vaccination during pregnancy. SARS-CoV-2 antibodies are found to be present in breastmilk, umbilical cord blood, and infant serum specimens following maternal vaccination during pregnancy and infection, and emerging research suggests maternal COVID-19 vaccination reduces infant infection and hospital admission rates. This study aimed to determine whether maternal vaccination during pregnancy with 2 primary doses or 2 primary doses plus booster of the mRNA COVID-19 vaccine series reduces the infection of omicron and delta SARS-CoV-2 and hospital admission of infants within 6 months following delivery.
Pregnancy Outcomes and Vaccine Effectiveness During the Period of Omicron as the Variant of Concern, INTERCOVID-2022: A Multinational, Observational Study
Authors: Villar J. , Soto Conti C.P. , Gunier R.B. , Ariff S. , Craik R. , Cavoretto P.I. , Rauch S. , Gandino S. , Nieto R. , Winsey A. , Menis C. , Rodriguez G.B. , Savasi V. , Tug N. , Deantoni S. , Fabre M. , Martinez de Tejada B. , Rodriguez-Sibaja M.J. , Livio S. , Napolitano R. , Maiz N. , Sobrero H. , Peterson A. , Deruelle P. , Giudice C. , Teji J.S. , Casale R.A. , Salomon L.J. , Prefumo F. , Cheikh Ismail L. , Gravett M.G. , Vale M. , Hernández V. , Sentilhes L. , Easter S.R. , Capelli C. , Marler E. , Cáceres D.M. , Albornoz Crespo G. , Ernawati E. , Lipschuetz M. , Takahashi K. , Vecchiarelli C. , Hubka T. , Ikenoue S. , Tavchioska G. , Bako B. , Ayede A.I. , Eskenazi B. , Thornton J.G. , Bhutta Z.A. , Kennedy S.H. , Papageorghiou A.T. ,   INTERCOVID-2022 International Consortium
Published: November 2023

(Lancet. 2023;401:447–457)

In 2021, COVID-19 during pregnancy was reported to be associated with an increased risk of maternal and neonatal outcomes. The SARS-CoV-2 virus has undergone genetic mutations since then and the subsequent impact of the omicron variant on maternal and neonatal health wasunknown. This study aimed to analyze the effects on maternal and perinatal outcomes of omicron during pregnancy as well as vaccine efficacy.
Antiretroviral Therapy and Adverse Pregnancy Outcomes in People Living with HIV
Authors: Eke A.C. , Mirochnick M. , Lockman S.
Published: November 2023

(N Engl J Med. 2023;388:344–356)

Human immunodeficiency virus (HIV) is detected in about 1.3 million pregnant individuals every year. The use of antiretroviral therapy (ART) is common in about 1.1 million (85%) of these cases. When ART is not prescribed, 15% to 30% of individuals born to those with HIV will develop HIV. Maternal zidovudine (ZDV), a 3-drug ART regimen, has been proven to reduce the number of infants who contract HIV from their mothers. ZDV decreases the rate of vertical transmission of HIV from 25.5% to 8.3%. This study aimed to show the key evidence in support of ART and to evaluate both contemporary and legacy methods of ART delivery to see how they compare.
Comparison of Labor Analgesia Efficacy Between Single-orifice and Multiorifice Wire-reinforced Catheters During Programmed Intermittent Epidural Boluses: A Randomized Controlled Clinical Trial
Authors: Yi J. , Li Y. , Yuan Y. , Xu Z. , Song Y. , Ye B. , Zhao Q. , Yang Y. , Du W. , Liu Z.
Published: November 2023

(Reg Anesth Pain Med. 2023;48:61–66)

Programmed intermittent epidural bolus (PIEB) has been used since 2006 for labor analgesia. It is theorized that high-flow epidural catheters may be necessary for proper anesthetic spread dynamics within the epidural space. Epidural catheters have varying characteristics that may affect anesthesia administration. Studies show that multiorifice catheters were proven superior when compared with single-orifice catheters; however, due to flow dynamics, single-orifice catheters may be preferred to close-ended multiorifice catheters due to diffusion distance and area coverage. This study aimed to show a comparison between single-orifice and multiorifice catheters when used for intermittent high-rate bolus administration.
Labor Epidural Analgesia and Subsequent Risk of Offspring Autism Spectrum Disorder and Attention-deficit/Hyperactivity Disorder: A Cross-National Cohort Study of 4.5 Million Individuals and Their Siblings
Authors: Hegvik T.A. , Klungsøyr K. , Kuja-Halkola R. , Remes H. , Haavik J. , D'Onofrio B.M. , Metsä-Simola N. , Engeland A. , Fazel S. , Lichtenstein P. , Martikainen P. , Larsson H. , Sariaslan A.
Published: November 2023

(Am J Obstet Gynecol. 2023;228:223.e1–233.e12)

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that commonly occurs in children, and many of its causes are currently unknown. It is known that there is a large genetic component, but other components or contributors aren’t known, especially in the context of environmental factors. Recent studies have attempted to correlate ASD with a number of external factors; one such study connected a diagnosis of ASD with the use of labor epidural analgesia. That study has since had several other research teams try to replicate the findings, without success. The replication attempts, however, have been limited by small samples and insufficient statistical power. This study attempts again to replicate the findings of an association between ASD and labor epidural analgesia, while also overcoming the limitations present in previous attempts to do so.
Anesthetic Management of Patients With Class 3 Obesity Undergoing Elective Cesarean Delivery: A Single-Center Historical Cohort Study
Authors: van den Bosch O.F.C. , Fiset M. , Downey K. , Maxwell C. , Carvalho J.C.A.
Published: November 2023

(Can J Anesth/J Can Anesth. 2023; 70:202–210)

Rising obesity rates have reached a high of one third or one fourth of adults in the United States and Canada, respectively. This leads to many individuals with this condition requiring medical care including anesthesia for labor and delivery. Obesity is known to be associated with complications in the administration and effectiveness of anesthesia as well as after cesarean delivery. Prior research has not focused on the nuances of specific categories of body mass index (BMI) and their association with outcomes, specifically for anesthesia during cesarean delivery. This study aimed to describe different techniques and outcomes for anesthesia in elective cesarean delivery in patients with class 3 obesity (BMI ≥40), specifically in groups with BMI 40.0 to 49.9, 50.0 to 59.9, and >60.0.
Evaluation of Ultrasound Airway Assessment Parameters in Pregnant Patients and their Comparison With that of Nonpregnant Women: A Prospective Cohort Study
Authors: Vajanthri S.Y. , Mohammed S. , Kumar M. , Chhabra S. , Bhatia P. , Kamal M. , Paliwal B.
Published: November 2023

(Int J Obstet Anesth. 2023;53:103623)

Pregnancy-induced changes in airway anatomy and physiology can make airway management more difficult in this population. Clinical airway assessment parameters are used to predict difficult airways; however, literature evaluating ultrasound (US) airway parameters in pregnant patients compared with nonpregnant patients is limited. This study aimed to evaluate and compare US airway assessment parameters in pregnant and non‐pregnant women. This study also investigated the associations between established difficult airway predictors and US parameters in the two groups.
Comparative Efficacy of Quadratus Lumborum Type-II and Erector Spinae Plane Block in Patients Undergoing Caesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial
Authors: Priya T.K. , Singla D. , Talawar P. , Sharma R.S. , Goyal S. , Purohit G.
Published: November 2023

(Int J Obstet Anesth. 2023;53:103614)

Pain following cesarean delivery (CD) is associated with other adverse maternal effects, so it is important to manage and minimize this occurrence. Regional techniques such as quadratus lumborum (QL) blocks and erector spinae plane blocks (ESPB) are used in postsurgical patients, yet no studies to date compare the efficacy of the 2 methods following CD. This study aimed to compare the efficacy of postcesarean analgesia using QL block type-II (QLB‐II) with ESPB following CD.
Self-fulfilling Prophecy: Does Structural and Interpersonal Bias Against Pregnant and Postpartum People With Substance Use Disorders Undermine Parenting Identity?
Authors: Goodman Daisy
Published: November 2023

Pregnant and parenting people with substance use disorders are a highly stigmatized group. Structural and interpersonal bias contribute to reluctance to engage in prenatal, postpartum, and well-child care for this population. Two studies described in this issue of theJournal of Addiction Medicineexplore the implications of health care provider–family relationships on experience of care for birthing people with substance use disorders and their infants. Patient voices describe how intensive monitoring of infants for sequelae of substance exposure and that being scrutinized as caregivers undermined their confidence as parents, contributed to self-blame, and damaged their trust in health care teams. Data from these studies suggest that the voices of pregnant and parenting individuals need to be present at local, regional, and national levels to mitigate harm when redesigning programs for this population.
Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals
Authors: Krawczyk Noa , Rivera Bianca D. , Chang Ji E. , Lindenfeld Zoe , Franz Berkeley
Published: November 2023

Background

Hospitals are a key touchpoint to reach patients with substance use disorders (SUDs) and link them with ongoing community-based services. Although there are many acute care interventions to initiate SUD treatment in hospital settings, less is known about what services are offered to transition patients to ongoing care after discharge. In this study, we explore what SUD care transition strategies are offered across nonprofit US hospitals.

Methods

We analyzed administrative documents from a national sample of US hospitals that indicated SUD as a top 5 significant community need in their Community Health Needs Assessment reports (2019–2021). Data were coded and categorized based on the nature of described services. We used data on hospitals and characteristics of surrounding counties to identify factors associated with hospitals' endorsement of transition interventions for SUD.

Results

Of 613 included hospitals, 313 prioritized SUD as a significant community need. Fifty-three of these hospitals (17%) offered acute care interventions to support patients' transition to community-based SUD services. Most (68%) of the 53 hospitals described transition strategies without further detail, 23% described scheduling appointments before discharge, and 11% described discussing treatment options before discharge. No hospital characteristics were associated with offering transition interventions, but such hospitals were more likely to be in the Northeast, in counties with higher median income, and states that expanded Medicaid.

Conclusions

Despite high need, most US hospitals are not offering interventions to link patients with SUD from acute to community care. Efforts to increase acute care interventions for SUD should identify and implement best practices to support care continuity.
Association of Neighborhood Characteristics and Chronic Pain in Children and Adolescents in the United States
Authors: Vandeleur Daron M. , Cunningham Maia M. , Palermo Tonya M. , Groenewald Cornelius B.
Published: November 2023

Objective:

To determine the associations between neighborhood characteristics and chronic pain during childhood and adolescence in the United States, 2020-2021.

Methods:

Cross-sectional analysis of the 2020 and 2021 National Survey of Children’s Health (NSCH). NSCH grouped parents’ responses to questions about neighborhood characteristics into five categories: neighborhood support, neighborhood safety, school support, neighborhood amenities, and presence of detracting neighborhood elements. Chronic pain was defined as parents reporting their children had “frequent or chronic difficulty with repeated or chronic physical pain, including headache or other back or body pain during the past 12 months.” Multivariable Poisson regression analyses estimated associations between neighborhood characteristics and chronic pain, adjusted for sociodemographic characteristics.

Results:

The sample contained 55,387 children (6-17 years), weighted to represent 44 million nationally. Children had significantly increased rates of chronic pain if they lived in neighborhoods that were unsupportive, unsafe, had unsafe schools, fewer amenities, and greater numbers of detracting elements (P<0.0001). After adjusting for covariates, children had significantly increased chronic pain if they lived in neighborhoods that were not supportive (adjusted prevalence rate ratio=1.7, (95% Confidence interval: 1.5-1.9, P<0.0001), with similar patterns observed for living in neighborhoods characterized as not safe, that did not have safe schools, with fewer amenities, and/or more detracting elements.

Discussion:

Disadvantageous neighborhood characteristics are associated with pediatric chronic pain prevalence. Future research should investigate underlying mechanisms of this association, and guide neighborhood interventions aimed at preventing and decreasing childhood chronic pain and its associated burdens.
Incidence of Myocardial Injury and Cardiac Dysfunction After Adult Traumatic Brain Injury: A Systematic Review and Meta-analysis
Authors: Chaikittisilpa Nophanan , Kiatchai Taniga , Liu Sunny Yang , Kelly-Hedrick Margot , Vavilala Monica S. , Lele Abhijit V. , Komisarow Jordan , Ohnuma Tetsu , Colton Katharine , Krishnamoorthy Vijay
Published: November 2023

Myocardial injury and cardiac dysfunction after traumatic brain injury (TBI) have been reported in observational studies, but there is no robust estimate of their incidences. We conducted a systematic review and meta-analysis to estimate the pooled incidence of myocardial injury and cardiac dysfunction among adult patients with TBI. A literature search was conducted using MEDLINE and EMBASE databases from inception to November 2022. Observational studies were included if they reported at least one abnormal electrocardiographic finding, elevated cardiac troponin level, or echocardiographic evaluation of systolic function or left ventricular wall motion in adult patients with TBI. Myocardial injury was defined as elevated cardiac troponin level according to the original studies and cardiac dysfunction was defined as the presence of left ventricular ejection fraction <50% or regional wall motion abnormalities assessed by echocardiography. The meta-analysis of the pooled incidence of myocardial injury and cardiac dysfunction was performed using random-effect models. The pooled estimated incidence of myocardial injury after TBI (17 studies, 3,773 participants) was 33% (95% CI: 27%-39%, I
2:s 93%), and the pooled estimated incidence of cardiac dysfunction after TBI (9 studies, 557 participants) was 16.% (95% CI: 9%-25.%, I
2: 84%). Although there was significant heterogeneity between studies and potential overestimation of the incidence of myocardial injury and cardiac dysfunction, our findings suggest that myocardial injury occurs in approximately one-third of adults after TBI, and cardiac dysfunction occurs in approximately one-sixth of patients with TBI.
Design and Validation of a Questionnaire to Measure Interprofessional Collaborative Practice for Auditing Integrated Hospital Care: Empirical Research
Authors: Hanskamp-Sebregts Mirelle , van Gurp Petra J. , Braspenning Jozé
Published: November 2023

Introduction:

Interprofessional teamwork is the key issue of delivering integrated hospital care; however, measuring interprofessional collaboration for auditing is fragmented. In this study, a questionnaire to measure InterProfessional collaborative Practice for Integrated Hospital care (IPPIH) has been developed and validated.

Methods:

A four-step iterative process was conducted: (1) literature search to find suitable questionnaires; (2) semistructured stakeholder interviews (individual and in focus groups) to discuss the topics and questions (face validity), (3) pretesting the prototype of the questionnaire in two different integrated care pathways for feasibility, usability, and internal consistency, and (4) testing (content and construct validity and responsiveness) of the revised questionnaire in eight integrated care pathways; the validation and responsiveness was tested by means of exploratory factor analysis, calculation of Cronbach alpha, item analysis, and linear mixed model analysis.

Results:

Based on six questionnaires and the opinion of direct stakeholders, the questionnaire IPPIH comprised 27 items. Five different domains could be distinguished: own skills, culture, coordination and collaboration, practical support, and appreciation with the Cronbach alpha varied from 0.91 to 0.48. The self-reported intensity of the collaboration within a specific care pathway significantly influenced the outcome (P = .000).

Discussion:

The product is a questionnaire, IPPIH, which can measure the degree of interprofessional collaborative practice in integrated hospital care pathways. The IPPIH was initially developed for quality assurance. However, the IPPIH also seems to be suitable as a self-assessment tool for directors to monitor and improve the interprofessional collaboration and the quality of their integrated care pathway.
Robotic urologic surgery using the KangDuo-Surgical Robot-01 system: A single-center prospective analysis
Authors: Xiong Shengwei , Fan Shubo , Chen Silu , Wang Xiang , Han Guanpeng , Li Zhihua , Zuo Wei , Li Zhenyu , Yang Kunlin , Zhang Zhongyuan , Shen Cheng , Zhou Liqun , Li Xuesong
Published: November 2023

Background:

The KangDuo-Surgical Robot-01 (KD-SR-01) system is a new surgical robot recently developed in China. The aim of this study was to present our single-center experience and mid-term outcomes of urological procedures using the KD-SR-01 system.

Methods:

From August 2020 to April 2023, consecutive urologic procedures were performed at Peking University First Hospital using the KD-SR-01 system. The clinical features, perioperative data, and follow-up outcomes were prospectively collected and analyzed.

Results:

A total of 110 consecutive patients were recruited. Among these patients, 28 underwent partial nephrectomy (PN), 41 underwent urinary tract reconstruction (26 underwent pyeloplasty, 3 underwent ureteral reconstruction and 12 underwent ureterovesical reimplantation [UR]), and 41 underwent radical prostatectomy (RP). The median operative time for PN was 112.5 min, 157.0 min for pyeloplasty, 151.0 min for ureteral reconstruction, 142.5 min for UR, and 138.0 min for RP. The median intraoperative blood loss was 10 mL for PN, 10 mL for pyeloplasty, 30 mL for ureteral reconstruction, 20 mL for UR, and 50 mL for RP. All procedures were successfully completed without conversion, and there were no major complications in any patient. The median warm ischemia time of PN was 17.3 min, and positive surgical margin was not noted in any patient. The overall positive surgical margin rate of RP was 39% (16/41), and no biochemical recurrence was observed in any RP patient during the median follow-up of 11.0 months. The surgical success rates of pyeloplasty and UR were 96% (25/26) and 92% (11/12) during the median follow-up of 29.5 months and 11.5 months, respectively.

Conclusion:

The KD-SR-01 system appears feasible, safe, and effective for most urological procedures, based on our single-center experience.
Rapid Online Assessment of Reading (ROAR): Evaluation of an Online Tool for Screening Reading Skills in a Developmental-Behavioral Pediatrics Clinic
Authors: Barrington Elizabeth , Sarkisian Sadie Mae , Feldman Heidi M. , Yeatman Jason D.
Published: November 2023

Objective:

Reading difficulties are highly prevalent and frequently co-occur with other neurodevelopmental/behavioral conditions. It is difficult to assess reading routinely in pediatric clinical practice because of time and resource constraints. Rapid Online Assessment of Reading (ROAR) is an objective, gamified assessment that children take in a web browser without adult supervision. This study's purpose was to evaluate ROAR as a screening tool for reading difficulties in a clinical setting.

Method:

A convenience sample of 6- to 14-year-old children, attending an in-person or telehealth visit in a developmental-behavioral pediatrics (DBP) clinic participated. Children took ROAR and completed the Woodcock-Johnson IV Letter-Word Identification (LWID) and Word Attack (WA). Basic Reading Skills (BRS), a standardized aggregate score of LWID and WA, was used as the gold-standard assessment. The strength of association between standard scores on ROAR and BRS was calculated. BRS scores < 90 (bottom quartile) were classified as poor readers. Receiver operating characteristic (ROC) curve analysis was used to assess the quality of ROAR as a screening test.

Results:

A sample of 41 children, 78% boys, mean age 9.5 years (SD 2.0 years), completed the study. The correlation of ROAR standard score with BRS was r = 0.66, p < 0.001. ROC curve analysis with ROAR scores accurately classified poor readers with an area under the curve (AUC) of 0.90.

Conclusion:

ROAR is a useful objective screening tool to identify children at high risk for reading difficulties. Assessment of the tool during a busy clinic was challenging, and a larger replication is warranted.
Metformin Versus Insulin for Gestational Diabetes: Cognitive and Neuropsychological Profiles of Children Aged 9 years
Authors: Paavilainen Elisa , Nyman Anna , Niinikoski Harri , Nikkinen Hilkka , Veijola Riitta , Vääräsmäki Marja , Tossavainen Päivi , Rönnemaa Tapani , Tertti Kristiina
Published: November 2023

Objective:

We compared cognitive profile and neuropsychological performance in 9-year-old offspring of mothers who were treated with metformin or insulin for gestational diabetes mellitus (GDM).

Methods:

A total of 172 children whose mothers were randomly assigned to receive either metformin or insulin for GDM were studied at the age of 9 years. Of these children, 127 were from Turku, Finland (63 metformin and 64 insulin), and 45 from Oulu, Finland (19 metformin and 26 insulin). Clinical and demographic background characteristics were obtained at enrolment, birth, and 9-year follow-up. Cognitive profiles were examined at age 9 years with the Wechsler Intelligence Scale for Children. Neuropsychological functions were examined with 2 subtests of the Developmental Neuropsychological Assessment test battery assessing comprehension of instructions and narrative memory, Trail Making Test assessing attention and with Behavioral Rating Inventory of Executive Functioning, including parent-rated and teacher-rated evaluations. Academic functioning was studied with reading fluency subtest of the Screening test for reading, writing, and calculus for first to sixth grades and information about educational support received at school reported by parents.

Results:

The cognitive profiles, including indexes of verbal comprehension, perceptual reasoning, working memory, and processing speed, did not differ significantly between metformin-treated and insulin-treated groups. Significant differences were not found between the treatment groups in assessed neuropsychological functions, reading fluency, or received level of support at school.

Conclusion:

Cognitive and neuropsychological outcomes were similar in 9-year-old children whose mothers had either metformin or insulin treatment of GDM.
Crouzon Syndrome Spanning Three Generations: Advances in the Treatment of Syndromic Midface Deficiency
Authors: Harmon Kelly A. , Ferraro Jennifer , Rezania Nikki , Carmona Taly , Figueroa Alvaro A. , Tragos Christina
Published: November 2023

Background:

Crouzon syndrome is an autosomal dominant genetic disorder characterized by craniosynostosis, midface retrusion, and exophthalmos. Over the past century, the treatment of craniofacial disorders like Crouzon syndrome has evolved significantly.

Methods:

An institutional review board–approved retrospective study was conducted to ascertain the treatment of three individuals with Crouzon syndrome from one family, complemented with a series of literature searches to examine the evolution of craniofacial surgical history.

Results:

Dr. David Williams Cheever developed the Le Fort I level to correct malocclusion, maxillomandibular malformations, and midface hypoplasia. Later, Dr. Paul Tessier introduced the Le Fort II and III osteotomies to treat syndromic midface hypoplasia. In 1978, Dr. Fernando Ortiz-Monasterio and Dr. Antonio Fuente del Campo published the first series of monobloc osteotomies, allowing for simultaneous correction of supraorbital and midface malformations, although complicated by blood loss and high infection rates. In 1992, McCarthy et al introduced the concept of gradual distraction to the craniofacial skeleton. In 1995, Polley et al performed the first monobloc advancement using external distraction. Subsequently, in 1997, Polley and Figueroa introduced a rigid external distraction device with multiple vector control to manage severe cleft maxillary hypoplasia. The technique was further refined and applied to treat syndromic midface hypoplasia, reducing complication rates. Currently, either external or internal distraction approaches are used to safely treat this challenging group of patients.

Conclusion:

The treatment of syndromic midface deficiency has significantly evolved over the past 50 years, as evidenced by this report of three generations of Crouzon syndrome.
Base editing of the mutated TERT promoter inhibits liver tumor growth
Authors: Zhao Gaoxiang , Ma Qingxia , Yang Huang , Jiang Hongfei , Xu Qianqian , Luo Shudi , Meng Zhaoyuan , Liu Juanjuan , Zhu Lei , Lin Qian , Li Min , Fang Jing , Ma Leina , Qiu Wensheng , Mao Zhengwei , Lu Zhimin
Published: November 2023

Background and Aims:

Base editing has shown great potential for treating human diseases with mutated genes. However, its potential for treating HCC has not yet been explored.

Approach and Results:

We employed adenine base editors (ABEs) to correct a telomerase reverse transcriptase (TERT) promoter mutation, which frequently occurs in various human cancers, including HCC. The mutated TERT promoter −124 C>T is corrected to −124 C by a single guide (sg) RNA-guided and deactivated Campylobacter jejuni Cas9 (CjCas9)-fused adenine base editor (CjABE). This edit impairs the binding of the E-twenty six/ternary complex factor transcription factor family, including E-twenty six-1 and GABPA, to the TERT promoter, leading to suppressed TERT promoter and telomerase activity, decreased TERT expression and cell proliferation, and increased cell senescence. Importantly, injection of adeno-associated viruses expressing sgRNA-guided CjABE or employment of lipid nanoparticle-mediated delivery of CjABE mRNA and sgRNA inhibits the growth of liver tumors harboring TERT promoter mutations.

Conclusions:

These findings demonstrate that a sgRNA-guided CjABE efficiently converts the mutated TERT promoter −124 C>T to −124 C in HCC cells and underscore the potential to treat HCC by the base editing-mediated correction of TERT promoter mutations.
Workload, nurse turnover, and patient mortality
Authors: Subramony Mahesh , Vogus Timothy J. , Chadwick Clint , Gowen Charles , McFadden Kathleen L.
Published: November 2023

Background

Hospitals are often tasked with improving patient care while simultaneously increasing operational efficiency. Although efficiency may be gained by maintaining higher patient volume per nurse (higher workload), high-quality patient care requires low levels of nurse turnover, which might be adversely affected by an increase in workload.

Purpose

Drawing upon job demands–resources theory, we hypothesized that hospital-level workload will predict nurse turnover and that nurse turnover will predict patient mortality, and that registered nurse hiring rates and human resource management practices will moderate (buffer) the positive relationship between nurse workload and nurse turnover, whereas quality care structures will moderate (buffer) the positive relationship between nurse turnover and patient mortality.

Methods

We tested this model utilizing multiple sources of time-lagged data collected from a sample of 156 hospitals in the United States.

Results

Our findings suggest that (a) nurse workload is associated with higher nurse turnover, (b) nurse turnover is positively associated with patient mortality, (c) nurse staffing buffers the workload–turnover relationship as a first-stage moderator, and (d) quality care structures act as a second-stage moderator that mitigates the effects of turnover on mortality.

Conclusions/Practice Implications

The reduction of nurse turnover and patient mortality requires investments in adequate levels of nurse staffing and implementation of quality care structures.
Incidence and Risk factors of Intraocular Inflammation after Brolucizumab Treatment in Japan: A Multicenter AMD Study
Authors: Inoda Satoru , Takahashi Hidenori , Maruyama-Inoue Maiko , Ikeda Shoko , Sekiryu Tetsuju , Itagaki Kanako , Matsumoto Hidetaka , Mukai Ryo , Nagai Yoshimi , Ohnaka Masayuki , Kusuhara Sentaro , Miki Akiko , Okada Annabelle A , Nakayama Makiko , Nishiguchi Koji M , Takeuchi Jun , Mori Ryusaburo , Tanaka Koji , Honda Shigeru , Kohno Takeya , Koizumi Hideki , Miyara Yasunori , Inoue Yuji , Takana Hiroki , Iida Tomohiro , Maruko Ichiro , Hayashi Atsushi , Ueda-Consolvo Tomoko , Yanagi Yasuo
Published: November 2023

Purpose:

To investigate the incidence of intraocular inflammation (IOI) and its risk factors following intravitreal injections of brolucizumab for neovascular age-related macular degeneration (nAMD) in Japan.

Methods:

A total of 1351 Japanese consecutive patients with nAMD who were treated with brolucizumab from May 2020 to May 2022 at 14 institutions were examined. The variables analyzed were the number of brolucizumab injections, time to onset of IOI, and risk factors.

Results:

IOI developed in 152 eyes (11.3%). Retinal vasculitis and/or retinal occlusion (RV and/or RO) occurred in 53 eyes (3.9%). Ninety-four patients received bilaterally, bilateral IOI occurred in 5 patients (5.3%). Sixteen eyes (1.2%) had irreversible visual acuity loss and nine eyes (0.67%) had visual loss of 3 lines or more due to RV and/or RO. The cumulative IOI incidence was 4.5%, 10.3%, and 12.2% at 30, 180, and 365 days (1-year), respectively. Prior history of IOI (including RV) and/or RO (odds ratio[OR], 5.41; P = 0.0075) and female sex (OR, 1.99; P = 0.0004) were significantly associated with IOI onset.

Conclusion:

The 1-year cumulative incidence of IOI in Japanese nAMD patients treated with brolucizumab was 12.2%. Prior history of IOI (including RV) and/or RO and female sex were significant risk factors.
Association of Intravenous Fluorescein Angiography and Adaptive Optics Imaging in Diabetic Retinopathy: A Prospective Case Series
Authors: Huang Ryan S. , Mihalache Andrew , Popovic Marko M. , Munn Colyn , Balas Michael , Issa Mariam , Melo Isabela Martins , Friedman Alon , Wright Tom , Yan Peng , Muni Rajeev H.
Published: November 2023

Purpose:

To our knowledge, we present the first case series investigating the relationship between adaptive optics (AO) imaging and intravenous fluorescein angiography (IVFA) parameters in patients with diabetic retinopathy (DR).

Methods:

Consecutive patients with DR over the age of 18 years presenting to a single centre in Toronto, Canada from 2020-2021 were recruited. AO was performed with the RTX1 camera (Imagine Eyes, Orsay, France) at retinal eccentricities of 2° and 4°. IVFA was assessed with the artificial intelligence-based RETICAD system to extract blood flow, perfusion, and blood-retinal barrier (BRB) permeability at the same retinal locations. Correlations between AO and IVFA parameters were calculated using Pearson’s correlation coefficient.

Results:

Across nine cases, a significant positive correlation existed between photoreceptor spacing on AO and BRB permeability (r=0.303, p=0.027), as well as perfusion (r=0.272, p=0.049) on IVFA. When stratified by location, a significant positive correlation between photoreceptor dispersion and both BRB permeability and perfusion (r=0.770, p=0.043; r=0.846, p=0.034, respectively) was observed. Cone density was also negatively correlated with BRB permeability (r=-0.819, p=0.046).

Conclusion:

Photoreceptor spacing on AO was significantly correlated with BRB permeability and perfusion on IVFA in patients with DR. Future studies with larger sample sizes are needed to understand the relationship between AO and IVFA parameters in diverse patient populations.
Potential Benefits of Integrin αvβ3 Antagonists in a Mouse Model of Experimental Dry Eye
Authors: Yeh Shu-I , Ho Tsung-Chuan , Chu Ting-Wen , Chen Show-Li , Tsao Yeou-Ping
Published: November 2023

Purpose:

The purpose of this study was to extensively evaluate the efficacy of integrin αvβ3 antagonists for the treatment of experimental dry eye (EDE).

Methods:

Vitronectin, an αvβ3 ligand, was used to induce tumor necrosis factor-α gene expression in human THP-1 macrophages. To induce EDE, C57BL/6 mice were housed in a low-humidity controlled environment chamber and injected subcutaneously with scopolamine for 7 days. Subsequently, αvβ3 antagonists, including RGDfD, c(RGDfD), c(RGDiD), c(RGDfK), ATN-161, SB273005, and cilengitide, were administered topically to EDE animals under controlled environment chamber conditions. Corneal epithelial damage in EDE was assessed by fluorescein staining. The density of conjunctival goblet cells and secretion of tears was measured by period acid–Schiff staining and phenol red-impregnated cotton threads, respectively. Inflammation markers, including tumor necrosis factor-α, interleukin (IL)-1β, IL-6, IL-17A, and metalloproteinase (MMP)-9, in the pooled cornea and conjunctiva tissues were examined by real-time polymerase chain reaction.

Results:

The inhibitory effects of αvβ3 antagonists on the vitronectin-induced tumor necrosis factor-α gene expression and integrin-mediated inflammatory signaling were validated in THP-1 macrophages. αvβ3 antagonists ameliorated the impairment of the corneal epithelial barrier with varying therapeutic efficacies, compared with vehicle-treated mice. c(RGDfD) and c(RGDiD) significantly protected against goblet cell loss, tear reduction, and proinflammatory gene expression in EDE.

Conclusions:

Topical applications of αvβ3 antagonists yield therapeutic benefits in EDE by promoting corneal epithelial defect healing and reducing inflammation. Antagonistic targeting αvβ3 may be a novel promising strategy to treat patients with dry eye disease.
Insights Into the Functional Mechanism of Diabetic Kidney Disease Treatment with Sinensetin Based on Network Pharmacology and Molecular Docking
Authors: Zhou Yao , Wu Qi , Wang Xufang , Li Wei , Liu Qiong , Gao Kun
Published: November 2023

Objective:

Sinensetin is an antioxidant widely used for treating various diseases; however, its function and targets in diabetic kidney disease (DKD) remain unknown. This study aimed to investigate the functional mechanism of sinensetin in DKD using network pharmacological and molecular docking methods.

Methods:

Potential targets of sinensetin for DKD treatment were identified using the Swiss Target Prediction (http://www.swisstargetprediction.ch/), STITCH (http://stitch.embl.de/), Online Mendelian Inheritance in Man (OMIM, https://omim.org/), and GeneCards (https://www.genecards.org/) databases. These potential targets were introduced into the STRING database to analyze protein–protein interactions (PPI) and identify key targets. These key targets were subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. The binding activities of these key targets were confirmed using molecular docking analysis.

Results:

A total of 53 key targets of sinensetin treatment in DKD were identified. Ten core targets, including protein kinase SRC (SRC), epidermal growth factor receptor (EGFR), and prostaglandin-endoperoxide synthase 2 (PTGS2) were identified using PPI network interactions. GO functional analysis revealed that reactive oxygen species metabolic processes, membrane rafts, and protein tyrosine kinase activity were involved in sinensetin treatment of DKD. The KEGG enrichment analysis exhibited that signaling pathways such as pathways in cancer, tryptophan metabolism, and the vascular endothelial growth factor (VEGF) signaling pathway play important roles. Molecular docking analysis suggested favorable docking between the ten core targets and sinensetin.

Conclusion:

Sinensetin plays a role in the treatment of DKD through various biological processes and signaling pathways. These data provide theoretical evidence for experimental studies on DKD treatment using sinensetin.
Evaluation of statistical correction strategies for corneal back surface astigmatism with toric lenses: a vector analysis
Authors: Langenbucher Achim , Hoffmann Peter , Cayless Alan , Wendelstein Jascha , Szentmáry Nóra
Published: November 2023

Purpose:

To compare actual and formula-predicted postoperative refractive astigmatism using measured posterior corneal power measurements and 4 different empiric posterior corneal astigmatism correction models.

Setting:

Tertiary care center.

Design:

Single-center retrospective consecutive case series.

Methods:

Using a dataset of 211 eyes before and after tIOL implantation (Hoya Vivinex), IOLMaster 700 (IOLM) or Casia2 (CASIA) keratometric and front/back surface corneal power measurements were converted to power vector components C0 (0/90 degrees) and C45 (45/135 degrees). Differences between postoperative and Castrop formula predicted refraction at the corneal plane using the labeled parameters of the tIOL and the keratometric or front/back surface corneal powers were recorded as the effect of corneal back surface astigmatism (BSA).

Results:

Generally, the centroid of the difference shifted toward negative C0 values indicating that BSA adds some against the rule corneal astigmatism (ATR). From IOLM/CASIA keratometry, the average difference in C0 was 0.39/0.32 diopter (D). After correction with the Abulafia-Koch, Goggin, La Hood, and Castrop nomograms, it was −0.18/−0.24 D, 0.27/0.18 D, 0.13/0.08 D, and 0.17/0.10 D. Using corneal front/back surface data from IOLM/CASIA, the difference was 0.18/0.12 D.

Conclusions:

The Abulafia-Koch method overcorrected the ATR, while the Goggin, La Hood, and Castrop models slightly undercorrected ATR, and using measurements from the CASIA tomographer seemed to produce slightly less prediction error than IOLM.