bluuebunny/crossref_metadata_2025 huggingface dataset:
Salidroside protect Chinese hamster V79 cells from genotoxicity and oxidative stress induced by CL-20
Authors: Li Cunzhi , Deng Hui , Liu Zhiyong , Lv Xiaoqiang , Gao Wenzhi , Gao Yongchao , Gao Junhong , Hu Lifang
Published: February 2023

Hexanitrohexaazaisowurtzitane (CL-20) is a high-energy elemental explosive widely used in chemical and military fields. CL-20 harms environmental fate, biosafety, and occupational health. However, there is little known about the genotoxicity of CL-20, in particular its molecular mechanisms. Therefore, this study was framed to investigate the genotoxic mechanisms of CL-20 in V79 cells and evaluate whether the genotoxicity could be diminished by pretreating the cells with salidroside. The results showed that CL-20-induced genotoxicity in V79 cells primarily through oxidative damage to DNA and mitochondrial DNA (mtDNA) mutation. Salidroside could significantly reduce the inhibitory effect of CL-20 on the growth of V79 cells and reduce the levels of reactive oxygen species (ROS), 8-hydroxy-2 deoxyguanosine (8-OHdG), and malondialdehyde (MDA). Salidroside also restored CL-20-induced superoxide dismutase (SOD) and glutathione (GSH) in V79 cells. As a result, salidroside attenuated the DNA damage and mutations induced by CL-20. In conclusion, oxidative stress may be involved in CL-20-induced genotoxicity in V79 cells. Salidroside could protect V79 cells from oxidative damage induced by CL-20, mechanism of which may be related to scavenging intracellular ROS and increasing the expression of proteins that can promote the activity of intracellular antioxidant enzymes. The present study for the mechanisms and protection of CL-20-mediated genotoxicity will help further to understand the toxic effects of CL-20 and provide information on the therapeutic effect of salidroside in CL-20-induced genotoxicity.
Traumatic brain injury and RSI is rocuronium or succinylcholine preferred?
Authors: Dao Anthony Q. , Mohapatra Shweta , Kuza Catherine , Moon Tiffany S.
Published: February 2023

Purpose of review

Traumatic brain injury is widespread and has significant morbidity and mortality. Patients with severe traumatic brain injury often necessitate intubation. The paralytic for rapid sequence induction and intubation for the patient with traumatic brain injury has not been standardized.

Recent findings

Rapid sequence induction is the standard of care for patients with traumatic brain injury. Historically, succinylcholine has been the agent of choice due to its fast onset and short duration of action, but it has numerous adverse effects such as increased intracranial pressure and hyperkalemia. Rocuronium, when dosed appropriately, provides neuromuscular blockade as quickly and effectively as succinylcholine but was previously avoided due to its prolonged duration of action which precluded neurologic examination. However, with the widespread availability of sugammadex, rocuronium is able to be reversed in a timely manner.

In patients with traumatic brain injury necessitating intubation, rocuronium appears to be safer than succinylcholine.
Tibial Bone Transport With a Single Implant All-Internal Bone Transport Nail
Authors: Blair James A. , Puneky George A. , Swaminathan Nagaraj , Klahs Kyle J. , Davis Jana M.
Published: February 2023

A single implant all-internal magnet-driven bone transport nail (BTN—NuVasive Specialized Orthopaedics Inc) has recently been introduced as a treatment method for segmental tibial bone defects. This innovation provides promise in the management of segmental bone defects because it negates numerous complications associated with circular external fixation and the need for multiple implants when considering hybrid plate-assisted bone segment transport constructs. Given the novelty of the BTN, description of the surgical application and patient outcome measures are scarce in the current literature. To date, we have treated 4 patients with an average age of 27 years (range 19–44 years) using the BTN for segmental tibial defects ranging from 50 to 128 mm. We have accumulated data over an average follow-up of 18.07 months (range 12.96–25.13 months), demonstrating good patient tolerance of the device. Three patients successfully completed their treatment course with a calculated average bone healing index of 41.4 days/cm (range 31.41–54.82 days/cm). One patient was noted to experience an asymptomatic docking site nonunion requiring subsequent surgery for nonunion repair. Implant-associated complications included symptomatic implant, axial malalignment, docking site nonunion, and external remote control technical malfunction. Injury-related complications were encountered and noted to include: superficial infection, wound dehiscence, peroneal tendonitis, and joint rigidity. In this study, the authors present a case series using this implant to date and discuss our experiences with the BTN with reference to clinical indications, tibial bone preparation, BTN implantation, transport protocol, docking site procedure, and clinical/radiographic outcomes.
Autologous Bone Graft From the Ipsilateral Distal Femur in Tibial Condyle Fractures
Authors: Rönnerfalk Mattias , Velin Lotta , Palm Lars , Meunier Andreas , Schilcher Jörg
Published: February 2023

Fractures of the proximal tibia often require void filling to support articular fragments in combination with internal fixation. The most common techniques are iliac autograft, allograft, or synthetic bone graft substitutes.

The distal femur and its large volume condyles are a source of cancellous bone graft within the surgical site of an open reduction and internal fixation procedure. We have used a minimally invasive technique to harvest bone graft from the distal femur, using a bone graft drill. We performed this investigation to determine whether our technique of using distal femoral autograft to fill bone voids when treating proximal tibial fractures with open reduction and internal fixation is effective and safe. We also sought to determine the degree to which the bone graft incorporates into the tibia during fracture healing, the degree to which the harvest site heals, and the degree of secondary joint line depression.

In all 12 patients, the bone graft had sufficient volume to fill the subchondral void in the proximal tibia, all fractures had healed at follow-up, and fracture reduction was maintained in most cases. We found no pain at the harvest site during follow-up, and there were no signs of drill penetration in articular or cortical structures. Drill holes at the harvest site showed sparse amounts of newly formed bone on CT in most of its circumference in all patients.

There were no pathological changes in the femoral condyles with relation to the bone grafting procedure, and 5 patients showed radiographic signs of osteoarthritis in one or more joint compartments of the knee. The results showed this technique to provide similar success as reported alternatives without major complications and we continue to use this technique of harvesting distal femoral autograft to supplement open reduction and internal fixation of selected proximal tibial fractures.
Management of Obturator Vessel Hemorrhage by Pubic Ramus Osteotomy During Acetabular Fixation—A Technical Trick
Authors: Seeker Luke C. , Bartlett Craig S.
Published: February 2023

It is known that hemorrhage from pelvic ring and acetabular fractures can cause hemodynamic instability. Methods to improve visualization and thus management of bleeding vessels are not commonly described. This report highlights techniques to manage hemorrhage from a retracted obturator vein during the definitive fixation of a complex acetabular fracture. After uncomplicated modified Stoppa anterior intrapelvic approach, abrupt and profuse bleeding was encountered from the distal end of a lacerated obturator vein, which had retracted into the obturator foramen. With unsuccessful attempts to achieve hemostasis, a superior pubic osteotomy was performed which allowed excellent visualization of the bleeding vein and ligation. It must be emphasized that the surgeon attempted all these other measures before performing an osteotomy. This technical trick contributes to the overall knowledge as a means of achieving emergent hemostasis associated with distal obturator vessel hemorrhage, a well described risk in complex acetabular fractures.
Definition of Tweener: Consensus Among Experts in Treating Early-onset Scoliosis
Authors: Quan Theodore , Matsumoto Hiroko , Bonsignore-Opp Lisa , Ramo Brandon , Murphy Robert F. , Brooks Jaysson T. , Welborn Michelle C. , Emans John B. , Anari Jason B. , Johnston Charles E. , Akbarnia Behrooz A. , McCarthy Richard , Flynn John , Sawyer Jeffrey R. , Vitale Michael G. , Roye Benjamin D. ,   Pediatric Spine Study Group
Published: February 2023

Background:

The term “Tweener” is colloquially used to refer to early-onset scoliosis (EOS) patients whose age and development make them candidates for multiple surgical options. The purpose of this study was to establish expert consensus on a definition to formally characterize the Tweener population.

Methods:

A 3-round survey of surgeons in an international EOS study group was conducted. Surgeons were provided with various patient characteristics and asked if each was part of their definition for Tweener patients. Responses were analyzed for consensus (≥70%), near-consensus (60% to 69%), and no consensus (<60%).

Results:

Consensus was reached (89% of respondents) for including chronological age in the Tweener definition; 8 to 10 years for females and 9 to 11 years for males. Surgeons agreed for inclusion of Sanders score, particularly Sanders 2 (86.0%). Patients who have reached Sanders 4, postmenarche, or have closed triradiate cartilage should not be considered Tweeners. Bone age range of 8 years and 10 months to 10 years and 10 months for females (12 y for males) could be part of the Tweener definition.

Conclusions:

This study suggests that the Tweener definition could be the following: patients with open triradiate cartilage who are not postmenarcheandhave not reached Sanders 4,andif they have one of the following: Sanders 2orchronological age 8 to 10 years for females (9 to 11 y for males)orbone age 8 years and 10 months to 10 years and 10 months for females (12 y for males). This definition will allow for more focused and comparative research on this population.

Level of Evidence:

Level V—expert opinion.
Factors Predictive of Tenotomy After Ponseti Casting for Idiopathic Clubfoot: A Tertiary Care Center Study
Authors: Sharma Sandeep , Banskota Bibek , Yadav Prakash , Rajbhandari Tarun , Bhusal Rajan , Banskota Ashok Kumar
Published: February 2023

Introduction:

Parents of children with clubfoot are likely to inquire about the need for tenotomy and about any factors that may be predictive. The present study was done to identify factors that may help predict the need for tenotomy in children undergoing Ponseti treatment for idiopathic clubfoot.

Methods:

A prospective observational study was conducted on patients under 5 years of age with idiopathic clubfoot and no previous treatment history treated at Hospital and Rehabilitation Centre for Disabled Children. The relationship between the Pirani score, Dimeglio score, age, and passive ankle dorsiflexion (DF) and the need for heel cord tenotomy was analyzed using appropriate statistical methods.

Results:

Of 83 patients (125 feet) with a mean age of 6 months, 93 feet (74.4%) required a percutaneous tenotomy. The mean initial Pirani and Dimeglio score for 125 club feet was 4.5 (SD=1.68) and 13.5 (SD=6.1), respectively. The mean initial passive ankle DF was −40.4 (SD=22.31). The Dimeglio (P=0.000), Pirani scores (P=0 .000), and passive ankle DF (P=0.000) showed significant association with the need for tenotomy.

Conclusions:

This study shows a strong association between initial Pirani and Demiglio scores and initial passive ankle DF as predictive of a heel cord tenotomy. However, age, sex, and laterality were not associated with the need for tenotomy.
Advanced ovarian clear cell carcinoma with RAD50 mutation treated by PARP inhibitor pamiparib combined with anti-angiogenesis therapy: a case report
Authors: Huang Xiaoyan , He Xiaojian , Li Dongliang , Chen Xiong , Chen Xi
Published: February 2023

Ovarian clear cell carcinoma (OCCC) is a relatively uncommon epithelial ovarian malignancy with unique clinical, histopathologic and genetic characteristics. Patients with advanced OCCC have poor outcomes and are resistant to standard chemotherapy. Targeted therapy offers a novel approach for treating OCCC. We report the case of a 45-year-old female patient with advanced OCCC who experienced relapse after standard treatment. Further, a frameshift mutation in the homologous recombination repair-related gene RAD50 (RAD50-p.I371Ffs*8) was identified by genetic testing. Next, the patient had received targeted combination therapy with poly (ADP-ribose) polymerase (PARP) inhibitor pamiparib and bevacizumab, achieving partial remission. Patient’s symptoms improved significantly compared to before. To date, the patient has been followed up for more than half a year with favorable survival and high quality of life. The case report suggested that parmiparib-targeted therapy is a viable treatment option for advanced OCCC patients with RAD50 mutation.
Efficacy and safety of enfortumab vedotin in the treatment of advanced urothelial carcinoma: a systematic review and meta-analysis
Authors: Wang Leibo , Shi Guanyu , Zhao Guoqiang , He Wei , Cen Zhuangding , Xu Feng
Published: February 2023

This study aimed to investigate whether Enfortumab vedotin (EV) is suitable for patients with locally advanced or metastatic urothelial carcinoma and to perform a meta-analysis of its efficacy and safety. Five studies involved 584 patients were included in the meta-analysis. The results of single-arm meta-analysis showed that with EV at 1.25 mg/kg, the objective response rate (ORR) was 47%. The meta-analysis indicated that EV showed good efficacy and safety in the patient population of locally advanced or metastatic urothelial carcinoma.
Creating a Self-management Mobile Application for People With Chronic Low Back Pain
Authors: Hong Se Jin , Chung Minsuh , Gu Yeonji , Kim Kyounghae
Published: February 2023

Mobile health can fulfill the unmet needs of patients with chronic low back pain by recommending individualized management plans. Limited mobile applications have been developed based on the needs, preferences, and values relative to self-management of patients with chronic low back pain. This study aimed to explore the experience of patients with chronic low back pain and the desired content, designs, and features of a self-management application. We conducted five focus groups (N = 24). Participants provided feedback on draft contents and they also discussed the desired designs and features of an application while reviewing a low-fidelity prototype. Data were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Three categories and eight subcategories emerged. Participants: (1) confronted difficulties of their pain experience along with vicious cycles of pain and unmet needs; (2) acknowledged the importance of self-management as they lived with chronic low back pain and realized how to self-manage their pain; and (3) suggested ways to fulfill needs and preferences among patients with chronic low back pain. The nature of chronic low back pain causes disruptions well-being and requires constant management. Developing user-centered strategies to enhance knowledge and promote self-management among chronic low back pain patients is required.
Nursing Informatics and Epigenetics: Methodological Considerations for Big Data Analysis
Authors: Milner John J. , Zadinsky Julie K. , Shiao S. Pamela K.
Published: February 2023

Nursing informatics requires an understanding of patient-centered data and clinical workflow, and epigenetic research requires an understanding of data analysis. The purpose of this article is to document the methodology that nursing informatics specialists can use to conduct epigenetic research and subsequently strengthen patient-centered care. A pilot study of a secondary methylation data analysis using The Cancer Genome Atlas data from individuals with colon cancer is utilized to illustrate the methodology. The steps for conducting the study using public and free resources are discussed. These steps include finding a data source; downloading and analyzing differentially methylated regions; annotating differentially methylated region, gene ontology and function analysis; and reporting results. A model of epigenetic testing workflow is provided, as is a list of publicly available data and analysis sources that can be used to conduct epigenetic research.
Fall Risk Prediction Models During the Initial COVID-19 Surge
Authors: Arnold Lea Ann , Carroll Chad , Eberlein Bill , Naidech Andrew M. , Colfer Kathryn , Ramsey Kristin , Sturgeon Cord
Published: February 2023

During the first COVID surge, multiple changes in nurse staffing and workflows were made to support care delivery in a resource-constrained environment. We hypothesized that there was a higher rate of inpatient falls during the COVID surge. Furthermore, we predicted that an automated predictive analytic algorithm would perform as well as the Johns Hopkins Fall Risk Assessment. A retrospective review of falls for 3 months before and the first 3 months of the first COVID surge was conducted. We determined the total number of falls and the overall fall rate and examined the distribution of scores and accuracy of fall predictive models for both groups. There was a statistically significant increase in fall rate during the first 3 months of the COVID surge compared with the 3 prior months (2.48/1000 patient-days vs 1.89/1000 patient-days respectively; P = .041). The Johns Hopkins instrument had a greater sensitivity of 78.9% compared with 57.0% for the predictive analytic model. Specificity and accuracy of the predictive analytic model were higher than the Johns Hopkins instrument (71.3% vs 54.1% and 71.2% vs 54.3%, respectively). These findings suggest that the automated predictive analytic model could be used in a resource-constrained environment to accurately classify patients' risk of fall.
Validation of Nursing Outcomes Classification: Knowledge and Self-management for Cardiac Disease
Authors: Oh Hyunkyoung , Moorhead Sue , Chae Sena
Published: February 2023

The Nursing Outcomes Classification provides two outcomes, Knowledge: Cardiac Disease and Self-management: Cardiac Disease, to assess knowledge and self-management behaviors of adults with cardiac disease. The purpose of this study was to validate the two nursing-sensitive outcomes to establish content validity. A methodological design was used using the Delphi technique. A total of 13 nurse experts in two domains participated in this study: five in standardized nursing terminologies and eight in self-management. Descriptive statistics and the Nurse-Patient Outcome Content Validity method were used to validate four aspects: definition adequacy of each outcome, clinical usefulness of measurement scales, importance of outcome indicators, and content similarity between the two outcomes. The definition adequacy, clinical usefulness, and content similarity of both outcomes were acceptable. A total of 81 indicators from the two outcomes were validated, and 60 were designated as critical. Nurses can evaluate cardiac patient outcomes effectively and accurately using these validated outcomes. The validated Nursing Outcomes Classification outcomes will also support the clinical decision-making of nursing students when they learn about patients with cardiac disease.
Evaluation of a Theory-Based Virtual Counseling Application in Nursing Education
Authors: Shorey Shefaly , Ang Emily N. K. , Ng Esperanza Debby , Yap John , Lau Lydia S. T. , Chui Chee Kong , Chan Yiong Huak
Published: February 2023

Effective communication skills in nursing are necessary for high-quality nursing care, but given the decline in nursing students' attitudes and their low self-confidence in effective communication with patients, a participatory and experiential training method is needed. Therefore, a virtual counseling application was developed using artificial intelligence and a three-dimensional avatar to facilitate learning of communication skills. This study aimed to evaluate the effectiveness of this theory-based virtual intervention on nursing students' learning attitudes, communication self-efficacy, and clinical performance. A longitudinal quasi-experimental study was conducted. Ninety-three undergraduate nursing students received virtual patient trainings with four clinical scenarios over 2 years. Data were analyzed using McNemar test and analysis of variance. Virtual patient training improved students' learning attitudes toward communication skills for scenarios involving the pregnant woman (20.4%, P = .03) and depressed patient (17.1%, P = .01) and enhanced perceived self-efficacy for scenarios involving the pregnant woman (22.6%, P = .002) and stressed nursing student (18.3%, P = .002). Students received lower clinical communication scores for pediatric, obstetric, and medical practicums compared with a previous cohort who received no training. Overall, this virtual counseling application can provide a valuable and cost-effective communication learning resource for the nursing curriculum.
How Nurses Develop Standardized Care Plans Under a Clinical Decision Support System
Authors: Zhai Yue , Zhang Yuxia
Published: February 2023

Standardized care plans are being increasingly introduced to health facilities; however, their level of adoption remains unsatisfactory. Little is known about nurses' use of standardized care plans in China. This study aims to investigate acute care nurses' practices and experiences of care planning within a clinical decision support system embedded with standardized nursing languages. We explored the importance and performance of nursing interventions by retrospective analysis of 400 standardized care plans (performance) and a survey among nurses (importance). Semistructured interviews were conducted to supplement quantitative findings and delve deeper into nurses' experience with standardized care plans. A total of six core nursing diagnoses were determined, each corresponding to seven to 15 nursing interventions. The correlations between nurses' perceived importance and actual performance of nursing interventions in the care plan were weak. Qualitative interviews identified three themes: negative attitudes toward the care plan, uncertainty regarding care planning, and new routines with the care plan. Our findings indicate that nurses' care planning may not reflect their professional judgments. Effective leadership from nurse administrators is warranted to engage nurses with standardized care plan implementation. The content of the standardized nursing language embedded-knowledge base should be continuously adapted to clinical needs to facilitate nurses' care planning practices.
Influence of patellofemoral joint degeneration on clinical outcomes after medial unicompartmental knee arthroplasty
Authors: Wu Limin , Chen Quan , Si Haibo , Wu Yuangang , Zeng Yi , Li Mingyang , Liu Yuan , Shen Bin
Published: February 2023

Background:

Patellofemoral joint (PFJ) degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty (UKA). More recently, some researchers have proposed that PFJ degeneration can be ignored in medial UKA, and others have proposed that this change should be reviewed in PFJ degenerative facets and severity. This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures (PROMs) and revision rates after medial UKA.

Methods:

Electronic databases (PubMed, Embase, Web of Science, etc.) were searched for studies assessing the influence of PFJ degeneration on medial UKA. A random-effects meta-analysis was conducted for the Oxford knee score (OKS), Knee society score (KSS), and revision rates and stratified by PFJ degenerative facets (medial/lateral/trochlear/unspecified), severe PFJ degeneration (bone exposed), and bearing type (mobile/fixed). Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.

Results:

A total of 34 articles with 7007 knees (2267 with PFJ degeneration) were included (5762 mobile-bearing and 1145 fixed-bearing) and 100 unspecified. Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS, and only lateral facets significantly decreased the OKS (mean difference [MD] = −2.18, P 
< 0.01) and KSS (MD = −2.61, P 
< 0.01). The severity degree of PFJ degeneration had no additional adverse effect on the OKS, KSS, or revision rates. For mobile-bearing UKA, only lateral PFJ degeneration significantly decreased the OKS (MD = −2.21, P < 0.01) and KSS (MD = −2.44, P < 0.01). For fixed-bearing UKA, no correlation was found between PROMs/revision rates and PFJ degeneration.

Conclusion:

For medial mobile-bearing UKA, slight to moderate degenerative changes in the PFJ, except lateral facet, did not compromise PROMs or revision rates. For medial fixed-bearing UKA, although it might not be conclusive enough, PROMs or revision rates were not adversely affected by PFJ degeneration (regardless of the facet).
Role of neutrophil extracellular traps in inflammatory evolution in severe acute pancreatitis
Authors: Kang Hongxin , Yang Yue , Zhu Lv , Zhao Xianlin , Li Juan , Tang Wenfu , Wan Meihua
Published: February 2023

Severe acute pancreatitis (SAP) is a life-threatening acute abdominal disease with two peaks of death: the first in the early stage, characterized by systemic inflammatory response-associated organ failure; and the second in the late stage, characterized by infectious complications. Neutrophils are the main immune cells participating in the whole process of SAP. In addition to the traditional recognition of neutrophils as the origination of chemokine and cytokine cascades or phagocytosis and degranulation of pathogens, neutrophil extracellular traps (NETs) also play an important roles in inflammatory reactions. We reviewed the role of NETs in the occurrence and development of SAP and its fatal complications, including multiple organs injury, infected pancreatic necrosis, and thrombosis. This review provides novel insights into the involvement of NETs throughout the entire process of SAP, showing that targeting NETs might be a promising strategy in SAP treatment. However, precision therapeutic options targeting NETs in different situations require further investigation.
Perioperative dexmedetomidine administration does not reduce the risk of acute kidney injury after non-cardiac surgery: a meta-analysis
Authors: Hu Bin , Tian Tian , Li Xintao , Liu Weichao , Chen Yinggui , Jiang Tianyu , Chen Peishan , Xue Fushan
Published: February 2023

Background:

Post-operative acute kidney injury (AKI) is one of the most common and serious complications after major surgery and is significantly associated with increased risks of morbidity and mortality. This meta-analysis was conducted to evaluate the effects of perioperative dexmedetomidine (Dex) administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.

Methods:

The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched for studies comparing the effects of Dex vs. placebo on kidney function after non-cardiac surgery, and a pooled fixed-effect meta-analysis of the included studies was performed. The primary outcome was the occurence of post-operative AKI. The secondary outcomes included the occurence of intra-operative hypotension and bradycardia, intensive care unit (ICU) admission, duration of ICU stay, and hospital length of stay (LOS).

Results:

Six studies, including four randomized controlled trials (RCTs) and two observational studies, with a total of 2586 patients were selected. Compared with placebo, Dex administration could not reduce the odds of post-operative AKI (odds ratio (OR), 0.44; 95% confidence interval (CI), 0.18–1.06; P = 0.07; I
2 = 0.00%, P = 0.72) in RCTs, but it showed a significant renoprotective effect (OR, 0.67; 95% CI, 0.48–0.95; P = 0.02; I
2 = 0.00%, P = 0.36) in observational studies. Besides, Dex administration significantly increased the odds of intra-operative bradycardia and shortened the duration of ICU stay. However, there was no significant difference in the odds of intra-operative hypotension, ICU admission, and hospital LOS.

Conclusions:

This meta-analysis suggests that perioperative Dex administration does not reduce the risk of AKI after non-cardiac surgery. However, the quality of evidence for this result is low due to imprecision and inconsistent types of non-cardiac operations. Thus, large and high-quality RCTs are needed to verify the real effects of perioperative Dex administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.
Cardiac Manifestations of Viral Infections, Including COVID-19: A Review
Authors: Weisleder Hillary , Jacobson Eliana , Frishman William H , Dhand Abhay
Published: February 2023

Viral infections have been linked to a variety of cardiac pathology, which may include acute myocarditis, dilated cardiomyopathy, heart failure, cardiogenic shock, pericarditis, acute coronary syndromes, and arrhythmias. We performed a systematic review of literature focusing on the cardiovascular effects of various viral infections, as well as providing an update on the current understanding of the pathophysiology of Coronavirus disease-2019 (COVID-19). Cardiac manifestations of viral illnesses are usually self-limiting, have variable clinical presentations, and require sufficient clinical suspicion for diagnosis and optimal management.
Is Red Cell Distribution Width a Reliable Marker for Cardiovascular Diseases? A Narrative Review
Authors: Heshmat-Ghahdarijani Kiyan , Fakhrolmobasheri Mohammad
Published: February 2023

Red cell distribution width (RDW) is an easy-to-access marker which is routinely measured in complete blood count (CBC) test. Besides the classic use of RDW as a marker for discriminating different types of anemia, recent studies had indicated the relationship between high RDW and cardiovascular diseases. High RDW is not only useful in the diagnosis and prognostication of various cardiovascular conditions but also could be used as a valuable tool for predicting the incidence of cardiovascular diseases. population-based studies have indicated that higher RDW could effectively predict the incidence of heart failure (HF), atherosclerotic diseases, and atrial fibrillation (AF). It has been also demonstrated that higher RDW is associated with worse outcomes in these diseases. Recent studies have shown that high RDW is also associated with other cardiovascular conditions including cardiomyopathies, and pulmonary hypertension. The predictive role of RDW in endovascular interventions has also been demonstrated by many recent studies. Here in this review, we attempt to compile the most recent findings with older reports regarding the relation between high RDW and HF, cardiomyopathies, pulmonary hypertension, AF, atherosclerotic disorders, primary hypertension, and the outcomes of endovascular interventions. we also discussed the role of RDW in the prognostication of different cardiovascular conditions when combined with classic classification criteria.
Postural Tachycardia Syndrome and COVID-19: Focus on Ivabradine Therapy
Authors: Dixit Keshav , Frishman William H.
Published: February 2023

In this article we discuss the association of postural orthostatic tachycardia syndrome (POTS) with coronavirus-19 (COVID-19), ivabradine’s unique mechanism of action, and its use in POTS patients. We highlight the pathophysiology and common etiologies of POTS, including preceding viral infections, vaccines, trauma, surgeries, and other stressors. COVID-19, a viral illness, has been associated with POTS through a variety of mechanisms that are not yet well understood. The initial management strategy for POTS is largely nonpharmacological, focusing on increasing venous return to the heart through physical therapy or other exercise activities.

Ivabradine is a selective inhibitor of the funny sodium channels within the sinoatrial node. This unique mechanism of action allows for the reduction of heart rate without any effect on the heart’s ionotropic activity. With an increase in the number of POTS cases, especially during the COVID pandemic, the importance of utilizing new medications and management strategies for POTS becomes imperative. Though ivabradine is currently only approved for the management of patients with coronary artery disease and heart failure by the Food and Drug Administration (FDA), it has also proven to be effective at reducing symptoms among patients with refractory POTS, and thus, should be considered for the management of patients who do not respond to initial treatment strategies.
Co-administration of bromocriptine and corticosterone produces short- and long-lasting reduction in intake of high-fat food in male rats
Authors: Castillo-Campohermoso Víctor H. , Molina-Martínez Luz M. , Barrios de Tomasi Eliana , Juárez Jorge
Published: February 2023

Dopaminergic and glucocorticoid activity has been associated with reduced food consumption; however, their possible synergic action has not yet been studied. With the aim of examining the effect of the co-administration of the dopamine receptor D2 agonist bromocriptine and corticosterone on palatable food intake, male Wistar rats were administered either bromocriptine (1 mg/kg), corticosterone (2 mg/kg), bromocriptine + corticosterone (1 mg + 2 mg/kg) or a vehicle, with a fifth group used as a control. In all cases, substances were administered 30 min before exposure to standard food or palatable food, the latter high in carbohydrates [high carbohydrate food (HCF), 75%] or high-fat food (HFF, 67%). Food consumption and body weight were recorded daily. Results showed higher consumption of standard food but lower consumption of HCF and HFF in the groups that received bromocriptine, alone or in combination. In general, lower total kcal intake was observed in the bromocriptine and bromocriptine + corticosterone groups during the period of pharmacological treatment and following re-exposure to palatable food. The low HFF intake in the bromocriptine + corticosterone group persisted 10 days after the pharmacological treatment was interrupted. This effect suggests plastic changes in either the mechanisms involved in the incentive value of palatable food – particularly foods with high-fat content – or those that regulate lipid metabolism. Our findings suggest that homeostatic and reward mechanisms could be influenced by the co-participation of the dopaminergic and hypothalamic-pituitary-adrenal systems, and the macronutrient content of food.
Evaluation of Limited Sampling Strategies for Bayesian Estimation of Daptomycin Area Under the Concentration–Time Curve: A Short Communication
Authors: Tuloup Vianney , Millet Aurélien , Taricco Alessandra , Parant François , Ferry Tristan , Goutelle Sylvain
Published: February 2023

Purpose:

Increasing evidence supports daptomycin therapeutic drug monitoring. The author's reference center used to perform therapeutic drug monitoring in patients who receive high-dose daptomycin for bone and joint infections, with a three-sample strategy to estimate the daptomycin daily area under the concentration–time curve (AUC). The objective of this study was to evaluate simpler strategies based on only 2 or 1 sample(s).

Methods:

The authors used the BestDose software to estimate the daptomycin AUC after Bayesian posterior estimation of individual pharmacokinetic (PK) parameters at steady state. The reference AUC (AUCfull) was based on 3 samples obtained predose (T0) and approximately 1 hour (T1) and 6 hours (T6) after the start of a 30-minute infusion of IV daptomycin. It was compared with the AUC based on all possible 2-sample and 1-sample strategies. Bias, imprecision, regression, and Bland–Altman plots were used to assess the performance of the alternative strategies.

Results:

Data from 77 patients were analyzed. The mean AUCfull value was 936 ± 373 mg·h/L. The best 2-sample strategy was T0 + T6, with a mean prediction bias of 0.13 mg·h/L and absolute imprecision of 3%. The T0 + T1 strategy also performed well with a mean bias of −10 mg·h/L and imprecision of 3%. The best 1-sample strategy was the T6 sample only with a bias of 2.19 mg·h/L and imprecision of 6%.

Conclusions:

Bayesian estimation of daptomycin AUC based on a two-sample strategy was associated with negligible bias and imprecision compared with the author's usual three-sample strategy. The trough and peak strategy may shorten and simplify patient visits and reduce assay labor and costs.
Effects of mixed heavy metals on kidney function in premenopausal and postmenopausal women
Authors: Nguyen Hai Duc
Published: February 2023

Objective

To evaluate the relationships between heavy metals (cadmium, lead, and mercury) and their mixtures and estimated glomerular filtration rate (eGFR) in premenopausal and postmenopausal women.

Methods

Using data from the Korean National Health and Nutrition Examination Survey (2009-2017), multivariate linear regression models, marginal effects, and weighted quantile sum regression, we assessed the associations between single heavy metals and their mixtures and eGFR among 5,372 women.

Results

Risks of reduced eGFR, comorbidities, and heavy metal exposure were found to be higher in postmenopausal women than in premenopausal women. A negative association of cadmium (β= −2.97; 95% CI, −5.10 to −0.85) and a positive association of mercury (β= 2.97; 95% CI, 1.49 to 4.44), with eGFR in postmenopausal women. Inverse associations of lead with eGFR in both premenopausal women (β= −4.75; 95% CI, −6.04 to −3.46) and postmenopausal women (β= −4.54; 95% CI, −6.96 to −2.13). Interactions were identified between lead and mercury, as well as cadmium and lead for eGFR among premenopausal women (β= −2.04; 95% CI, −2.98 to −1.10) and postmenopausal women (β= −3.52; 95% CI, −6.04 to −1.01), respectively. There was a negative association between mixed heavy metals and eGFR in both premenopausal women (β= −2.23; 95% CI, −3.51 to −0.96) and postmenopausal women (β= −3.86; 95% CI, −6.89 to −0.83). Lead was found as a key chemical related to reduced eGFR. Cutoff values for each heavy metal concentration related to eGFR were provided.

Conclusion

Postmenopausal women were more influenced by mixed heavy metals' effects on kidney function than premenopausal women. Early interventions (eg, water filtering, heavy metal yearly screening) in women, especially postmenopausal women, are needed to reduce the incidence of chronic kidney disease.
A Study of the Reliability, Validity, and Physiological Changes of Sit-to-Stand Tests in People With Heart Failure
Authors: Adsett Julie A. , Bowe Rachel , Kelly Rebecca , Louis Menaka , Morris Norman , Hwang Rita
Published: February 2023

Purpose:

The objective of this study was to describe the psychometric properties and physiological response of the five times sit-to-stand (STST-5) and 60-sec sit-to-stand test (STST-60) in adults with heart failure (HF).

Methods:

People with HF enrolled in a 12-wk exercise rehabilitation program completed two STST-5 and two STST-60 as part of their usual baseline and follow-up assessments. Test-retest reliability, validity, and responsiveness of the two STSTs were described. Results were correlated with the 6-min walk test (6MWT) and timed up and go test (TUGT), and rating of perceived exertion and physiological responses were compared between all tests. Feasibility was also reported according to the presence of adverse events and adherence to the protocol.

Results:

Forty-nine adults with HF participated in this study. Intraclass correlation coefficients of the STST-5 and STST-60 were 0.91 (95% CI, 0.78-0.96) and 0.96 (95% CI, 0.93-0.98), respectively. The STST-60 was strongly associated with both the 6MWT (r = 0.76) and the TUGT (r
s =−0.77). The STST-5 was strongly associated with the TUGT (r
s = 0.79) and moderately associated with the 6MWT (r
s =−0.70). Rating of perceived exertion and lower limb fatigue were greater in the STST-60 than in the 6MWT (P < .001) or STST-5 (P < .001). Adverse events occurred in five participants undertaking the STST-60 and one participant undertaking the STST-5.

Conclusions:

The STST-5 and STST-60 are reliable and valid measures of functional exercise capacity in people with HF.
Efficacy and Safety of Exercise Testing and Rehabilitation for Aortic Dissection Patients
Authors: Jepsen Lau Røge , D'Oria Mario , Pedersen Steen Fjord , Budtz-Lilly Jacob
Published: February 2023

Objective:

Although physical exercise has established benefits for long-term cardiovascular health, concern regarding further aortic events has limited the evidence for exercise among aortic dissection (AD) patients. The objective was to perform a scoping review of the current concepts and gaps in the literature regarding the benefit and safety of cardiovascular testing and rehabilitation among post-AD patients.

Review Methods:

A scoping review of the literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Eligibility criteria included any studies with AD in relation to exercise rehabilitation or testing and physical or mental health. Electronic databases were queried for relevant studies (last queried, November 1, 2021).

Results:

Six observational studies were included with a total of 381 patients with AD, all of whom underwent surgical intervention. Study heterogeneity prevented data synthesis and a formal systematic review, although four dominant themes emerged: cardiovascular-related outcomes, aorta-related outcomes, quality of life (QoL), and serious adverse events. Patients with AD have reduced baseline physical capacity and QoL. Rehabilitation programs may increase both physical status and QoL. Rates of serious adverse rates are minimal yet poorly defined.

Conclusions:

Within the context of apparent benefits from cardiovascular testing and rehabilitation for patients with AD who have undergone intervention, this scoping review highlights the need for increased comparative research specific to exercise among patients with AD and outcomes such as mortality and reinterventions.
Home-Based Pulmonary Rehabilitation and Health Coaching in Fibrotic Interstitial Lung Disease
Authors: Duke Jennifer D. , Moua Teng , Ridgeway Jennifer L. , Roy Madison , Benzo Maria , Hoult Johanna , Benzo Roberto
Published: February 2023

Purpose:

Pulmonary rehabilitation is a behavioral modification intervention shown to improve exercise tolerance and patient-reported quality of life in patients with fibrotic interstitial lung disease. Home-based rehabilitation may provide easier access for those who struggle to complete center-based rehabilitation programs due to increased symptom burden or frailty.

Methods:

We present the quantitative and qualitative findings of a pilot study of 21 patients with fibrotic interstitial lung disease who participated in a 12-wk home-based pulmonary rehabilitation program with activity monitoring and health coaching.

Results:

Pre- and post-intervention patient-reported outcome questionnaires suggested improvements in dyspnea and respiratory-related quality of life but were underpowered to meet statistical significance. Half had increases in mean daily step counts while a quarter declined because of disease progression. Qualitative analysis of semistructured participant interviews suggested a significant baseline disease burden with related secondary impacts, including anxiety regarding disease progression and prognosis. Many who participated had no specific program expectations or self-determined goals but still found the program impactful, particularly on their abilities to adapt and cope with the disease.

Conclusion:

Our study suggests feasibility in a diverse set of patients with varying severity and diagnostic subtypes. We also provide quantitative and qualitative aspects of program impact on patient well-being and highlight the complex interaction between measured physical and self-reported outcomes and disease experience.
Recommendations for Medical Discharge Documentation and Academic Supports for University Students Recovering From Concussion
Authors: Memmini Allyssa K. , Popovich Michael J. , Schuyten Kristen H. , Herring Stanley A. , Scott Katie L. , Clugston James R. , Choe Meeryo C. , Bailey Christopher M. , Brooks M. Alison , Anderson Scott A. , McCrea Michael A. , Kontos Anthony P. , Wallace Jessica S. , Mihalik Johna K. Register , Kasamatsu Tricia M. , McLeod Tamara Valovich , Rawlins Michelle L. Weber , Snedden Traci R. , Kaplan Matthew , Akani Briana , Orr La'Joya C. L. , Hasson Rebecca E. , Rifat Sami F. , Broglio Steven P.
Published: February 2023

Objective:

This study sought to (1) collate the experiences of university students with concussion history and academic stakeholders through interviews and (2) develop concussion management recommendations for institutions of higher learning using a multidisciplinary Delphi procedure.

Setting:

Remote semistructured interviews and online surveys.

Participants:

The first aim of this study included undergraduate university students with concussion history who did not participate in varsity athletics (n = 21; 57.1% female), as well as academic faculty/staff with experience assisting university students with their postconcussion academic needs (n = 7; 71.4% female). The second aim enrolled 22 participants (54.5% female) to serve on the Delphi panel including 9 clinicians, 8 researchers, and 5 academic faculty/staff.

Design:

An exploratory-sequential mixed-methods approach.

Main Measures:

Semistructured interviews were conducted to unveil barriers regarding the return-to-learn (RTL) process after concussion, with emergent themes serving as a general framework for the Delphi procedure. Panelists participated in 3 stages of a modified Delphi process beginning with a series of open-ended questions regarding postconcussion management in higher education. The second stage included anonymous ratings of the recommendations, followed by an opportunity to review and/or modify responses based on the group's consensus.

Results:

The results from the semistructured interviews indicated students felt supported by their instructors; however, academic faculty/staff lacked information on appropriate academic supports and/or pathways to facilitate the RTL process. Of the original 67 statements, 39 achieved consensus (58.2%) upon cessation of the Delphi procedure across 3 main categories: recommendations for discharge documentation (21 statements), guidelines to facilitate a multidisciplinary RTL approach (10 statements), and processes to obtain academic supports for students who require them after concussion (8 statements).

Conclusions:

These findings serve as a basis for future policy in higher education to standardize RTL processes for students who may need academic supports following concussion.