bluuebunny/crossref_metadata_2025 huggingface dataset:
Flouroscopic Versus Conventional Epidural Blood Patch in Obstetrics: A Retrospective Cohort Study
Authors: Orbach-Zinger S. , Lekar Leibzon M. , Gonen O. , Zribi B. , Wazwaz S.A. , Binyamin Y. , Heesen M. , Matatov Y. , Shimon O. , Eidelman L.A.
Published: September 2023

(Acta Anaesthesiol Scand. 2022;66:563–568)

Within obstetric anesthesia, accidental dural puncture is the most prevalent complication, contributing to a postdural puncture headache (PDPH) in 60% to 70% of patients. Currently, epidural blood patch (EBP) is a standard treatment for PDPH, yet questions regarding optimal blood volume, effectivity, and others remain. EBP can be done through conventional EBP (C-EBP) or through fluoroscopy-guided EBP (F-EBP) methods. The aim of this study is to determine headache intensity at hospital discharge, compare blood volumes used in C-EBPs versus F-EBPs, and analyze the outcomes of both treatment methods.
Accuracy and Trending Ability of Finger Plethysmographic Cardiac Output Monitoring in Late Pregnancy
Authors: Bonnin P. , Constans B. , Duhamel A. , Kyheng M. , Ducloy-Bouthors A.S. , Estevez M.G. , Tavernier B. , Gaudet A.
Published: September 2023

(Can J Anesth 2022;69:1340–1348)

Hemodynamic variation is a well-known part of pregnancy, particularly variation in cardiac output (CO). CO reduction in the third trimester is prominent when a patient is in the supine position and the weight of the pregnancy results in compression of the inferior vena cava (IVC). This is often corrected by a simple shift in position to the left lateral decubitus (LLD). Decreases in CO can have severe consequences for mother and child, particularly in circumstances of postpartum hemorrhage. Therefore, accurate and consistent CO monitoring is important to ensuring the best outcomes for delivery.
Stability of Lidocaine Solutions Following Sodium Bicarbonate Alkalinization
Authors: Hyuga S. , Tomoda Y. , Okutomi T.
Published: September 2023

(Reg Anesth Pain Med 2022;47:773–774)

It is known that the effectiveness of local anesthesia can be increased by alkalinization using sodium bicarbonate by increasing the fraction of the drug that is undissociated. There is a research gap, however, in examining the degree of alkalinization in different concentrations of lidocaine, its pharmacological stability, and bacterial contamination. This study aimed to fill that gap by examining changes in the amount of unaltered lidocaine according to pH in different concentrations, and by assessing its stability and the incidence of bacterial contamination during preparation.
Maternal Race and Pre-eclampsia: Cohort Study and Systematic Review With Meta-analysis
Authors: Arechvo A. , Voicu D. , Gil M.M. , Syngelaki A. , Akolekar R. , Nicolaides K.H.
Published: September 2023

(BJOG. 2022;129:2082–2093)

Pre-eclampsia is a complication affecting 2% to 4% of pregnancies and is associated with a high rate of maternal and infant mortality. The risk of developing pre-eclampsia is related to age, weight, race, method of conception, personal and family history, and pre-existing conditions. Studies from predominantly white countries have indicated that some minority groups have an increased incidence of pre-eclampsia, and other minority groups have decreased or similar incidence to white women. These studies, however, have mostly observed relative incidence without correcting for confounding variables in maternal characteristics and medical history. This study aimed to examine associations between race and pre-eclampsia after adjusting for confounding factors of demographics and medical history, and to present a systematic review and meta-analysis of information on this topic.
Associations of Unintended Pregnancy With Maternal and Infant Health Outcomes: A Systematic Review and Meta-analysis
Authors: Nelson H.D. , Darney B.G. , Ahrens K. , Burgess A. , Jungbauer R.M. , Cantor A. , Atchison C. , Eden K.B. , Goueth R. , Fu R.
Published: September 2023

(JAMA. 2022;328:1714–1729)

Unintended pregnancy is a common occurrence in the United States and has been associated with adverse outcomes for both mothers and infants. This systematic review and meta-analysis aimed to understand the relationships between unintended pregnancy and health outcomes during pregnancy and postpartum among current US populations to better inform clinical practice and health policy and improve outcomes.
Fetal Heart Rate Tracings Associated With Eclamptic Seizures
Authors: Ambia A. , Wells C. , Yule C. , McIntire D. , Cunningham F.
Published: September 2023

(Am J Obstet Gynecol. 2022;227:622.e1–622.e6)

Complications of eclamptic seizures include postpartum hemorrhage, placental abruption, stroke, pulmonary edema from heart failure, aspiration pneumonia, preterm delivery, stillbirth, and neonatal death. Though first published in 1974, the relationship between fetal heart rate decelerations and eclampsia has not characterized the timing, duration, and frequency of these changes. This study aimed to describe and characterize fetal heart rate changes following eclampsia and determine obstetric management following seizures.
Intrauterine Cannabis Exposure and Fetal and Maternal Blood Flow: A Case-control Study
Authors: Brik M. , Sandonis M. , Gil J. , Hernandez-Fleury A. , Parramón-Puig G. , Maiz N. , Suy A. , Carreras E.
Published: September 2023

(Acta Obstet Gynecol Scand. 2022;101:1207–1214)

It is known that consuming cannabis during pregnancy increases the risk of complications for both mother and infant, but the mechanisms of this increased risk are unknown. Endogenous cannabinoid systems are associated with cardiovascular regulation, and exogenous cannabis consumption has been shown to have some cardiovascular effects. This study aimed to examine the effects of cannabis consumption during pregnancy on fetal and maternal blood flow and explore the mechanisms of cardiovascular risk.
A Dedicated Antenatal Clinic for Pregnant Women With Morbid and Super-obesity: Patient Characteristics, Outcomes, Perceptions and Lessons Learnt From Establishing the DIAMOND Clinic
Authors: Tyson K. , Teale G. , Vasilevski V. , Cassells K. , Sweet L.
Published: September 2023

(Aust N Z J Obstet Gynaecol 2022;62:635–642)

Body mass index (BMI) has long been used as an indicator of overall health and risk for adverse outcomes in many situations, including pregnancy. Obesity has become more prevalent in recent years, and women with morbid obesity (BMI 40 or above) and super-obesity (BMI 50 or above) have significant risk factors to themselves and their pregnancies. To begin to address these risk factors, the DIAMOND clinic was proposed (DIAbetes, Maternal Obesity, Nutrition and Diet). This paper is a reflection on the early stages of this clinic, patient characteristics and outcomes, and an assessment of patient satisfaction and perception of care. A retrospective audit and patient satisfaction survey were conducted.
Placental Location and Obstetrical-Neonatal Outcomes: A Retrospective Study
Authors: Doctory N. , Romano A. , Navon I. , Barbash-Hazan S. , Bardin R. , Hadar E.
Published: September 2023

(Int J Gynecol Obstet. 2023;160:641–645)

The placenta is vital in pregnancy for nutrient transfer from mother to fetus, and different positions of the placenta can affect pregnancy outcomes. Placental placement can be categorized as anterior, posterior, fundal, or lateral, with anterior placenta being the most common orientation and lateral placenta the least common. Lateral placenta in particular poses some risks because the circulation available to the placenta in this orientation is significantly less; reduced blood flow has been correlated with adverse outcomes such as pre-eclampsia, fetal growth restriction, small for gestational age, and postpartum hemorrhage, among others. This study attempted to understand the association of lateral placental orientation with poor outcomes in pregnancy. The primary outcome for this study was neonatal birth weight, as a continuous measure, and categorized for small for gestational age. Secondary outcomes included maternal and perinatal gestational hypertension, pre-eclampsia, HELLP syndrome, placental abruption, nonreassuring fetal heart rate, oligohydramnios, polyhydramnios, preterm birth, and mode of delivery.
The Impact of Withholding Nitrous Oxide in Labor During the COVID-19 Pandemic on Maternal and Neonatal Outcomes
Authors: Froessler B. , Malek M. , Jila M. , Parange A. , Kelly T.L.
Published: September 2023

(Aust N Z J Obstet Gynaecol. 2022;62:910–914)

During the initial wave of the COVID-19 pandemic, the common option for laboring women in Australia to receive nitrous oxide (N2O) for analgesia was discontinued to prevent viral transmission. While there is insufficient data in the literature to define the second stage of labor as an aerosol-generating behavior and the provision of N2O an aerosol-generating procedure (AGP), the majority of obstetrics and gynecological associations world-wide advised against its use due to the potential for hyperventilation, coughing, vomiting, and other forceful exhalations associated with labor pain. With this interruption, the pandemic provided a “natural experiment” to reconsider the value added by N2O, particularly its effect on the use of other labor analgesia as well as maternal and neonatal outcomes.
Epidural Catheter Replacement Rates With Dural Puncture Epidural Labor Analgesia Compared With Epidural Analgesia Without Dural Puncture: A Retrospective Cohort Study
Authors: Berger A.A. , Jordan J. , Li Y. , Kowalczyk J.J. , Hess P.E.
Published: September 2023

(Int J Obstet Anesth. 2022;52:103590)

Lumbar epidural analgesia (LEA) is a common method of labor analgesia. Traditional LEA, dural-puncture epidural (DPE), and combined spinal-epidural analgesia (CSE) are approaches to epidural catheter placement. Epidural catheters are known to malfunction following placement (12% to 13%), requiring replacement or conversion to general anesthesia (GA) if failure occurs during emergency intrapartum cesarean delivery (CD). Factors contributing to placement failure include body mass index (BMI) or weight, procedure type (CSE vs. LEA), gestational age, anesthesiologist experience, type of epidural catheter, patient age, and mode of delivery. Few studies have compared catheter failure rates between LEA and CSE. This retrospective analysis compares epidural catheter failure rates of DPE or LEA.
Interleukin-1 Receptor Antagonist, Mode of Analgesia and Risk of Cesarean Delivery After Onset of Labor: A Mendelian Randomization Analysis
Authors: Ackland G.L. , Van Duijvenboden S. , Abbott T.E.F. , Gutierrez del Arroyo A. , Wilson M.J. , David A.L. ,   the EPIFEVER-2 Investigators
Published: September 2023

(Br J Anaesth. 2022;128:89–97)

Inflammation during labor can cause a host of complications that can in turn lead to emergency cesarean delivery due to increased risks to both mother and child. The body has natural responses to inflammation, one of which is the release of an anti-inflammatory cytokine, an interleukin-1 receptor antagonist (IL-1ra). The gene that encodes the expression of IL-1ra has 2 upstream alleles that increase mRNA expression and IL-1ra concentration. Previously in similar situations where genes have been identified and associated, Mendelian randomization techniques have been able to show causal relationships between the genes and observable outcomes.
Embracing Paradigmatic Diversity in Nursing
Authors: Deeb Ahmad M. , Vaughan Crystal , Puddester Rebecca , Curnew Deanne
Published: September 2023

Arguably, the quest for a central, unifying paradigm in nursing has distracted from moving disciplinary knowledge forward in an accessible, meaningful manner. In this discursive philosophical article, we uphold that multiparadigmatic research teams and diverse approaches inform effective nursing praxis. We provide an overview of our worldviews (dialectical pluralism, critical realism, humanism, and pragmatism) and their philosophical assumptions and describe how they are commensurate with nursing. We present the Stadium Model in Nursing as a metaphor to illustrate how various worldviews function like different sections of a stadium to offer diverse, yet important vantages of our nursing phenomena of interest.
Promoting Connection in the Faith Community Through Letter Writing
Authors: Long Elizabeth M.
Published: September 2023

Faith community nurses can reduce loneliness and provide connection for homebound members of faith communities through promotion of letter writing. Undergraduate nursing students who were matched with members of their own faith community wrote letters to older adults for 10 weeks as a community service-learning project. Data from the UCLA Loneliness Scale pre- and post-intervention showed reduced loneliness and greater connection among recipients of the letters.
Therapy Dog Presence in an Undergraduate Nursing Program
Authors: Bellflowers Lois A. , Ruttencutter Gwen Scott
Published: September 2023

Research supports the use of animal-assisted interactions and pet therapy in various settings. Undergraduate nursing students experience high levels of stress and anxiety which often continue as they become professional nurses. Entering the workforce equipped with positive coping strategies may help newly licensed nurses to combat stressors. This qualitative descriptive study examined the experiences of undergraduate nursing students with the presence of a therapy dog. Four major themes regarding the role of therapy dogs were identified: as a coping strategy, as a mood moderator, as a positive distraction, and for community building.
Clinical and Hemodynamic Improvement in Pulmonary Hypertension After Switching to Sacubitril/Valsartan in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Brockmöller Janine , Ivanoski Stevan , Hundack Lukas , Blohm Jan-Henrik , Januszewski Monika , Remppis Bjoern Andrew , Burgdorf Christof
Published: September 2023

Patients with heart failure with preserved ejection fraction (HFpEF) and pulmonary hypertension have poor survival, and established medical therapies for both conditions are not available. In this retrospective study of 69 patients with HFpEF and either isolated postcapillary pulmonary hypertension (IpcPH, n = 53) or combined postcapillary and precapillary pulmonary hypertension (CpcPH, n = 16), we investigated the effects of sacubitril/valsartan on pulmonary hypertension measured using right heart catheterization at baseline (ie, presacubitril/valsartan) and 99 (94–123) days after switching to sacubitril/valsartan. After switching to sacubitril/valsartan, right heart catheterization showed significantly lower pulmonary artery pressures (systolic/diastolic/mean) in both patient groups compared with presacubitril/valsartan [IpcPH: 44 (38–52)/15 (12–19)/28 (22–33) mm Hg vs. 47 (40–55)/18 (15–23)/31 (26–35) mm Hg, P < 0.01; CpcPH: 54 (43–57)/18 (12–23)/34 (30–36) mm Hg vs. 61 (50–79)/24 (19–30)/40 (31–53) mm Hg, P < 0.05]. The median sacubitril/valsartan dose at follow-up was 24/26 (24/26–49/51) mg twice daily in both patients with IpcPH and CpcPH. Clinically, the New York Heart Association functional class improved by at least 1 class in 32 of 69 patients (P < 0.01). In conclusion, sacubitril/valsartan therapy improves pulmonary hypertension in patients with HFpEF and either IpcPH or CpcPH. Further prospective randomized trials are needed for confirmation of our results.
Functional involvement of endothelial lipase in hepatitis B virus infection
Authors: Shirasaki Takayoshi , Murai Kazuhisa , Ishida Atsuya , Kuroki Kazuyuki , Kawaguchi Kazunori , Wang Ying , Yamanaka Souma , Yasukawa Rio , Kawasaki Narumi , Li Ying-Yi , Shimakami Tetsuro , Sumiyadorj Ariunaa , Nio Kouki , Sugimoto Saiho , Orita Noriaki , Takayama Hideo , Okada Hikari , Thi Bich Phuong Doan , Iwabuchi Sadahiro , Hashimoto Shinichi , Ide Mayuko , Tabata Noriko , Ito Satoru , Matsushima Kouji , Yanagawa Hiroshi , Yamashita Taro , Kaneko Shuichi , Honda Masao
Published: September 2023

Background:

HBV infection causes chronic liver disease and leads to the development of HCC. To identify host factors that support the HBV life cycle, we previously established the HC1 cell line that maintains HBV infection and identified host genes required for HBV persistence.

Methods:

The present study focused on endothelial lipase (LIPG), which binds to heparan sulfate proteoglycans (HSPGs) in the cell membrane.

Results:

We found HBV infection was impaired in humanized liver chimeric mouse-derived hepatocytes that were transduced with lentivirus expressing short hairpin RNA against LIPG. Long-term suppression of LIPG combined with entecavir further suppressed HBV replication. LIPG was shown to be involved in HBV attachment to the cell surface by using 2 sodium taurocholate cotransporting peptide (NTCP)-expressing cell lines, and the direct interaction of LIPG and HBV large surface protein was revealed. Heparin and heparinase almost completely suppressed the LIPG-induced increase of HBV attachment, indicating that LIPG accelerated HBV attachment to HSPGs followed by HBV entry through NTCP. Surprisingly, the attachment of a fluorescently labeled NTCP-binding preS1 probe to NTCP-expressing cells was not impaired by heparin, suggesting the HSPG-independent attachment of the preS1 probe to NTCP. Interestingly, attachment of the preS1 probe was severely impaired in LIPG knockdown or knockout cells. Inhibitors of the lipase activity of LIPG similarly impaired the attachment of the preS1 probe to NTCP-expressing cells.

Conclusions:

LIPG participates in HBV infection by upregulating HBV attachment to the cell membrane by means of 2 possible mechanisms: increasing HBV attachment to HSPGs or facilitating HSPG-dependent or HSPG-independent HBV attachment to NTCP by its lipase activity.
Sarcoid Granuloma of the Choroid and Ciliary Body in 50 Cases
Authors: Baş Zeynep , Sajjadi Zaynab , Shields Carol L.
Published: September 2023

Precis:

Analysis of 50 patients with sarcoid granuloma of the choroid/ciliary body revealed granulomas with yellow color (41,82%) and irregular vermiform margins (46,92%). Imaging features included clear subretinal fluid (6,12%), dirty subretinal fluid (14,28%), and cystoid macular edema (1,2%).Systemic sarcoidosis was detected during ophthalmic care (4,8%) or diagnosed after presentation (3,6%).

Purpose:

To describe the clinical and imaging features of sarcoid granuloma of the choroid and ciliary body.

Methods:

Retrospective case series of patients with choroid and/or ciliary body sarcoid granuloma managed at the Ocular Oncology Service at Wills Eye Hospital.

Results:

The mean patient age at diagnosis was 51.0 years (54.1, 11.0-83.8 years). The mean logMAR visual acuity at presentation was 0.3 (0.2, 0.0-3.0)[Snellen equivalent 20/40 (20/30, HM-20/20)]. Clinical features included mean basal dimension of 5.2 mm (4.0, 0.3-20.0 mm) and thickness of 1.7 mm (1.8, 0.0-3.6 mm), yellow color (41, 82%), multifocality (18, 36%), and irregular vermiform margins (46, 92%). Related clinical features included inflammation of the anterior chamber (1, 2%), vitreous (5, 10%), and retina (5, 10%). Imaging features by optical coherence tomography of the choroid lesions (n=49) demonstrated clear subretinal fluid (6, 12%), “dirty” subretinal fluid (14, 28%), cystoid macular edema (1, 2%), overlying retinal edema (6, 12%), and localized vitreous cellularity (1, 2%). Management included sub-Tenon’s triamcinolone (11, 22%), intravitreal triamcinolone (3, 6%), systemic corticosteroids (19, 38%), or observation (26, 52%). Systemic sarcoidosis was present prior to ocular diagnosis (13, 26%), detected during ophthalmic care (4, 8%), detected after ocular diagnosis (3, 6%), or not found (30, 60%) over mean follow-up of 13.7 months (6.9, 0.0-138.2).

Conclusions:

Sarcoid granuloma of the choroid and/or ciliary body can manifest without anterior segment or vitreous/retina inflammation in many cases and reveal underlying systemic sarcoidosis in 40% of cases. A distinguishing feature of choroidal sarcoid granuloma was its vermiform margin.
Higher Triad Risk Scores Are Associated With Increased Risk for Trabecular-Rich Bone Stress Injuries in Female Runners
Authors: Roche Megan , Nattiv Aurelia , Sainani Kristin , Barrack Michelle , Kraus Emily , Tenforde Adam , Kussman Andrea , Olson Emily Miller , Kim Brian , Fahy Katherine , Miller Emily , Diamond Elyse , Meraz Sonya , Singh Sonal , Nattiv Aurelia , Fredericson Michael
Published: September 2023

Objective:

Bone stress injuries (BSIs) in trabecular-rich bone are associated with greater biological risk factors compared with cortical-rich bone. We hypothesized that female runners with high Female Athlete Triad (Triad)-related risk would be at greater risk for trabecular-rich BSIs than runners with low Triad-related risk.

Design:

Prospective cohort study.

Setting:

Two NCAA institutions.

Participants:

Female runners were followed prospectively for up to 5 years.

Intervention:

The intervention consisted of team nutrition presentations focused on optimizing energy availability plus individualized nutrition sessions. Triad Cumulative Risk Assessment (CRA) categories were assigned yearly based on low-energy availability, menstrual status, age of menarche, low body mass index, low bone mineral density, and prior BSI.

Main Outcome Measures:

The outcome was the annual incidence of trabecular- and cortical-rich BSI. Generalized Estimating Equations (GEE, to account for the correlated nature of the observations) with a Poisson distribution and log link were used for statistical modeling.

Results:

Cortical-rich BSI rates were higher than trabecular-rich BSI rates (0.32 vs 0.13 events per person-year). Female runners with high Triad-related risk had a significantly higher incidence rate ratio of trabecular-rich BSI (RR: 4.40, P = 0.025) and cortical-rich BSI (RR: 2.87, P = 0.025) than women with low Triad-related risk. Each 1-point increase in Triad CRA score was associated with a significant 26% increased risk of trabecular-rich BSI (P = 0.0007) and a nonsignificant 14% increased risk of cortical-rich BSI (P = 0.054).

Conclusions:

Increased Triad CRA scores were strongly associated with increased risk for trabecular-rich BSI. Incorporating Triad CRA scores in clinical care could guide BSI prevention.
Neuropsychiatric adverse effects from CFTR modulators deserve a serious research effort
Authors: VanElzakker Michael B. , Tillman Emma M. , Yonker Lael M. , Ratai Eva-Maria , Georgiopoulos Anna M.
Published: September 2023

Purpose of review

This review highlights the problem of neuropsychiatric adverse effects (AEs) associated with elexacaftor/tezacaftor/ivacaftor (ETI), current suboptimal mitigation approaches, a novel testable mechanistic hypothesis, and potential solutions requiring further research.

Recent findings

Studies show that a minority of persons with cystic fibrosis (PwCF) initiating cystic fibrosis transmembrane conductance regulator (CFTR) modulators experience neuropsychiatric AEs including worsening mood, cognition, anxiety, sleep, and suicidality. The GABA-A receptor is a ligand-gated chloride channel, and magnetic resonance spectroscopy neuroimaging studies have shown that reduced GABA expression in rostral anterior cingulate cortex is associated with anxiety and depression. Recent research details the impact of peripheral inflammation and the gut-brain axis on central neuroinflammation. Plasma ETI concentrations and sweat chloride have been evaluated in small studies of neuropsychiatric AEs but not validated to guide dose titration or correlated with pharmacogenomic variants or safety/efficacy.

Although ETI is well tolerated by most PwCF, some experience debilitating neuropsychiatric AEs. In some cases, these AEs may be driven by modulation of CFTR and chloride transport within the brain. Understanding biological mechanisms is a critical next step in identifying which PwCF are likely to experience AEs, and in developing evidence-based strategies to mitigate them, while retaining modulator efficacy.
Budget impact analysis of temocillin insurance coverage for urinary tract infections caused by ESBL-producing pathogens in Iran
Authors: Seyedifar Meysam , Sabouri Menhajuddin , Soodi Omid , Ghasemi Hananeh
Published: September 2023

Background:

One of the most prevalent infections with a significant disease burden is urinary tract infections (UTIs), which occurs in approximately 50% of women at least once in their lifetime. Antimicrobial resistance to pathogens causing UTIs is expanding worldwide and has been associated with increased use of broad-spectrum antibiotics, including carbapenems, leading to significant costs for insurance and healthcare systems. The emergence of resistance to carbapenems has led to an increasing need for and interest in carbapenem-sparing strategies, including the use of narrow-spectrum antibiotics, such as temocillin. Temocillin has a strong bactericidal effect, along with high tolerability and a good safety profile. It is also stable toward most extended-spectrum beta-lactamases (ESBL). The purpose of our study was to design a budget impact analysis (BIA) model and estimate the budget impact of temocillin insurance coverage for the treatment of UTIs caused by ESBL-producing bacteria from the perspective of the payer.

Methods:

The BIA model with insurance payer perspective was used to estimate the impact of temocillin insurance coverage on the treatment of UTIs caused by ESBL-producing bacteria over a 1-year time horizon in Iran. Direct medicine costs, hospitalization and paraclinical costs, and side effect costs were considered in this model. To assess the impact of uncertainty on the model inputs, 1-way sensitivity analyses were performed.

Results:

The model demonstrates that inclusion of temocillin in insurance coverage, decreasing treatment costs from $36 million to $34 million, will result in overall savings of > $1.9 million and lead to > $9 million savings in insurance costs for antimicrobial resistance.

Conclusion:

The inclusion of temocillin in the insurance coverage in Iran for patients developing UTIs caused by ESBL-producing bacteria would be cost-saving for insurance and decrease the risk associated with emerging antimicrobial resistance.
The application of rapid response team in category 1 emergency caesarean section teaching for OBGYN residents in the delivery room
Authors: Xu Xia , Lin Ying , Weng Ling , Guo Yanni , Lin Lin , Yan Jianying
Published: September 2023

Category 1 cesarean section (CS) can be a life-saving procedure when there is immediate threat to the life of the woman or fetus. However, category 1 CS is a challenge for obstetrics and gynecology residents, and it is necessary to establish an effective and straightforward teaching strategy. This study aimed to evaluate the efficiency of rapid response team (RRT) on category 1 CS teaching for obstetrics and gynecology residents in the delivery room. A total of 142 residents who underwent standardized residency training programs in the delivery room were divided into a RRT teaching group and a traditional response (TR) teaching group. In the RRT teaching group, Category 1 emergency CS teaching was started and explored by rapid response team. The training included both theoretical and practical components. After the training, decision-to-delivery interval (DDI), neonatal Apgar score, operation time and rate of postpartum hemorrhage were compared. A questionnaire on the subjective assessment of various aspects of the program was conducted at the end of the training period. The DDI in minutes in the RRT teaching group (n = 72) was significantly shorter than that of the TR teaching group (n = 70) (11.83 ± 4.16 vs 13.56 ± 5.47, P = .0364). The score of satisfaction from residents in the RRT teaching group was significantly higher than that of the TR group [7 (6, 9) vs 9 (7, 10), P = .0154]. Compared with the TR teaching group, more residents thought their clinical skills have been improved (94.29% vs 100%, P = .0396) and willing to recommend their training method to others (91.43% vs 100%, P = .0399) in the RRT teaching group. However, no significant differences were observed in the incidence of postpartum hemorrhage between the 2 groups. RRT teaching is beneficial in the standardized training and teaching of residents in the delivery room. It improves the DDI of category 1 emergency cesarean section and the degree of satisfaction.
Efficacy of preoperative Shugan Sanjie decoction combined with mammotome-assisted minimally invasive surgery in the treatment of idiopathic granulomatous mastitis: A retrospective cohort study
Authors: Shen Qian , Liu Lin-ling , Cen Meng-Yan , Mao Juan-Juan
Published: September 2023

The management of idiopathic granulomatous mastitis (IGM) poses a significant challenge because of its ambiguous etiology. This study aimed to investigate the efficacy of traditional Chinese medicine (TCM) combined with mammotome-assisted minimally invasive surgery (MAMIS) for the treatment of IGM. This retrospective cohort study included patients with IGM who underwent treatment at our hospital between January 2017 and June 2022. Patients treated with Shugan Sanjie decoction alone and preoperative Shugan Sanjie decoction combined with MAMIS were included in Groups A and B, respectively. We focused on the demographics, clinical characteristics, and outcomes of the patients in the 2 groups. A total of 124 female patients with an average age of 33.9 ± 3.6 years were included in the study. The demographic and clinical characteristics of patients in Groups A (n = 55) and B (n = 69) were similar (P > .05). However, there were significant differences between the 2 groups in terms of treatment duration, 1-year complete remission (CR), and recurrence. Group B showed shorter treatment time (11.7 ± 5.1 vs 15.3 ± 6.4 months, P = .001), higher 1-year CR (72.5% vs 45.5%, P = .002), and lower recurrence (7.2% vs 21.8%, P = .019) in comparison to Group A. Shugan Sanjie decoction promoted the shrinkage of breast lesions in patients with IGM. Combined with MAMIS, this treatment regimen shortened the treatment duration, accelerated the recovery process, and reduced the recurrence rate.
Verification of the relationship between the sequential organ failure assessment score and the length of intensive care unit and hospital stay in terms of medical resources input
Authors: Kawasaki Hirofumi , Fudamoto Kazue , Yamamoto Mutsumi , Iwaanakuchi Takashi , Yoshida Takuma , Hashiguchi Teruto , Uto Yumiko
Published: September 2023

This study aimed to clarify the relationship between the sequential organ failure assessment (SOFA) score and the length of intensive care unit (ICU) and hospital stays and verify whether the SOFA score can indicate the optimal length of ICU stay. Medical resource input was evaluated as the medical treatment score, converted by volume, within 2 days after ICU admission. After classifying emergency patients into surgical and nonsurgical categories, the relationship between medical resources, SOFA score, and ICU and hospital stay lengths was analyzed. Medical resource input was high when the SOFA score was high after ICU admission. A positive correlation was confirmed between the SOFA score and length of ICU stay in surgical and nonsurgical patients. Nonsurgical patients are more likely to be discharged within the diagnosis procedure combination hospital stages I and II if medical resources are high in the initial stages of ICU admission. The SOFA score affects medical resource input and the length of ICU stay. The early input of medical resources after ICU admission reduces the length of hospital stay in the diagnosis procedure combination, suggesting that the SOFA score is a valuable indicator of the optimal length of ICU stay.
Does mid-luteal progesterone predict pregnancy in intrauterine insemination cycles following sequential clomiphene citrate and gonadotropin treatment?
Authors: Çinar Mehmet , Tokmak Aytekin , Kuru Pekcan Meryem , Sarsu Mustafa , Üstün Yaprak , Özakşit Gülnur
Published: September 2023

This study aimed to determine whether serum mid-luteal progesterone (MLP) levels measured in the current treatment cycles of infertile women undergoing controlled ovarian hyperstimulation and intrauterine insemination following the sequential use of clomiphene citrate and gonadotropin may predict pregnancy. A total of 107 consecutive anovulatory women were included in this prospective cohort study. Patients with other causes of infertility were also excluded from the study. None of the patients received progesterone treatment for luteal phase support. The data recorded for each woman included age, body mass index, infertility type and duration, basal hormone levels, and previous and current cycle characteristics with MLP levels. Ovulation was confirmed using MLP and sonographic evaluation in all patients. An MLP level of > 3 ng/mL was regarded as a sign of ovulation. After treatment, the patients were divided into 2 groups according to the presence or absence of pregnancy, and the obtained data were compared between the groups. There were no significant differences in age, body mass index, or basal hormone levels between the 2 groups (all P > .05). However, the duration of infertility was significantly shorter in the pregnancy group (P = .003). The anovulation rate in this cohort was 18.7% (n = 20). A total of 15 (14%) were examined. MLP levels were 25.1 ± 13.8 ng/mL and 18.3 ± 14.5 ng/mL in the pregnant and nonpregnant groups, respectively (P:.089). Based on the receiver operating characteristic curve analysis, it was determined that there was no predictive value of the mid-luteal phase progesterone level for pregnancy in patients in whom ovulation was detected. Mid-luteal serum progesterone levels did not predict pregnancy in infertile women who underwent controlled ovarian hyperstimulation with sequential clomiphene citrate plus gonadotropin treatment and intrauterine insemination.
Accurate diagnosis of pulmonary inflammatory myofibroblastic tumor by imaging technology before operation: A case report
Authors: Sun Lv , Zhu Yuhang , Chen Cheng , Huang Jiajia , Li Bangguo
Published: September 2023

Rationale:

Pulmonary inflammatory myofibroblastic tumor (IMT) is a rare borderline tumor, which has the potential of malignant including invasion of surrounding tissues, distant metastasis and recurrence. However, the preoperative diagnosis is difficult and it can also be difficult to distinguish from malignancy in small tissue samples. Preoperative accurate diagnosis has important clinical significance for patients to choose treatment measures and improve the quality of rehabilitation. We was examined by computed tomography (CT) plain scan plus enhanced scan, magnetic resonance diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) imaging technology in an adult female, compared with lung cancer and pulmonary cryptococcus infection for diagnosis of pulmonary IMT.

Patient concerns:

A 32-year-old female patient was admitted to the hospital “physical examination revealed nodules in the right upper lung for 1 week”.

Diagnoses:

The patient was diagnosed with Pulmonary inflammatory myofibroblastic tumor.

Interventions:

Single-port thoracoscopic lobectomy was performed after multidisciplinary consultation.

Outcomes:

DWI and ADC improves the accuracy of preoperative diagnosis and well guides the formulation of treatment measures. The combined CT, DWI, and ADC magnetic resonance imaging technology has more important significance in the diagnosis and differential diagnosis of IMT and lung malignant tumors.

Lessons:

Although accurate preoperative diagnosis of pulmonary IMT is difficult. Chest CT examination combined with DWI and ADC imaging technology has high clinical significance for the diagnosis of IMT.
Bevacizumab-induced arrhythmia in a patient with lung adenocarcinoma: A case report
Authors: Li Jing , Zhang Furong , Lu Yuanyuan
Published: September 2023

Rationale:

Cardiotoxicity is an important side effect of vascular endothelial growth factor inhibitors therapy in the treatment of cancer. Massive studies have shown bevacizumab-related hypertension, venous, and arterial thrombosis.

Patient concerns:

A 56-year-old female patient was treated with bevacizumab monotherapy for lung adenocarcinoma. The patient was detected a poor R-wave increase with slight ST segment elevation in V1–V3 leads, and ventricular arrhythmia.

Diagnosis:

The incidental arrhythmia caused by bevacizumab was considered.

Interventions:

The patients received aspirin and amiodarone (0.2 g tid) to treat arrhythmia. After consultation with the cardiology department, the patient received a diagnostic coronary angiography. Coronary angiography showed 30% of the right coronary artery stenoses and no obvious organic stenosis in the left main artery, left anterior ascending, or left circumflex.

Outcomes:

The patient exhibited disappearance of chest tightness and rapid heartbeat after the treatment of amiodarone. Electrocardiogram monitoring results returning to normal.

Lessons:

This is the first reported case of bevacizumab-associated arrhythmia. It is advisable to consider the risk of arrhythmia in bevacizumab monotherapy or combines treatment.
Efficacy and safety of transarterial chemoembolization plus lenvatinib in the treatment of advanced hepatocellular carcinoma: A meta-analysis
Authors: Li Dailong , Liu Siqi , Cheng Chunlai , Xu Lu , Zhao Pingfan
Published: September 2023

Background:

The benefits of transarterial chemoembolization (TACE) plus lenvatinib in advanced hepatocellular carcinoma (HCC) remain controversial. Therefore, we performed a meta-analysis to evaluate the efficacy and safety of TACE plus lenvatinib in the treatment of advanced HCC.

Methods:

Up to February 26, 2023, the databases of PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, China National Knowledge Infrastructure, and Wanfang were searched, and clinical studies of TACE plus lenvatinib (experimental group) versus TACE or lenvatinib (control group) in the treatment of advanced HCC were included. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included literature. Revman5.4 software was used for meta-analysis.

Results:

A total of 1855 patients were included in 18 studies. The results of the meta-analysis showed that TACE plus lenvatinib could increase the objective response rate (ORR) (odds ratio [OR] = 3.25, 95% confidence interval [CI]: 2.46–4.31; OR = 3.55, 95%CI: 2.53–4.97) and disease control rate (DCR) (OR = 3.27, 95%CI: 2.44–4.38; OR = 3.45, 95%CI: 2.28–5.24), 12-month (OR = 3.43, 95%CI: 2.08–5.65; OR = 2.78, 95%CI: 1.90–4.05) and 18-month (OR = 2.97, 95%CI: 1.77–5.00; OR = 2.62, 95%CI: 1.54–4.47) progression-free survival (PFS) rate, 12-month (OR = 2.34, 95%CI: 1.53–3.58; OR = 3.64, 95%CI: 2.65–5.01) and 18-month (OR = 2.27, 95%CI: 1.48–3.48; OR = 3.23, 95%CI: 2.33–4.48) overall survival (OS) rate compared with TACE or lenvatinib alone. In addition, the experimental group could significantly reduce the expression levels of serum alpha-fetoprotein (AFP) (standard mean difference [SMD] = 1.22, 95%CI: 0.67–1.78) and vascular endothelial growth factor (VEGF) (SMD = 1.27, 95%CI: 0.87–1.67). In terms of adverse events of drugs, the incidence of grade ≥ 3 hypertension and elevated aspartate aminotransferase and alanine aminotransferase in the experimental group was higher than that in the control group (P < .05).

Conclusion:

Compared with TACE or lenvatinib alone, TACE plus lenvatinib has achieved remarkable efficacy in patients with advanced HCC, and the efficacy versus risk need to be carefully balanced in clinical application.
Diagnostic accuracy of MUC7 expression for bladder cancer: A systematic review and meta-analysis
Authors: Zhang Jiwang , Li Zhou
Published: September 2023

Background:

There have been many studies on MUC7 and bladder cancer (BC) that have been published; however, all sample sizes were not enough which led to their conclusions being based on small samples. Therefore, this meta-analysis aims to systematically analyze the diagnostic value of MUC7 for bladder cancer and provide a scientific basis for the diagnosis of bladder cancer.

Methods:

To obtain relevant literature on MUC7 diagnosed bladder cancer, databases such as PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang data, Chongqing VIP, and Chinese Biomedical Literature Database were searched from the establishment of the database to July 11, 2023. According to established inclusion and exclusion criteria, literature was screened and data were extracted. The Quality Assessment of Diagnostic Accuracy Studies 2 was used to evaluate the risk of bias and applicability of included literature. Meta-disc1.4 and Stata12.0 software were used for Meta-analysis.

Results:

Twelve studies were included, including728 BC patients and 458 non-BC controls. The pooled sensitivity and pooled specificity were 0.74 (95% confidence interval [CI]: 0.71–0.77) and 0.92 (95% CI: 0.90–0.95), respectively. The pooled negative likelihood ratio was 0.27 (95% CI: 0.20–0.36), and the pooled positive likelihood ratio was 9.58 (95% CI: 5.40–17.00). The diagnostic odds ratio was 40.95 (95% CI: 20.31–82.59), and the area under the curve was 0.91 in the overall summary of the receiver operating characteristic curve.

Conclusion:

MUC7 might be a potential biomarker for diagnosing BC. However, more large sample and multicenter studies are needed to prove whether it can be used in clinical diagnosis.
The efficacy of transcutaneous electronic acupoint stimulation for improving postoperative recovery after gynecologic surgery: A systematic review and meta-analysis
Authors: Ge Yueping , Zheng Jianhong
Published: September 2023

Background:

This systematic review and meta-analysis aimed to evaluate the efficacy of transcutaneous electronic acupoint stimulation (TEAS) for improving postoperative recovery after gynecologic surgery.

Methods:

We performed a thorough search of 6 databases until March 2023, identifying 12 randomized controlled trials that met our predefined inclusion criteria and encompassed a total of 1510 patients. For continuous outcomes, we calculated the weighted mean difference (WMD), and for binomial outcomes, we used the risk ratio (RR). We evaluated heterogeneity among the included studies using Cochran I
2 and Q statistics, utilizing a random-effects model when the I
2 value exceeded 50%. To assess publication bias, we employed Egger test.

Results:

Our analysis found that TEAS significantly reduced the risk of postoperative nausea (RR: 0.60, 95% CI: 0.43–0.83, P = .002) and postoperative vomiting (RR: 0.54, 95% CI: 0.43–0.67, P < .001), visual analogue scale (WMD: −0.47, 95% CI: −0.76 to −0.17, P = .002), as well as shortened the time to first bowel movement (WMD: −18.43, 95% CI: −20.87 to −15.99, P < .001) and time to first flatus (WMD: −8.98, 95% CI: −12.46 to −5.51, P < .001) compared to the conventional group.

Conclusions:

Our findings suggested that TEAS may improve postoperative recovery following gynecologic surgery. However, to confirm these results, larger randomized controlled trials encompassing a more diverse range of patient populations are urgently required.
Uncovering anti-influenza mechanism of Ophiocordyceps sinensis using network pharmacology, molecular pharmacology, and metabolomics
Authors: Zhou Jinna , Wang Mu , Sun Tao , Zhou Xiaorong , Wang Jinhu , Wang Yao , Zhang Ran , Luo Run , Yu Hong
Published: September 2023

Ophiocordyceps sinensis is a precious Chinese traditional herb with a long medicinal history. This study used UPLC-MS metabolomics to explore and compare the metabolic profiles of the stroma (OSBSz), sclerotium (OSBSh), and mycelium (OSBS) of O sinensis to analyze their differential metabolites and identified potential active components. Then combined with network pharmacology and molecular docking to explore the mechanism of differential metabolites with anti-influenza properties. The results indicate that the stroma, sclerotium, and mycelium showed significant differences in metabolites. The key pathways for differential metabolites were butanoate metabolism, thiamin metabolism, alanine, aspartate and glutamate metabolism, citrate cycle, and arginine biosynthesis. Protein-protein interaction analysis identified potential targets, including SRC, RHOA, HSP90AA1, VEGFA, ITGB1, PRKCA, and ITGA1, and the key protective pathways in-volved PI3K-Akt, HIF-1, influenza A, and Coronavirus disease 2019. The molecular docking results showed that the core metabolite D-(−)-glutamine has high binding affinity with SRC, RHOA, and EGFR, re-flecting the multi-component and multi-target network system of O sinensis. In short, the combination of metabonomics, network pharmacology and macromolecular docking technology provides a new way to explore the anti-influenza research of O sinensis. This is undoubtedly an important theoretical support for the clinical application of O sinensis in the future.
Analysis of the comprehensive needs of primary caregivers of hospitalized colorectal cancer patients and characteristics analysis of high comprehensive needs population
Authors: Lin Lu , Xie Congyan , Chen Jing , Wang Fen , Dong Bei , Tian Li
Published: September 2023

To identify the care needs of primary caregivers of colorectal cancer (CRC) patients and specify the characteristics of high-needs caregivers. A cross-sectional survey was conducted on the primary caregivers of CRC patients using the Comprehensive Needs Assessment Tool in Cancer Caregivers. The care needs and the characteristics of caregivers with high needs were identified using the Chi-square test and Logistic regression. The results of the survey of 364 primary caregivers of CRC patients showed that the top 2 dimensions of caregiver needs were the healthcare staff and the information dimension. The characteristics of caregivers with high demand for healthcare staff included on-the-job, a family per capita monthly income of <4000 yuan, and the CRC patients they took care of paid medical expenses through self-pay/public expense/rural insurance. The characteristics of caregivers with high information needs included living in the city, on-the-job, a family per capita monthly income of <4000 yuan, and the CRC patients they took care of paid medical expenses through self-pay/public expense/rural insurance. In clinical settings, the information needs of primary caregivers of CRC patients should be given due attention. Particular attention should be paid to the primary caregivers of CRC patients who live in cities, are on-the-job, have a per capita monthly income of <4000 yuan, and pay medical expenses through self-pay/public/rural insurance.