bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation-Based Training in Obstetric Anesthesia: An Update
Authors: MacLennan K. , Minehart R.D. , Vasco M. , Eley V.A.
Published: February 2024

(Int J Obstet Anesth. 2023:54:103643)

Anesthesiologists play a very important role in the care of pregnant patients. Simulation training is a tool that has been integrated into anesthesiology training to teach hands-on skills and teamwork to both incoming and experienced clinicians. The criteria for properly equipped simulations include clearly stated procedures and expectations, a curriculum whose goal is to meet said expectations, clearly stated simulation modalities, proper instructors, and proper feedback protocols. This study aimed to analyze the use of simulations for obstetric anesthesia.
Crisis Pregnancy Centers
Authors: Villarreal S.
Published: February 2024

(Obstet Gynecol. 2023;141(4):674–675)

Crisis pregnancy centers are distinct and different from pregnancy resource centers and women’s clinics. This article gives perspective to define the differences and encourages the offering of resources to vulnerable individuals, as well as advocating voting against funding allocations that support their dangerous practices.
Periodontal Health and Pregnancy Outcomes: Time to Deliver
Authors: Bostanci N.
Published: February 2024

(Acta Obstet Gynecol Scand. 2023;102:648–651)

One often overlooked area of health care is oral care. Oral diseases and conditions are often neglected but are incredibly common, and pregnancy-associated hormonal changes can affect periodontal health. This editorial gives a big-picture view of recent literature relating to periodontal health in pregnancy and the associations with significant pregnancy outcomes.
Tranexamic Acid-Associated Intrathecal Toxicity During Spinal Anaesthesia
Authors: Patel Santosh
Published: February 2024

(Eur J Anaesthesiol. 2023; 40:334–342)

Although most drug administration errors in the operating room setting are intravenous, cases of inappropriate neuraxial medication administration have been recorded and can be particularly catastrophic. The use of tranexamic acid (TXA) during surgery is increasing for certain surgical procedures where it has been shown to be effective at reducing blood loss and the need for transfusion. It is therefore often readily available in operating rooms during cesarean section and orthopedic procedures where neuraxial blocks are frequently utilized. This study aimed to assess the effects of neuraxial TXA administration based on published cases.
Preventing Neuraxial Administration of Tranexamic Acid
Authors: Orser B.A. , Hyland S. , Byrick R.
Published: February 2024

(Can J Anesth/J Can Anesth. (2023) 70:811–816)

This editorial refers to a recent case published by Dr Pysyk and Dr Filteau describing an inadvertent administration of tranexamic acid into the epidural space. The authors of the editorial discuss this case involving a medication error and propose mechanisms to prevent similar errors in the future. While the error was recognized and managed without immediate adverse effects, the potential for catastrophic consequences was highlighted.
Effects of Cumulative Duration of Repeated Anesthesia Exposure on Fetal Brain Development in the Ovine Model
Authors: Bleeser T. , Basurto D. , Russo F. , Vergote S. , Valenzuela I. , Van den Broucke S. , Kunpalin Y. , Joyeux L. , Van der Veeken L. , Vally J.C. , Emam D. , van der Merwe J. , Van de Velde M. , Devroe S. , Deprest J. , Rex S.
Published: February 2024

(J Clin Anesth. 2023;85:111050)

This study examines the impact of repeated and prolonged exposure to sevoflurane anesthesia on fetal neurodevelopment in pregnant sheep. The rationale behind this research lies in the concern over the possible negative effects of long or repeated exposure to anesthesia during pregnancy on fetal brain development, particularly based on findings in animal studies. The experiment involves exposing pregnant sheep to different anesthesia regimens and conducting neurobehavioral assessments of their offspring. It aims to determine whether repeated exposure results in neurodevelopmental impairments. The study follows ethical guidelines designed to align with principles promoting humane animal research.
Fetal Heart Rate Responses to Maternal Sleep-Disordered Breathing
Authors: DiPietro J.A. , Bai J. , Sgambati F.P. , Henderson J.L. , Watson H. , Raghunathan R.S. , Pien G.W.
Published: February 2024

(Am J Obstet Gynecol. 2023;228(4):459.e1–459.e8)

The physical changes inherent in pregnancy can amplify underlying comorbidities. One common problem worsened in pregnancy is sleep-disordered breathing. Sleep-disordered breathing has been investigated in relation to pregnancy and found to have a host of negative outcomes associated with it, including gestational diabetes, preeclampsia, preterm delivery, and stillbirth. Risk factors for sleep-disordered breathing often overlap with risk factors for other pregnancy complications, and thus relationships can be difficult to characterize. One area needing investigation is the effect of sleep-disordered breathing on fetal heart rate (FHR), which is an indicator of wellbeing during pregnancy. This study was designed to examine the FHR response to sleep-disordered breathing in pregnant women with obesity. The authors hypothesized that apnea or hypopnea would elicit a detectable response in FHR that would be potentiated in women with more severe symptoms.
The Effectiveness of Continuous Positive Airway Pressure for Treating Obstructive Sleep Apnoea in Pregnancy: A Systematic Review
Authors: Nugent R. , Wee A. , Kearney L. , de Costa C.
Published: February 2024

(Aust N Z J Obstet Gynaecol 2023. 2023;63(3):290–300)

Obstructive sleep apnea (OSA) is characterized by recurrent pauses in breathing during sleep due to upper airway collapse, resulting in decreased oxygen levels. OSA affects around 10.5% of parturients during early pregnancy and up to 30% at term. In pregnancy, OSA is associated with an increased risk for gestational hypertension, pre-eclampsia, and gestational diabetes. Infants born to mothers with OSA may have a lower birth weight and are at increased risk for premature delivery and neonatal intensive care unit admission. Baseline obesity increases the risk of OSA during pregnancy, with lifestyle modifications being the standard treatment, though their influence on maternal outcomes is limited. Continuous positive airway pressure (CPAP) is an effective OSA treatment; however, little research exists on the impact of CPAP on either maternal or fetal outcomes. This systematic review sought to investigate if the use of CPAP improved outcomes for pregnant women with or at risk of OSA.
Current Perspectives on Maternal Critical Care
Authors: Cranfield K. , Horner D. , Vasco M. , Victory G. , Lucas D.N.
Published: February 2024

(Anaesthesia. 2023;78(6):758–769)

Progress made in reducing maternal mortality rates is plateauing. Projections indicate that maternal mortality rates will reach nearly twice the sustainable development goal of the World Health Organization by 2030. While the reasons for the lack of progress are complex and include factors such as changing maternal demographics and socioeconomic disparities, addressing maternal morbidity is a necessary component of achieving a continuous decrease in maternal mortality. Maternal critical care is an emerging area in obstetrics that will play a crucial role in improving outcomes in maternal morbidity. The recommendations are based on a study in the United Kingdom. However, these principles are likely to be broadly applicable.
Iron Deficiency in Pregnancy and Postpartum: It is Time for a Change
Authors: Auerbach M. , Munro M.G.
Published: February 2024

(Obstet Gynecol. 2023;141(6):1046–1048)

Iron deficiency is the most common micronutrient deficiency in the world and affects more than half of pregnancies. Ferrous sulfate is an effective treatment for subsidizing iron intake and is readily available in many formulations. This article is an editorial examining accumulated evidence about iron deficiency during pregnancy and the efficacy of treatments.
Childhood Outcomes After Induction of Labor or Expectant Management for Preterm Prelabor Rupture of Membranes: A 10-Year Follow-up of the PPROMEXIL Trials
Authors: Simons N.E. , de Ruigh A.A. , van’t Hooft J. , Aarnoudse-Moens C.S.H. , van Wely M. , van der Ham D.P. , van Teeffelen A.S.P. , Roseboom T.J. , Mol B.W. , Leemhuis A.G. , Pajkrt E.
Published: February 2024

(Am J Obstet Gynecol. 2023;228:588.e1–588.e13)

Managing late preterm prelabor rupture of membranes (PPROM) between 34+0 and 36+6 weeks’ gestation helps balance the advantages of extending the pregnancy with the risk of intra-amniotic infection. Two Dutch PPROM Expectant Management Versus Induction of Labor (PPROMEXIL) trials were conducted between 2007 and 2011. These randomized controlled studies analyzed induction of labor (IOL) compared to expectant management (EM) in pregnant women with late PPROM. While neonatal sepsis risks were similar between both groups, children at 2 years of age did show slightly higher neurodevelopmental delays with EM compared to IOL. Long-term data on child development beyond age 2 in children born after late PPROM are lacking. The aim of this PPROMEXIL follow-up study was to evaluate the effects of IOL versus EM on child outcomes.
American College of Cardiology and American Heart Association Blood Pressure Categories: A Systematic Review of the Relationship With Adverse Pregnancy Outcomes in the First Half of Pregnancy
Authors: Slade L.J. , Mistry H.D. , Bone J.N. , Wilson M. , Blackman M. , Syeda N. , von Dadelszen P. , Magee L.
Published: February 2024

(Am J Obstet Gynecol. 2023;228(4):418–429.e34)

Many risk factors contribute to adverse outcomes in pregnancy related to elevated blood pressure. High blood pressure or hypertension, has also been shown to be connected to poor outcomes outside of pregnancy, and clinical guidelines have recently changed to reflect stage 1 and stage 2 hypertension rather than a global definition of hypertension. Guidelines for defining hypertension in pregnancy, however, have not changed with general practice guidelines. There is substantial evidence linking hypertension with pregnancy complications such as pre-eclampsia and eclampsia, but there has been no movement to adjust guidelines for hypertension diagnosis or treatment in pregnancy. This systematic review aimed to evaluate whether there is evidence to support the changing of practice guidelines and the definition of hypertension in pregnancy to the American College of Cardiology (ACC) and American Heart Association (AHA) recommendations to help identify individuals at risk of developing pre-eclampsia or other pregnancy complications.
Prolonged Labor and Adverse Cardiac Outcomes in Pregnant Patients With Congenital Heart Disease
Authors: McCoy J.A. , Kim Y.Y. , Nyman A. , Levine L.D.
Published: February 2024

(Am J Obstet Gynecol. 2023;228(6):728.e1–728.e8)

Congenital heart disease (CHD) is one of the most common types of birth defects and affects 8 to 9 per 1000 births. Many patients who have it are diagnosed in infancy, but some are not diagnosed until later in life. The number of patients with CHD who reach childbearing years has increased substantially. Pregnancy can pose difficult challenges, especially in labor and delivery. The physiologic changes that occur during delivery, including increased cardiac demand, rapid changes in intravascular volume, and blood loss, result in significant risk for patients with CHD. The European Registry of Pregnancy and Cardiac disease and the Cardiac Disease in Pregnancy 2 studies have demonstrated that the immediate postpartum period is the highest risk time for heart failure.
Impact of Cesarean Versus Vaginal Delivery on the Risk of Postpartum Acute Kidney Injury: A Retrospective Database-Controlled Study in 116,876 Parturients
Authors: Potnuru P.P. , Ganduglia C. , Schaefer C.M. , Suresh M. , Eltzschig H.K. , Jiang Y.
Published: February 2024

(J Clin Anesth. 2022;82:110915)

Cesarean deliveries are the most common major abdominal surgeries performed in the United States, at a rate of 31.8% of all deliveries. While rates of cesarean deliveries are rising on a global level, maternal or neonatal mortality or morbidity are not decreasing. As such, experts all over the world have pushed to decrease cesarean delivery rates.
Persistent Opioid Use After Cesarean Delivery in the United States of America: A Systematic Review
Authors: Landau R. , Cavanaugh P.F. , DiGiorgi M.
Published: February 2024

(Int J Obstet Anesth. 2023:54:103644)

A total of 31.9% of births in the United States occur through cesarean delivery (CD), while a total of 18.6% of births worldwide occur through CD. Following CD, opioids are commonly prescribed for pain management, and just 5 days of opioid use can develop into a chronic use condition. It is unclear how many postpartum opioid prescriptions lead to opioid addiction. This review aimed to analyze and assess previous studies related to long-term opioid use following CD.
Opioid Analgesia for Breastfeeding Mothers
Authors: Bateman D.N. , Hale T.W.
Published: February 2024

(BMJ. 2023;380:p514)

Both pain management for mothers following delivery and breastfeeding are things that health care professionals often encourage. Historically, codeine was a common opioid prescribed for postpartum pain. This decreased significantly after an infant death was seemingly caused by maternal codeine-paracetamol use while breastfeeding. While that case was debunked, there is again rising concern about how the use of opioids by mothers following delivery affects breastfeeding infants.
Global and Regional Burden and Trend of Neoplasms Attributable to Alcohol Consumption in the Past 3 Decades
Authors: Song Hui-Wen , Ge Jin-Hua , Xie Bi-Xia , Jiang Mei-Ting , Pan Jin-Shui
Published: February 2024

Objectives

To provide valuable insights for targeted cancer screening among high-risk patients, we analyzed the global and regional burden of neoplasms resulting from alcohol consumption between 1990 and 2019.

Methods

The information used in this study was collected from the Global Burden of Disease 2019 dataset. Initially, the database was used to extract details of mortality rates, disability-adjusted life years (DALYs), and the number of individuals affected by alcohol-related neoplasms (ARNs). Subsequently, the data were compared by cancer type, sex, age, region, and sociodemographic index. Furthermore, the study involved the calculation and comparison of estimated annual percentage changes in age-standardized DALYs rates (ASDRs) and mortality rates.

Results

The impact of alcohol on the burden of cancer varied by type of cancer, sex, age, and geographical location. Notably, males exhibited significantly higher ASDRs compared with females. Specifically, in 2019, alcohol emerged as the primary contributor to the number of DALYs associated with esophageal cancer, followed by liver cancer and colorectal cancer in men. Patients aged 50+ years exhibited a heightened rate of DALYs associated with ARNs. From 1990 to 2019, ASDRs among individuals with ARNs did not exhibit a decline in low-middle and low sociodemographic index regions.

Conclusions

Alcohol consumption represents a significant risk factor for the burden of cancer, particularly within the realm of digestive system malignancies. Consequently, targeted cancer screening efforts should be directed toward the population that engages in alcohol drinking, with a particular focus on men aged 50 years and older, residing in economically disadvantaged areas.
Development and external validation of a quantitative diagnostic model for malignant gastric lesions in clinical opportunistic screening: A multicenter real-world study
Authors: Zheng Hongchen , Liu Zhen , Chen Yun , Ji Ping , Fang Zhengyu , He Yujie , Guo Chuanhai , Xiao Ping , Wang Chengwen , Yin Weihua , Li Fenglei , Chen Xiujian , Liu Mengfei , Pan Yaqi , Liu Fangfang , Liu Ying , He Zhonghu , Ke Yang
Published: February 2024

Background:

Clinical opportunistic screening is a cost-effective cancer screening modality. This study aimed to establish an easy-to-use diagnostic model serving as a risk stratification tool for identification of individuals with malignant gastric lesions for opportunistic screening.

Methods:

We developed a questionnaire-based diagnostic model using a joint dataset including two clinical cohorts from northern and southern China. The cohorts consisted of 17,360 outpatients who had undergone upper gastrointestinal endoscopic examination in endoscopic clinics. The final model was derived based on unconditional logistic regression, and predictors were selected according to the Akaike information criterion. External validation was carried out with 32,614 participants from a community-based randomized controlled trial.

Results:

This questionnaire-based diagnostic model for malignant gastric lesions had eight predictors, including advanced age, male gender, family history of gastric cancer, low body mass index, unexplained weight loss, consumption of leftover food, consumption of preserved food, and epigastric pain. This model showed high discriminative power in the development set with an area under the receiver operating characteristic curve (AUC) of 0.791 (95% confidence interval [CI]: 0.750–0.831). External validation of the model in the general population generated an AUC of 0.696 (95% CI: 0.570–0.822). This model showed an ideal ability for enriching prevalent malignant gastric lesions when applied to various scenarios.

Conclusion:

This easy-to-use questionnaire-based model for diagnosis of prevalent malignant gastric lesions may serve as an effective prescreening tool in clinical opportunistic screening for gastric cancer.
Evaluating the Efficacy of Continuous Water-Cooling 115-Watt 6.78-MHz Monopolar RF Therapy for Fine Wrinkle Reduction
Authors: Kim JongSeo
Published: February 2024

Background:

Cosmetic procedures using radiofrequency (RF) technology have garnered significant attention as noninvasive approaches to skin rejuvenation and wrinkle reduction. This study investigates the efficacy of RF therapy in enhancing skin texture, firmness, and appearance. By harnessing the 6.78-MHz “VolNewMer” RF device, skin aging concerns, particularly in terms of skin roughness, laxity, and wrinkles, can be treated.

Methods:

This study engaged a cohort of 50 participants seeking wrinkle reduction and skin-lifting treatments. Employing noninvasive methods, the efficacy of RF therapy was evaluated immediately posttreatment and 1-month posttreatment. Skin roughness was quantified using a computer-based analysis of standardized 3D scanner images, capturing uniform lighting and angles to ensure accurate measurements.

Results:

Among the 45 participants who completed the study, significant improvements in skin roughness were observed. The average roughness (Ra) value decreased from 16.71 to 11.88 arbitrary units immediately posttreatment, signifying a 28.42% enhancement. At the 1-month follow-up, the Ra value further decreased to 12.33 arbitrary units, reflecting a sustained 26.23% improvement. However, 16 participants exhibited even greater improvements at 1 month than immediate.

Conclusions:

RF therapy’s profound impact on skin tightening and rejuvenation is rooted in its ability to trigger immediate collagen contraction, bolstering skin elasticity. The dual-phase process of immediate and delayed skin improvement underscores the intricate interplay between thermal stimulation and collagen remodeling. Optimal energy levels and controlled endpoint monitoring ensure safe and effective RF treatments. The use of the VolNewMer device tips and sliding technique contributes to patient comfort and treatment precision.
A novel model to study mechanisms of cholestasis in human cholangiocytes reveals a role for the SIPR2 pathway
Authors: Islam Diana , Israr Izza , Taleb Mohamed A. B. , Rao Aditya , Yosief Robel , Sultana Rukhsar , Sampaziotis Fotios , Tysoe Olivia C. , Trauner Michael , Karpen Saul J. , Ghanekar Anand , Kamath Binita M.
Published: February 2024

Background:

Ductular reactivity is central to the pathophysiology of cholangiopathies. Mechanisms underlying the reactive phenotype activation by exogenous inflammatory mediators and bile acids are poorly understood.

Methods:

Using human extrahepatic cholangiocyte organoids (ECOs) we developed an injury model emulating the cholestatic microenvironment with exposure to inflammatory mediators and various pathogenic bile acids. Moreover, we explored roles for the bile acid activated Sphingosine-1-phosphate receptor 2 (S1PR2) and potential beneficial effects of therapeutic bile acids UDCA and norUDCA.

Results:

Synergistic exposure to bile acids (taurocholic acid, glycocholic acid, glycochenodeoxycholic acid) and TNF-α for 24 hours induced a reactive state as measured by ECO diameter, proliferation, lactate dehydrogenase activity and reactive phenotype markers. While NorUDCA and UDCA treatments given 8 hours after injury induction both suppressed reactive phenotype activation and most injury parameters, proliferation was improved by NorUDCA only. Extrahepatic cholangiocyte organoid stimulation with S1PR2 agonist sphingosine-1-phosphate reproduced the cholangiocyte reactive state and upregulated S1PR2 downstream mediators; these effects were suppressed by S1PR2 antagonist JET-013 (JET), downstream mediator extracellular signal-regulated kinase 1/2 inhibitor, and by norUDCA or UDCA treatments. JET also partially suppressed reactive phenotype after bile acid injury.

Conclusions:

We developed a novel model to study the reactive cholangiocyte state in response to pathological stimuli in cholestasis and demonstrated a contributory role of S1PR2 signaling in both injury and NorUDCA/UDCA treatments. This model is a valuable tool to further explore the pathophysiology of human cholangiopathies.
Factors Associated With Diabetes Self-Care Performance in Indonesians With Type 2 Diabetes: A Cross-Sectional Study
Authors: SUKARNO Anita , HU Sophia Huey-Lan , CHIU Hsiao-Yean , LIN Yen-Kuang , FITRIANI Kep S. , WANG Chao-Ping
Published: February 2024

Background

In Indonesia, the number of Type 2 diabetes cases is increasing rapidly, making it the third leading cause of death and among the leading noncommunicable disease healthcare expenditures in the country. Thus, there is a critical need for Indonesians with Type 2 diabetes to perform better self-care to optimize their health and prevent the onset of comorbidities.

Purpose

This study was designed to investigate the influence of knowledge, depression, and perceived barriers on Type 2 diabetes self-care performance in Indonesia.

Methods

A cross-sectional study was conducted on 185 patients with Type 2 diabetes, with demographic, diabetes history, obesity status, diabetes knowledge, depression, perceived barriers, and self-care performance data collected. The Indonesian version of the Revised Diabetes Knowledge Test, Depression Anxiety Stress Scale, Perceived Barrier Questionnaire and Self-Care Inventory-Revised were used. Descriptive, bivariate, and multiple linear regression analyses were performed.

Results

Study participants were found to have moderate diabetes self-care performance scores. Annual eye checks, blood glucose self-monitoring, healthy diet selection, and regular exercise were the least common self-management techniques performed and were consistent with the perceived difficulties of the participants. Being illiterate or having an elementary school education (β = 4.59, p = .002), having a junior or senior high school education (β = 3.01, p = .006), having moderate depression (β = −0.92, p = .04), diabetes knowledge (β = 0.09, p = .006), and perceived barriers (β = 0.31, p < .001) were found to explain 40% of the variance in self-care performance. Educational level, depression, and perceived barriers were the strongest factors that impacted Type 2 diabetes self-care performance in this study.

Conclusions/Implications for Practice

Nurses should not only provide diabetes education but also identify barriers to diabetes self-care early, screen for the signs and symptoms of depression, and target patients with lower levels of education.
Metabolic dysfunction-associated steatotic liver disease and the risk of mortality in individuals with type 2 diabetes: a systematic review and meta-analysis
Authors: Wongtrakul Wasit , Charatcharoenwitthaya Natthinee , Charatcharoenwitthaya Phunchai
Published: February 2024

The systematic review aimed to assess the risks of metabolic dysfunction-associated steatotic liver disease (MASLD) on all-cause and cause-specific mortality in patients with type 2 diabetes (T2DM). EMBASE and MEDLINE were searched from inception to June 2022 for observational studies examining the relationship between MASLD and the risk of mortality among T2DM patients. Meta-analysis was conducted using random-effects models with hazard ratios (HRs) to quantify the risk of mortality. A total of 5877 articles were screened, and ultimately, 12 eligible studies encompassing 368 528 T2DM patients, with a median follow-up of 8.9 years (interquartile range, 4.7–14.5), were included. Our analysis revealed a significant association between MASLD and an increased risk of all-cause mortality in T2DM patients [HR 1.28; 95% confidence interval (CI), 1.05–1.58; I2
 = 90%]. Meta-regression analyses did not show significant effects of mean age, mean BMI, and percentage of smokers, hypertension, and hyperlipidemia on the association between MASLD and the risk of all-cause mortality. However, we found that MASLD was not significantly associated with mortality related to cardiovascular diseases (HR 1.05; 95% CI, 0.82–1.35; I
2 = 0%) or cancer (HR 1.21; 95% CI, 0.41–3.51; I2
 = 79%) among patients with T2DM. No publication bias was observed. This comprehensive meta-analysis provides substantial evidence supporting a significant association between MASLD and an increased risk of all-cause mortality among the T2DM population. These findings underscore the potential benefits of screening for MASLD in T2DM patients, aiding in the early identification of high-risk individuals and enabling risk modification strategies to improve survival.
Renal dysfunction during treatment of chronic hepatitis B with tenofovir disoproxyl fumarate and associated risk factors
Authors: Maciel Alessandra M. de A. , Ferraz Maria Lucia C. G. , Perez Renata de M. , Brandão-Mello Carlos Eduardo
Published: February 2024

Objectives

To analyze the evolution of glomerular filtration rate (GFR) and the presence of renal tubular dysfunction during the treatment of chronic hepatitis B virus (HBV) infection with tenofovir disoproxil fumarate (TDF) and to determine the risk factors involved.

Methods

Retrospective cohort observational study of adults with chronic hepatitis B. Exclusion: hepatitis C virus-HBV coinfection, diabetes, baseline GFR less than 60 ml/min. Measurements of serum and urinary creatinine and phosphate; urinary albumin, retinol-binding protein (RBP) and neutrophil gelatinase-associated lipocalin (NGAL) were performed. Univariate and multivariate analyses tracked factors associated with worsening GFR.

Results

A total of 120 individuals were included: 35% NAÏVE (G1); 49.2% HBV using TDF (G2); 15.8% HBV-HIV using TDF (G3); 63.3% men; 60.8% white; 30% hypertensive. Average age was 50.5 years (SD ± 12.9 years). Reactive HBeAg predominated in G3 (P < 0.001) and cirrhosis in G2 (P < 0.036). NGAL was elevated in 5.3% of cases (G1 = 3.2%; G2 = 8.7%; G3 = 0%; P = 0.582), RBP in 6.7% (G1, G3 = 0%; G2 = 13.6%; P = 0.012), urinary phosphate/creatinine ratio in 16.2% (G1 = 15.2%; G2 = 14.5%; G3 = 23.5%; P = 0.842) and urinary albumin/creatinine ratio in 12.9% (G1 = 12.2%; G2 = 10.7%; G3 = 21.1%; P = 0.494). Worsening of renal function occurred in 22.5% of the population (G1 = 11.9%; G2 = 28.8%; G3 = 26.3%; P = 0.122), independently associated only with systemic arterial hypertension [adjusted odds ratio (AOR) = 4.14; P = 0.008], but not to TDF (AOR = 2.66; P = 0.110) or male sex (AOR = 2.39; P = 0.135). However, the concomitance of these variables generated a high estimated risk for this outcome (51%).

Conclusions

Renal tubular dysfunction was uncommon according to NGAL, RBP or urinary phosphate/creatinine ratio. TDF was not an independent factor for worsening renal function, significantly associated only with systemic arterial hypertension. However, in hypertensive men, the use of TDF should be monitored.
Lipid metabolism during pregnancy: consequences for mother and child
Authors: Mulder Janneke W.C.M. , Kusters D. Meeike , Roeters van Lennep Jeanine E. , Hutten Barbara A.
Published: February 2024

Purpose of review

Accommodating fetal growth and development, women undergo multiple physiological changes during pregnancy. In recent years, several studies contributed to the accumulating evidence about the impact of gestational hyperlipidemia on cardiovascular risk for mother and child. This review aims to provide a comprehensive overview of the current research on lipid profile alterations during pregnancy and its associated (cardiovascular) outcomes for mother and child from a clinical perspective.

Recent findings

In a normal pregnancy, total and LDL-cholesterol levels increase by approximately 30–50%, HDL-cholesterol by 20–40%, and triglycerides by 50–100%. In some women, for example, with familial hypercholesterolemia (FH), a more atherogenic lipid profile is observed. Dyslipidemia during pregnancy is found to be associated with adverse (cardiovascular) outcomes for the mother (e.g. preeclampsia, gestational diabetes, metabolic syndrome, unfavorable lipid profile) and for the child (e.g. preterm birth, large for gestational age, preatherosclerotic lesions, unfavorable lipid profile).

The lipid profile of women during pregnancy provides a unique window of opportunity into the potential future cardiovascular risk for mother and child. Better knowledge about adverse outcomes and specific risk groups could lead to better risk assessment and earlier cardiovascular prevention. Future research should investigate implementation of gestational screening possibilities.
Newborn screening for lipid disorders
Authors: Shao Xiangqiang , Steiner Robert , Peterson Amy L.
Published: February 2024

Purpose of review

Newborn screening is one of the most successful public health programs of the last century and offers unparalleled access to universal screening for a variety of metabolic and other disorders. Interest in development of newborn screening for lipid disorders has intensified in recent years. Screening newborns for lipid disorders has important implications for the health of the newborn as well as their relatives, and in the case of more common lipid disorders like familial hypercholesterolemia, could have important public health implications.

Recent findings

Recent studies have demonstrated feasibility of measuring biomarkers for heterozygous familial hypercholesterolemia from newborn screening dried blood spot specimens. Another lipid disorder, cerebrotendinous xanthomatosis, is currently amenable to newborn screening utilizing currently available assays. New research in next-generation sequencing as a primary screen in newborns will also identify both common and rare lipid disorders in newborns.

Historically, newborn screening for lipid disorders was not done for many reasons, but new research has developed testing methods that may successfully identify common and rare lipid disorders. This will impact the health of the newborn but could also impact family members and public health.
Comparison of proximal and minus lens autorefraction techniques to measure monocular accommodative amplitude
Authors: Parks Sidney M. , Kulp Marjean T. , Anderson Heather A.
Published: February 2024

SIGNIFICANCE

This study provides a faster method for objectively measuring accommodative amplitude with an open-field autorefractor in a research setting.

PURPOSE

Objective measures of accommodative amplitude with an autorefractor take time because of the numerous stimulus demands tested. This study compares protocols using different amounts and types of demands to shorten the process.

METHODS

One hundred participants were recruited for four age bins (5 to 9, 10 to 14, 15 to 19, and 20 to 24 years) and monocular amplitude measured with an autorefractor using three protocols: proximal, proximal-lens (letter), and proximal-lens (picture). For proximal, measurements were taken as participants viewed a 0.9 mm “E” placed at 13 demands (40 to 3.3 cm = 2.5 to 30 D). The other protocols used a target (either the “E” or a detailed picture) placed at 33 and 12.5 cm followed by 12.5 cm with a series of lenses (−2, −4, and −5.5 D). Adjustments were made for lens effectivity for the three lens conditions, which were thus 9.6, 11.1, and 12.0 D for individuals without additional spectacle lenses. Accommodative amplitude was defined as the greatest response measured with each technique. One-way analysis of variance was used to compare group mean amplitudes across protocols and differences between letter protocols by age bin.

RESULTS

Amplitudes were significantly different between protocols (p < 0.001), with proximal having higher amplitudes (mean ± standard deviation, 8.04 ± 1.70 D) compared with both proximal-lens protocols (letter, 7.48 ± 1.42 D; picture, 7.43 ± 1.42 D) by post hoc Tukey analysis. Differences in amplitude between the proximal and proximal-lens (letter) protocol were different by age group (p = 0 .003), with the youngest group having larger differences (1.14 ± 1.58 D) than the oldest groups (0.17 ± 0.58 and 0.29 ± 0.48 D, respectively) by post hoc Tukey analysis.

CONCLUSIONS

The proximal-lens protocols took less time and identified the maximum accommodative amplitude in participants aged 15 to 24 years; however, they may underestimate true amplitude in younger children.
Patient barriers and facilitators for making environmental and behavioral modifications for dry eye in the United States
Authors: Saldanha Ian J. , Petris Rebecca , Ifantides Cristos , Hauswirth Scott G. , Gregory Darren G. , Qureshi Riaz , McCann Paul , Liu Su-Hsun , Abraham Alison G. , Li Tianjing
Published: February 2024

BACKGROUND

Managing dry eye disease (DED) is expensive. Often, prescribed treatments improve clinical signs but not patient-reported symptoms. In large surveys, clinicians and patients ranked environmental and behavioral modifications among the most important DED-related research priorities. Our purpose was to investigate the barriers to and facilitators of use of these modifications by patients with DED in the United States and how their use may be impacted by socioeconomic status (SES).

METHODS

Using Qualtrics, we conducted an anonymous online survey of adults with DED living in the United States in August to September 2022. Patients were identified through the Dry Eye Foundation, Sjögren's Foundation, and a DED clinic in Colorado. We used an established index for classifying respondent SES based on education, household income, and employment. Outcomes included use of environmental and behavioral modifications and barriers to and facilitators of their use.

RESULTS

We included 754 respondents (SES: 382 low, 275 high, and 97 unclear). Most were aged 18 to 49 years (67%), female (68%), and White (76%) and reported dealing with DED for ≤5 years (67%). The most frequent modifications were taking breaks to rest eyes (68%), increasing water intake (68%), and using hot/cold compresses (52%). For these three, the biggest facilitators were as follows: belief that the modification works (27 to 37%), being recommended it (24 to 26%), and ease of use/performance (21 to 32%). Across modifications, the biggest barriers were difficulty of use (55%), lack of family/employer/social/community support (33%), and lack of awareness (32%). The data do not suggest discernible patterns of differences in barriers or facilitators by SES.

CONCLUSIONS

Greater emphasis should be placed on explaining to patients how environmental and behavioral modifications might mitigate DED. Employers and members of patients' support systems should be guided regarding how best to support patients in managing DED symptoms.
Relationship Between Tenofovir Diphosphate Concentrations in Dried Blood Spots and Virological Outcomes After Initiating Tenofovir–Lamivudine–Dolutegravir as First-Line or Second-Line Antiretroviral Therapy
Authors: van Heerden Jennifer Kate , Meintjes Graeme , Barr David , Zhao Ying , Griesel Rulan , Keene Claire Marriott , Wiesner Lubbe , Galileya Lufina Tsirizani , Denti Paolo , Maartens Gary
Published: February 2024

Background:

Tenofovir diphosphate (TFV-DP) concentration in dried blood spots is a marker of long-term adherence. We investigated the relationship between TFV-DP concentrations and virological outcomes in participants initiating tenofovir–lamivudine–dolutegravir (TLD) as first-line or second-line antiretroviral therapy.

Setting:

Three primary care clinics in Khayelitsha, Cape Town, South Africa.

Methods:

We conducted a post hoc analysis of 2 randomized controlled trials of participants initiating TLD. TFV-DP concentrations and viral loads were measured at 12, 24, and 48 weeks. Multivariable logistic regression was performed to assess the association with virological suppression (<50 copies/mL) per natural logarithm increase in TFV-DP concentration. Generalized estimating equations with logit link were used to assess associations with virological rebound. The Akaike Information Criterion and Quasi-likelihood Information Criteria were used to compare models built on continuous TFV-DP data to 4 previously defined concentration categories.

Results:

We included 294 participants in the analysis, 188 (64%) of whom initiated TLD as second-line therapy. Adjusted odds ratios (95% CIs) of virological suppression were 2.12 (1.23, 3.75), 3.11 (1.84, 5.65), and 4.69 (2.81, 8.68) per natural logarithm increase in TFV-DP concentration at weeks 12, 24, and 48, respectively. In participants with virological suppression at week 12, the adjusted odds ratio for remaining virologically suppressed was 3.63 (95% CI: 2.21 to 5.69) per natural logarithm increase in TFV-DP concentration. Models using continuous TFV-DP data had lower Akaike Information Criterion and Quasi-likelihood Information Criteria values than those using categorical data for predicting virological outcomes.

Conclusion:

TFV-DP concentrations in dried blood spots exhibit a dose–response relationship with viral load. Analyzing TFV-DP concentrations as continuous variables rather than conventional categorization may be appropriate.
Analysis of Diagnosis and Treatment Strategies for Primary Juvenile Psammomatoid Ossifying Fibroma Complicated With Primary Aneurysmal Bone Cyst
Authors: Li Fengzhen , Cheng Xiangyu , Xu Zengyi , Wang Tianyu , Cao Zhiwen , Cai Boyu , Peng Hu , Liu Huanhai
Published: February 2024

Background:

Juvenile Psammomatoid Ossifying Fibroma (JPOF) is a type of noncancerous bone tumor that usually affects adolescents in the craniomaxillofacial area. Clinical manifestations are usually symptoms caused by the tumor’s invasive compression of surrounding tissues. Aneurysmal Bone Cyst (ABC) is also a benign bone tumor, and it typically occurs in long bones and the spine. Only 2% to 3% of cases occur in the head and neck. Due to the rarity of this combination of clinical cases, clinicians face difficulties in comprehensively understanding this complex lesion. Therefore, a comprehensive review of the clinical manifestations and characteristic imaging findings is necessary for surgeons.

Case presentations:

On April 6, 2019, a 13-year-old boy presented with left maxillofacial bulge and pain for 1 month. Magnetic resonance imaging of the paranasal sinuses showed an irregular hive-like mass signal in the left maxillary sinus, and cystic changes with fluid levels were seen in the lesion. After the initial diagnosis of JPOF with primary ABC, we decided to perform a facial mid-facial resection of maxillary sinus tumor to remove the tumor tissue. Finally, after 3 recurrences and 4 operations, there was no tumor recurrence for 20 months after the last operation, and the patient was still under continuous follow-up.

Conclusions:

This case provided a reference for the diagnosis and treatment of JPOF combined with ABC. In particular, a new understanding of the association between the two diseases and the management of recurrence were proposed, which had the potential to improve clinical understanding of this complicated condition.
Study of Topography of Stylomastoid Foramen With Respect to Nearby Landmarks to Carry Out Facial Nerve Block With Minimum Complications
Authors: Singh Rajani
Published: February 2024

Nadbath facial nerve block is the most common procedure to anesthetize the facial nerve at stylomastoid foramen in intraocular surgeries, but it is associated with complications. Also, this foramen exhibits ethnic and racial variations with regard to its location. There is scanty literature describing the topographical location of this foramen. So, the study is carried out. The purpose of the study is to describe the topography of stylomastoid foramen from the surrounding landmarks so that Nadbath facial nerve block can be performed with minimum complications. The study was conducted using 80 adult dry skulls of unknown age and sex, and the distance of this foramen was measured from the tip, upper end, and lower end of the anterior border of the mastoid process and jugular foramen. The statistical analysis consisting of mean, SD, median, range mode, and t test was calculated. Mean distances of stylomastoid foramen from the upper end, the lower end of anterior border and tip of mastoid process and jugular foramen on right side were 1.5±0.16, 1.02±0.09, 0.84±0.09, and 0.49±0.06 cm and those on left side were 1.5±0.16, 1.02±0.09, 0.84±0.09, and 0.5±0.06 cm, respectively. The mode of these distances was 1.5, 1, 0.8, and 0.5, both on the right and left sides. The topographic information about stylomastoid foramen given in this study is useful to anesthetists to carry out Nadbath facial nerve block successfully with minimum complications.
Is Gillies Temporal Incision Necessary to Successfully Reduce Zygomaticomaxillary Fracture Combined With Orbital Wall Fracture?
Authors: Park Tae Hwan
Published: February 2024

Gillies temporal approach has been widely used to reduce zygoma fractures. Traditionally, it is the preferred method to reduce the isolated zygomatic arch fracture. It can be combined with other approaches, such as subciliary and intraoral incisions for more complex zygomatic fractures, so-called tripod fractures. In this study, the author hypothesized that complex zygomaticomaxillary bone fracture reduction can successfully be achieved without Gillies temporal incision. The author retrospectively analyzed the medical records and 3D facial Computed Tomography (CT) scans of 80 patients who had orbitozygomaticomaxillary fractures that affected >3 sites among the frontozygomatic suture, zygomaticomaxillary buttress, zygomatic arch, and orbital walls from May 2021 to August 2023. A single surgeon performed all surgical operations. All fractures were reduced with 2 incisions, lower eyelid incisions (subciliary or subconjunctival) and intraoral incisions (gingivobuccal approach), within a week of the initial traumatic event. After sufficient exposure to fractured sites using 2 incisions, the author reduced the fracture with a bony hook at the inferior orbital rim, lateral wall, or Boise elevator at the intraoral incision. All cases were successfully corrected without any complications. In conclusion, the author can successfully reduce complex zygomaticomaxillary fracture combined with orbital wall fractures without temporal Gillies approach.
Legal hypergraphs
Authors: Coupette Corinna , Hartung Dirk , Katz Daniel Martin
Published: February 2024

Complexity science provides a powerful framework for understanding physical, biological and social systems, and network analysis is one of its principal tools. Since many complex systems exhibit multilateral interactions that change over time, in recent years, network scientists have become increasingly interested in modelling and measuring
dynamic
networks featuring
higher-order relations
. At the same time, while network analysis has been more widely adopted to investigate the structure and evolution of law as a complex system, the utility of dynamic higher-order networks in the legal domain has remained largely unexplored. Setting out to change this, we introduce
temporal hypergraphs
as a powerful tool for studying legal network data. Temporal hypergraphs generalize static graphs by (i) allowing any number of nodes to participate in an edge and (ii) permitting nodes or edges to be added, modified or deleted. We describe models and methods to explore
legal hypergraphs
that evolve over time and elucidate their benefits through case studies on legal citation and collaboration networks that change over a period of more than 70 years. Our work demonstrates the potential of dynamic higher-order networks for studying complex legal systems, and it facilitates further advances in legal network analysis.

This article is part of the theme issue ‘A complexity science approach to law and governance’.
The latent net effectiveness of institutional complexes: a heuristic model
Authors: Adipudi Ashok Vardhan , Kim Rakhyun E.
Published: February 2024

International institutions strive to achieve their own objectives while operating within a complex network of interdependencies. These interdependencies create an extensive web of relationships that serve as potential pathways for broader institutional impacts. The actions taken by individual institutions, their mutual influences, and the pattern of connectivity collectively shape the overall performance of institutional complexes. Understanding the performance of these complexes is crucial, yet we currently lack a methodology to assess it. To address this gap, we have developed a conceptual framework that integrates three distinct areas of study on three different scales: institutional effectiveness, institutional interlinkages, and institutional networks. This framework enables us to consider what we call the latent net effectiveness, or collective problem-solving potential, of a group of interconnected institutions. To put this framework into practice, we have devised a heuristic model, drawing from the extensive literature on international environmental institutions. As an illustrative example, we have applied this model to a network of 378 multilateral environmental agreements with 810 known issue linkages. Our work underscores the relevance of considering the system-level properties of institutional complexes and emphasizes the need for timely network-based governance and policy interventions to enhance the overall effectiveness of institutional complexes.

This article is part of the theme issue ‘A complexity science approach to law and governance'.