bluuebunny/crossref_metadata_2025 huggingface dataset:
Support vector machine based feature extraction for gender recognition from objects using lasso classifier
Authors: Galla Damodara Krishna Kishore , Mukamalla Babu Reddy , Chegireddy Rama Prakasha Reddy
Published: November 2020

Object detection and gender recognition were two different categories to be classified in a single section is a complicated task and this approach helps in supporting the blind people for an artificial vision. In this paper, our method to the betters vision sensation of blind persons by conversion of visualized data to audio data. Therefore this artificial intelligence model helps in detecting the objects as well as human face recognition with gender classification based on face recognition approach. This model processed with feature extraction and classification models. The feature extraction was comprised with multi scale-invariant feature transform (MSIFT), with feature optimization with support vector machine algorithm then classified using LASSO classifier. For better performance identification, three different classification models were implemented and tested too. Feature selection helps in making tests early to detect the objects and recognizing human actions using image processing approach. This approach can be applied for both offline and online modes. But in this scenario, an offline mode was implemented and was tested with a combination of different databases. For this process of classification ridge regression (RR), elastic net (EN), lasso regression (LR) and LASSO regression were implemented. The final classification results with accuracy are as follows for RR-89.6%, EN-93.5%, LR-93.2% and proposed approach (LRGS) with 98.4% accurate detection rate with prediction name of classes.
Glycoprotein IIb/IIIa inhibitors for cardiogenic shock complicating acute myocardial infarction: a systematic review, meta-analysis, and meta-regression
Authors: Saleiro Carolina , Teixeira Rogério , De Campos Diana , Lopes João , Oliveiros Bárbara , Costa Marco , Gonçalves Lino
Published: November 2020

Background

Cardiogenic shock complicates 5–10% of myocardial infarction (MI) cases. Data about the benefit of glycoprotein IIb/IIIa inhibitors (GPI) in these patients is sparse and conflicting.

Methods

We performed a systematic review, meta-analysis, and meta-regression of studies assessing the impact of GPI use in the setting of MI complicated cardiogenic shock on mortality, angiographic success, and bleeding events. We systematically searched for studies comparing GPI use as adjunctive treatment versus standard care in this setting. Random-effects meta-analysis and meta-regression were performed.

Results

Seven studies with a total of 1216 patients (GPI group, 720 patients; standard care group, 496 patients) were included. GPI were associated with a 45% relative reduction in the odds of death at 30 days (pooled OR 0.55; 95% CI 0.35–0.85;I2= 57%;P= 0.007) and a 49% reduction in the odds of death at 1 year (pooled OR 0.51; 95% CI 0.32–0.82;I2= 58%;P= 0.005). Reduction in short-term mortality seemed to be more important before 2000, as this benefit disappears if only the more recent studies are analyzed. GPI were associated with a 2-fold increase in the probability of achieving TIMI 3 flow (pooled OR, 2.05; 95% CI 1.37–3.05;I2= 37%,P= 0.0004). Major bleeding events were not increased with GPI therapy (pooled OR, 1.0; 95% CI 0.55–1.83;I2= 1%,P= 0.99). Meta-regression identified that patients not receiving an intra-aortic balloon pump seemed to benefit the most from GPI use (Z= − 1.57,P= 0.005).

Conclusion

GPI therapy as an adjunct to standard treatment in cardiogenic shock was associated with better outcomes, including both short- and long-term survival, without increasing the risk of bleeding.
Development of Integrated Land Simulator
Authors: Nitta Tomoko , Arakawa Takashi , Hatono Misako , Takeshima Akira , Yoshimura Kei
Published: November 2020

Accurate simulations of land processes are crucial for many purposes, such as climate simulation, weather, flood, and drought prediction, and climate change impact assessment studies. In this paper, we present a new land simulator called the Integrated Land Simulator (ILS). The ILS consists of multiple models that represent processes related to land (hereafter, referred to as “land models”). They are coupled by a general-purpose coupler, Jcup, and executed using the Multiple Program Multiple Data approach. Currently, ILS includes a physical land surface model, the Minimal Advanced Treatments of Surface Interaction and Runoff model, and a hydrodynamic model, the Catchment-based Macro-scale Floodplain model, and the inclusion of additional land models is planned. We conducted several test simulations to evaluate the computational speed and scalability and the basic physical performance of the ILS. The results will become a benchmark for further development.
Interpersonal determinants of eating behaviours in Dutch older adults living independently: a qualitative study
Authors: Bukman Andrea Johanna , Ronteltap Amber , Lebrun Mila
Published: November 2020

Background

Eating behaviour of older adults is influenced by a complex interaction of determinants. Understanding the determinants of a specific target group is important when developing targeted health-promoting strategies. The aim of this study was to explore interpersonal determinants of eating behaviours in older adults living independently in a specific neighbourhood in the Netherlands.

Methods

In the neighbourhood of interest, populated by relatively many older adults, fifteen semi-structured interviews were conducted with independently living older adults (aged 76.9 ± 6.4y). Interviews were complemented with observations among the target group: three occasions of grocery shopping and three collective eating occasions in the neighbourhood. A thematic approach was used to analyse the qualitative data.

Results

When we asked the older adults unprompted why they eat what they eat, the influence of interpersonal determinants did not appear directly; respondents rather mentioned individual (e.g. habits) and environmental factors (e.g. food accessibility). Key findings regarding interpersonal factors were: 1) Behaviours are shaped by someone’s context; 2) Living alone influences (determinants of) eating behaviour via multiple ways; 3) There is a salient norm that people do not interfere with others’ eating behaviour; 4) Older adults make limited use of social support (both formal and informal) for grocery shopping and cooking, except for organised eating activities in the neighbourhood. In this particular neighbourhood, many facilities (e.g. shops at walking distance) are present, and events (e.g. dinners) are organised with and for the target group, which likely impact (determinants of) their behaviours.

Conclusions

The study showed that older adults do not directly think of interpersonal factors influencing their eating behaviour, but rather of individual or environmental factors. However, multiple interpersonal factors did appear in the interviews and observations. Moreover, neighbourhood-specific factors seem to play a role, which underlines the need to understand the specific (social) setting when developing and implementing intervention programmes. Insights from this study can assist in developing health-promoting strategies for older adults, taking into account the context of the specific neighbourhood.
Anti-dyslipidemic properties of green gold nanoparticle: improvement in oxidative antioxidative balance and associated atherogenicity and insulin resistance
Authors: Javanshir Reyhane , Honarmand Moones , Hosseini Mehran , Hemmati Mina
Published: November 2020

Background

Nowadays, the green synthesis of AuNPs in the presence of plants has been attracted a lot of attention. Herein, in vivo antidiabetic activity of AuNPs synthesized using Ziziphus jujuba in streptozotocin-induced diabetic rats has been evaluated.

Methods

Formation of AuNPs was confirmed by UV-vis, HR-TEM and XRD. Different doses of jujube gold nanoparticles (0.5 and 1 mg/kg) were used to treat streptozotocin-induced diabetic rats in different groups. At the end of experiment (21 days), serum level of fasting blood glucose (FBG), insulin, Body weight, HOMA-IR, vitamin D, ALT, AST, urea, creatinine, lipid profile, prooxidant-antioxidant balance (PAB) and liver oxidative stress markers were determined.

Results

results showed a significant decrease in the level of liver MDA (P = 0.001), fasting blood glucose (P = 0.0001), HOMA-IR (P = 0.0001), ALT (P = 0.0001), AST (P = 0.0001), urea (P = 0.02), Triglycerides (P = 0.002), Total cholesterol (P = 0.0001), PAB (P = 0.0001) and AIP (P = 0.001) and in contrast a significant increase total antioxidant capacity (P = 0.02), insulin (P = 0.03), Body weight (P = 0.0001) and vitamin D (P = 0.0001) in the AuNPs-treated diabetic group compared to the diabetic rats. No significant change was observed in the total thiol group (P = 0.18), LDL-C (P = 0.43), creatinine (P = 0.09) and HDL-C (P = 0.71) level in diabetic rats treated with AuNPs compared to diabetic rats.

Conclusion

The results of this study proves that green AuNPs exerted promising antidiabetic and anti-oxidant properties.
Endoscope-assisted scleral buckle procedure
Authors: Platt Sean M. , Barkmeier Andrew J.
Published: November 2020

Background

Retinal reattachment surgery requires clear visualization of the posterior segment for optimal outcomes. Select patients may benefit most from primary scleral buckling without vitrectomy, but lack adequate posterior segment ophthalmoscopic visualization to use standard techniques.

Case presentation

The authors describe a retinal reattachment technique utilizing endoscope-assisted visualization to perform a primary scleral buckle procedure for a 34yo female with Peters’ Anomaly and a macula-sparing retinal detachment. Retinal reattachment was achieved with a single procedure and she remained stable with preservation of baseline visual acuity at 30 months follow-up.

Conclusion

In cases where a primary scleral buckle procedure is the preferred retinal detachment repair technique but posterior segment visualization is limited, intraoperative fundus examination, cryotherapy administration, and scleral buckle positioning can be facilitated with intraocular endoscopy.
Insights of COVID-19 pandemic impact on anesthetic management for patients undergoing cancer surgery in the National Cancer Institute, Egypt
Authors: Elsabeeny Walaa Y. , Abd El Dayem Omnia Y. , Rabea Ahmed , Ibrahim Rania S. M. , Mahmoud Heba G. M. , Kamal Eman , Osman Randa A. , Ghoneim Ayman
Published: November 2020

New corona virus disease COVID-19 is a pandemic outbreak viral infection that is highly contagious. The disease can affect any age groups. Majority of patients show mild or no symptoms. Immunocompromised patients and patients with co-morbidities are more vulnerable to have more aggressive affection with higher rate of complications. Thus, cancer patients carry a higher risk of infection. Diseased patient can transmit infection throughout the disease course starting from the incubation period to clinical recovery. All healthcare workers contacting COVID-19-positive patients are at great risk of infection, especially the anesthesiologists who can be exposed to high viral load during airway manipulation. In the National Cancer Institute of Egypt, we apply a protocol to prioritize cases where elective cancer surgeries that would not affect patient prognosis and outcome are postponed during the early phase and peak of the pandemic till reaching a plateau. However, emergency and urgent surgeries that can compromise cancer patient’s life and prognosis take place after the proper assessment of the patient’s condition.

Aim

This review aims to spot the management of cancer patients undergoing surgery during the COVID-19 pandemic in the National Cancer Institute, Egypt.
Drug-eluting balloon: is it useful?
Authors: Laksono Sidhi , Setianto Budhi , Surya Steven Philip
Published: November 2020

Background

Coronary artery disease is one of the major issues in the medical world around the globe. The prevalence tends to increase. The use of coronary intervention is one of the ways often used in the management of coronary artery disease due to its satisfying result from earlier studies. Nowadays, there are several different techniques in coronary intervention: balloon vs stent.

Main body

The stent-based vascular interventions are increasingly being used over balloon-based coronary intervention. However, revascularization intervention using stent often have undesirable long-term effects compared to balloon. Besides, stent-based interventions are also considered more expensive, use more complicated techniques, and use more drug regimens. On the other hand, percutaneous coronary intervention techniques using balloons coated by anti-proliferation drugs have begun to be glimpsed by many interventionists. Studies have found many benefits that cannot be given by stent-based intervention therapy.

Conclusions

Angioplasty using percutaneous coronary intervention techniques reveals satisfying result compared to conservative medical treatment. The indication and technique of percutaneous coronary intervention is still evolving until now. Currently, percutaneous coronary intervention using stent, either bare-metal stent or drug-eluting stent, is preferred by interventionist. Nevertheless, recent clinical trial favors the using of drug-eluting balloon for percutaneous coronary intervention in terms of both clinical outcome and complication in several scenarios.
Coping with depression and anxiety in Egyptian physicians during COVID-19 pandemic
Authors: Khalaf Ola Osama , Khalil Mohamed A. , Abdelmaksoud Reham
Published: November 2020

Background

The COVID-19 pandemic is a public health emergency with a negative impact on mental health. Healthcare workers are one of the most vulnerable groups to psychological stress in pandemics especially COVID-19. In this cross-sectional study, we assessed depression, stress, and coping among a sample of Egyptian physicians using an electronic survey. It included demographic data; Depression, Anxiety and Stress Scale-21 Items (DASS-21); and Brief Resilient Coping Scale (BRCS).

Results

We found that the majority of the sample were females (61.2%), in medical specialties (51.2%), and living with vulnerable family members (92.4 %). The majority (63%) suffered from severe or extremely severe depression, 77.6% had extremely severe anxiety, and 72% suffered from stress. BRCS showed that only 17.1% had high resilient coping. Female physicians had significantly higher depression, anxiety, and stress scores of DASS than male physicians (p= 0.001, < 0.001, and < 0.001, respectively). The anxiety scale was significantly higher in those with chronic diseases (p= 0.040) while the stress scale was lower significantly in those with higher academic degree (p= 0.034). Age had a significantly negative correlation with DASS anxiety (p= 0.031) and stress scores (p= 0.037). The BRCS score had a significantly negative correlation with the depression, anxiety, and stress scales of DASS (p= 0.018, 0.014, and 0.007 respectively).

Conclusion

The COVID-19 pandemic has a negative impact on the psychological well-being of the studied Egyptian physicians. Prophylactic measures should be implemented to avoid development of psychiatric symptoms in physicians.
Accelerate disaster risk mapping using an automated zonal change detection model for loss estimation and recovery: a flood case study
Authors: Amasha Ali
Published: November 2020

Background

The flash flood still constitutes one of the major natural meteorological disasters harmfully threatening local communities, that creates life losses and destroying infrastructures. The severity and magnitude of disasters always reflected from the size of impacts. Most of the conventional research models related to flooding vulnerability are focusing on hydro-meteorological and morphometric measurements. It, however, requires quick estimate of the flood losses and assess the severity using reliable information. An automated zonal change detection model applied, using two high-resolution satellite images dated 2009 and 2011 coupled with LU/LC GIS layer, on western El-Arish City, downstream of Wadi El-Arish basin. The model enabled to estimate the severity of a past flood incident in 2010.

Results

The model calculated the total changes based on the before and after satellite images based on pixel-by-pixel comparison. The estimated direct-damages nearly 32,951 m2of the total mapped LU/LC classes; (e.g., 11,407 m2as 3.17% of the cultivated lands; 6031 m2as 7.22% of the built-up areas and 4040 m2as 3.62% of the paved roads network). The estimated cost of losses, in 2010 economic prices for the selected three LU/LC classes, is nearly 25 million USD, for the cultivation fruits and olives trees, ~ 4 million USD for built-up areas and ~ 1 million USD for paved roads network.

Conclusion

The disasters’ damage and loss estimation process takes many detailed data, longtime, and costed as well. The applied model accelerates the disaster risk mapping that provides an informative support for loss estimation. Therefore, decision-makers and professionals need to apply this model for quick the disaster risks management and recovery.
Correction to: Formation of the modern scenic city of Hangzhou: towards conservation integrated urban planning, 1950s–1990s
Authors: Fu Shulan , Jin Panpan
Published: November 2020

An amendment to this paper has been published and can be accessed via the original article.
Using resistivity data to study the waterflooding process: A case study in tight sandstone reservoirs of the Ordos Basin, China
Authors: Jiang Zhihao , Fu Jinhua , Li Gaoren , Mao Zhiqiang , Zhao Peiqiang
Published: November 2020

Water injection is one of the most common methods used to enhance the oil recovery of reservoirs with low permeability and strong heterogeneity. However, with the injection of water in the production process, the formation water salinity, oil saturation, and the distribution of the residual oil in the reservoir are altered, causing difficulties in the evaluation of the flooded layers. Consequently, it is crucial to understand the changes in reservoir resistivity when evaluating waterflooded layers with different wettabilities. Resistivity experiments for high-resistivity (HR) and normal-resistivity (NR) tight sandstone samples are carried out to simulate different types of waterflooding processes. Specifically, fresh water and the original formation water with higher salinity are separately used to displace oil in rock samples, including the HR and NR samples. Our results indicate that the salinity of injected water and the reservoir wettability can affect the reservoir resistivity after waterflooding. When fresh water is injected, the resistivity of NR and HR samples initially decreases, and then increases due to reduced oil saturation and increased salinity of the injected fresh water. In contrast, the resistivity of NR and HR samples decreases monotonically when the original formation water is injected. Our study also indicates that the formation water injection facilitates resistivity logging evaluation of high-resistance waterflooding layers better than fresh-water injection. To our knowledge, this is the first report of such a rich set of resistivity experiments in tight sandstone waterflooded reservoirs with complex wettability. Finally, combining waterflooding resistivity experiments with relative permeability, we have developed a fast, new, convenient method for evaluating the extent of waterflooding of a tight sandstone reservoir, which has been successfully applied to field-data examples for water-cut evaluation.
Characterization of organic content, brittleness index, and geomechanical properties of the Eocene Cambay Shales — Insights from the Ankleshwar oil field in western India
Authors: Ganguli Shib Sankar , Sen Souvik , Verma Sumit
Published: November 2020

Shale resource assessment involves a detailed characterization of organic and geomechanical parameters for better insights on the reservoir properties and classifying areas of economic yield. To assess the Eocene Younger Cambay Shale (YCS) Group of the Ankleshwar field, western India, for feasible shale resource play, we have applied a multistage screening methodology that combines an estimation of organic richness, brittleness index (BI), and geomechanical analyses. The estimated thermal maturity and average total-organic-carbon (TOC) contents are within the range of 0.8–1.0 and 1.8 wt%, respectively. These estimates are comparable to the reported core-based measurements. BI based on the mineralogical composition reveals that the YCS intervals of marine origin fall into the “less-ductile” to “brittle” zone, whereas the elastic property-based estimated BI falls into the “less-brittle” to “high brittle” zone. We have established a field relationship between the BI and the shale volume, and we also deciphered the effect of TOC content on the rock-elastic properties. Pore pressure in the shales is slightly above the hydrostatic gradient (10.5–11.5 MPa/km). The estimated average fracture pressure of 18.5 MPa/km, together with the BI of moderately ductile to less-brittle behavior suggests that the studied shales are capable of withstanding substantial strain while hydrofracturing for effective production. We demonstrate an expedient example to characterize a potential shale unit within a producing hydrocarbon field using the drilled wells with limited or no core data.
Course and Predictive Factors of Incomplete Response to Therapy in Low- and Intermediate-Risk Thyroid Cancer
Authors: Alzahrani Ali S , Moria Yosra , Mukhtar Noha , Aljamei Hadeel , Mazi Sedra , Albalawi Lina , Aljomaiah Abeer
Published: November 2020

Context

Controversy surrounds the extent and intensity of the management of American Thyroid Association (ATA) intermediate- and low-risk patients with differentiated thyroid cancer (DTC). Understanding the natural history and factors that predict outcome is important for properly tailoring the management of these patients.

Objective

This work aims to study the natural course and predictive factors of incomplete response to therapy in low- and intermediate-risk DTC.

Patients and Methods

We studied a cohort of 506 consecutive patients [418 women (82.6%) and 88 men (17.4%)] with low and intermediate risk with a median age of 35 years (interquartile range [IQR], 27-46 years). We analyzed the natural course and the predictive factors of biochemically or structurally incomplete response.

Results

Of 506 patients studied, 297 (58.7%) patients were in the low-risk group and 209 (41.3%) were in the intermediate-risk group. Over a median follow-up of 102 months (IQR, 66-130 months), 458 (90.5%) patients achieved an excellent response, 17 (3.4%) had a biochemically incomplete status, and 31 (6.1%) had a structurally incomplete status. In univariable and multivariable analyses, age (≥ 33 years) (P < .0001, odds ratio 1.06 [1.04-1.08]) and lateral lymph node metastasis (LNM; P < .0001, odds ratio 3.2 [1.7-5.9]) were strong predictive factors for biochemically and structurally incomplete response to therapy. Sex, tumor size, multifocality, extrathyroidal extension, and lymphovascular invasion did not predict incomplete response to therapy.

Conclusions

Patients with low- and intermediate-risk DTC have favorable outcomes. Age and lateral LNM are strong predictors of an incomplete response to therapy. This suggests that older patients and those with LNM should be managed and followed up more actively than younger patients and those without LNM.
Intraoperative Hypotension Is Associated With Adverse Clinical Outcomes After Noncardiac Surgery
Authors: Gregory Anne , Stapelfeldt Wolf H. , Khanna Ashish K. , Smischney Nathan J. , Boero Isabel J. , Chen Qinyu , Stevens Mitali , Shaw Andrew D.
Published: November 2020

BACKGROUND:

Intraoperative hypotension (IOH) occurs frequently during surgery and may be associated with organ ischemia; however, few multicenter studies report data regarding its associations with adverse postoperative outcomes across varying hemodynamic thresholds. Additionally, no study has evaluated the association between IOH exposure and adverse outcomes among patients by various age groups.

METHODS:

A multicenter retrospective cohort study was conducted between 2008 and 2017 using intraoperative blood pressure data from the US electronic health records database to examine postoperative outcomes. IOH was assessed in 368,222 noncardiac surgical procedures using 5 methods: (a) absolute maximum decrease in mean arterial pressure (MAP) during surgery, (b) time under each absolute threshold, (c) total area under each threshold, (d) time-weighted average MAP under each threshold, and (e) cumulative time under the prespecified relative MAP thresholds. MAP thresholds were defined by absolute limits (≤75, ≤65, ≤55 mm Hg) and by relative limits (20% and 40% lower than baseline). The primary outcome was major adverse cardiac or cerebrovascular events; secondary outcomes were all-cause 30- and 90-day mortality, 30-day acute myocardial injury, and 30-day acute ischemic stroke. Residual confounding was minimized by controlling for observable patient and surgical factors. In addition, we stratified patients into age subgroups (18–40, 41–50, 51–60, 61–70, 71–80, >80) to investigate how the association between hypotension and the likelihood of major adverse cardiac or cerebrovascular events and acute kidney injury differs in these age subgroups.

RESULTS:

IOH was common with at least 1 reading of MAP ≤75 mm Hg occurring in 39.5% (145,743) of cases; ≤65 mm Hg in 19.3% (70,938) of cases, and ≤55 mm Hg in 7.5% (27,473) of cases. IOH was significantly associated with the primary outcome for all age groups. For an absolute maximum decrease, the estimated odds of a major adverse cardiac or cerebrovascular events in the 30-day postsurgery was increased by 12% (95% confidence interval [CI], 11-14) for ≤75 mm Hg; 17.0% (95% CI, 15-19) for ≤65 mm Hg; and by 26.0% (95% CI, 22-29) for ≤55 mm Hg.

CONCLUSIONS:

IOH during noncardiac surgery is common and associated with increased 30-day major adverse cardiac or cerebrovascular events. This observation is magnified with increasing hypotension severity. The potentially avoidable nature of the hazard, and the extent of the exposed population, makes hypotension in the operating room a serious public health issue that should not be ignored for any age group.
Parental Psychosocial Factors Moderate Opioid Administration Following Children’s Surgery
Authors: Kain Alexandra S. , Fortier Michelle A. , Donaldson Candice D. , Tomaszewski Daniel , Phan Michael , Jenkins Brooke N.
Published: November 2020

BACKGROUND:

This investigation aimed to examine the impact of parental psychosocial variables on the administration of opioids to young children experiencing postoperative pain.

METHODS:

Participants in this longitudinal analysis were children ages 2–12 undergoing tonsillectomy with or without adenoidectomy and their parents. Parents completed validated instruments assessing trait anxiety, perceived stress, and coping style before surgery, and children and parents completed instruments assessing pain and administration of opioids and acetaminophen on days 1, 2, 3, and 7 at home after surgery. The structure of the data was such that parents and children completed multiple data assessments making the data multilevel (ie, days of data within dyads). To address this issue of data structure, multilevel modeling was used to analyze the dataset.

RESULTS:

Participants included 173 parent-child dyads (mean child age = 5.99 ± 2.51) recruited between 2012 and 2017. We found that parent-related psychosocial variables, such as trait anxiety, stress, and coping style, moderated the relationship between the child’s pain and postoperative medication administration. Specifically, when predicting hydrocodone, the interactions between anxiety and pain and stress and pain were significant; when child pain was high, high-anxiety and high-stressed parents gave their children 19% and 12% more hydrocodone, respectively, compared to low-anxiety and low-stressed parents. When predicting acetaminophen, the interactions between anxiety and pain, a blunting coping style and pain, and a monitoring coping style and pain were significant.

CONCLUSIONS:

These results suggest the need to identify parents who experience high levels of perceived stress and trait anxiety and use appropriate interventions to manage stress and anxiety. This may ensure children receive optimal amounts of pain medication following surgery.
Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean
Authors: Bollag Laurent , Lim Grace , Sultan Pervez , Habib Ashraf S. , Landau Ruth , Zakowski Mark , Tiouririne Mohamed , Bhambhani Sumita , Carvalho Brendan
Published: November 2020

The purpose of this article is to provide a summary of the Enhanced Recovery After Cesarean delivery (ERAC) protocol written by a Society for Obstetric Anesthesia and Perinatology (SOAP) committee and approved by the SOAP Board of Directors in May 2019. The goal of the consensus statement is to provide both practical and where available, evidence-based recommendations regarding ERAC. These recommendations focus on optimizing maternal recovery, maternal-infant bonding, and perioperative outcomes after cesarean delivery. They also incorporate management strategies for this patient cohort, including recommendations from existing guidelines issued by professional organizations such as the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists. This consensus statement focuses on anesthesia-related and perioperative components of an enhanced recovery pathway for cesarean delivery and provides the level of evidence for each recommendation.
Association Between Lower Preoperative Cognition With Intraoperative Electroencephalographic Features Consistent With Deep States of Anesthesia in Older Patients: An Observational Cohort Study
Authors: Gutiérrez Rodrigo G. , Egaña José I. , Maldonado Felipe A. , Sáez Iván A. , Reyes Fernando I. , Soulat Hugo , Purdon Patrick L. , Penna Antonello
Published: November 2020

BACKGROUND:

Patients with low cognitive performance are thought to have a higher risk of postoperative neurocognitive disorders. Here we analyzed the relationship between preoperative cognition and anesthesia-induced brain dynamics. We hypothesized that patients with low cognitive performance would be more sensitive to anesthetics and would show differences in electroencephalogram (EEG) activity consistent with a brain anesthesia overdose.

METHODS:

This is a retrospective analysis from a previously reported observational study. We evaluated cognitive performance using the Montreal cognitive assessment (MoCA) test. All patients received general anesthesia maintained with sevoflurane or desflurane during elective major abdominal surgery. We analyzed the EEG using spectral, coherence, and phase-amplitude modulation analyses.

RESULTS:

Patients were separated into a low MoCA group (<26 points, n = 12) and a high MoCA group (n = 23). There were no differences in baseline EEG, nor end-tidal age-corrected minimum alveolar concentration (MACage). However, under anesthesia, the low MoCA group had lower α-β power (high MoCA: 2.9 [interquartile range {IQR}: 0.6–5.8 dB] versus low MoCA: −1.2 [IQR: −2.1 to 0.6 dB], difference 4.1 [1.0–5.7]) and a lower α peak frequency (high MoCA: 9.0 [IQR: 8.3–9.8 Hz] versus low MoCA: 7.5 [IQR: 6.3–9.0 Hz], difference 1.5 [0–2.3]) compared to the high MoCA group. The low MoCA group also had a lower α band coherence and a stronger peak-max phase–amplitude coupling (PAC). Finally, patients in the low MoCA group had longer emergence times (high MoCA 663 ± 345 seconds versus low MoCA: 960 ± 352 seconds, difference 297 [15–578]). Multiple linear regression shows up that both age and MoCA scores are independently associated with intraoperative α-β power.

CONCLUSIONS:

All these EEG features, together with a prolonged emergence time, are consistent with the possibility that older patients with low cognitive performance are receiving a brain anesthesia overdose compare to cognitive normal patients.
Postoperative Neurocognitive Disorders After Closed-Loop Versus Manual Target Controlled-Infusion of Propofol and Remifentanil in Patients Undergoing Elective Major Noncardiac Surgery: The Randomized Controlled Postoperative Cognitive Dysfunction-Electroencephalographic-Guided Anesthetic Administration Trial
Authors: Mahr Nicolas , Bouhake Yannis , Chopard Gilles , Liu Ngai , Boichut Nathalie , Chazot Thierry , Claveau Melanie , Vettoretti Lucie , Tio Gregory , Pili-Floury Sebastien , Samain Emmanuel , Besch Guillaume
Published: November 2020

BACKGROUND:

The aim of the study was to investigate whether closed-loop compared to manual bispectral index (BIS)–guided target-controlled infusion of propofol and remifentanil could decrease the incidence of postoperative neurocognitive disorders after elective major noncardiac surgery.

METHODS:

Patients aged >50 admitted for elective major noncardiac surgery were included in a single-blind randomized (ratio 2:1) trial. The anesthetic protocol was allocated by randomization into either closed-loop or manual BIS-guided propofol and remifentanil titration. The BIS target range was 40–60. All patients had cognitive assessment the day before surgery and within 72 hours after surgery using a battery of neuropsychological tests. The primary outcome was the rate of postoperative neurocognitive disorders. Postoperative neurocognitive disorders were defined as a decrease >20% from baseline on at least 3 scores. Intergroup comparison of the primary outcome was performed using the χ2 test.

RESULTS:

A total of 143 and 61 patients were included in the closed-loop and manual groups, respectively (age: 66 [8] vs 66 [9] years). The primary outcome was observed in 18 (13%) and 10 (16%) patients of the closed-loop and manual groups, respectively (relative risk [95% confidence interval {CI}], 0.77 [0.38-1.57], P = .47). Intraoperative propofol consumption was lower (4.7 [1.4] vs 5.7 [1.4] mg·kg−1·h−1, mean difference [MD] [95% CI], −0.73 [−0.98 to −0.48], P < .0001) and the proportion of time within the BIS target range higher (84 [77–89] vs 74 [54–81]%, MD [95% CI], 0.94 [0.67-1.21], P < .0001) in the closed-loop group.

CONCLUSIONS:

Closed-loop compared to manual BIS-guided total intravenous anesthesia provided a significant reduction in episodes of an excessive depth of anesthesia while decreasing intraoperative propofol requirement but no evidence for a reduction of the incidence of postoperative neurocognitive disorders after elective major noncardiac surgery was observed.
Changes in Pain Medicine Training Programs Associated With COVID-19: Survey Results
Authors: Kohan Lynn , Durbhakula Shravani , Zaidi Munfarid , Phillips Christopher R. , Rowan Cody C. , Brenner Gary J. , Cohen Steven P.
Published: November 2020

BACKGROUND:

The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis of unprecedented proportions that has altered the practice of medicine. The pandemic has required pain clinics to transition from in-person visits to telemedicine, postpone procedures, and cancel face-to-face educational sessions. There are no data on how fellowship programs have adapted.

METHODS:

A 17-question survey was developed covering topics including changes in education, clinical care, and psychological stress due to the COVID pandemic. The initial survey was hosted by Qualtrics Inc and disseminated by the Association of Pain Program Directors on April 10, 2020, to program directors at Accreditation Council for Graduate Medical Education (ACGME)–accredited fellowships. Results are reported descriptively and stratified by COVID infection rate, which was calculated from Centers for Disease Control and Prevention data on state infections, and census data.

RESULTS:

Among 107 surveys distributed, 70 (65%) programs responded. Twenty-nine programs were located in states in the upper tertile for per capita infection rates, 17 in the middle third, and 23 in the lowest tertile. Nearly all programs (93%) reported a decreased workload, with 11 (16%) reporting a dramatic decrease (only urgent or emergent cases). Just more than half of programs had either already deployed (14%) or credentialed (39%) fellows to provide nonpain care. Higher state infection rates were significantly associated with reduced clinical demand (R
s = 0.31, 95% confidence interval [CI], 0.08-0.51; P = .011) and redeployment of fellows to nonpain areas (R
s = 0.30, 95% CI, 0.07-0.50; P = .013). Larger program size but not infection rate was associated with increased perceived anxiety level of trainees.

CONCLUSIONS:

We found a shift to online alternatives for clinical care and education, with correlations between per capita infection rates, and clinical care demands and redeployment, but not with overall trainee anxiety levels. It is likely that medicine in general, and pain medicine in particular, will change after COVID-19, with greater emphasis on telemedicine, virtual education, and greater national and international cooperation. Physicians should be prepared for these changes.
The Epiaortic Ultrasound Diagnosis of Iatrogenic Subadventitial Hematoma
Authors: Moeller Shaun C. , Serbanescu Mara A. , Abernathy James H. , Kostibas Megan P. , Lawton Jennifer S. , Cha Stephanie L.
Published: November 2020

Iatrogenic aortic injury is a rare but potentially lethal complication of cardiac surgery. While sometimes resulting in aortic dissection or intramural hematoma, injury more frequently results in subadventitial hematoma, a more benign pathology. Here, we describe a case where intraoperative transesophageal echocardiography (TEE) identified such a hematoma but was unable to rule out dissection. Epiaortic ultrasound was subsequently performed, which definitively demonstrated the absence of a dissection flap or extraluminal flow. Per our review, this is the first report documenting the successful use of epiaortic imaging to identify subadventitial hematoma in the setting of inconclusive TEE findings.
Salvage of a Passive Recharge Burst Spinal Cord Stimulation Implant With 10 kHz Spinal Cord Stimulation for Failed Back Surgery Syndrome: A Case Report
Authors: Chang Kitae , Hagedorn Jonathan M.
Published: November 2020

Spinal cord stimulation (SCS) is a minimally invasive procedure used for a broad spectrum of chronic pain conditions. Unfortunately, complications can occur that may lead to device explantation. The most common reason for explantation is loss of efficacy (LoE). “Salvage therapy” is the conversion from 1 mode of stimulation to another when LoE occurs. Salvage therapy has been described with multiple modes of stimulation. To our knowledge, salvage therapy with high-frequency SCS for LoE with burst SCS has not been previously described. We present a case of salvage therapy utilizing 10 kHz SCS for LoE with a passive recharge burst SCS.
Liberalism and Inner Life: The Curious Cases ofMansfield ParkandVillette
Authors: Scribner Abby
Published: November 2020

This article takes up two famously disliked nineteenth-century novels—Jane Austen's Mansfield Park and Charlotte Brontë's Villette—and argues that they are dissatisfying to readers because their protagonists fail to cohere as liberal subjects around a legible interior realm. Mansfield Park initially offers its east room as a spatial analogue for Fanny Price's interior, but it gradually revokes narrative access to the space in order to defer wholly to external status markers. Likewise, Villette's Lucy Snowe creates architectural constructions as a means of representing her inner realm to an outside world. However, each instance results in an impossible space that fails to establish the contours of Lucy's interior. The article reads the failures of subjectivation in the two novels in light of critical accounts that link the nineteenth-century novel to liberalism, a link that is often established through a shared emphasis on the interior. It thus examines what could come next once such a link is broken: a reevaluation of the default political perspective of the nineteenth-century novel but also a renewed understanding of the variety of subjective forms that liberalism is able to capture.
A piggybacking mechanism enables peroxisomal localization of the glyoxylate cycle enzyme Mdh2 in yeast
Authors: Gabay-Maskit Shiran , Cruz-Zaragoza Luis Daniel , Shai Nadav , Eisenstein Miriam , Bibi Chen , Cohen Nir , Hansen Tobias , Yifrach Eden , Harpaz Nofar , Belostotsky Ruth , Schliebs Wolfgang , Schuldiner Maya , Erdmann Ralf , Zalckvar Einat
Published: November 2020

Eukaryotic cells have evolved organelles that allow the compartmentalization and regulation of metabolic processes. Knowledge of molecular mechanisms that allow temporal and spatial organization of enzymes within organelles is therefore crucial for understanding eukaryotic metabolism. Here, we show that the yeast malate dehydrogenase 2 (Mdh2) is dually localized to the cytosol and to peroxisomes and is targeted to peroxisomes via association with Mdh3 and a Pex5-dependent piggybacking mechanism. This dual localization of Mdh2 contributes to our understanding of the glyoxylate cycle and provides a new perspective on compartmentalization of cellular metabolism, which is critical for the perception of metabolic disorders and aging.
Mechanistic analysis of the enhanced RNAi activity by 6-mCEPh-purine at the 5′ end of the siRNA guide strand
Authors: Brechin Vincent , Shinohara Fumikazu , Saito Jun-ichi , Seitz Hervé , Tomari Yukihide
Published: November 2020

A key approach for improving siRNA efficacy is chemical modifications. Through an in silico screening of modifications at the 5′-end nucleobase of the guide strand, an adenine-derived compound called 6-(3-(2-carboxyethyl)phenyl)-purine (6-mCEPh-purine) was identified to improve the RNAi activity in cultured human cells and in vivo mouse models. Nevertheless, it remains unclear how this chemical modification enhances the siRNA potency. Here, we used a series of biochemical approaches to quantitatively evaluate the effect of the 6-mCEPh-purine modification at each step in the assembly of the RNAi effector complex called RISC. We found that the modification improves the formation of mature RISC at least in two different ways, by fixing the loading orientation of siRNA duplexes and increasing the stability of mature RISC after passenger strand ejection. Our data will provide a molecular platform for further development of chemically modified siRNA drugs.
Housing with support for older people: a mixed-methods systematic review protocol
Authors: Coyle Camille , Buggy Sarah , Cagney Olivia , Farragher Louise , Lee Caitriona , Patje Darren , Long Jean
Published: November 2020

Background: The implementation of housing with support is rapidly expanding, particularly as life expectancy is increasing throughout the world. This expansion is likely to intensify in the context of coronavirus disease 2019 (COVID-19), which has revealed the risks of relying primarily on nursing homes. This mixed-methods systematic review aims to: 1) explore older people’s perceptions and experiences of housing with support and 2) examine the impact of providing housing with support for older people on their quality of life.

Methods: The databases Ovid Medline, Ovid Social Policy & Practice, EBSCO CINAHL, and EBSCO SOCIndex will be searched, and grey literature will also be identified. Quality assessment will be carried out using Joanna Briggs Institute’s Critical Appraisal Checklist for Qualitative Research as well as a tool from the National Institutes of Health for observational cohort studies. This review will employ convergent parallel design; as such, qualitative and quantitative findings will be synthesised separately in the initial stage of analysis. The results from the qualitative and quantitative syntheses will then be integrated in the final stage of the analysis.

Conclusion: This systematic review will synthesise the evidence regarding older people’s perceptions and experiences of housing with support and the impact of providing housing with support for older people on their quality of life.
Geometric Modeling of Stress Visualization Tools Based on the Functional-Voxel Method
Authors: Pushkarev S. , Plaksin A. , Sycheva A. , Harlanova P.
Published: November 2020

One of the approaches to the construction of graphic images of the stress state for the force vector applied to a point is considered in this work. Has been proposed a geometric model for a continuous medium, formed by a bunch of projection planes for each point of the examined object’s space. This permits to obtain a model for a volume vector in the form of a distributed decomposition into stress components at each point specified by a bunch of projection planes. The building a model for a volume vector, defined as a set of specified laws of direction and length, in the context of modeling stress from an applied force vector to a selected point, is based on strength of materials’ classical laws for calculation the stress state values at an inclined section. Such approach allows use a voxel graphic structure for computer representation of the simulated stress, rather than a finite element mesh. In such a case, there is no obtained result’s error dependence on the spatial position of the mesh nodal points, which is often a problem in FEM calculations. The resulting functional-voxel computer model of the volume stress vector is a structural unit for modeling the distributed load on areas of complex configuration. In this case, the elementary summation of such vectors allows any uneven distribution of the load relative to each point on the specified area. The considered approach works well with geometric models initially represented analytically in the form of a function space (for example, models obtained by the R-functional modelling – RFM-method), and reduced to functional-voxel computer models. A method for deformation modeling based on obtained stresses by means of local transformations of the function space, describing the investigated geometric object, is demonstrated.
Using fibrin sealant for skin graft fixation to avoid sedation in children with burns: a prospective study
Authors: Kwa Kelly AA , Pijpe Anouk , Korte Dirk de , Snoeks Annabel , Breederveld Roelf S , Meij-de Vries Annebeth
Published: November 2020

Objective:

To investigate whether a fibrin sealant, Fitrix (Sanquin Blood Supply Foundation, The Netherlands), for fixation of skin grafts in children with burn wounds is less invasive and equally effective in comparison with skin staples.

Method:

A single-centre prospective observational cohort study was conducted. Children requiring skin grafting after burns were included and received the fibrin sealant. This group was compared with a retrospective control group of children whose skin grafts were fixed with skin staples. Study outcomes were graft take, graft dislocation, other wound complications, healing and need for sedation.

Results:

In the fibrin sealant and the control groups, 17 and 27 patients were included, respectively. The percentage of total body surface area (%TBSA) grafted was smaller (p=0.028) in the fibrin sealant group (median 1.0, interquartile range (IQR) 1.5 versus 2.0, IQR 2.5). There was no significant difference in graft take or wound healing. There were two graft dislocations in the fibrin sealant group and none in the control group. Other complications included a patient with graft failure in the fibrin sealant group, and another patient with a vanishing graft and wound infection in the control group. There were fewer sedations in the fibrin sealant group compared with the control group (one versus 20, p<0.0001).

Conclusion:

The fibrin sealant used in this study was non-inferior for the fixation of skin grafts in comparison with skin staples, and avoided sedation procedures.