bluuebunny/crossref_metadata_2025 huggingface dataset:
The Hepatitis C Care Cascade During the Direct-Acting Antiviral Era in a United States Commercially Insured Population
Authors: Ferrante Nicole D , Newcomb Craig W , Forde Kimberly A , Leonard Charles E , Torgersen Jessie , Linas Benjamin P , Rowan Sarah E , Wyles David L , Kostman Jay , Trooskin Stacey B , Lo Re Vincent
Published: September 2022

Background

Periodic surveillance of the hepatitis C virus (HCV) care cascade is important for tracking progress toward HCV elimination goals, identifying gaps in care, and prioritizing resource allocation. In the pre-direct-acting antiviral (DAA) era, it was estimated that 50% of HCV-infected individuals were diagnosed and that 16% had been prescribed interferon-based therapy. Since then, few studies utilizing nationally representative data from the DAA era have been conducted in the United States.

Methods

We performed a cross-sectional study to describe the HCV care cascade in the United States using the Optum de-identified Clinformatics® Data Mart Database to identify a nationally representative sample of commercially insured beneficiaries between January 1, 2014 and December 31, 2019. We estimated the number of HCV-viremic individuals in Optum based on national HCV prevalence estimates and determined the proportion who had: (1) recorded diagnosis of HCV infection, (2) recorded HCV diagnosis and underwent HCV RNA testing, (3) DAA treatment dispensed, and (4) assessment for cure.

Results

Among 120,311 individuals estimated to have HCV viremia in Optum during the study period, 109,233 (90.8%; 95% CI, 90.6%–91.0%) had a recorded diagnosis of HCV infection, 75,549 (62.8%; 95% CI, 62.5%–63.1%) had a recorded diagnosis of HCV infection and underwent HCV RNA testing, 41,102 (34.2%; 95% CI, 33.9%–34.4%) were dispensed DAA treatment, and 25,760 (21.4%; 95% CI, 21.2%–21.6%) were assessed for cure.

Conclusions

Gaps remain between the delivery of HCV-related care and national treatment goals among commercially insured adults. Efforts are needed to increase HCV treatment among people diagnosed with chronic HCV infection to achieve national elimination goals.
Risk Factors for Colistin-Resistant Carbapenem-Resistant Klebsiella pneumoniae in the Postacute Care Setting
Authors: Zhang Helen L , Han Jennifer H , Lapp Zena , Snitkin Evan , Goldstein Ellie J C , Muldoon Sean , Tolomeo Pam , Lautenbach Ebbing
Published: September 2022

We assessed risk factors for colistin resistance among carbapenem-resistant Klebsiella pneumoniae (CRKP) from 375 patients in long-term acute care hospitals. Recent colistin or polymyxin B exposure was associated with increased odds of colistin resistance (adjusted odds ratio = 1.11 per day of exposure, 95% confidence interval = 1.03–1.19, P = .007).
Mutation of histone H3 serine 28 to alanine influences H3K27me3-mediated gene silencing in Arabidopsis thaliana
Authors: Xu Linhao , Cheng Jinping , Jiang Hua
Published: September 2022

Histone modifications are essential for chromatin activity and play an important role in many biological processes. Trimethylation of histone H3K27 (H3K27me3) is a repressive modification established by Polycomb Repressive Complex 2 (PRC2). Although the presence of the histone H3 serine 28 phosphorylation (H3S28ph) modification at adjacent amino acid residues has both positive and negative effects on Polycomb silencing in mammals, little is known about the effect of H3S28ph on H3K27me3-mediated gene silencing in plants. In this study, we show that mutating H3S28A in Arabidopsis (Arabidopsis thaliana) causes a dominant-negative effect that leads to an early-flowering phenotype by promoting the expression of flowering-promoting genes independently of abnormal cell division. While H3S28ph levels decreased due to the H3S28A mutation, H3K27me3 levels at the same loci did not increase. Moreover, we observed decreased H3K27me3 levels at some known PRC2 target genes in H3.3S28A transgenic lines, rather than the expected enhanced H3K27me3-mediated silencing. In line with the reduced H3K27me3 levels, the expression of the PRC2 catalytic subunits CURLY LEAF and SWINGER decreased. Taken together, these data demonstrate that H3.3S28 is required for PRC2-dependent H3K27me3-mediated silencing in Arabidopsis, suggesting that H3S28 has a noncanonical function in H3K27me3-mediated gene silencing.
Measuring Support for Women’s Political Leadership
Authors: Sundström Aksel , Stockemer Daniel
Published: September 2022

Public opinion surveys are a fundamental tool to measure support for women’s political rights. This article focuses on perceptions of women’s suitability for leadership. To what extent do influential cross-country surveys that include such items suffer from measurement errors stemming from gender of interviewer effects? Building on the literature on social desirability, we expect that respondents are more likely to express preference for men’s suitability as political leaders with male interviewers and more likely to state support for women’s leadership when interviewed by a woman. We hypothesize that these processes are conditioned by having one’s spouse present, by age differences between respondents and interviewers, as well as by respondents’ levels of education. Analyzing Afrobarometer data, we generally find support for our claims. In addition, it seems that men are slightly more affected by such effects than women are. These gender of interviewer effects persist when analyzing alternative survey rounds and are insensitive to various fixed effects specifications and robustness tests. For the analysis of survey data, we suggest that researchers using gender-related items should control for gender of interviewer effects. We propose that comparative survey programs pay even more attention to interviewer characteristics and the interview situation in their protocols.
Quality of life, disease activity and preferences for administration routes in rheumatoid arthritis: a multicentre, prospective, observational study
Authors: Direskeneli Haner , Karadag Omer , Ates Askin , Tufan Abdurrahman , Inanc Nevsun , Koca Serdar S , Cetin Gozde Y , Akar Servet , Cinar Muhammet , Yilmaz Sedat , Yilmaz Neslihan , Dalkilic Ediz , Bes Cemal , Yilmazer Baris , Sahin Ali , Ersözlü Duygu , Tezcan Mehmet E , Sen Nesrin , Keser Gokhan , Kalyoncu Umut , Armagan Berkan , Hacibedel Basak , Helvacioglu Kerem , Cesur Teoman Y , Basibuyuk Canberk S , Alkan Serdar , Gunay Levent Mert
Published: September 2022

Objective

We aimed to evaluate quality of life (QoL), disease activity, compliance to treatment, patient and physician preferences for route of administration (RoA), status of health and pain in RA patients starting advanced treatments or needing a switch, and the factors associated with patient preferences.

Methods

A multicentre, prospective, observational and 1-year follow-up study was conducted, between 2015 and 2020, in adult RA patients using advanced treatments for the first time or needing a switch in their current treatments. All the data collected were entered into electronic case report forms. DAS in 28 joints with ESR [DAS28-4(ESR)], EuroQol 5-Dimensional Questionnaire (EQ-5D), HAQ Disability Index (HAQ-DI), Compliance Questionnaire for Rheumatology (CQR-19), Work Productivity and Activity Impairment Instrument (WPAI) and Patient Global Assessment-Visual Analogue Scale (PGA-VAS) questionnaires were used for longitudinal assessments.

Results

Four hundred and fifty-nine patients were enrolled. Three hundred and eight patients (67.1%) attended the final study visit at 12 months and were included for comparative analyses. Irrespective of RoA, the disease activity and QoL improved significantly at 12 months, whereas compliance worsened. At baseline and 12 months, EQ-5D and DAS28-4(ESR) scores were significantly correlated (P < 0.001). The WPAI scores changed significantly in favour of better outcomes over 12 months after initiation of advanced treatment or switching (P < 0.001). A higher proportion of patients preferred an oral RoA, in comparison to physicians (53.6% vs 31.4%; P < 0.001). Patient and physician RoA preferences were independent of gender, age, disease duration, advanced treatment type and the EQ-5D-3L, DAS28-4(ESR), HAQ-DI, PGA-VAS and CQR-19 scores at baseline.

Conclusion

The oral route was more frequently preferred by patients compared with physicians, although patients’ preference rates showed a slight increase towards the end of the treatment, which might be an important factor for RA outcomes. Better control of disease activity and QoL were achieved at 12 months, regardless of RoA.
Does collective bargaining reduce health inequalities between labour market insiders and outsiders?
Authors: Sochas Laura , Reeves Aaron
Published: September 2022

Collective bargaining institutions are correlated with better population health. However, there are still major gaps in our understanding regarding the impact of collective bargaining on health inequalities, particularly between labour market ‘insiders’ and ‘outsiders’. In this study, we investigate the effect of collective bargaining coverage on individuals’ self-rated health, and whether the impact varies according to labour market status. We use four waves of the European Values Survey (1981–2018) and three-level nested random intercept models across 33 OECD and European countries (N = 66 301). We find that stronger and more inclusive collective bargaining institutions reduce health inequalities between the unemployed and the employed by disproportionately improving the health of the unemployed. This study implies that targeting the political institutions that shape the distribution of power and resources is important for reducing health inequalities.
Conglomeration of T- and B-Cell Matrix Responses Determines the Potency of Human Bone Marrow Mesenchymal Stromal Cells
Authors: Porter Amanda P , Pirlot Bonnie M , Dyer Kalyn , Uwazie Crystal C , Nguyen Jimmy , Turner Caitlin , Rajan Devi , Hematti Peiman , Chinnadurai Raghavan
Published: September 2022

Cell manufacturing facilities need to define the potency of mesenchymal stromal cells (MSCs) as cellular therapeutics in advanced clinical trials or marketing approval. Since MSCs’ mechanism of action in humans is not well defined, more than a single functional property of MSCs needs to be captured as a surrogate measure of potency utilizing assay matrix technologies. However, the current limitation is the sole investigation of MSC-mediated T-cell suppression as a surrogate measure of potency. We investigated the effect of MSCs on B-cell matrix responses to be incorporated into the assay matrix potency analytical system. Our results demonstrate that MSCs inhibit B-cell differentiation and block pan-antibody secretion upon activation of B cells in the PBMCs. In contrast, MSCs are inferior in blocking B-cell matrix responses when purified B cells are used. Mechanistic analysis has demonstrated that MSC-mediated inhibition of B-cell matrix responses is non-contact dependent and Tryptophan metabolic pathway plays a major role, akin to the mechanism of MSC-mediated T-cell suppression. MSCs also inhibit both T-cell and B-cell responses when both of these lymphoid populations are concurrently activated in the PBMCs. Secretome analysis of MSC and T/B cell-activated PBMC cocultures identified direct and inverse correlative matrix signatures between humoral antibody isotypes and secretory molecules. The current analysis of the combined and concomitant investigation of T-cell and B-cell matrix responses fulfills the potency assay matrix strategy by incorporating MSCs’ interaction with more than a single inflammatory immune responder.
Patient Race and Racial Composition of Delivery Unit Associated With Disparities in Severe Maternal Morbidity: A Multistate Analysis 2007–2014
Authors: Sastow D.L. , Jiang S.Y. , Tangel V.E. , Matthews K.C. , Abramovitz S.E. , Oxford-Horrey C.M. , White R.S.
Published: September 2022

(Int J Obstet Anesth. 2021;47:103160)

Black women have a higher rate of severe maternal morbidity (SMM) than non-Hispanic White women. Although investigations of SMM and race/ethnicity have typically centered around inequalities at the patient level, SMM is also associated with quality of care at the hospital level. Mothers who give birth in hospitals that serve a disproportionate number of black women (Black-serving hospitals) are more likely to have SMM than mothers who deliver at hospitals that serve fewer black women. Likewise, mothers who deliver at hospitals with a relatively greater proportion of patients without insurance or on public insurance (safety-net burden) have an increased risk for SMM. Few studies have investigated the relationship between hospital-level and patient‐level factors and risk for SMM. Using State Inpatient Databases (SID), data from Healthcare and Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality (AHRQ) for the years 2007–2014, this retrospective observational study attempted to calculate the odds of SMM with the hospital-level factors of safety-net burden and Black-serving classification, both separately and in conjunction with the patient’s race/ethnicity.
Comparison of Chloroprocaine Versus Lidocaine With Epinephrine, Sodium Bicarbonate, and Fentanyl for Epidural Extension Anesthesia in Elective Cesarean Delivery: A Randomized, Triple-blind, Noninferiority Study
Authors: Sharawi N. , Bansal P. , Williams M. , Spender H. , Mhyre J.
Published: September 2022

(Anesth Analg. 2021;132: 666–675)

Neuraxial analgesia is utilized in over 70% of labors in the United States. The authors of this study report a general consensus among their local and nonlocal peers that 3% chloroprocaine or CP, a local anesthetic with a quick preparation time, and 2% lidocaine, epinephrine, bicarbonate, and fentanyl, or LEBF, which needs additional preparation time, have similar onset times when used to convert epidural pain relief to epidural anesthesia for cesarean delivery (CD). To their knowledge, no study has confirmed this assumption. This study analyzes the onset times of CP and LEBF.
Effectiveness of Uterine Tamponade Devices for Refractory Postpartum Hemorrhage After Vaginal Birth: A Systematic Review
Authors: Pingray V. , Widmer M. , Ciapponi A. , Hofmeyr G.J. , Deneux C. , Gülmezoglu M. , Bloemenkamp K. , Oladapo O.T. , Comandé D. , Bardach A. , Vázquez P. , Cormick G. , Althabe F.
Published: September 2022

(BJOG. 2021;128:1732–1743)

Most postpartum hemorrhage (PPH) deaths occur due to uterine atony. While first-line interventions for PPH such as uterotonics, tranexamic acid, and uterine massage are effective for most patients, 10% to 20% of patients are unresponsive to these and are deemed to have “refractory” PPH. Uterine tamponade devices (UTD) used to treat refractory PPH include uterine balloon tamponade (UBT) and uterine suction tamponade (UST). The World Health Organization has previously issued a conditional recommendation for the use of UBT to treat refractory PPH due to uterine atony, based on case series and studies with no control population. Since then, several relevant studies, including randomized controlled trials, have been published. This systematic review aims to evaluate uterine tamponade devices for safety and effectiveness in treating atonic refractory PPH following vaginal birth and examine the effects of including uterine tamponade devices into institutional PPH protocols.
Preincision Adjunctive Prophylaxis for Cesarean Deliveries: A Systematic Review and Meta-analysis
Authors: Markwei M.T. , Babatunde I. , Rathi N. , Fan C. , Prah M.-A. , Joo J. , Hackett L. , Soper D.E. , Goje O.
Published: September 2022

(Am J Obstet Gynecol. 2021;225:382.e1–382.e13)

Surgical site infections (SSI) occur after 2% to 7% of cesarean deliveries. While the administration of preincision beta-lactam antibiotics is recommended, there is a high rate of SSIs following cesarean delivery. Adjunctive prophylaxis, or the administration of a second antibiotic, has been shown to decrease postcesarean SSI rates. Azithromycin has been the adjunctive prophylaxis drug of choice in addition to cefazolin. As azithromycin was more difficult to obtain during the COVID-19 pandemic, clarithromycin has been used in its place. This study aimed to evaluate the use of preincision cefazolin with macrolides or metronidazole compared with cefazolin alone in terms of decreasing the incidence of SSIs following cesarean delivery.
Spontaneous Intracranial Hypotension
Authors: Schievink W.I.
Published: September 2022

(N Engl J Med. 2021;385:2173–2178)

Spontaneous intracranial hypotension presents as below-normal cerebrospinal fluid (CSF) due to CSF leakage from an unknown cause. While spontaneous intracranial hypotension is treatable, it is difficult to diagnose. Imaging has identified 3 types of spontaneous spinal CSF leaks: linear tear in the dura posterolateral or ventral to the spinal cord; diffuse dilatations of the dural sac or leakage at the simple meningeal diverticula; or the space between the CSF-venous fistulas and proximal veins. It is estimated that spontaneous intracranial hypotension occurs in 4 to 5 cases per 100,000 population.
Turn Your Attention to Distractions
Authors: Rothman B.S. , Bledsoe S. , Rice M.J.
Published: September 2022

(Anesth Analg. 2022;134:266–268)

The use of personal electronic devices (PEDs) in health care can support effective communication, enhance patient safety and contribute to higher quality of care. PEDs allow providers to document care in electronic medical records, communicate securely, and leverage applications for situational awareness. They can also be used to support medical education and direction, as well as care team models, regardless of location.
Adverse Pregnancy Outcomes Attributable to Socioeconomic and Ethnic Inequalities in England: A National Cohort Study
Authors: Jardine J. , Walker K. , Gurol-Urganci I. , Webster K. , Muller P. , Hawdon J. , Khalil A. , Harris T. , van der Meulen J. ,   on behalf of the National Maternity and Perinatal Audit Project Team
Published: September 2022

(Lancet. 2021;398:1905–1912)

Pregnancy outcomes (eg, stillbirth, preterm birth, and neonatal and infant mortality) in high-income countries tend to be worse among patients from ethnic minority groups and lower socioeconomic status (SES) compared with White patients or patients of higher SES. While there are efforts to reduce these inequalities, more information is needed to understand which groups are most affected and how severe these gaps are. This national cohort study examined the socioeconomic and ethnic inequalities in the rates of fetal growth restriction (FGR), preterm birth, and stillbirth, accounting for health conditions at the beginning of pregnancy and complications that affect pregnancy.
Association of Medicaid Expansion With Neuraxial Labor Analgesia Use in the United States: A Retrospective Cross-Sectional Analysis
Authors: Xiao M. , Whitney D. , Guo N. , Sun E. , Wong C. , Bentley J. , Butwick A.
Published: September 2022

(Anesth Analg. 2022;134:505–514)

Before 2010, 1 in 4 women and 1 in 8 pregnant women were uninsured. The United States’ Patient Protection and Affordable Care Act enacted in 2010 aimed to insure these uninsured individuals and families by increasing Medicaid coverage. The number of states observing this act, as it is optional, has increased from 26 in 2014 to 38 in 2021. While Medicaid expansion increased coverage for prenatal care and childhood, Medicaid’s effect on neuraxial labor analgesia use is unclear. Previous studies show lower pain scores, and higher patient satisfaction scores are linked with neuraxial analgesia for the 75% of women who receive it. Localized labor analgesia minimizes general anesthesia risks, including airway complications, postoperative pain, and neonatal resuscitation. This study analyzes the effects of Medicaid expansion on neuraxial labor analgesia use since its adoption.
Trends, Characteristics, and Outcomes of Placenta Accreta Spectrum: A National Study in the United States
Authors: Matsuzaki S. , Mandelbaum R.S. , Sangara R.N. , McCarthy L.E. , Vestal N.L. , Klar M. , Matsushima K. , Amaya R. , Ouzounian J.G. , Matsuo K.
Published: September 2022

(Am J Obstet Gynecol. 2021;225:534.e1–534.e38)

Placenta accreta spectrum (PAS) is a rare but dangerous condition that occurs when placental tissue attaches into the gravid uterus, specified by degrees of invasive attachment. Maternal death is among the risks of this condition in the peri-cesarean delivery (CD) period. Other reports on PAS draw from a small number of patients or are limited to a single hospital. A large national survey was performed to investigate population-wide prevalence, risks, characteristics, and outcomes for patients with PAS in the context of CD.
Attention-deficit/Hyperactivity Disorder in Children Following Prenatal Exposure to Antidepressants: Results From the Norwegian Mother, Father, and Child Cohort Study
Authors: Lupattelli A. , Mahic M. , Handal M. , Ystrom E. , Reichborn-Kjennerud T. , Nordeng H.
Published: September 2022

(BJOG. 2021;128:1917–1927. [Epub June 8, 2021])

Previous investigations into the risk of offspring developing attention-deficit/hyperactivity disorder (ADHD) due to prenatal exposure to antidepressants have produced inconsistent conclusions. While familial factors have been identified as the most important influence for increased ADHD risk in children exposed at any point prenatally to antidepressants, it is unknown if timing or duration of exposure increase risk. This study measured the association of child ADHD by diagnoses and symptoms with prenatal use of selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor antidepressants at any time during pregnancy, or by timing and duration. Quantification bias of exposure misclassification was handled by study replication in an exposure-controlled subgroup.
Temporal Trends in Between and Within-country Inequalities in Cesarean Delivery in Low- and Middle-income Countries: A Bayesian Analysis
Authors: Hasan M.M. , Ahmed S. , Soares Magalhaes R.J. , Begum T. , Fatima Y. , Mamun A.A.
Published: September 2022

(BJOG. 2021;128:1928–1937. [Epub June 1, 2021])

Cesarean delivery (CD) is recognized as an important life-saving intervention that also carries adverse risks. Following the dramatic rise in CD globally, health organizations have provided recommendations for avoiding preventable CD. Previous analysis of trends in CD coverage have examined global, regional, and national-level rates, but exclude other socioeconomic analysis. Low- and middle-income countries (LMIC) are the focus of this study with the intention of identifying groups vulnerable to avoidable CD and strategies to prevent these cases.
Characterizing the Need for Multiple Epidural Blood Patches in the Treatment of Postdural Puncture Headache: An Observational Study
Authors: Mustafa R. , Barman R. , Kurian E. , Eldrige J. , Frank R. , Kissoon N. , Garza I. , Whealy M. , Cutsforth-Gregory J. , Olatoye O.
Published: September 2022

(Reg Anesth Pain Med. 2021;46:1110–1112)

Previous studies have determined the effectiveness of epidural blood patch (EBP) on postdural puncture headache (PDPH) patients, though little research has been done on repeated image guided EBP. This study aims to predict the factors contributing to and the rate of repeated image-guided EBP treatment for (PDPH) patients.
Introduction of a Standardized Maternity Early Warning System: Indicative Data From a Before-and-After Study at a Large Pilot Site Before National Rollout in Aotearoa New Zealand
Authors: Drake M. , Austin G. , Dann L. , Li Y. , Shuker C. , Psirides A.
Published: September 2022

(Anaesthesia. 2021;76:1600–1606)

While there are recognition and response standards in place to decrease preventable adverse outcomes for nonpregnant adult patients and there is maternity-specific observation scoring system (MEOWS) in place for obstetric patients in the United Kingdom. An in-depth multidisciplinary review of study cases in Aotearoa New Zealand showed inadequate recognition and response standards may have significantly impacted maternal morbidity. A major tertiary hospital in Auckland piloted a modified version of the Aotearoa New Zealand early warning system (NZEWS) to promote better recognition and response of deteriorating pregnant women (NZMEWS). This study aimed to determine the efficacy of NZMEWS shown in the number of code blue and code red (cardiorespiratory arrests and very unwell women need an emergency response team, respectively) comparing the occurrence of codes before and after NZMEWS implementation.
Unanticipated Consequences of Switching to Sugammadex: Anesthesia Provider Survey on the Hormone Contraceptive Drug Interaction
Authors: Dwan R.L. , Raymond B.L. , Richardson M.G.
Published: September 2022

(Anesth Analg. 2021;133:958–966)

Sugammadex is thought to reduce the efficacy of hormonal contraceptive (HC) due to its ability to bind progesterone. In February 2017, a large, tertiary-care medical center switched from neostigmine to sugammadex as the neuromuscular blockade (NMB) drug of choice. Care should be taken by anesthesiologists to recommend alternative contraceptive methods for patients exposed to sugammadex to avoid unintentional pregnancy. This study, conducted 2 years following the switch to sugammadex, aims to assess the institution’s anesthesiologist provider management of the drug and any knowledge gaps present.
Spontaneous Abortion Following COVID-19 Vaccination During Pregnancy
Authors: Kharbanda E.O. , Haapala J. , DeSilva M. , Vazquez-Benitez G. , Vesco K.K. , Naleway A.L. , Lipkind H.S.
Published: September 2022

(JAMA. 2021;326:1629–1631)

Spontaneous abortion is one of the most important outcomes of interest for COVID-19 vaccine studies in the pregnant population. At the time of publication of this study, 1 vaccine was approved and 2 were authorized for use in pregnant women. Data on maternal COVID-19 safety was primarily collected through passive surveillance. This study used data collected from case-control surveillance of pregnant women COVID-19 and vaccination data from electronic health records, with spontaneous abortion as the main outcome.
Covid-19 Vaccination During Pregnancy and First-trimester Miscarriage
Authors: Magnus M.C. , Gjessing H.K. , Eide H.N. , Wilcox A.J. , Fell D.B. , Håberg S.E.
Published: September 2022

(N Engl J Med. 2021;385:2008–2010. [Epub October 20, 2021])

Parturient women are encouraged to receive the COVID-19 vaccination to decrease adverse maternal outcomes, however, vaccination safety data during pregnancy is limited.
A Randomized Pilot Clinical Trial of Pravastatin Versus Placebo in Pregnant Patients at High Risk of Preeclampsia
Authors: Constantine M.M. , West H. , Wisner K.L. , Caritis S. , Clark S. , Venkataramanan R. , Stika C.S. , Rytting E. , Wang X. , Ahmed M.S.
Published: September 2022

(Am J Obstet Gynecol. 2021;225:666.e1–15)

Preeclampsia affects up to 8% of pregnancies and is associated with maternal and neonatal morbidities. Preeclampsia also shares characteristics with other cardiovascular diseases. Pravastatin has been considered a possible method of preventing preeclampsia, supported by preclinical studies and pilot clinical studies using 10 mg pravastatin in high-risk patients. This study aimed to determine the safety and pharmacokinetic parameters of 20 mg pravastatin in patients with a high risk of preeclampsia.
Use of Metformin to Prolong Gestation in Preterm Preeclampsia
Authors: Cluver C.A. , Hiscock R. , Decloedt E.H. , Hall D.R. , Schell S. , Mol B.W. , Brownfoot F. , Kaitu'u-Lino T.J. , Walker S.P. , Tong S.
Published: September 2022

(BMJ. 2021;374:n2103)

Preterm preeclampsia affects 10% of all women with preeclampsia worldwide. Although preeclampsia prevention is attempted with therapies including low-dose aspirin, there are no current treatments for preeclampsia once diagnosed other than delivery. Preterm preeclampsia causes increased risk for both maternal and neonatal morbidity and mortality, especially in developing areas without adequate obstetric or NICU care.
Addition of Oral Iron Bisglycinate to Intravenous Iron Sucrose for the Treatment of Postpartum Anemia-randomized Controlled Trial
Authors: Yefet E. , Mruat Rabah S. , Sela N.D. , Hosary Mhamed S. , Yossef A. , Nachum Z.
Published: September 2022

(Am J Obstet Gynecol. 2021;225:668.e1–668.e9. [Epub June 23, 2021])

Postpartum anemia has serious adverse maternal outcomes. Iron is the primary cause of postpartum anemia. Moderate to severe anemia is recommended to be treated with intravenous (IV) iron such as iron sucrose. Although IV iron has been found to be superior to oral treatment for rate of serum ferritin and hemoglobin (Hb) increase, compliance after discharge may be low due to need for use of medical facilities for administration. Adding oral to IV iron has not been evaluated. This study aimed to determine whether oral iron bisglycinate added to IV iron sucrose for the treatment of postpartum anemia was more effective than IV iron sucrose.
Effect of Minimally Invasive Surfactant Therapy Versus Sham Treatment on Death or Bronchopulmonary Dysplasia in Preterm Infants With Respiratory Distress Syndrome The OPTIMIST: A Randomized Clinical Trial
Authors: Dargaville P.A. , Kamlin O.F. , Orsini F. , Wang X. , De Paoli A.G. , Kanmaz Kutman H.G. , Cetinkaya M. , Aiyappan A. , Lemyre B. , Kuo S. , Rajadurai V.S. , O’Shea J. , Biniwale M. , Ramanathan R. , Kushnir A. , Bader D. , Thomas M.R. , Mallinath C. , Buksh M.J. , Bhatia R. , Sullivan C.L. , Shinwell E.S. , Dyson A. , Barker D.P. , Kugelman A. , Donovan T.J. , Tauscher M.K. , Murthy V. , Ali S.K.M. , Yossuck P. , Clark H.W. , Soll R.F. , Carlin J.B. , Davis P.G.
Published: September 2022

(JAMA. 2021;326:2478–2487)

Continuous positive airway pressure (CPAP) is recommended for newly born preterm infants. A previous meta-analysis of clinical trials compared CPAP to intubation and ventilation in terms of death or bronchopulmonary dysplasia and found CPAP had a relative risk of 0.91 [95% confidence interval (CI), 0.84-0.99]. In the studies used in meta-analysis, exogenous surfactant was administered only to infants with relatively high levels of inspired oxygen. This study, the OPTIMIST-A trial aimed to determine whether minimally invasive surfactant therapy, using a thin catheter, would lower the incidence of death and/or bronchopulmonary dysplasia.
Hydrocortisone to Improve Survival Without Bronchopulmonary Dysplasia
Authors: Watterberg K.L. , Walsh M.C. , Li L. , Chawla S. , D'Angio C.T. , Goldberg R.N. , Hintz S.R. , Laughon M.M. , Yoder B.A. , Kennedy K.A. , McDavid G.E. , Backstrom-Lacy C. , Das A. , Crawford M.M. , Keszler M. , Sokol G.M. , Poindexter B.B. , Ambalavanan N. , Hibbs A.M. , Truog W.E. , Schmidt B. , Wyckoff M.H. , Khan A.M. , Garg M. , Chess P.R. , Reynolds A.M. , Moallem M. , Bell E.F. , Meyer L.R. , Patel R.M. , Van Meurs K.P. , Cotten C.M. , McGowan E.C. , Hines A.C. , Merhar S. , Peralta-Carcelen M. , Wilson-Costello D.E. , Kilbride H.W. , DeMauro S.B. , Heyne R.J. , Mosquera R.A. , Natarajan G. , Purdy I.B. , Lowe J.R. , Maitre N.L. , Harmon H.M. , Hogden L.A. , Adams-Chapman I. , Winter S. , Malcolm W.F. , Higgins R.D. ,   Eunice Kennedy Shriver NICHD Neonatal Research Network
Published: September 2022

(N Engl J Med. 2022;386:1121–1131)

The diagnosis of bronchopulmonary dysplasia (BPD) in extremely preterm infants portends potentially abnormal growth, neurodevelopment, and respiratory function. This prevalent condition affects half of extreme preterm birth survivors and likely has a multiplicity of causes: prematurity, oxygen exposure, mechanical ventilation, and inflammatory processes. Dexamethasone was previously widely used until adverse neurological effects including cerebral palsy and cognitive impairment became apparent in the patient population later in life. Despite these complications, many extremely premature infants continue to receive dexamethasone therapy for BPD. Hydrocortisone, another steroid, when administered to extremely premature neonates has produced advantageous characteristics and has shown promising test results in neonates who are developing BPD. Administration of hydrocortisone showed mitigating effects on neonatal inflammation and decreased adverse neurodevelopmental effects. This extended trial, beginning in 2011, investigates the efficacy of high-dose hydrocortisone treatment at improving life expectancy without BPD by monitoring for severe neurodevelopmental disorder through 22 to 26 months.
Safety of Nirsevimab for RSV in Infants With Heart or Lung Disease or Prematurity
Authors: Domachowske J. , Madhi S.A. , Simões E.A.F. , Atanasova  ,   the MEDLEY Study Group
Published: September 2022

(N Engl J Med. 2022;386:892–894)

Nirsevimab (N) is a monoclonal antibody with an extended half-life and enhanced potency at inhibiting respiratory syncytial virus (RSV) in cell-culture and animal models over the existing drug palivizumab (Pa). The results from the first RSV season of a study spanning 2 seasons on the safety and pharmacokinetics of N are reported. Otherwise healthy late-term and term infants infected with RSV were assessed in MELODY phase 2B and phase 3 trials, while a separate ongoing study is evaluating the efficacy of N in infants at risk for severe RSV infection.
Women With Kidney Disease Can Be Given a Personal Risk Assessment for Pregnancy
Authors: Saul H. , Gursul D.
Published: September 2022

(BMJ. 2021;375:n2526)

Advanced chronic kidney disease (CKD) is associated with a higher risk of preterm birth and low birthweight neonates. Studies exploring maternal and neonatal complications associated with CKD have been scarce. A large recent study examined predictive factors for the risk of complications and progression of kidney disease during pregnancy among patients with CKD.
Intrathecal Catheter Use After Accidental Dural Puncture in Obstetric Patients: Literature Review and Clinical Management Recommendations
Authors: Orbach-Zinger S. , Jadon A. , Lucas D. N. , Sia A. T. , Tsen L. C. , Van de Velde M. , Heesen M.
Published: September 2022

(Anaesthesia. 2021;76:1111–1121)

In the event of an accidental dural puncture (ADP) the epidural can be either resited or a catheter can be inserted intrathecally for use as a continuous spinal (intrathecal, IT) catheter, thus eliminating the need for needle reinsertion. An IT catheter may also permit swift labor analgesia and facilitate cesarean delivery anesthesia. However, clinical management of IT catheters for labor analgesia is not without risk of adverse effects. Accordingly, this review evaluates recent studies on IT catheters for parturients, including the management and quality of analgesia and anesthesia, the effect on postdural puncture headache (PDPH) risk, obstacles to use, and deficiencies in our current understanding.
The Association Between Labor Epidural Case Volume and the Rate of Accidental Dural Puncture
Authors: Sidhu N.S. , Cavadino A. , Ku H. , Kerckhoffs P. , Lowe M.
Published: September 2022

(Anaesthesia. 2021;76:1060–1067)

Labor analgesia accomplished with epidural catheter placement can be complicated by accidental dural puncture (ADP), with recent reported rates at obstetric centers ranging from 0.52% to 3.6%. The incidence of postdural puncture headache following ADP is frequent and can be severe and debilitating. The assumption that ADP rate is higher among trainees compared with specialists has opposing data in the literature, which analysis may have been confounded by a factor of skill decay. This study examined the effect of decreased labor epidural volume and skill decay on ADP rate and the effect of training grade among anesthesia trainees on likelihood of ADP.
Factors Associated With an Increased Risk of Instrumental Vaginal Delivery in Women With Epidural Analgesia for Labor: A Retrospective Cohort Study
Authors: Au-Yong P.S. , Tan C.W. , Tan W.H. , Tan K.H. , Goh Z. , Sultana R. , Sng B.L.
Published: September 2022

(Eur J Anaesthesiol. 2021;38:1059–1066)

Although epidural analgesia is an effective and common method of pain management during labor and delivery, studies suggest there may be an increased risk of instrumental vaginal delivery (IVD, forceps or vacuum extractor) use. Instrumental delivery increases risk of maternal and neonatal morbidity and outcomes. This study aimed to identify women at increased risk of instrumental delivery and strategies to decrease associated maternal and neonatal morbidity.
Severe Recalled Labor Pain and Elective Cesarean Section in a Subsequent Delivery: A Cohort Study of Norwegian Parous Women
Authors: Junge C. , von Soest T. , Seidler A. , Eberhard-Gran M. , Garthus-Niegel S.
Published: September 2022

(Acta Obstet Gynecol Scand. 2021;100:1678–1687)

Although the pain experienced in labor is quickly forgotten by most women, some with negative childbirth experiences may recall intense labor pain years later. These women may experience postpartum anxiety which can have a negative impact on the women and their ability to tend to their newborns. This can also affect other childbearing decisions including increased spacing between pregnancies, a reduced number of children, and an increased request for elective cesarean delivery (CD) in subsequent pregnancies. The rate of CD in Norway has risen by 13.3% from 1972 despite the WHO CD recommendation of a 10% to 15% CD rate together with evidence that there is no reduction in maternal or child mortality if the CD rate is >10%. With patient-requested CD increasing, the authors from Norway investigated whether a patient’s recall of labor pain from a previous vaginal delivery (VD) influenced their preference for their future mode of delivery. In addition, potential confounders such as maternal demographic, somatic and mental health factors were also evaluated in case these may have influenced such an association.
A Randomized Double-blind Comparison of Phenylephrine and Norepinephrine for the Management of Postspinal Hypotension in Pre-eclamptic Patients Undergoing Cesarean Section
Authors: Mohta M.R.L. , Chilkoti G.T. , Agarwal R. , Malhotra R.K.
Published: September 2022

(Eur J Anaesthesiol. 2021;38:1077–1084)

Phenylephrine is the vasopressor of choice during cesarean delivery (CD) with spinal anesthesia; however, it can cause reflex bradycardia. Norepinephrine is being investigated as an alternative due to its ability to maintain better blood pressure (BP), heart rate, and cardiac output compared with phenylephrine while still seeing similar neonatal outcomes. Studies involving pre-eclamptic women need to be conducted to determine norepinephrine’s effectiveness in this population. This study aimed to compare bolus doses of norepinephrine and phenylephrine for postspinal hypotension in pre-eclamptic women undergoing CD.
Association Between Hyperbaric Bupivacaine Dose and Maternal Hypotension: Retrospective Database Study of 8226 Women Undergoing Cesarean Delivery Under Spinal Anesthesia
Authors: Weiniger C.F. , Heesen M. , Knigin D. , Deutsch F. , Hilber N. , Avidan A.
Published: September 2022

(Anesth Analg. 2021;133:967–975)

Maternal hypotension is common following an intrathecal hyperbaric bupivacaine dose for cesarean delivery. Studies have varied results or insufficient data when investigating the optimal dose of hyperbaric bupivacaine to reduce the incidence of hypotension. The aim of the study was to determine the relationship between hyperbaric bupivacaine dose and spinal-induced maternal hypotension for women undergoing cesarean delivery.
The Effects of Exercise Programs on Exercise Capacity and Quality of Life in Patients Who Have Undergone Non-Small Cell Lung Cancer Treatment: A Systematic Review
Authors: Pruchnicki Michaela L. , Sullivan Glenney Susan
Published: September 2022

Background:

Research has shown that individuals diagnosed with lung cancer suffer from decreased exercise capacity and health-related quality of life. There is a need to determine the effect of specific exercise intervention on exercise capacity and health-related quality of life in the non–small cell lung cancer population in order for exercise to be incorporated into the standard of care.

Purpose:

The purpose of this systematic review was to determine the effects of exercise training on exercise capacity and quality of life in patients who have undergone treatment for non–small cell lung cancer.

Methods:

Three databases were searched for articles that met the inclusion criteria. The search resulted in a total of 332 articles with 16 that met the criteria for inclusion.

Results:

Eight of the 16 studies showed significant improvement in exercise capacity and 4 showed significant improvement in quality of life with exercise training.

Discussion and Limitations:

This review provided limited evidence that exercise training in addition to usual care will provide improvement in overall exercise capacity and quality of life in this population. Limitations included reports of small sample size in the articles included, few databases searched, and heterogeneity of exercise programs.

Conclusions:

This systematic review supports exercise training as a method for improving exercise capacity and health-related quality of life in patients who have been diagnosed with non–small cell lung cancer. Further research must be done with more subjects and exercise protocols to make specific recommendations for exercise training in this population.
Patient-Reported Pain and Function Outcomes in Children With Congenital Vertical Talus Treated With the Minimally Invasive Method
Authors: Cummings Jason L. , Hosseinzadeh Pooya
Published: September 2022

Background:

In 2006, a new minimally invasive method was introduced for the definitive correction of congenital vertical talus (CVT) deformity. There are no studies to date that have utilized the Patient-Reported Outcome Measurement Information System (PROMIS) to evaluate long-term quality of life outcomes in these patients.

Methods:

We identified all children with CVT who underwent treatment with the minimally invasive method and were seen at our institution after 2015. A retrospective chart review was then performed on these patients, and PROMIS scores were recorded for the following domains: Pain Interference, Mobility, and Peer Relations. Subgroup analysis was performed on patients who experienced recurrence and those who required a second corrective surgery. An alpha level of 0.05 was used for all analyses.

Results:

There were 24 children who were treated for CVT at our institution after 2015 and had completed PROMIS surveys. Seven (29.2%) of these patients developed recurrence during the follow-up period. Among the entire cohort, the mean PROMIS pain interference score was 48±9, the mean PROMIS mobility score was 42±13, and the mean PROMIS peer relations score was 54±9. There were no statistically significant differences in the PROMIS scores between the entire cohort and those who experienced radiographic recurrence in any of the 3 domains (P>0.05). Children who initiated treatment after the age of 12 months had lower PROMIS mobility scores than those who initiated treatment before 12 months of age (32.48 vs. 47.31, P=0.02).

Conclusion:

On average, children who undergo treatment with this technique end up within 1 SD of the reference population in all 3 domains that were measured (pain interference, mobility, and peer relations) regardless of sex, age, and status of recurrence. However, there was a trend towards lower mobility scores in this population compared with the reference population (42±13 vs. 50±10). Treatment should be initiated at less than 12 months of age whenever possible to maximize patient-reported outcomes.

Level of Evidence:

Level III.
Effects of postsystolic shortening and diastolic dyssynchrony on myocardial work in untreated early hypertension patients
Authors: Tsai Huey-Ru , Hsu Han-Chung , Wu Chun-I , Lee Wen-Huang , Tsai Wei-Chuan
Published: September 2022

Objectives:

Myocardial work is estimated from noninvasive pressure-strain loop for advanced assessment of left ventricular function. Postsystolic shortening and diastolic dyssynchrony of left ventricle were noted early in hypertension. Their novel effects on myocardial work will be illustrated in this study.

Methods:

We recruited 43 newly diagnosed hypertensive patients (mean age 51.3 ± 12.5 years, 55.8% men) and 32 age-matched and sex-matched healthy individuals (mean age 52.7 ± 10.5 years, 37.5% men) as control. Pressure-strain loop derived myocardial work incorporated global longitudinal strain from speckle tracking echocardiography with brachial artery cuff pressure. Postsystolic strain index (PSI) was defined by the percentage of postsystolic shortening over peak strain. Diastolic dyssynchrony was assessed by standard deviation of time to peak early diastolic strain rate (TDSr-SD) of 18 segments, and maximal difference of time to peak early diastolic strain rate (TDSr-MD) between any two segments.

Results:

After multivariate regression analysis, global myocardial work index (GWI) was independently correlated with TDSr-SD (B = −0.498, P = 0.001) and TDSr-MD (B = −0.513, P = 0.001). Global myocardial constructive work (GCW) was independently correlated with TDSr-SD (B = −0.334, P = 0.025) and TDSr-MD (B = −0.397, P = 0.007). Global myocardial wasted work (GWW) was independently correlated with PSI (B = 0.358, P = 0.019). Global myocardial work efficiency (GWE) was lower in hypertensive patients than healthy control (P = 0.001). The untreated hypertensive patients were different from the healthy individuals with higher TDSr-SD, TDSr-MD, GWI, GCW, GWW, and PSI (all P < 0.05).

Conclusion:

In conclusion, the effect of diastolic dyssynchrony mainly influenced constructive work, whereas postsystolic shortening affected wasted work in early untreated hypertension.
Renal arteriovenous fistula complicated with malignant hypertension: a case report
Authors: Zhang Zhiyu , Zhang Xiaobo , Gui Yang , Wang Xi , Tong Anli , Yu Songlin , Li Mingxi , Zheng Ke , Qin Yan , Xia Peng , Chen Limeng
Published: September 2022

Renal arteriovenous fistula (RAVF) is a rare vascular disease and is usually presented with severe hypertension. Renin–angiotensin–aldosterone system (RAAS) activation was proposed to play a key role in RAVF-induced hypertension but the data was inconsistent. We reported a case of RAVF presented as malignant hypertension, which was detected by contrast-enhanced ultrasonography and successfully managed by interventional embolization. A 35-year-old male was presented with a headache and blurred vision. His blood pressure was up to 220/110 mmHg, with significantly elevated serum creatinine and proteinuria. Hypertensive target organ impairments were noted. A RAVF was detected by contrast-enhanced renal ultrasonography. He underwent renal artery angiography and renal arteriovenous fistula embolization. RAAS activation was also evaluated by separate renal vein sampling. The patient's blood pressure and target-organ damage improved after RAVF embolization and blood pressure control. This is a rare case of renal arteriovenous fistula with malignant hypertension. Contrast-enhanced ultrasonography can be useful for diagnosis.