bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and Efficacy of Ultrasound-Guided Cryoablation for Benign Breast Fibroepithelial Lesions
Authors: Plaza Michael J , Kumar Aswin V , Sanchez-Gonzalez Marcos A
Published: August 2019

Objective

The purpose of this study is to evaluate the safety and efficacy of cryoablation for benign breast fibroepithelial lesions (FELs) that otherwise warrant surgical excision, including symptomatic fibroadenomas, growing fibroadenomas, and cellular FELs.

Methods

All patients from 2016–2018 who had ultrasound-guided cryoablation of a symptomatic and/or growing fibroadenoma or cellular fibroepithelial lesion were reviewed. The electronic medical record was reviewed for any procedure-related complications and reduction in mass volume by ultrasound and was recorded to assess for efficacy. Patients were surveyed using a seven-point Likert scale to assess satisfaction with the procedure and a ten-point visual analog pain scale to assess level of discomfort.

Results

Twenty-four women (average age 37.1 years, range 19–57 years) with 26 FELs were treated with no adverse events and 100% technical success. Thirteen cellular FELs and 13 symptomatic and/or growing fibroadenomas were ablated. Twenty-two patients had an average imaging follow-up of 11.7 months (range 5–23 months), and 18 patients completed the follow-up survey. There was 92% (22/24) clinical success, defined as a greater-than-50% reduction in mass volume. Average reduction in mass volume was 86% overall. Eighty-five percent (17/20) would recommend the procedure to others and reported pain during the procedure to be minimal (average 2.4 out of 10) with overall satisfaction rating of 6.2 out of 7. Twelve symptomatic masses demonstrated a significant reduction in pain after cryoablation (P = 0.01).

Conclusion

Cryoablation is a safe and efficacious minimally invasive nonsurgical alternative for the treatment of benign breast FELs.
Optimization of treatment strategy by using a machine learning model to predict survival time of patients with malignant glioma after radiotherapy
Authors: Mizutani Takuya , Magome Taiki , Igaki Hiroshi , Haga Akihiro , Nawa Kanabu , Sekiya Noriyasu , Nakagawa Keiichi
Published: August 2019

The purpose of this study was to predict the survival time of patients with malignant glioma after radiotherapy with high accuracy by considering additional clinical factors and optimize the prescription dose and treatment duration for individual patient by using a machine learning model. A total of 35 patients with malignant glioma were included in this study. The candidate features included 12 clinical features and 192 dose–volume histogram (DVH) features. The appropriate input features and parameters of the support vector machine (SVM) were selected using the genetic algorithm based on Akaike’s information criterion, i.e. clinical, DVH, and both clinical and DVH features. The prediction accuracy of the SVM models was evaluated through a leave-one-out cross-validation test with residual error, which was defined as the absolute difference between the actual and predicted survival times after radiotherapy. Moreover, the influences of various values of prescription dose and treatment duration on the predicted survival time were evaluated. The prediction accuracy was significantly improved with the combined use of clinical and DVH features compared with the separate use of both features (P < 0.01, Wilcoxon signed rank test). Mean ± standard deviation of the leave-one-out cross-validation using the combined clinical and DVH features, only clinical features and only DVH features were 104.7 ± 96.5, 144.2 ± 126.1 and 204.5 ± 186.0 days, respectively. The prediction accuracy could be improved with the combination of clinical and DVH features, and our results show the potential to optimize the treatment strategy for individual patients based on a machine learning model.
A posthumanist pedagogy using digital text analysis to enhance critical thinking in higher education
Authors: O'Halloran Kieran
Published: August 2019

I model a critical posthumanist pedagogy that uses text analysis software and is aimed at higher education students. A key purpose of the pedagogy is to help students enhance empathetic, critical and independent thinking. For their project assignment, the student chooses an unfamiliar campaign seeking to eliminate suffering and extend rights. They gather all texts from the campaign website into a corpus, which thus represents the campaign writ large. Then they use appropriate software to ascertain, efficiently and rigorously, common campaign concerns across this corpus. This puts students in a position to discern any significant concerns in the campaign corpus that are not addressed in text(s) supporting the status quo which the campaign opposes. Should significant omissions be found, students critically evaluate the status quo text(s) from the campaign’s perspective. Since this perspective derives from the student identifying (at least temporarily) with software generated data, it is a posthuman subjectivity. Engaging digitally and empathetically with a campaign’s data at scale for creation of a posthuman subjectivity can broaden awareness of disadvantage, discrimination, and suffering as well as expand horizons. Moreover, at the end of the assignment, the student is expected to formulate their own position vis-à-vis the previously unfamiliar campaign. Conditions have been created then for the student to enhance independent thinking too.
Cosmic web anisotropy is the primary indicator of halo assembly bias
Authors: Ramakrishnan Sujatha , Paranjape Aseem , Hahn Oliver , Sheth Ravi K
Published: August 2019

The internal properties of dark matter haloes correlate with the large-scale halo clustering strength at fixed halo mass – an effect known as assembly bias – and are also strongly affected by the local, non-linear cosmic web. Characterizing a halo’s local web environment by its tidal anisotropy α at scales approximately four times the halo radius, we demonstrate that these multiscale correlations represent two distinct statistical links: one between the internal property and α, and the other between α and large-scale (${\gtrsim}30\, h^{-1}\, {\rm Mpc}$) halo bias b1. We focus on scalar internal properties of haloes related to formation time (concentration cvir), shape (mass ellipsoid asphericity c/a), velocity dispersion structure (velocity ellipsoid asphericity cv/av and velocity anisotropy β), and angular momentum (dimensionless spin λ) in the mass range $8\times 10^{11}\lesssim M_{\rm vir}/(\, h^{-1}\, \mathrm{M}_{\odot })\lesssim 5\times 10^{14}$. Using conditional correlation coefficients and other detailed tests, we show that the joint distribution of α, b1, and any of the internal properties c ∈ {β, cv/av, c/a, cvir, λ} is consistent with p(α, b1, c) ≃ p(α)p(b1|α)p(c|α), at all but the largest masses. Thus, the assembly bias trends c↔b1 reflect the two fundamental correlations c↔α and b1↔α. Our results are unaffected by the exclusion of haloes with recent major merger events or splashback objects, although the latter are distinguished by the fact that α does not explain their assembly bias trends. The overarching importance of α provides a new perspective on the nature of assembly bias of distinct haloes, with potential ramifications for incorporating realistic assembly bias effects into mock catalogues of future large-scale structure surveys and for detecting galaxy assembly bias.
A new sample of southern radio galaxies: host-galaxy masses and star-formation rates
Authors: Marubini Takalani , Jarvis Matt J , Fine Stephen , Mauch Tom , McAlpine Kim , Prescott Matthew
Published: August 2019

In this study we define a new sample of distant powerful radio galaxies in order to study their host galaxy properties and provide targets for future observations of H i absorption with new radio telescopes and to understand the fuelling and feedback from such sources. We have cross-matched the Sydney University Molonglo Sky Survey (SUMSS) radio catalogue at 843 MHz with the VISTA Hemisphere Survey (VHS) near-infrared catalogue using the likelihood ratio technique. Photometric redshifts from the Dark Energy Survey are then used to assign redshifts to the radio source counterparts. We found a total of 249 radio sources with photometric redshifts over a 148 deg2 region. By fitting the optical and near-infrared photometry with spectral synthesis models we determine the stellar mass and star formation rates of the radio sources, finding typical stellar masses of 1011–1012 M⊙ for the powerful high-redshift radio galaxies. We also find a population of low-mass blue galaxies. However, by comparing the derived star formation rates to the radio luminosity, we suggest that these sources are false positives in our likelihood ratio analysis. Follow-up, higher resolution (≲5 arcsec) radio imaging would help alleviate these mid-identifications, as the limiting factor in our cross-identifications is the low resolution (∼45 arcsec) of the SUMSS radio imaging.
mTOR-regulated U2af1 tandem exon splicing specifies transcriptome features for translational control
Authors: Chang Jae-Woong , Yeh Hsin-Sung , Park Meeyeon , Erber Luke , Sun Jiao , Cheng Sze , Bui Alexander M , Fahmi Naima Ahmed , Nasti Ryan , Kuang Rui , Chen Yue , Zhang Wei , Yong Jeongsik
Published: August 2019

U2 auxiliary factor 1 (U2AF1) functions in 3′-splice site selection during pre-mRNA processing. Alternative usage of duplicated tandem exons in U2AF1 produces two isoforms, U2AF1a and U2AF1b, but their functional differences are unappreciated due to their homology. Through integrative approaches of genome editing, customized-transcriptome profiling and crosslinking-mediated interactome analyses, we discovered that the expression of U2AF1 isoforms is controlled by mTOR and they exhibit a distinctive molecular profile for the splice site and protein interactomes. Mechanistic dissection of mutually exclusive alternative splicing events revealed that U2AF1 isoforms’ inherent differential preferences of nucleotide sequences and their stoichiometry determine the 3′-splice site. Importantly, U2AF1a-driven transcriptomes feature alternative splicing events in the 5′-untranslated region (5′-UTR) that are favorable for translation. These findings unveil distinct roles of duplicated tandem exon-derived U2AF1 isoforms in the regulation of the transcriptome and suggest U2AF1a-driven 5′-UTR alternative splicing as a molecular mechanism of mTOR-regulated translational control.
Postmortem Dissections of Common Targets for Lesion and Deep Brain Stimulation Surgeries
Authors: Holanda Vanessa M , Okun Michael S , Middlebrooks Erik H , Gungor Abuzer , Barry Margaret E , Forder John , Foote Kelly D
Published: August 2019

BACKGROUND

The subthalamic nucleus (STN), globus pallidus internus (GPi), and pedunculopontine nucleus (PPN) are effective targets for deep brain stimulation (DBS) in many pathological conditions. Previous literature has focused on appropriate stimulation targets and their relationships with functional neuroanatomic pathways; however, comprehensive anatomic dissections illustrating these nuclei and their connections are lacking. This information will provide insight into the anatomic basis of stimulation-induced DBS benefits and side effects.

OBJECTIVE

To combine advanced cadaveric dissection techniques and ultrahigh field magnetic resonance imaging (MRI) to explore the anatomy of the STN, GPi, and PPN with their associated fiber pathways.

METHODS

A total of 10 cadaveric human brains and 2 hemispheres of a cadaveric head were examined using fiber dissection techniques. The anatomic dissections were compared with 11.1 Tesla (T) structural MRI and 4.7 T MRI fiber tractography.

RESULTS

The extensive connections of the STN (caudate nucleus, putamen, medial frontal cortex, substantia innominata, substantia nigra, PPN, globus pallidus externus (GPe), GPi, olfactory tubercle, hypothalamus, and mammillary body) were demonstrated. The connections of GPi to the thalamus, substantia nigra, STN, amygdala, putamen, PPN, and GPe were also illustrated. The PPN was shown to connect to the STN and GPi anteriorly, to the cerebellum inferiorly, and to the substantia nigra anteriorly and superiorly.

CONCLUSION

This study demonstrates connections using combined anatomic microdissections, ultrahigh field MRI, and MRI tractography. The anatomic findings are analyzed in relation to various stimulation-induced clinical effects. Precise knowledge of neuroanatomy, anatomic relationships, and fiber connections of the STN, GPi, PPN will likely enable more effective targeting and improved DBS outcomes.
The Relationship Between Electronic Cigarette Use and Conventional Cigarette Smoking Is Largely Attributable to Shared Risk Factors
Authors: Kim Sooyong , Selya Arielle S
Published: August 2019

Introduction

The growing popularity of electronic cigarettes (e-cigarettes) among youth raises concerns about possible causal effects on conventional cigarette smoking. However, past research remains inconclusive due to heavy confounding between cigarette and e-cigarette use. This study uses propensity score methods to robustly adjust for shared risk in estimating the relationship between e-cigarette use and conventional smoking.

Methods

Cross-sectional data from 8th and 10th graders were drawn from the 2015–2016 waves of Monitoring the Future (n = 12 421). The effects of (1) lifetime and (2) current e-cigarette use on (A) lifetime and (B) current conventional cigarette smoking were examined using logistic regression analyses with inverse propensity weighting based on 14 associated risk factors.

Results

After accounting for the propensity for using e-cigarettes based on 14 risk factors, both lifetime and current e-cigarette use significantly increased the risk of ever smoking a conventional cigarette (OR = 2.49, 95% CI = 1.77 to 3.51; OR = 2.32, 95% CI = 1.66 to 3.25, respectively). However, lifetime (OR = 2.17, 95% CI = 0.62 to 7.63) and current e-cigarette use (OR = 0.95, 95% CI = 0.55 to 1.63) did not significantly increase the risk of current conventional cigarette smoking.

Conclusions

E-cigarette use does not appear to be associated with current, continued smoking. Instead, the apparent relationship between e-cigarette use and current conventional smoking is fully explained by shared risk factors, thus failing to support claims that e-cigarettes have a causal effect on concurrent conventional smoking among youth. E-cigarette use has a remaining association with lifetime cigarette smoking after propensity score adjustment; however, future research is needed to determine whether this is a causal relationship or merely reflects unmeasured confounding.

Implications

This study examines the relationship between e-cigarette use and conventional smoking using inverse propensity score weighting, an innovative statistical method that produces less-biased results in the presence of heavy confounding. Our findings show that the apparent relationship between e-cigarette use and current cigarette smoking is entirely attributable to shared risk factors for tobacco use. However, e-cigarette use is associated with lifetime cigarette smoking, though further research is needed to determine whether this is a causal relationship or merely reflects unaccounted-for confounding. Propensity score weighting produced significantly weaker effect estimations compared to conventional regression control.
Real exchange rate misalignment and civil conflict: Evidence from sub-Saharan Africa
Authors: Ambaw Dessie Tarko , Sim Nicholas
Published: August 2019

Real exchange rate (RER) misalignment, which is the deviation of the actual RER from its equilibrium, occurs frequently in developing countries. In this article, we show that civil conflict in sub-Saharan Africa (SSA) can be influenced by RER misalignment. To do so, we construct an RER misalignment index whose variation is driven by shocks to each country’s RER fundamentals. Based on a panel of 35 countries from 1975 to 2006, we find that RER misalignment may increase the incidence of civil conflict in sub-Saharan Africa on average. Crucially, this effect is present even when rainfall and commodity price shocks—two widely acknowledged causes of civil conflict—are controlled for. Therefore, our article suggests that RER stabilization can foster political stability in the region.
Simultaneous Bilateral Carotid Thrombectomies: A Technical Note
Authors: Larrew Thomas , Hubbard Zachary , Almallouhi Eyad , Banerjee Chirantan , Moss Mark , Spiotta Alejandro M
Published: August 2019

BACKGROUND

Although extremely rare, acute bilateral large vessel occlusion (LVO) is a morbid condition that requires prompt intervention.

OBJECTIVE

To report the technique used to achieve recanalization of bilateral internal carotid artery (ICA) terminus occlusions.

METHODS

This is a case of bilateral ICA terminus occlusions managed with simultaneous bilateral thrombectomies with poor collateral circulation.

RESULTS

Recanalization of bilateral ICA with thrombolysis in cerebral infarction (TICI) grade 0 to left TICI 2b flow with distal left A1 occlusion and right TICI 3 flow was achieved in 32 min with the use of simultaneous catheterization and aspiration thrombectomies.

CONCLUSION

The described technique offers an efficient and feasible means to reduce time to recanalization and radiation in cases of bilateral LVO.
Kompaneets equation for neutrinos: Application to neutrino heating in supernova explosions
Authors: Suwa Yudai , Tahara Hiroaki W H , Komatsu Eiichiro
Published: August 2019

We derive a “Kompaneets equation” for neutrinos, which describes how the distribution function of neutrinos interacting with matter deviates from a Fermi–Dirac distribution with zero chemical potential. To this end, we expand the collision integral in the Boltzmann equation of neutrinos up to the second order in energy transfer between matter and neutrinos. The distortion of the neutrino distribution function changes the rate at which neutrinos heat matter, as the rate is proportional to the mean square energy of neutrinos, $E_\nu^2$. For electron-type neutrinos the enhancement in $E_\nu^2$ over its thermal value is given approximately by $E_\nu^2/E_{\nu,\rm thermal}^2=1+0.086(V/0.1)^2$, where $V$ is the bulk velocity of nucleons, while for the other neutrino species the enhancement is $(1+\delta_v)^3$, where $\delta_v=mV^2/3k_{\rm B}T$ is the kinetic energy of nucleons divided by the thermal energy. This enhancement has a significant implication for supernova explosions, as it would aid neutrino-driven explosions.
Benefits of Musculoskeletal Physical Therapy in Emergency Departments: A Systematic Review
Authors: Matifat Eveline , Méquignon Marianne , Cunningham Caitriona , Blake Catherine , Fennelly Oma , Desmeules François
Published: August 2019

Background

Over the past few decades, physical therapists have emerged as key health care providers in emergency departments (EDs), especially for patients with musculoskeletal disorders (MSKD).

Purpose

The purpose of this review was to update the current evidence regarding physical therapist care for patients with MSKD in EDs and to update current recommendations for these models of care.

Data Sources

Systematic searches were conducted in 5 bibliographic databases.

Study Selection

The studies selected presented quantitative data related to the care of patients with MSKD by physical therapists in an ED setting.

Data Extraction

Raters reviewed studies and used the Effective Public Health Practice Project Quality Assessment Tool to assess their methodological quality.

Data Synthesis

Fifteen studies were included. Two studies, 1 of weak and 1 of strong quality, demonstrated that physical therapist care in EDs was as effective as or more effective than usual medical care for pain reduction, and 6 studies of varying quality reported that physical therapist care in EDs was as effective as usual care in EDs in reducing disability. Eight studies of varying quality reported that physical therapist care could significantly reduce waiting time in EDs. Four studies of varying quality reported that physical therapists ordered no more, or even fewer, medical images than physicians. In terms of health care costs, 2 studies of moderate to high quality found no significant differences in costs between physical therapist care and usual care in EDs. Finally, 6 studies of varying quality reported that patients were as satisfied or more satisfied with physical therapist care as with usual medical care in EDs.

Limitations

The roles of physical therapists in EDs vary depending on the setting, legislation, and training of providers. Only a limited number of high-quality studies were identified.

Conclusions

Although the quality of the evidence is heterogeneous, physical therapist care for patients with MSKD in EDs may be beneficial.
Normal gait, albumin and d-dimer levels identify low risk emergency department patients: a prospective observational cohort study with 365-day 100% follow-up
Authors: Lyngholm L , Nickel C H , Kellett J , Chang S , Cooksley T , Brabrand M
Published: August 2019

Background

If survival could be reliably predicted many patients could be safely managed outside of hospital in an ambulatory care setting.

Aim

Comparison of common laboratory findings, co-morbidities, mobility and vital signs as predictors of mortality of acutely ill emergency department (ED) attendees.

Design

Prospective observational study.

Methods

Secondary analysis of 1334 consenting acutely ill patients attending a Danish ED.

Results

67 (5%) out of 1334 patients died within 100 days. After logistic regression seven predictors of 100 days mortality remained significant: an albumin level ≤34 gm/l, D-dimer level >0.51 mg/l, an Asadollahi score (based on admission laboratory data and age) ≥12, a platelet count <159 X 1000/ml, impaired mobility on presentation, a respiratory rate ≥30 bpm and a Charlson co-morbidity index ≥3. Only 5 of the 442 without any of these variables died within 365 days. Only one of the 517 patients with a stable independent gait and normal d-dimer and albumin levels died within 100 days, none died within 30 days of assessment and 12 died within 365 days. Of the remaining 817 patients 66 (8%) died within 100 days.

Conclusion

These findings suggest that normal gait, albumin and d-dimer levels are the most parsimonious way of identifying low risk ED patients.
Society of Behavioral Medicine Position Statement: promote sun-safety policies and practices for youth in educational, childcare, and recreational settings
Authors: Heckman Carolyn J , Riley Mary , Coups Elliot J , Niu Zhaomeng , Stapleton Jerod L
Published: August 2019

Youth should be allowed and encouraged to engage in sun-safe behaviors in educational, childcare, and recreational settings, including use of sunscreen, wide-brimmed hats, other sun-protective clothing, and shade.
Challenging the Traditional Definition of a Difficult Intubation: What is Difficult?
Authors: Bradley J.A. , Urman R.D. , Yao D.
Published: August 2019

(Anesth Analg. 2019;128(3):584–586. Doi:10.1213/ANE.0000000000003886)

While video laryngoscopy (VL) has brought substantial changes to the practice of airway management, the way anesthesiologists define a “difficult intubation” has not been altered accordingly. The American Society of Anesthesiologists has defined a “difficult airway” as “the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with intubation, or both,” and also has set forth clear, separate definitions of difficult endotracheal intubation and difficult laryngoscopy. These latter 2 definitions can be subjective and interpreted inconsistently, however, and varied devices and contexts make these definitions even more ambiguous. A patient may not be labeled as a difficult intubation by one provider, but labeled difficult by another provider in a different setting. A study by Lewis and colleagues showed when VL was used, there were significantly fewer failed intubations compared with direct laryngoscopy (DL) alone. However, VL has not outdone the success rate of awake fiberoptic intubations in patients with perceived difficult airway. VL is available in >90% of operating rooms in British National Health Service hospitals according to a survey by Cook and Kelly, and some studies have recommended the use of VL become standard of care for both routine and difficult intubations.
Recurrence of Preeclampsia and the Risk of Future Hypertension and Cardiovascular Disease: A Systematic Review and Meta-Analysis
Authors: Brouwers L. , van der Meiden-van Roest A.J. , Savelkoul C. , Vogelvang T.E. , Lely A.T. , Franx A. , van Rijn B.B.
Published: August 2019

(BJOG. 2018;125:1642–1654)

Preeclampsia, which is associated with cardiovascular disease (CVD), occurs in 3% to 5% of first pregnancies and has a recurrence rate of 15% in subsequent pregnancies. In fact, a pregnancy complicated by preeclampsia may suggest a disposition to CVD and help to identify women at risk for future disease. However, not all women with preeclampsia develop CVD. In the present review, the available evidence was evaluated on recurrent pregnancy complications, particularly preeclampsia, and future lifetime cardiovascular risk.
Modified Early Obstetric Warning Scores: A Promising Tool but More Evidence and Standardization is Required
Authors: Robbins T. , Shennan A. , Sandall J.
Published: August 2019

(Acta Obstet Gynecol Scand. 2019;98:7–10)

While maternal mortality in the United Kingdom is low compared with the rest of the world (4.65 per 100,000 live births, 2012-2014) there was no significant change in mortality between 2009-2011 and 2012-2014. Early warning systems (EWS) may be a tool for avoiding delays in identifying and treating acutely ill women. EWS use specific charts to monitor and record vital signs and clinical observations, using a color-coded system to indicate the need for a clinical response when an abnormal observation is recorded. This commentary examined the evidence regarding modified early obstetric warning scores (MEOWS) and current issues with the use of MEOWS.
Horner’s Syndrome Following Obstetric Neuraxial Blockade: A Systematic Review of the Literature
Authors: Chambers D.J. , Bhatia K.
Published: August 2019

(Int J Obstet Anesth. 2018;35:75–87)

Horner syndrome (HS), characterized by ipsilateral miosis, ptosis and anhydrosis, has been reported following regional anesthetic techniques such as cervical and brachial plexus blocks and epidural anesthetics. Although rare, HS has been reported in women who underwent obstetric neuraxial blockade (NB). The current authors undertook a systematic review of the literature that reported HS after obstetric NB in order to better inform anesthesiologists regarding the course and management of this condition.
Clearsight Use for Hemodynamic Monitoring During the Third Trimester of Pregnancy: A Validation Study
Authors: Duclos G. , Hili A. , Resseguier N. , Kelway C. , Haddam M. , Bourgoin A. , Carcopino X. , Zieleskiewicz L. , Leone M.
Published: August 2019

(Int J Obstet Anesth. 2018;36:85–95)

Monitoring cardiac output (CO) in pregnant patients has been suggested as a means to improve outcomes for mother and child as blood pressure and clinical signs may not be sufficient proxys for CO. Currently, the gold standard for CO measurement is the thermodilution technique via a pulmonary artery catheter or transthoracic echocardiography (TTE). This study aimed to evaluate the Clearsight, a noninvasive hemodynamic monitoring system that uses “volume clamp” technology to produce a continuous arterial BP wave, as a valid monitor of CO and stroke volume (SV) in parturients compared with TTE.
Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism
Authors: van der Pol L.M. , Tromeur C. , Bistervels I.M. , Ni Ainle F. , van Bemmel T. , Bertoletti L. , Couturaud F. , van Dooren Y.P.A. , Elias A. , Faber L.M. , Hofstee H.M.A. , van der Hulle T. , Kruip M.J.H.A. , Maignan M. , Mairuhu A.T.A. , Middeldorp S. , Nijkeuter M. , Roy P.M. , Sanchez O. , Schmidt J. , Ten Wolde M. , Klok F.A. , Huisman M.V.
Published: August 2019

(N Engl J Med. 2019;380(12):1139–1149. Doi:10.1056/NEJMoa1813865)

Pregnancy and venous thromboembolism (VTE) share many symptoms and physiological changes, presenting a challenge for VTE diagnosis in pregnant women. The threshold for testing pregnant women for pulmonary embolism is low, as this population is at higher risk for VTE and fatal pulmonary embolism. While some studies have examined the practice of ruling out pulmonary embolism in pregnant women without imaging tests (only using decision rules or D-dimer tests), there is a lack of international consensus regarding diagnostic approaches for pulmonary embolism during pregnancy. The YEARS study showed a low incidence of diagnostic failure when using the YEARS diagnostic algorithm in men and women. This study aimed to evaluate a pregnancy-adapted version of the YEARS algorithm for the management of suspected pulmonary embolism during pregnancy.
Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist
Authors: Haskins S.C. , Kruisselbrink R. , Boublik J. , Wu C.L. , Perlas A.
Published: August 2019

(Reg Anesth Pain Med. 2018;43:689–698)

A significant cause of patient morbidity in the perioperative setting is pulmonary aspiration of gastric contents. Despite patients following the American Society of Anesthesiologists recommendations for fasting before a procedure, there is substantial variability in gastric-emptying time among patients. This may lead to a small percentage of patients that still have solid gastric contents at the time of operation. Gastric ultrasound has the potential to play an important role in the perioperative setting to provide reliable information regarding gastric content and assessment of aspiration risk.
Assessing Long-Term Neurodevelopmental Outcome Following General Anesthesia in Early Childhood: Challenges and Opportunities
Authors: Walkden G.J. , Pickering A.E. , Gill H.
Published: August 2019

(Anesth Analg. 2019;128(4):681–694. Doi:10.1213/ANE.0000000000004052)

While general anesthesia has long been considered a safe practice in pediatric surgery, there has been growing concern that it may have lasting neurodevelopmental effects on those exposed during early childhood or as fetuses. In the United Kingdom, general anesthesia is administered to ~5% of children before they reach age 6. Animal studies, including nonhuman primates, have showed an association between altered brain development in immature animals and commonly used IV and inhalational anesthetic agents. There have been conflicting results in human observational studies of anesthetic-induced neurotoxicity, but regulatory and professional bodies have released precautionary statements. This study aimed to better inform design of future clinical studies on this topic by reviewing 76 clinical studies of long-term neurodevelopmental outcome after general anesthesia exposure in early childhood or before birth.
United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women
Authors: Butwick A.J. , Bentley J. , Wong C.A. , Snowden J.M. , Sun E. , Guo N.
Published: August 2019

(JAMA Netw Open. 2018;1:e186567)

Guidelines for levels of maternal care for obstetric analgesia and anesthesia, as per the American College of Obstetricians and Gynecologists, state that anesthesia services should be available in all hospitals offering maternal care. However, there is insufficient research to determine the extent or characteristics of the geographic variability across US states in neuraxial analgesia use. The authors of the present study used multilevel modeling, accounting for patient-level and state-level factors, to assess variability in neuraxial analgesia practices in the United States in 2015.
Comparison of the ED50 and ED95 of Intrathecal Bupivacaine in Parturients Undergoing Cesarean Delivery With or Without Prophylactic Phenylephrine Infusion: A Prospective, Double-Blind Study
Authors: Xiao F. , Drzymalski D. , Liu L. , Zhang Y. , Wang L. , Chen X.
Published: August 2019

(Reg Anesth Pain Med. 2018;43(8):885–889)

Spinal-induced hypotension is a common problem resulting from the sympathectomy associated with the administration of intrathecal local anesthetic for cesarean delivery, and is associated with nausea, vomiting, loss of consciousness, impaired fetal oxygenation, and fetal acidosis. Prophylactic phenylephrine infusion is often used to decrease the risk of spinal-induced hypotension; however, its use has been associated with decreased rostral spread of intrathecal local anesthetic in pregnancy. The purpose of this study was to determine the median effective dose (ED50) and 95% effective dose (ED95) of spinal hyperbaric bupivacaine for cesarean delivery with and without a phenylephrine infusion.
Patterns of Recovery From Pain After Cesarean Delivery
Authors: Booth J.L. , Sharpe E.E. , Houle T.T. , Harris L. , Curry R.S. , Aschenbrenner C.A. , Eisenach J.C.
Published: August 2019

(Pain. 2018;159:2088–2096)

There is a lack of knowledge about patterns of recovery from pain and its predictors after surgery. Often times, clinicians only witness pain experience if the patient returns for routine care after discharge, which overall limits the clinical ability to provide appropriate pain management. In order to establish clinically relevant, generalizable patterns of recovery, as well as identify predictors from preoperative and perioperative data, patients were followed for 2 months after elective cesarean delivery via text-messaging to assess daily pain scores.
Successful Spinal Anesthesia for Cesarean Section in a Patient With Marfan Syndrome Complicated by Dural Ectasia
Authors: Skjellerup N.
Published: August 2019

(Int J Obstet Anesth. 2018;35:88–92)

Marfan syndrome (MFS) is an autosomal dominant condition characterized by connective tissue abnormalities across multiple systems. Patients with MFS may have a dilated aortic root, and this can place the parturient at increased risk during labor and delivery. Cesarean delivery is sometimes recommended for women with MFS who have an aortic root diameter >40 mm. However, reduced effectiveness of spinal anesthesia has been reported in some patients with MFS. The failure is thought to possibly be related to the dural ectasia that is present in many patients with MFS; this may lead to incomplete cephalad distribution of intrathecal local anesthetic. This case report detailed a parturient who was undergoing her second cesarean delivery after failed neuraxial anesthesia during her first delivery, with the author postulating that warmed isobaric bupivacaine, injected as far away as possible from the ectatic dural sac, may be able to overcome inconsistent intrathecal distribution.
Thirst in Patients With Heart Failure in Sweden, the Netherlands, and Japan
Authors: van der Wal Martje H.L. , Waldréus Nana , Jaarsma Tiny , Kato Naoko P.
Published: August 2019

Background:

Thirst is a distressing symptom and influences quality of life of patients with heart failure (HF). Knowledge about thirst in HF is insufficient; therefore, the aim of this study was to describe factors related to thirst, self-reported reasons for thirst, and interventions to relieve thirst in 3 different countries.

Methods:

A cross-sectional study was conducted in Sweden, the Netherlands, and Japan. Patients were recruited at the HF clinic or during HF hospitalization. Thirst was assessed by a visual analog scale (0–100); reasons for thirst and interventions to relieve thirst were assessed by an open-ended questionnaire. Patients were divided into low and high thirst based on the first and third tertiles of the visual analog scale.

Results:

Two hundred sixty-nine patients participated in the study (age, 72 ± 12 years). Mean thirst intensity was 24 ± 24, with a mean thirst of 53 ± 15 in the highest tertile. No significant differences in thirst among the 3 countries were found. Multivariable logistic regression analysis showed that a higher dose of loop diuretics (odds ratio, 3.47; 95% confidence interval, 1.49–8.06) and fluid restriction (odds ratio, 2.21; 95% confidence interval, 1.08–4.32) were related to thirst. The most reported reasons for thirst were salty/spicy food (20%) and low fluid intake (18%). Most of the patients (56%) drank more in case of thirst; 20% only drank a little bit, probably related to a fluid restriction.

Conclusions:

Thirst in patients with HF was related to a higher dose of loop diuretics and fluid restriction. Healthcare providers should realize that it is important to assess thirst regularly and reconsider the need of a fluid restriction and the amount of loop diuretics in case of thirst.
ECG pre-hospital teletransmission by emergency teams staffed with an emergency physician and paramedics and its impact on transportation and hospital admission
Authors: Sowizdraniuk Joanna , Smereka Jacek , Ladny Jerzy Robert , Kaserer Alexander , Palimonka Krzysztof , Ruetzler Kurt , Skierczynska Agnieszka , Szarpak Lukasz
Published: August 2019

Electrocardiography (ECG) is essential to detect and diagnose life threatening cardiac conditions and to determine further treatment. Correct interpretation of an ECG can be challenging, especially in the out-of-hospital setting and by less experienced emergency team members.

The aim of this study was to compare the rate of ECG transmission from an out-of-hospital emergency scene to an in-hospital cardiologist on call in EMS-B and EMS-S providers and its impact on direct transportation to a cardiac catheterization laboratory and hospital admission.

The study was designed as an observational study. Data from 3 separate emergency medical service teams were collected. Two teams are staffed by paramedics only (EMT-B), while another specialized team is staffed with an emergency physician (EMT-S). 5864 out-of-hospital emergencies were performed during a 12-month period and were analyzed for this study.

In 124 out of 5864 (2.1%) out-of-hospital emergencies, an ECG transmission from the out-of-hospital scene to an in-hospital cardiologist on call was performed. Rate of transmission was similar between both teams (EMT-B n = 70, 2.2% vs EMT-S n = 54, 2.0%, P = .054). After coordinating with the cardiologist on call, 11 patients (15.7%) of the EMT-B (15.7%) and 24 patients (44.4%) of the EMT-S were directly transported from the scene of emergency to a cardiac catheterization laboratory (P < .001). Overall, 80% of patients treated by EMT-S, compared to 52.5% treated by the EMT-B required subsequent hospital admission (P < .05).

Transmission of ECG from the out-of-hospital emergency scene to the in-hospital cardiologist is infrequently performed. The rate of STEMI in transmitted ECG's by emergency teams staffed with an emergency physician was higher compared to emergency teams staffed with paramedics only.
Posterior reversible encephalopathy syndrome with essential thrombocythemia
Authors: Zhang Yunqiao , Lu Zixiang , Li Yanping , Wu Jie , Liu Ting , Xie Xian , He Xiaolin , Zeng Yong
Published: August 2019

Rationale:

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease of the posterior subcortical white matter that manifests as headache, seizures, visual impairment, disturbance of consciousness, and changes in mental state. While PRES is associated with specific imaging findings involving the posterior circulation area of the brain. In the present study, we report the first case of PRES associated with essential thrombocythemia (ET).

Patient concerns:

A 49-year-old man suddenly experienced headache, followed by the gradual appearance of consciousness disorders and mental behavior abnormalities. Neurological tests showed that the patient had a Glasgow Coma Scale score of 12, normal muscle strength and tension of the limbs, and was negative for meningeal irritation.

Diagnosis:

Magnetic resonance imaging of the brain showed extensive vasogenic edema in the deep white matter of the right cerebellum and the left occipital and temporal lobes and a diagnosis of PRES was considered. Routine blood test showed that his platelet count was markedly increased, and the JAK2 V617F mutation analysis with allele-specific real-time polymerase chain reaction was positive. The bone marrow biopsy indicated an increasing number of megakaryocytes. These findings indicated ET.

Interventions:

PRES was treated with a dehydrating agent and supportive and symptomatic treatments. Aspirin tablets were prescribed to address the patient's ET.

Outcome:

After treatment, the abnormal findings on head imaging were completely reversed. His neurological symptoms were completely relieved.

Lessons:

PRES may be correlated with ET; specifically, ET may trigger PRES and be a risk factor for the acute onset of neurological deficits.
Liver abscess caused by ingestion of fishbone
Authors: Li Jiangfa , Zhao Daokang , Lei Liping , Zhang Longmiao , Yu Yaqun , Chen Qian
Published: August 2019

Rationale:

The penetration of a foreign body through the stomach wall and causing liver abscess is rare. A case of liver abscess caused by secondary bacterial infection was reported in the current study.

Patient concerns:

A 58-year-old male patient had a history of eating fish and presented with recurrent fever with chills. The patient had a previous fever for 9 days without any obvious inducement and the highest body temperature rose to 40.8°C, along with fear of cold and chills. Body temperature declined to normal value after 5 days of infusion treatment (drugs were unknown) in the local clinic. Two days afterward, his body temperature again rose to 40.3°C at its highest.

Diagnosis and intervention:

Abdominal computed tomography (CT) showed that there was a quasicircular low-density focus in the left hepatic lobe which was most likely a liver abscess. A dense strip was found in proximity to the left hepatic lobe, implying the retention of a catheter in the upper abdominal cavity or a foreign body. On conditions of related preoperative preparations and general anesthesia, the left hepatic lobe was resected with the laparoscope. During the operation, a fish bone was found in the liver. Postoperative symptomatic and supportive treatment was carried out without antibiotics for liver protection.

Outcomes:

The patient was cured through surgical treatment and found to be in a good condition. The patient was successfully discharged and recovered well in the follow-up visit 3 months after the operation.

Lessons:

Liver abscess caused by fish spines is rare. The contrast-enhanced CT of the abdomen and the minimally invasive abdominal operation both played critical roles in the diagnosis and treatment of the case. The general population, who mistakenly eat fish bones, should seek medical treatment as soon as possible.
Ozone and pulsed electro-magnetic field therapies improve endometrial lining thickness in frozen embryo transfer cycles
Authors: Merhi Zaher , Moseley-LaRue Rajean , Moseley Amber Ray , Smith André Hugo , Zhang John
Published: August 2019

Rationale:

In assisted reproductive technology, a persistently thin endometrial lining represents a huge challenge during frozen embryo transfer (FET) cycles.

Patient concerns:

Three patients who had a persistently thin endometrial lining despite the use of several medical agents known to improve endometrial lining thickness.

Diagnoses:

Infertility undergoing FET cycles.

Interventions:

A combination of transdermal and intravaginal ozone therapy along with Pulsed Electro-Magnetic Field (PEMF) therapy.

Outcomes:

Ozone with PEMF, both of which are known to have vasodilatatory, anti-inflammatory, and anti-oxidant actions, were successful in improving the thickness of the endometrial lining in all 3 patients. Two out of 3 patients became pregnant following single embryo transfer.

Lessons:

Ozone with PEMF constitute a novel experimental approach for women with persistently thin endometrial lining undergoing FET. This novel approach needs validation by large well-designed studies.
Effects of infrared laser moxibustion on cancer-related fatigue in breast cancer survivors
Authors: Mao Huijuan , Mao Jun J. , Chen Junchao , Li Qing , Chen Xuefen , Shen Xubo , Zhao Ling , Wei Jianzi , Shen Xueyong
Published: August 2019

Background:

Cancer-related fatigue (CRF) is the most common and distressing symptom associated with cancer treatment that breast cancer survivors (BCS) experience. We previously found that laser moxibustion may be efficacious for CRF. The primary aim of this study is to determine the specific efficacy of 10.6 μm infrared laser moxibustion on CRF. The secondary aim is to evaluate the effect of infrared laser moxibustion on co-existing symptoms that BCS experience.

Methods:

We will conduct a randomized, sham-controlled, three-arm trial of infrared laser moxibustion (ILM) against sham ILM (SILM) and waitlist control (WLC) among BCS with moderate to severe fatigue. The two intervention groups will receive either real or sham infrared laser moxibustion on four acupoints (i.e., ST36 [bilateral], CV4, and CV6) for 20 minutes each session for 6 weeks (twice per week). The primary endpoint is the change in fatigue score from Baseline to Week 6 as measured by the Chinese version of the Brief Fatigue Inventory (BFI-C). Our secondary aim is to compare the severity of co-morbidities (e.g., depression, insomnia, and pain) among the 3 groups.

Discussion:

The results of our trial will establish evidence for the efficacy of infrared laser moxibustion for CRF, a very common and challenging symptom.

Trial registration number:

NCT03553355.
Facial nerve palsy presenting as rare neurological complication of Kawasaki disease
Authors: Yuan Ye , Lu Na
Published: August 2019

Rationale:

Facial nerve palsy (FNP) is one of the rare neurologic symptoms of Kawasaki disease (KD), associated with a higher incidence of coronary arteries lesions and may be an indicator of more severe disease.

Patient concerns:

A 3-month-old male infant with persistent fever, irritability, and facial asymmetry.

Diagnoses:

KD with FNP.

Interventions:

The infant received intravenous immunoglobulin (IVIG) (2 g/kg/16 hours) and aspirin (50 mg/kg/day) were started on the 8th day of illness.

Outcomes:

Fever and FNP resolved within 48 hours after IVIG treatment. The inflammatory markers all improved to normal or near-normal levels before discharge; all infectious studies returned negative. His left facial weakness was unappreciable at day of discharge.

Lessons:

FNP associated with KD is an uncommon finding but may indicate an increased risk of coronary artery involvement. KD should always be kept in mind in the differential diagnosis of a child who presents with prolonged unexplained fever, even with incomplete diagnostic features, as well as the need to be aware of unusual manifestations, such as FNP.