bluuebunny/crossref_metadata_2025 huggingface dataset:
NOVEL TARGETED HEALTH PSYCHOLOGY CLINIC REFERRAL IMPROVES BLOOD PRESSURE: PRELIMINARY RESULTS OF A RETROSPECTIVE STUDY
Authors: Jenkins Sian , Cross Ainslea , Khunti Kamlesh , Gupta Pankaj
Published: June 2023

Objective:

Despite hypertension medications being widely available, many patients do not have adequately controlled blood pressure. Consequently, alternative interventions are required to support patients. Recently, we have established a novel health psychology clinic to provide additional support to help patients improve blood pressure control.

This retrospective study compared outcomes before and after referral to a targeted health psychology clinic. Our aim was to determine the effectiveness of this novel clinic on patient outcomes with a view to improving the service and support rollout in other departments.

Design and method:

Patient notes referred to the Health Psychology clinic were reviewed from October 2020 to December 2022 (audit number: 11703). Patient data was linked anonymised and details reflecting key outcomes, demographics and specific psychology interventions were extracted.

Results:

In the preliminary findings, 11 patients were included for analysis. Patient age ranged from 28-79 years, 18% were female and 45% were White. Patients were prescribed a mean of 3.1 hypertension medications. The mean time between the first blood pressure reading and final reading was 44.1±27.8 weeks, with a mean number of 6.6±6 visits to the clinic. Interventions were tailored to each patient's need. Four patients were supported with anxiety management, three used biofeedback and three used breathing techniques. Two patients were supported with weight management, with one patient losing 31.7kg in 6 months.

The mean systolic blood pressure (SBP) change was -11.55±17.78 mmHg (P = 0.0568), and diastolic blood pressure (DBP) was -5.80±13.15 mmHg (P = 0.1965). Two patients had increased blood pressure for unknown reasons. When these two cases were removed from analysis, the overall mean changes for SBP were -18.11±11.30 mmHg (P = 0.0013) and -9.88± 11.03mmHg for DBP (P = 0.0690). Of these blood pressure readings, 7 were conducted in the office, 2 at home, and 1 with 24hour ABPM.

Conclusions:

Our preliminary findings show that targeted psychological support for hypertensive patients experiencing difficulties with anxiety or depression may improve blood pressure. Health psychology interventions may be suitable to support patients where medication alone does not support optimum hypertension management. Further large prospective studies are needed to confirm these findings.
FACTORS ASSOCIATED WITH PROGRESSION OF ARTERIAL STIFFNESS IN ISCHEMIC STROKE SURVIVORS: THE NORWEGIAN STROKE IN THE YOUNG STUDY
Authors: Eilertsen Rune Krogh , Midtbø Helga , Sindre Rasmus Bach , Waje-Andreassen Ulrike , Gerdts Eva
Published: June 2023

Objective:

Progressive arterial stiffening may contribute to risk for recurrent cardiovascular events in ischemic stroke survivors. Few studies have investigated sex differences in prospective change in arterial stiffness in this patient group.

Design and method:

Arterial stiffness by carotid-femoral pulse wave velocity (PWV) and ambulatory 24-hours blood pressure (BP) were assessed in 81 women and 190 men included in the Norwegian Stroke in the Young (NOR-SYS) study at 3 months and 5.5 years after the incident ischemic stroke.

Results:

At baseline patients were 49.5 ± 9.9 years old. Women had less prevalent hypertension (48 % vs. 62 %, p<0.05) than men, while age, obesity and smoking prevalence did not differ significantly. During follow-up, BP increased from 129/79 mmHg to 133/83 mmHg in women (p<0.05) and remained statistically unchanged in men (136/83 vs 139/84 mmHg, p = 0.10). Among patients with hypertension, 79% of women were treated at baseline and 77% at follow-up (p = ns), while antihypertensive treatment increased from 82% to 87% in men (p<0.05). Daily smoking was reduced from 47% to 21% in women and from 51% to 21% in men (both p<0.001). Fewer women than men were treated with statins at follow-up (63% vs. 76%, p<0.05). PWV was lower in women than in men both at baseline (7.3 m/s vs. 8.1 m/s) and at follow-up (7.3 m/s vs. 8.0 m/s, both p<0.001), but the average change during follow-up did not differ between genders. In linear regression analysis, increase in PWV was associated with higher 24-hour systolic BP, and lack of antihypertensive treatment at follow-up (both with p<0.05); while no association was found with sex, smoking at follow-up or statin treatment (Table1).

Conclusions:

In ischemic stroke survivors, 5-year increase in PWV did not differ between the sexes and was associated with higher 24-hour systolic BP and lack of antihypertensive treatment, pointing to the importance of antihypertensive treatment in this patient group.
LIPOPROTEIN (A): TREATMENT IN THE METABOLIC CONTEXT
Authors: Joaquim Meireles-Brandao , R. Meireles-Brandao Lucia , Rui Coelho , Francisco Rocha-Goncalves
Published: June 2023

Objective:

Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor but is closely associated with other similar risk factors that are manageable with appropriate treatment and guidance. We aimed to study the impact of using combined therapy for managing Lp(a) levels in patients at high cardiovascular risk but without major adverse cardiovascular events, in primary prevention.

Design and method:

We conducted a retrospective observational study in 516 patients randomly selected from a group of 1677 patients who attended cardiovascular risk and metabolism consultations between 1995 and 2015. The disorders observed and therapies used were classified into nosological and pharmacological groups, respectively. Cardiovascular risk was calculated based on the Framingham risk score, the European Society of Cardiology's SCORE and the American College of Cardiology's ASCVD Risk Estimator, and changes in patients’ lifestyle were assessed.

Results:

Significant differences (p<0.001) were found in almost all metabolic variables, except fasting insulin and C-peptide. Lp(a) levels were also significantly reduced (p<0.001). Carotid intima-media thickness improved, decreasing from 2.90 mm to 1.40 mm; however, there was no reduction in the number of cases of vascular stenosis. Of patients with hepatic steatosis (85.5%), 40.7% presented hepatomegaly, but liver function was only altered in a few patients (14.5%). Lipid-lowering therapy, especially statins, significantly decreased Lp(a), benefiting from synergy with other treatments aimed at other metabolic situations associated.

Conclusions:

Lp(a) is a key overall indicator of vascular risk and should be considered a target in context of combined therapy. Besides a healthy lifestyle, primary prevention should include combined drug therapies to address all cardiovascular risk factors and to delay the atherosclerotic process.
CLINICAL EFFICACY AND SAFETY OF TREATMENT WITH BISOPROLOL AND HYDROCHLOROTHIAZIDE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Cicero Arrigo , Tocci Giuliano , Kennedy Cormac , Grassi Davide , Fogacci Federica
Published: June 2023

Objective:

To assess the blood pressure (BP) lowering effect and the safety profile of treatment with bisoprolol and hydrochlorothiazide in patients affected by hypertension.

Design and method:

The study was designed in according to guidelines of the 2020 preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement.

A systematic literature search was conducted in multiple electronic databases to identify the randomized controlled clinical studies investigating the effect of combined treatment with bisoprolol and hydrochlorothiazide on BP. Effect sizes for changes in SBP and DBP were expressed as mean differences (MDs) and 95% confidence intervals (95%CIs). For safety analysis, odds ratios (OR) and 95% CI intervals were calculated using the Mantel-Haenszel method.

Results:

Data were pooled from 5 clinical studies. Meta-analysis of available data showed that treatment with Bisoprolol / Hydrochlorothiazide significantly reduced SBP [MD: -8.35 mmHg, 95%CI (-11.44, -5.25) mmHg, P <0.001, compared to control; MD: -9.88 mmHg, 95%CI (-12.62, -7.14) mmHg, P <0.001, compared to placebo] and DBP [MD: -7.62 mmHg, 95%CI (-11.20, -4.04) mmHg, P <0.001, compared to control; MD: -8.79 mmHg, 95%CI (-11.92, -5.67) mmHg, P <0.001, compared to placebo]. Moreover, BP response rate and BP control rate after treatment with Bisoprolol / Hydrochlorothiazide were significantly greater compared to control [Response rate: OR: 4.86 mmHg, 95%CI (2.52, 9.37), P <0.001; Control rate: OR: 1.67 mmHg, 95%CI (1.11, 2.51), P = 0.014]. Finally, treatment with Bisoprolol / Hydrochlorothiazide was associated with a reduced risk of any AE and peripheral edema compared to control.

Conclusions:

Our results show that treatment with Bisoprolol/Hydrochlorothiazide has favorable effects on BP and an good safety profile.
THE INFLUENCES OF ACHIEVED BLOOD PRESSURE ON CARDIOVASCULAR OUTCOMES IN HYPERTENSIVE PATIENTS WITH DIFFERENT LEFT VENTRICULAR GEOMETRIC PATTERN: A PROSPECTIVE COHORT STUDY IN CHINA
Authors: Yicheng Zhu , Yingqing Feng
Published: June 2023

Objective:

Intensive antihypertensive therapy might bring additional benefits for hypertensive patients with high risks of cardiovascular diseases. The left ventricular(LV) geometric patterns could reasonably stratify cardiovascular risks in hypertensive patients, which might facilitate the selection of individuals who were more suitable for intensive antihypertensive therapy.

Design and method:

This investigation is a community-based, multi-center, prospective cohort study to investigate the geographical profile of cardiovascular disease risk across China. In total, 7680 hypertensive patients were recruited. Firstly, we divided all individuals into four subgroups, including normal geometry(NG), concentric remolding(CR), eccentric hypertrophy(EH) and concentric hypertrophy(CH) based on the diagnostic thresholds recommended by the EACVI/ASE and EMINCA study respectively, respectively. Secondly, we defined the primary endpoint as composite endpoints including the stroke, hospitalization for heart failure and coronary artery disease. We exhibited the hazard ratios of patients with different achieved systolic blood pressure (achieved SBP>140mmHg, 130<SBP< = 140mmHg, and SBP< = 130mmHg) after receiving anti-hypertensive therapy from general practitioners in the NG, CR, EH and CH subgroups based on the diagnostic thresholds of echocardiographic measurements from EMINCA study and EACVI/ASE guideline respectively.

Results:

We firstly validated that the diagnostic thresholds based on EMINCA study could preferably stratify cardiovascular risks for Chinese hypertensive patients considering the racial differences (Figure 1). And we demonstrated the additional benefits from intensive antihypertensive therapy featured by a SBP target lower than 130mmHg only occurred in the patients with CH regardless of according to the diagnostic thresholds from EMINCA study and EACVI/ASE guidelines (Figure 2). Intriguingly, we found the unexpected negative correlation between achieved SBP and occurrence of the primary endpoint in the patients with CR, exhibited by higher cardiovascular risks of patients with a achieved SBP below 130mmHg (Figure 2), which might be due to that CR patients were positively associated with extracardiac organ damage and might be more susceptible to the hypotension and organ hypoperfusion.

Conclusions:

The patients with CH might profit additionally from intensive anti-hypertensive therapy, but it needs to be more cautious in the patients with CR.
QUANTITATIVE MEASUREMENT OF EMPATHY AND ANALYSIS OF ITS CORRELATION TO CLINICAL FACTORS IN KOREAN PATIENTS WITH HYPERTENSION
Authors: Heo Ran , Shin Jinho , Kim Byung Sik , Kim Hyun-Jin
Published: June 2023

Objective:

We aim to evaluate empathy using the Korean Consultation and Relational Empathy (CARE) measure in patients from various clinical environments and the factors influencing the degree of empathy in patients with hypertension.

Design and method:

Empathy is the core of the physician-patient relationship. The CARE measure is a useful tool for assessing patient-rated empathy. There have been scarce data on empathy in hypertension patients in Korea. We aim to evaluate empathy using the Korean CARE measure in patients from various clinical environments and the factors influencing the degree of empathy in patients with hypertension.

Data were collected from patients with hypertension. Patients were from primary, secondary, and tertiary clinics. Characteristics of the patients, physicians, and disease status were collected. The difference in CARE score was studied according to the clinical factors.

Results:

A total of 143 patients with hypertension were included. About 60% of patients were male. The mean age was 62. They had an average number of 2.6 comorbid diseases. More than half of patients experienced overt cardiovascular diseases such as heart failure, and coronary heart disease. About half of them had a history of hospitalization due to cardiovascular disease. The overall average CARE score was 45.6±7.0. The CARE score was not significantly different according to the characteristics of the patient, physician, or disease status. This trend was maintained in hypertensive patients.

Conclusions:

The Korean CARE measure could assess patient-rated empathy in various clinical practices. The empathy of patients was high regardless of multiple factors.
THE SELECTIVE DELETION OF TYROSYNE HYDROXYLASE GENE IN THE ENDOTHELIUM AFFECTS CARDIOVASCULAR FUNCTION
Authors: Fiordelisi Antonella , Gambardella Jessica , Cerasuolo Federica Andrea , Avvisato Roberta , Paolillo Roberta , D’Apice Stefania , Buonaiuto Antonietta , Perrino Cinzia , Ciccarelli Michele , Iaccarino Guido , Sorriento Daniela
Published: June 2023

Objective:

We showed that the endothelium can synthesize and release catecholamines in response to hypoxia. However, the pathophysiological implications of such findings are still unknown since no mouse model is available to achieve this goal. The aim of the study is the generation and characterization of a transgenic mouse model in which the tyrosine hydroxylase (TH) gene is selectively deleted in the endothelium.

Design and method:

The animal model was generated using the CRE-LOX system with specific tissue expression of the CRE recombinase. TH-FLOX mice and Tie2-CRE mice were crossed to obtain mice with endothelial knock-out of the TH gene (TH - / -). The level of circulating CA was assessed by ELISA assay. We measured blood pressure with a non-invasive method (CODA Tail-Cuff). In vitro, TH gene was deleted in mouse endothelial cells by a specific siRNA to evaluate its effects on endothelial function.

Results:

The level of circulating catecholamines is significantly reduced in TH -/- mice compared to TH +/+ mice, suggesting a key role of the endothelium in the production of circulating CAs. We evaluated blood pressure levels and found a significant increase in TH -/- young mice compared to TH +/+ mice. In vitro, we evaluated the effects of TH deletion on endothelial function. The deletion induced a significant reduction of nitric oxide, angiogenesis on Matrigel, and an increase in apoptosis and inflammatory cytokines suggesting an autocrine effect of catecholamines produced by the endothelium.

Conclusions:

These data indicate that the reduced production of endothelial CA alters vascular function, suggesting that endothelial catecholamines are essential for the proper functioning of the cardiovascular system.
Screening for Late-Onset Gestational Diabetes: Are There Any Clinical Benefits?
Authors: Cauldwell Matthew , Chmielewska Basia , Kaur Kiran , van-de-l'Isle Yolande , Sherry Anneka , Coote Ingrid Watt , Steer Philip J.
Published: June 2023

(Abstracted from BJOG 2022;129(13):2176–2183

Gestational diabetes mellitus (GDM) affects approximately 1 in 16 women in the United Kingdom. Screening for GDM involves a 2-hour, 75-g oral glucose tolerance test (OGTT) at 24 to 28 weeks of gestation; a fasting value of plasma glucose of ≥5.6 mM or 2-hour plasma glucose level of ≥7.8 mM indicates GDM. However, as pregnancy progresses, levels of hormones, particularly placental lactogen, change and increase insulin resistance.
Uterine Myoma Position-Based Radiofrequency Ablation (UMP-b RFA): 36 Months Follow-up Clinical Outcomes
Authors: Fasciani Alessandro , Turtulici Giovanni , Pedullà Alessio , Sirito Rodolfo
Published: June 2023

(Abstracted from Eur J Obstet Gynecol 2023;281:23–28

The most frequently diagnosed benign pathology in the female population, uterine fibromatosis, is also a ubiquitous issue of health. Causing anemia, infertility, sexual intercourse pain, recurrent abortions, uterine bleeding, and pelvic pain, this pathology extends significant repercussions on not only women, but also their work activities and families. Treatments proven over time to be effective, such as gonadotropin hormone-releasing hormone antagonists, ulipristal acetate, or gonadotropin hormone-releasing hormone analogues, also give adverse effects in the process of failing to eliminate the pathology. In addition, these treatments cannot be used by patients attempting pregnancy.
Breaking Down Silos Between Medical Education and Health Systems: Creating an Integrated Multilevel Data Model to Advance the Systems-Based Practice Competency
Authors: Reilly James B. , Kim Jung G. , Cooney Robert , DeWaters Ami L. , Holmboe Eric S. , Mazotti Lindsay , Gonzalo Jed D.
Published: June 2023

The complexity of improving health in the United States and the rising call for outcomes-based physician training present unique challenges and opportunities for both graduate medical education (GME) and health systems. GME programs have been particularly challenged to implement systems-based practice (SBP) as a core physician competency and educational outcome. Disparate definitions and educational approaches to SBP, as well as limited understanding of the complex interactions between GME trainees, programs, and their health system settings, contribute to current suboptimal educational outcomes elated to SBP. To advance SBP competence at individual, program, and institutional levels, the authors present the rationale for an integrated multilevel systems approach to assess and evaluate SBP, propose a conceptual multilevel data model that integrates health system and educational SBP performance, and explore the opportunities and challenges of using multilevel data to promote an empirically driven approach to residency education. The development, study, and adoption of multilevel analytic approaches to GME are imperative to the successful operationalization of SBP and thereby imperative to GME’s social accountability in meeting societal needs for improved health. The authors call for the continued collaboration of national leaders toward producing integrated and multilevel datasets that link health systems and their GME-sponsoring institutions to evolve SBP.
Obstetric Outcomes Among Women With a History of Intimate Partner Violence in the United States
Authors: Mead Julia S. , Pollack Catherine C. , Paris Amy E. , Emeny Rebecca T. , Puleo Robyn A. , St Ivany Amanda R.
Published: June 2023

OBJECTIVE:

To evaluate the association between exposure to intimate partner violence (IPV) and delivery method in a U.S. obstetric cohort.

METHODS:

The study population included U.S. women with a history of recent live birth, drawn from the 2009–2018 PRAMS (Pregnancy Risk Assessment Monitoring System) cohort. The primary exposure was self-reported IPV. The primary outcome of interest was method of delivery (vaginal or cesarean). Secondary outcomes included preterm birth, small for gestational age (SGA), and admission to the neonatal intensive care unit (NICU). Bivariate associations between the primary exposure (ie, self-report of IPV vs no self-report of IPV) and each covariate of interest were assessed with weighted quasibinomial logistic regression. Weighted multivariable logistic regression was conducted to evaluate the association between IPV and delivery method controlling for confounders.

RESULTS:

A total of 130,000 women were included in this secondary analysis of a cross-sectional sample, representing 7,500,000 women nationwide based on PRAMS sampling design. Of these, 0.8% reported abuse in the 12 months before their current pregnancy and 1.3% reported abuse during pregnancy; 1.6% of the study population reported abuse both before and during pregnancy. After adjusting for maternal sociodemographic characteristics, IPV exposure at any time was not significantly associated with cesarean delivery, compared with no IPV exposure (odds ratio [OR] 0.98, 95% CI 0.86–1.11). Of secondary outcomes, 9.4% of women experienced preterm birth and 15.1% had neonates admitted to the NICU. Exposure to IPV was associated with a 21.0% increased risk of preterm birth, compared with women without exposure (OR 1.21, 95% CI 1.05–1.40), and a 33.3% increased risk of NICU admission (OR 1.33, 95% CI 1.17–1.52) after controlling for confounders. There was no difference in the risk of delivering a neonate who was SGA.

CONCLUSION:

Intimate partner violence was not associated with an increased risk of cesarean delivery. Intimate partner violence before or during pregnancy was associated with increased risk of adverse obstetric outcomes, such as preterm birth and NICU admission, corroborating previous research findings.
Risk of Hysterectomy After Endometrial Ablation
Authors: Oderkerk Tamara J. , Beelen Pleun , Bukkems Ardy L. A. , Van Kuijk Sander M. J. , Sluijter Hilde M. M. , van de Kar Mileen R. D. , Herman Malou C. , Bongers Marlies Y. , Geomini Peggy M. A. J.
Published: June 2023

OBJECTIVE:

To assess the risk of hysterectomy after nonresectoscopic endometrial ablation in patients with heavy menstrual bleeding.

DATA SOURCES:

The EMBASE, MEDLINE, ClinicalTrials.gov and Cochrane databases were searched for eligible articles from inception until June 13, 2022. We used combinations of search terms for endometrial ablation and hysterectomy.

METHODS OF STUDY SELECTION:

Articles included in the review described the incidence of hysterectomy at a specific point in time after ablation with a minimum follow-up duration of 12 months.

TABULATION, INTEGRATION, AND RESULTS:

The literature search yielded a total of 3,022 hits. A total of 53 studies met our inclusion and exclusion criteria, including six retrospective studies, 24 randomized controlled trials, and 23 prospective studies. A total of 48,071 patients underwent endometrial ablation between 1992 and 2017. Follow-up duration varied between 12 and 120 months. Analyses per follow-up moment showed 4.3% hysterectomy rate at 12 months of follow-up (n=29 studies), 11.1% at 18 months (n=1 study), 8.0% at 24 months (n=11 studies), 10.2% at 36 months (n=12 studies), 7.6% at 48 months (n=2 studies), and 12.4% at 60 months (n=6 studies). Two studies reported a mean hysterectomy rate at 10 years after ablation of 21.3%. Minimal clinically relevant differences in hysterectomy rates were observed among the different study designs. Furthermore, we found no significant differences in hysterectomy rate among the different nonresectoscopic endometrial ablation devices.

CONCLUSION:

The risk of hysterectomy after endometrial ablation seems to increase from 4.3% after 1 year to 12.4% after 5 years. Clinicians can use the results of this review to counsel patients about the 12% risk of hysterectomy 5 years after endometrial ablation.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42020156281.
Efficacy of Propranolol to Reduce Cesarean Delivery in Prolonged Labor
Authors: McCoy Jennifer A. , Walheim Lauren , McCabe Meaghan G. , Levine Lisa D.
Published: June 2023

OBJECTIVE:

To evaluate the rates of cesarean delivery in patients with prolonged labor randomized to receive intravenous (IV) propranolol compared with placebo.

METHODS:

A double-blind, placebo-controlled, randomized trial was conducted at two hospitals within a large academic health system. Eligible patients were at 36 weeks or more with a singleton gestation and prolonged labor, defined as: 1) prolonged latent phase of labor (dilation less than 6 cm after 8 hours or more with ruptured membranes and receiving oxytocin infusion) or 2) prolonged active phase of labor (dilation 6 cm or greater and less than 1-cm cervical dilation change over 2 hours or more with ruptured membranes and receiving oxytocin infusion). Patients were excluded for severe preeclampsia, maternal heart rate less than 70 beats per minute, maternal blood pressure less than 90/50 mm Hg, asthma, diabetes requiring insulin during labor, or a cardiac contraindication to β-blockade. Patients were randomized to propranolol (2 mg IV) compared with placebo (2 mL normal saline IV), with one possible repeat dose. The primary outcome was cesarean delivery; secondary outcomes included labor duration, shoulder dystocia, and maternal and neonatal morbidity. With an estimated cesarean delivery rate of 45%, α 0.05, and 80% power, we required 163 patients per group to detect a 15% absolute reduction in cesarean delivery rate. A planned interim analysis was performed, and the trial was stopped for futility.

RESULTS:

From July 2020 to June 2022, 349 patients were eligible and approached; 164 were enrolled and randomized, with 84 in the propranolol group and 80 in the placebo group. The rate of cesarean delivery was not different between groups (57.1% propranolol vs 57.5% placebo, relative risk [RR] 0.99, 95% CI 0.76–1.29). Results were similar by subgroup of prolonged latent (n=123) and active (n=41) phases of labor and nulliparous (n=137) and multiparous (n=27) patients. Though not statistically significant, the frequency of postpartum hemorrhage was higher in the propranolol group (20% vs 10%, RR 2.02, 95% CI 0.93–4.43).

CONCLUSION:

In this multisite, double-blind, placebo-controlled randomized trial, there was no difference in cesarean delivery rate for patients who received propranolol compared with those who received placebo for management of prolonged labor.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04299438.
COVID-19 infection with complicated fulminant myocarditis: a case report
Authors: Miao Kun , Lai Jinsheng , Wang Feng , Wang Luyun , Zhao Chunxia , Wang Dao Wen
Published: June 2023

Herein, we report the case of a young female patient who suffered from myositis and heart failure due to fulminant myocarditis induced by the 2019 coronavirus disease (COVID-19). After receiving intra-aortic balloon pump (IABP) and immunomodulatory treatment, her vital signs gradually stabilized and the IABP was removed. Cardiac and muscle magnetic resonance imaging confirmed extensive myocardial and skeletal muscle edema. Though it is not uncommon for COVID-19 infection to be complicated by myocarditis and myositis, such serious muscle injury warrants clinical vigilance.
Risk factors for Hirschsprung disease-associated enterocolitis: a systematic review and meta-analysis
Authors: Zhang Xintao , Sun Dong , Xu Qiongqian , Liu Han , Li Yunfeng , Wang Dongming , Wang Jian , Zhang Qiangye , Hou Peimin , Mu Weijing , Jia Chunling , Li Aiwu
Published: June 2023

Background:

The incidence of Hirschsprung disease (HSCR) is nearly 1/5000 and patients with HSCR are usually treated through surgical intervention. Hirschsprung disease-associated enterocolitis (HAEC) is a complication of HSCR with the highest morbidity and mortality in patients. The evidence on the risk factors for HAEC remains inconclusive to date.

Methods:

Four English databases and four Chinese databases were searched for relevant studies published until May 2022. The search retrieved fifty-three relevant studies. The retrieved studies were scored on the Newcastle-Ottawa Scale (NOS) by three researchers. Revman 5.4 software was employed for data synthesis and analysis. Stata 16 software was employed for sensitivity analysis and bias analysis.

Results:

A total of fifty-three articles were retrieved from the database search, which included 10012 cases of HSCR and 2310 cases of HAEC. The systematic analysis revealed anastomotic stenosis or fistula (I
2=66%, RR=1.90, 95% CI 1.34–2.68,
P

<0.001), preoperative enterocolitis (I
2=55%, RR=2.07, 95% CI 1.71–2.51,
P

<0.001), preoperative malnutrition (I
2=0%, RR=1.96, 95% CI 1.52–2.53,
P

<0.001), preoperative respiratory infection or pneumonia (I
2=0%, RR=2.37, 95% CI 1.91–2.93,
P

<0.001), postoperative ileus (I
2=17%, RR=2.41, 95% CI 2.02–2.87,
P

<0.001), length of ganglionless segment>30 cm (I
2=0%, RR=3.64, 95% CI 2.43–5.48,
P

<0.001), preoperative hypoproteinemia (I
2=0%, RR=1.91, 95% CI 1.44–2.54,
P

<0.001), and Down syndrome (I
2=29%, RR=1.65, 95% CI 1.32–2.07,
P

<0.001) as the risk factors for postoperative HAEC. Short-segment HSCR (I
2=46%, RR=0.62, 95% CI 0.54–0.71,
P

<0.001) and transanal operation (I
2=78%, RR=0.56, 95% CI 0.33–0.96,
P
=0.03) were revealed as the protective factors against postoperative HAEC. Preoperative malnutrition (I
2=35
%
,RR=5.33, 95% CI 2.68–10.60,
P

<0.001), preoperative hypoproteinemia (I
2=20%, RR=4.17, 95% CI 1.91–9.12,
P

<0.001), preoperative enterocolitis (I
2=45%, RR=3.51, 95% CI 2.54–4.84,
P

<0.001), and preoperative respiratory infection or pneumonia (I
2=0%, RR=7.20, 95% CI 4.00–12.94,
P

<0.001) were revealed as the risk factors for recurrent HAEC, while short-segment HSCR (I
2=0%, RR=0.40, 95% CI 0.21–0.76,
P
=0.005) was revealed as a protective factor against recurrent HAEC.

Conclusion:

The present review delineated the multiple risk factors for HAEC, which could assist in preventing the development of HAEC.
Neoadjuvant immunochemotherapy for locally advanced resectable oral squamous cell carcinoma: a prospective single-arm trial (Illuminate Trial)
Authors: Huang Yingying , Sun Jingjing , Li Jun , Zhu Dongwang , Dong Minjun , Dou Shengjin , Tang Yong , Shi Wentao , Sun Qi , Zhao Tongchao , Zhou Zhihang , Zhou Xinyu , Liu Ying , Li Jiang , Zhu Guopei , Zhang Ding , Chen Yanan , Zhu Qi , Ju Wutong , Zhong Laiping
Published: June 2023

Background:

Locally advanced oral squamous cell carcinoma (LAOSCC) is associated with a high rate of recurrence and poor survival. Given the recent successes of neoadjuvant immunochemotherapy (NAICT) in solid tumors, it is promising to use this treatment modality to achieve better pathological response and improve the survival of LAOSCC, and clinical evidence is needed to assess its safety and efficacy.

Patients and methods:

A prospective trial of NAICT with toripalimab (PD-1 inhibitor) and albumin paclitaxel/cisplatin (TTP) was conducted in patients with clinical stage III and IVA OSCC. Intravenous albumin paclitaxel (260 mg/m2), cisplatin (75 mg/m2), and toripalimab (240 mg) were given in sequence on day 1 of each 21-day cycle for two cycles, followed by radical surgery and risk-adapted adjuvant (chemo)radiotherapy. The primary endpoints were safety and major pathological response (MPR). Targeted next generation sequencing and multiplex immunofluorescence were performed to assess clinical molecular characteristics and the tumor immune microenvironment in the pre- and post-NAICT tumor samples.

Results:

Twenty patients were enrolled. NAICT was well-tolerated with a low incidence of grade 3-4 adverse events (AEs) in three patients. The completion rates of NAICT and subsequent R0 resection were 100%. The MPR rate was 60%, including 30% pathological complete response. MPR was achieved in all 4 patients with a combined positive score of PD-L1>10. The density of tertiary lymphatic structure (TLS) in post-NAICT tumor samples predicted the pathological response to NAICT. During the median 23-month follow-up, the disease-free survival was 90%, and the overall survival was 95%.

Conclusions:

NAICT with the TTP protocol in LAOSCC is feasible and well tolerated, with a promising MPR and no obstruction on subsequent surgery. This trial is supportive of further randomized trials using NAICT in LAOSCC.
Cardiovascular outcomes in subclinical thyroid disease: an update
Authors: Ettleson Matthew D.
Published: June 2023

Purpose of review

Subclinical thyroid disease is defined by a thyroid stimulating hormone (TSH) level outside of the normal range with normal circulating thyroid hormone levels. Excess adverse cardiovascular outcomes have been observed in certain patient populations with subclinical hypothyroidism (SCH) and hyperthyroidism (SCHr). The role of thyroid hormone and antithyroid treatments for subclinical thyroid disease remains debated.

Recent findings

Cardiovascular disease appears to be a major mediator of all-cause mortality in patients with SCH, in particular those aged at least 60 years of age. In contrast, pooled clinical trial results did not find that levothyroxine reduced the incidence of cardiovascular events or mortality in this patient population. The association between SCHr and atrial fibrillation is well established; however, a 5-year follow-up of older patients with mild (TSH 0.1–0.4 mIU/l) SCHr found no increased incidence of atrial fibrillation. Separately, SCHr was associated with derangements in endothelial progenitor cell function that may underlie vascular disease independent from effects on cardiac function.

The impact of treatment of subclinical thyroid disease on cardiovascular outcomes remains uncertain. Additional prospective and trial data are needed to evaluate treatment effects on cardiovascular outcomes in younger populations.
A Rational and Standardized Prenatal Examination
Authors: Sarosi Ellery , Gatta Luke A. , Berman Deborah R. , Kuller Jeffrey A.
Published: June 2023

Importance

As prenatal care is in transition after the COVID-19 pandemic, reviewing fundamental physical examination approaches is necessary for providers examining obstetrical patients.

Objective

The objective of this review is 3-fold: (1) convey why the age of telemedicine necessitates reconsideration of the standardized physical examination in routine prenatal care; (2) identify the screening efficacy of examination maneuvers used within a standard prenatal examination of the neck, heart, lungs, abdomen, breasts, skin, lower extremities, pelvis, and fetal growth; and (3) propose an evidence-based prenatal physical examination.

Evidence Acquisition

A comprehensive literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines.

Results

We conclude that an evidence-based prenatal examination for asymptomatic patients includes the following maneuvers: inspection and palpation for thyromegaly and cervical lymphadenopathy, cardiac auscultation, fundal height measurement, and a pelvic examination for purposes including testing for gonorrhea and chlamydia, assessing pelvimetry, and assessing cervical dilation later in the pregnancy, intrapartum, or in the setting of ultrasonogram-detected prelabor preterm cervical shortening.

Conclusions and Relevance

Although not true of all physical examination maneuvers, this article demonstrates that there are maneuvers that continue to play important screening roles in asymptomatic patients. With the increase in virtual visits and fewer in-person prenatal appointments, the rational basis for maneuvers recommended in this review should inform decision making around the prenatal examination performed.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to discuss how telemedicine impacts the standardized physical examination in routine prenatal care; identify the screening efficacy of examination maneuvers used within a standard prenatal examination of the neck, heart, lungs, abdomen, breasts, skin, lower extremities, fetal growth, and pelvis; and propose an evidence-based prenatal physical examination.
Cell-Free Fetal DNA for Genetic Evaluation in Copenhagen Pregnancy Loss Study (COPL): A Prospective Cohort Study
Authors: Schlaikjær Hartwig Tanja , Ambye Louise , Gruhn Jennifer R. , Petersen Jesper Friis , Wrønding Tine , Amato Letizia , Chi-Ho Chan Andrew , Ji Boyang , Bro-Jørgensen Maiken Hemme , Werge Lene , Petersen Mette Marie Babiel Schmidt , Brinkmann Clara , Petersen Julie Birch , Dunø Morten , Bache Iben , Herrgård Markus J. , Jørgensen Finn Stener , Hoffmann Eva R. , Nielsen Henriette Svarre ,   and The COPL Consortium
Published: June 2023

(Abstracted from Lancet 2023;401:762–771

Spontaneous pregnancy loss occurs in approximately 1 in 4 pregnancies; however, diagnostic workup is mostly restricted to women with recurrent pregnancy loss. The lack of workup on first pregnancy loss is likely a result of the high de novo fetal aneuploidy rate; however, this ignores the association of euploid pregnancy loss with an increased risk of future losses.
Modern antiretroviral regimens in pregnant women: virologic outcomes and durability
Authors: Smith Christiana , Silveira Lori , Crotteau Megan , Garth Krystle , Canniff Jennifer , Fetters Kirk B. , Lazarus Sarah , Capraro Shannon , Weinberg Adriana
Published: June 2023

Objectives:

Data are lacking on the virologic efficacy and durability of modern antiretroviral treatment (ART) regimens during pregnancy. We compared virologic outcomes at delivery among women receiving dolutegravir versus other ART and the rate of change of the initial pregnancy regimen.

Design:

Single site retrospective cohort between 2009-2019.

Methods:

We used univariable and multivariable generalized estimating equations to model the relationship between the maternal ART anchor and the proportion of women with a viral load ≥20 HIV RNA copies/mL of plasma closest to delivery (suboptimal virologic control) and with a viral load ≥20 copies/mL at any time in the third trimester. We also compared changes in ART during pregnancy.

Results:

We evaluated 230 pregnancies in 173 mothers. Rates of optimal virologic control at delivery did not significantly differ in mothers who received dolutegravir (93.1%), rilpivirine (92.1%), boosted darunavir (82.6%), or efavirenz (76.9%), but were significantly lower among mothers receiving atazanavir (49.0%) or lopinavir (40.9%). The odds of having a viral load ≥20 copies/mL at any time in the third trimester was also higher for atazanavir and lopinavir. Raltegravir, elvitegravir, or bictegravir were used in <10 mothers at delivery, which precluded statistical analyses. The frequency of change in ART was significantly higher in mothers who initially received elvitegravir (68%) or efavirenz (47%) than dolutegravir (18%).

Conclusions:

Dolutegravir-, rilpivirine- and boosted darunavir-containing regimens conferred excellent virologic control in pregnancy. Atazanavir and lopinavir, elvitegravir, and efavirenz were associated with either high rates of virologic failure or regimen change during pregnancy.
Automatic Detection of Pancreatic Lesions and Main Pancreatic Duct Dilatation on Portal Venous CT Scans Using Deep Learning
Authors: Abi Nader Clément , Vetil Rebeca , Wood Laura Kate , Rohe Marc-Michel , Bône Alexandre , Karteszi Hedvig , Vullierme Marie-Pierre
Published: June 2023

Objectives

This study proposes and evaluates a deep learning method to detect pancreatic neoplasms and to identify main pancreatic duct (MPD) dilatation on portal venous computed tomography scans.

Materials and Methods

A total of 2890 portal venous computed tomography scans from 9 institutions were acquired, among which 2185 had a pancreatic neoplasm and 705 were healthy controls. Each scan was reviewed by one in a group of 9 radiologists. Physicians contoured the pancreas, pancreatic lesions if present, and the MPD if visible. They also assessed tumor type and MPD dilatation. Data were split into a training and independent testing set of 2134 and 756 cases, respectively.

A method to detect pancreatic lesions and MPD dilatation was built in 3 steps. First, a segmentation network was trained in a 5-fold cross-validation manner. Second, outputs of this network were postprocessed to extract imaging features: a normalized lesion risk, the predicted lesion diameter, and the MPD diameter in the head, body, and tail of the pancreas. Third, 2 logistic regression models were calibrated to predict lesion presence and MPD dilatation, respectively. Performance was assessed on the independent test cohort using receiver operating characteristic analysis. The method was also evaluated on subgroups defined based on lesion types and characteristics.

Results

The area under the curve of the model detecting lesion presence in a patient was 0.98 (95% confidence interval [CI], 0.97–0.99). A sensitivity of 0.94 (469 of 493; 95% CI, 0.92–0.97) was reported. Similar values were obtained in patients with small (less than 2 cm) and isodense lesions with a sensitivity of 0.94 (115 of 123; 95% CI, 0.87–0.98) and 0.95 (53 of 56, 95% CI, 0.87–1.0), respectively. The model sensitivity was also comparable across lesion types with values of 0.94 (95% CI, 0.91–0.97), 1.0 (95% CI, 0.98–1.0), 0.96 (95% CI, 0.97–1.0) for pancreatic ductal adenocarcinoma, neuroendocrine tumor, and intraductal papillary neoplasm, respectively. Regarding MPD dilatation detection, the model had an area under the curve of 0.97 (95% CI, 0.96–0.98).

Conclusions

The proposed approach showed high quantitative performance to identify patients with pancreatic neoplasms and to detect MPD dilatation on an independent test cohort. Performance was robust across subgroups of patients with different lesion characteristics and types. Results confirmed the interest to combine a direct lesion detection approach with secondary features such as the MPD diameter, thus indicating a promising avenue for the detection of pancreatic cancer at early stages.
Comparison of Medical Treatment Efficiency With Shear Wave Elastography Values of Thrombus in Patients With Lower Extremity Deep Vein Thrombosis
Authors: İnce Suat , Özgokçe Mesut , Özkaçmaz Sercan , Dündar İlyas , Türko Ensar , Ayyıldız Veysel A. , Göya Cemil
Published: June 2023

In lower-extremity deep vein thrombosis (DVT), thrombus age is essential for successful treatment. The aim of our study was to compare the shear wave elastography (SWE) values measured before treatment and achieved lumen patency after treatment in lower-extremity DVT patients with total occlusion. Patients diagnosed with DVT in the acute-subacute stage (<4 week) with total thrombosis in lower extremity were included in this prospective study. Shear wave elastography measurements were performed where the thrombus was most prominent and homogeneous. To evaluate patient response to treatment, lumen patency (partial [>25%] or total recanalization) was examined using color Doppler imaging in the first and third months posttreatment. Shear wave elastography values with and without patency were compared using an independent t test. Among 75 patients in this study, at the first-month color Doppler imaging examination, the SWE values were 1.77 ± 0.49 (1.09–3.03) m/s in patients who achieved lumen patency (n = 42) and 2.21 ± 0.54 (1.24–3.36) m/s in those who did not show lumen patency (n = 33). The difference between the groups' mean elastography value was statistically significant (P < 0.001). At the third-month examination, the SWE values were 1.76 ± 0.46 (1.09–3.03) m/s in patients with lumen patency (n = 55) and 2.52 ± 0.48 (1.74–3.36) in patients without lumen patency (n = 20). The difference between the 2 groups' mean elastography value was statistically significant (P < 0.001). We concluded that it is more difficult to achieve lumen patency in veins occluded by thrombus with higher elasto values, and endovascular interventional procedures should be considered during the initial treatment of high SWE value thrombosis.
Outcomes With Belatacept Exposure During Pregnancy in Kidney Transplant Recipients: A Case Series
Authors: Coscia Lisa , Cohen David , Dube Geoffrey K. , Hofmann R. Michael , Moritz Michael J. , Gattis Sara , Basu Arpita
Published: June 2023

Background.

Posttransplant fertility returns quickly, and female recipients of child-bearing age may conceive while on immunosuppression. However, pregnancy after transplantation confers risks to the recipient, transplant, and fetus, including gestational hypertension, preeclampsia, gestational diabetes, transplant dysfunction, preterm labor, and low birthweight infants. Additionally, mycophenolic acid (MPA) products are teratogenic. Literature evidence regarding belatacept, a selective T-cell costimulation blocker, during pregnancy and while breastfeeding is extremely limited. When female transplant recipients on a belatacept-based regimen are desirous of pregnancy or at the time of conception, transplant providers manage the immunosuppression regimen in 1 of 2 ways: (1) switch both belatacept and MPA to a calcineurin inhibitor–based regimen with or without azathioprine, which is the more common practice but requires several modifications, having potential negative outcomes; or (2) only switch MPA to azathioprine while continuing belatacept.

Methods.

This case series includes 16 pregnancies in 12 recipients with exposure to belatacept throughout pregnancy and while breastfeeding. Patient information was obtained from several sources, including Transplant Pregnancy Registry International, providers at Emory University, and Columbia University, as well as literature review.

Results.

Pregnancy outcomes included 13 live births and 3 miscarriages. No birth defects or fetal deaths were reported in any of the live births. Seven infants were breastfed while their mothers continued belatacept. Outcomes appear comparable to those documented with the administration of calcineurin inhibitors.

Conclusions.

This case series provides data supporting the continued administration of belatacept during pregnancy. Additional research will assist in developing better guidelines to counsel female transplant recipients on belatacept desiring to pursue pregnancy.
Characterization of Shigella flexneri in northern Vietnam in 2012–2016
Authors: Nguyen Dong Tu , Morita Masatomo , Ngo Tuan Cuong , Le Thanh Huong , Le Dang Hai , Nguyen Hoai Thu , Akeda Yukihiro , Ohnishi Makoto , Izumiya Hidemasa
Published: June 2023

Introduction. Shigellosis remains a considerable public health concern in developing countries.

Shigella flexneri

and

Shigella sonnei

are prevalent worldwide and

S. sonnei

has been replacing

S. flexneri

.

Gap Statement.

S. flexneri

still causes outbreaks of shigellosis in northern Vietnam but limited information is available on its genetic characteristics.

Aim. This study aimed to characterize the genetic characteristics of

S. flexneri

strains from northern Vietnam.

Methodology. This study used 17 isolates from eight incidents, collected in northern Vietnam between 2012 and 2016. The samples were subjected to whole genome sequencing, molecular serotyping, cluster analysis and identification of antimicrobial resistance genes. Additionally, phylogenetic analysis was performed including isolates from previous studies.

Results. Clusters were identified according to spatiotemporal backgrounds. The results suggested that two incidents in Yen Bai province in 2015 and 2016 were derived from a very recent common ancestor. All isolates belonged to phylogroup (PG) 3, which was divided into two sub-lineages. Thirteen of 17 isolates, including those from the Yen Bai incidents, belonged to sub-lineage Sub-1 and were serotyped as 1a. The remaining four isolates belonged to sub-lineage Sub-2 and were the globally predominant serotype 2a. The Sub-1

S. flexneri

isolates possessed the gtrI gene, which encodes the glycosyl transferase that determines serotype 1a, with bacteriophage elements in the vicinity.

Conclusion. This study revealed two PG3 sub-lineages of

S. flexneri

in northern Vietnam, of which Sub-1 might be specific to the region.