bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrograde Autologous Priming Technique to Reduce Hemodilution during Cardiopulmonary Bypass in the Pediatric Cardiac Patient
Authors: Hagedorn Corinna , Glogowski Kimberly , Valleley Melinda , McQuiston Laura , Consbruck Kailee ,   Illustrations by Oyer A
Published: July 2023

Blood conservation techniques during pediatric congenital heart surgery continue to be a vital strategy in reducing hemodilution during cardiopulmonary bypass. Development of mini circuits, retrograde autologous priming, modified ultrafiltration, and use of a cell saver are methods adopted by pediatric heart programs to limit transfusions. Excessive hemodilution may warrant the need for transfusion in the pediatric patient, which carries significant risks in the overall care of the patient. Retrograde autologous priming is a safe and effective way to limit the amount of hemodilution, and thereby reduce the need for transfusion.
A Simple Scoring System to Predict Survival after Venoarterial Extracorporeal Membrane Oxygenation
Authors: Worku Berhane , Khin Sandi , Gaudino Mario , Avgerinos Dimitrios , Gambardella Ivan , D’Ayala Marcus , Ramasubbu Kumudha , Gulkarov Iosif , Salemi Arash
Published: July 2023

Patients undergoing consideration for venoarterial extracorporeal membrane oxygenation (VA ECMO) require an immediate risk profile assessment in the setting of incomplete or no information. A retrospective cohort study of 100 patients undergoing VA ECMO placement at three institutions was carried out. Variables strongly associated with survival to discharge were used to calculate a risk stratification score. Indications for VA ECMO support included postcardiotomy shock (24%), ischemic etiologies (33%), nonischemic cardiomyopathy (32%), and other etiologies (11%). Pre–VA ECMO arrest occurred in 69%, and 30% of patients underwent cannulation during arrest. Survival to discharge was 38%. Three variables demonstrated a strong trend toward predicting survival to discharge: lactate >10 mmol/L (p = .054), albumin <3 g/dL (p = .062), and platelet count <180 K/uL (p = .064), and these variables were included in a scoring system. The extremes of age and duration of pre–VA ECMO ventilation were associated with a dismal prognosis and were also included. These five variables were used to construct a mortality prediction score. A score of 0 was associated with 10% expected mortality, whereas a score of 4+ was associated with 100% expected mortality. Mortality increased in a stepwise fashion with increasing scores. The expected mortality closely paralleled the observed mortality. A simple scoring system composed of easily collected variables may help predict mortality. However, it is not intended to replace an experienced clinician’s judgment, but to enhance it.
Homemade Salvage Setup for a Catastrophic Heater/Cooler Failure on Cardiopulmonary Bypass
Authors: Rajanbabu Balram Babu , Dhandapani Kalaimani
Published: July 2023

Perfusion-related problems are still reported at incidence, varying from .72 to 2.86%, and add to the morbidity and mortality of cardiac surgery. Awareness of such problems and establishing protocols to avoid and manage them is a key factor in further improving patient outcomes. In this report, we describe a homemade setup which was used as a desperate salvage measure to rewarm a 1-year-old baby on cardiopulmonary bypass for intracardiac repair, who was inadvertently cooled to 24°C because of a malfunctioning heater/cooler machine.
A Quick Reference Tool for Goal-Directed Perfusion in Cardiac Surgery
Authors: Rance Geoffrey , Srey Rithy , Shapeton Alexander D. , Leissner Kay B. , Zenati Marco A.
Published: July 2023

Traditionally, blood flow rates on cardiopulmonary bypass are based primarily on a formula that matches cardiac index to the patient’s body surface area (BSA). However, Ranucci and associates in the Goal-Directed Perfusion Trial (GIFT) trial have shown that coupling the BSA with delivery of oxygen (DO2), known as goal-directed perfusion (GDP), may be a safer approach to determine appropriate blood flows. The objective of this study was to create a GDP reference tool that would allow perfusionists to quickly determine the lowest acceptable blood flow needed to provide a patient of any BSA with a satisfactory DO2 without the need for additional dedicated technology. We approached this problem by deriving a formula for flow (L/min), based on BSA, oxygen content of the blood, and a minimum DO2 of 280 mL·min−1m−2. A quick reference GDP chart was created based on the derived formula, requiring only the patient’s BSA and hemoglobin level to determine a safe minimum flow rate. The proposed tool allows any cardiac surgery center to adopt the GDP technique, even in the absence of instantaneous DO2 monitoring equipment.
Introducing the Loop for Circuit Access during Extracorporeal Membrane Oxygenation: Feasibility and Safety
Authors: Broman Lars Mikael , Eriksson Christer , Frenckner Björn , Palmér Kenneth
Published: July 2023

In extracorporeal membrane oxygenation (ECMO), blood is drained from the patient, and pumped through a membrane oxygenator/lung (ML) for gas exchange and then back to the patient. For monitoring blood gases, samples may be sampled downstream from the ML. This exposes the patient for embolization risk (air/clot) when the stopcocks are flushed. For safe sampling procedures, the Loop was introduced. It is a constant low-flow arteriovenous shunt (AVS) used preferably in venoarterial ECMO. It is composed of three different length and diameter three-way stopcocks connected to the circuit just downstream the ML with its return upstream the pump. It offers safe arterial blood sampling and a simultaneous access point to the venous side of the circuit. Since its introduction, no patient complications have been reported to be accounted for by the Loop. The Loop is an AVS permitting a safe access point for post membrane blood sampling and for injections in the venous pre-pump limb. It has a low cost and is easy to install and maintain. It may be used in any ECMO configuration.
Net Prime Volume Is Associated with Increased Odds of Blood Transfusion
Authors: Dickinson Timothy A. , Wu Xiaoting , Sturmer David L. , Goldberg Joshua , Fitzgerald David C. , Paone Gaetano , Likosky Donald S. ,   on Behalf of the PERForm Registry and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
Published: July 2023

Hemodilutional anemia has been cited as a contributing factor to red blood cell (RBC) transfusions in cardiac surgery patients. Accordingly, efforts have been made to minimize hemodilution by reducing cardiopulmonary bypass (CPB) prime volume. We sought to assess the impact of these efforts on intraoperative RBC transfusions. We evaluated 21,360 patients undergoing coronary artery bypass with or without aortic valve surgery between July 2011 through December 2016 at any of 42 centers participating in the Perfusion Measures and Outcomes registry. The primary exposure was net CPB prime volume (total prime volume minus retrograde autologous prime volume) indexed to body surface area (mL/m2), which was further divided into quartiles (Q1: <262 mL/m2, Q2: 262–377 mL/m2, Q3: 377–516 mL/m2, and Q4: >516 mL/m2). The primary outcome was intraoperative RBC transfusion. We modeled the effect of index net prime volume on transfusion, adjusting for patient (age, gender, race, diabetes, vascular disease, previous myocardial infarction, ejection fraction, creatinine, preoperative hematocrit (HCT), total albumin, status, aspirin, and antiplatelet agents), procedural (procedure types) characteristics, surgical year, and hospital. The median net prime volume was 378 mL/m2(25th percentile: 262 mL/m2, 75th percentile: 516 mL/m2). Relative to patients in Q1, patients in Q4 were more likely to be older, female, nondiabetic, have higher ejection fraction, have more ultrafiltration volume removed, and undergo more elective and aortic valve procedures (allp< .05). Patients in Q4 relative to Q1 were exposed to lower nadir HCTs on bypass,p< .05. The net prime volume was associated with an increased risk of transfusion (8.9% in Q1 vs. 22.6% in Q4,p< .001). After adjustment, patients in Q4 (relative to Q1) had a 2.9-fold increased odds (ORadj= 2.9, 95% CI [2.4, 3.4]) of intraoperative RBC transfusion. In this large, multicenter experience, patients exposed to larger net prime volumes were associated with greater adjusted odds of receiving intraoperative transfusions. Our findings reinforce the importance of efforts to reduce the net CPB prime volume. Based on these findings and other supporting evidence, the net prime volume should be adopted as a national quality measure.
Proprietários florestais. Lógicas, dinâmicas e coordenação na gestão dos espaços florestais
Authors: Canadas Maria João , Novais Ana , Reis Pedro , Santos José L. , Baptista Fernando O.
Published: July 2023

A identificação das práticas de gestão dos espaços florestais pelos seus proprietários é fundamental para compreender a evolução das funções ambientais e socioeconómicas desses mesmos espaços.

Dos resultados de um conjunto de inquéritos a proprietários florestais, realizados em diferentes momentos e regiões, privilegiamos três vertentes de análise: a resposta de gestão dos proprietários ao risco de incêndio; a mudança e diversidade de práticas de gestão de eucaliptais; e a disponibilidade dos proprietários para a coordenação da gestão à escala da paisagem.

Nas conclusões destacamos, em primeiro, que a não realização de intervenções de redução de combustível não é sinónimo de não gestão ou abandono, e pode corresponder a uma estratégia de minimização do risco económico, quando o rendimento expectável não cobre o custo dessas intervenções. Em segundo, a alteração das condições gerais de produção e o aumento da diversidade dos povoamentos de eucalipto, que acompanhou a expansão de área, favorece a diferenciação da rentabilidade e o consequente aumento da carga combustível nas situações mais marginais. Por último, ainda que haja disponibilidade e até mobilização dos proprietários para a gestão coordenada, a sua implementação está dependente da continuidade de objetivos e apoios financeiros das políticas.
Effects of Muscle Energy Technique versus Shoulder Mobilization on Pain and Function in Patients with Subacromial Pain Syndrome
Authors: Ishaq Shahid , Dustgir Atif , Mehdi Zunaira , Mahmood Khalid , Fatima Rukhsar , Tasawer Muhammad Noman
Published: July 2023

Background Subacromial pain syndrome is most leading cause of disability that includes the wide spectrum of disorders including subacromial tendinopathy, partial or full thickness tear of rotator cuff and subacromial bursitis. The manual therapy interventions for this condition are still debatable.

Aim To evaluate the comparative effects of muscle energy technique (MET) versus posterior shoulder mobilization with movement (MWM) on pain, function and shoulder range of motion in patients with subacromial pain syndrome.

Method Patients diagnosed with subacromial pain syndrome were recruited in this pragmatic parallel double blinded randomized clinical trial. The sample was selected through non-probability convenient sampling technique. Forty patients out of 56 meeting the eligibility criteria were equally divided into two groups, MET group (n = 20) and MWM group (n = 20), through a randomization web service. Data were collected at baseline and after successful completion of a six week trial treatment. Pain severity was measured by using a numeric pain rating scale, shoulder disability was measured by using the Shoulder Pain and Disability Index (SPADI) and ranges of motion were measured by using goniometry. Data was analyzed through SPSS 24.

Results Outcome measures including pain, disability and shoulder range of motion were significantly (p ≤ 0.05) improved in both groups after the intervention. When comparing both groups, pain score was U = 82.0 (p ≤ 0.001) and disability score was t = –2.913 (p ≤ 0.006) favoring MET.

Conclusion Both MET and MWM were effective for symptomatic management in this sample of 40 patients with subacromial impingement syndrome. MET seems to show some superior effects as compared to MWM.
Ursachen und Management von IOL-Dislokationen
Authors: Khoramnia Ramin , Baur Isabella Diana , Auffarth Gerd U.
Published: July 2023

Die frühe (< 3 Monate) IOL-Dislokation tritt aufgrund einer unzureichenden Fixation im Kapselsack auf, während die späte Dislokation (≥ 3 Monate) durch eine zunehmende Insuffizienz des
Zonulaapparates begründet ist. Aktuell werden zur Aphakiekorrektur bei IOL-Tausch vor allem Irisfixierte IOL (IFIOL) und mittels Naht oder nahtlos fixierte sklerafixierte IOL (SFIOL)
eingesetzt. Es wurden verschiedene Methoden zur Sklerafixierung mit oder ohne Naht beschrieben. Die wichtigsten Techniken werden in dieser Arbeit zusammengefasst. IFIOL und SFIOL ermöglichen
vergleichbare Visusergebnisse, unterscheiden sich aber in ihrem Risikoprofil. Die Entscheidung, welche Methode zum Einsatz kommt, hängt u. a. auch von den Gegebenheiten im jeweiligen Fall
und der Präferenz des Operateurs ab.
Sicher klassifizieren – Untersuchung der LWS – die Tests
Authors: Luomajoki Hannu
Published: July 2023

Die Untersuchung des unteren Rückens ist eine Mammutaufgabe. In Ausgabe 4/23 gab Prof. Dr. Hannu Luomajoki einen Überblick über die Abläufe des Befundens. Teil 2 konzentriert sich auf die wichtigsten körperlichen Untersuchungen.
Update Spiegeltherapie
Authors: Thieme Holm
Published: July 2023

Die Spiegeltherapie wirkt dank der Plastizität des Gehirns. Sie nutzt die visuelle Spiegelreflexion einer gesunden Extremität, um Funktionen der betroffenen Extremität zu verbessern und/oder Schmerzen zu verringern. Mit diesem Refresher bringen Sie sich auf den aktuellen Stand der Forschung zur Therapie und erhalten wertvolle Informationen für das Anwenden in der Praxis.
Natural History of Non-Functioning Pituitary Adenomas: A Systematic
Review and Meta-Analysis
Authors: Rikvold Stefan Dukanovic , Pedersen Mathias Brown , Andreassen Mikkel , Krogh Jesper
Published: July 2023

The management of non-functioning pituitary tumors (NFPTs) relies on the risk of
tumor growth and new endocrinopathies. The objective of this systematic review
was to assess the risk of growth, new pituitary endocrinopathies, and surgery in
patients with conservatively treated NFPTs. We conducted a bibliographical
search identifying studies assessing NFPTs followed conservatively. Estimates
were pooled using random-effects meta-analysis reporting events per 100 person
years (PYs), in case of high heterogeneity (I2>75%) only the
range of observed effects was reported. We identified 30 cohort studies
including 1957 patients with a mean follow-up time of 4.0 (SD 1.5) years. The
overall risk of tumor growth ranged from 0.0 to 14.2/100 PYs
(I2=90%), while the overall risk of new endocrinopathies was
0.9/100 PYs (95% CI. 0.5 to 1.2; I2=35%)
and risk of surgery ranged from 0.0 to 7.7/100 PYs
(I2=80%). Compared to microadenomas, macroadenomas had
higher risk of growth (p=0.002), higher risk of surgery
(p=0.006), and non-significant differences in risk of new
endocrinopathies (p=0.15). An analysis of microadenomas found the
risk of growth to be 1.8/100 PYs (95% CI. 0.9 to 2.8;
I2=58%), the risk of new endocrinopathies
0.7/100 PYs (95% CI. 0.0 to 1.6; I2=37%)
and the risk of surgery 0.5/100 PYs (0.1 to 0.9;
I2=37%). These data support individualized follow-up
strategies of patients with NFPTs and particularly a less rigorous follow-up of
patients with microadenomas.
Functional MR urography in children – update 2023
Authors: Kirsch Hanne , Krüger Paul-Christian , John-Kroegel Ulrike , Waginger Matthias , Mentzel Hans-Joachim
Published: July 2023

Background Functional MR urography (fMRU) has developed into an innovative, radiation-free option for assessing parameters of kidney function in pediatric radiology. The importance of fMRU in comparison to the standardized established nuclear medicine procedure (99mTc-Mercapto-acetyltriglycerine, MAG3 scintigraphy) is shown using SWOT analysis.

Methods To assess the current state of research, a selective literature search was carried out in PubMed. Taking into account the current scientific status, the examination technique, preparation, and evaluation of fMRU are presented.

Results As a result of the comparison with MAG3, fMRU is suitable for certain indications and represents an optimal combination of morphological and functional representation of the kidneys and urinary tract, especially in the case of surgical consequences.

Conclusion fMRU has been successfully established as a diagnostic method for assessing the morphology and function of the kidneys in competition with MAG3 scintigraphy.

Key Points 

Citation Format
„Ich möchte zu Hause wohnen bleiben“ – Projekt DeinHaus 4.0
Authors: Aschoff Frank
Published: July 2023

Menschen ermöglichen, möglichst lange selbstbestimmt im eigenen Zuhause zu bleiben. Mit diesem Ziel leitet die Physiotherapeutin Prof. Dr. Sabine Ittlinger von der Technischen Hochschule Rosenheim das Projekt DeinHaus 4.0. Auch für Physiotherapeut*innen entstehen hier interessante Perspektiven, um ihre Kompetenzen und ihr Leistungsspektrum zu erweitern.
Aberrantly Expressed lncRNA LINC00847 May Serve as a Promising
Prognostic Factor for Thyroid Cancer
Authors: Hei Guoli , Yu Yan , Wu Yang , Huang Jianyuan
Published: July 2023

Thyroid cancer is a tumor that occurs in the head and neck, which originates from
the thyroid follicular epithelial cells. The current research is discussed and
elaborated from the perspective of molecular prognostic biomarkers to gain a
deeper understanding of the molecular mechanism of thyroid cancer and to provide
more effective treatment and prognostic methods for patients. Thyroid cancer
patients were explored from histological, cellular and clinical levels.
Real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect
the expression of LINC00847 and miR-146b-5p in the tissues and cells of the
subjects. Cell growth and thyroid cancer progression were determined by the cell
counting kit-8 (CCK-8) and transwell assays. The LINC00847 sponge miR-146b-5p
was assessed by bioinformatics tools and luciferase reporter assay, and the
Kaplan–Meier method and multivariate Cox regression analysis suggested
the prognostic value of high expression of LINC00847. In thyroid cancer tissues
and cells, the expression of LINC00847 was decreased. Overexpression of
LINC00847 remarkably inhibited the proliferation level, migration ability and
invasion ability of thyroid cancer cells. Besides, miR-146b-5p was upregulated
in thyroid cancer tissues and cells. It was confirmed that LINC00847 targeting
miR-146b-5p had a regulatory effect on the progression of thyroid cancer, and
LINC00847 was negatively correlated with miR-146b-5p. LINC00847 may be
considered a meaningful prognostic marker to influence tumor growth through
sponge miR-146b-5p, which provides a new basis for the prognosis and treatment
of thyroid cancer.
Cervical myelitis: a practical approach to its differential diagnosis on MR imaging
Authors: Weidauer Stefan , Hattingen Elke , Arendt Christophe Théo
Published: July 2023

Background Differential diagnosis of non-compressive cervical myelopathy encompasses a broad spectrum of inflammatory, infectious, vascular, neoplastic, neurodegenerative, and metabolic etiologies. Although the speed of symptom onset and clinical course seem to be specific for certain neurological diseases, lesion pattern on MR imaging is a key player to confirm diagnostic considerations.

Methods The differentiation between acute complete transverse myelitis and acute partial transverse myelitis makes it possible to distinguish between certain entities, with the latter often being the onset of multiple sclerosis. Typical medullary MRI lesion patterns include a) longitudinal extensive transverse myelitis, b) short-range ovoid and peripheral lesions, c) polio-like appearance with involvement of the anterior horns, and d) granulomatous nodular enhancement prototypes.

Results and Conclusion Cerebrospinal fluid analysis, blood culture tests, and autoimmune antibody testing are crucial for the correct interpretation of imaging findings. The combination of neuroradiological features and neurological and laboratory findings including cerebrospinal fluid analysis improves diagnostic accuracy.

Key Points:
Enamine N-Oxides: Design, Synthesis, and Function in Bioortho­gonal Reactions
Authors: Kim Justin , Kang Dahye
Published: July 2023

Enamine N-oxides act as a chemical linchpin bridging two bioorthogonal associative and dissociative reactions. This article describes the design of enamine N-oxides, their synthesis through the retro-Cope elimination reaction, the use of solvent, hyperconjugation, strain, and rehybridization effects to achieve bioorthogonal reactivity, and their rapid reductive cleavage with diboron reagents. The coordinated assembly and disassembly of the enamine N-oxide motif constitutes a powerful chemical operation that enables the attachment and detachment of small molecules from biomacromolecules in a biological setting.

1 Introduction

2 Background

3 General Access to Linear Enamine N-Oxides

4 Strain-Promoted Hydroamination Reaction

5 Electronically Activated Alkynes

6 Chemically Revertible Reactions

7 Conclusion
Practical Asymmetric Synthesis of Sulfoximines and Sulfimides from Sulfinamides
Authors: Kano Taichi , Tsuzuki Saori
Published: July 2023

Chiral sulfoximines and sulfimides are an interesting class of compounds in various areas. However, methodologies for preparing these chiral sulfur compounds in a stereoselective manner have been underdeveloped. Herein, we briefly summarize our recent studies on asymmetric synthesis of sulfoximines and sulfimides from readily available enantioenriched sulfinamides. In these studies, optically pure sulfoximines and sulfimides having various carbon substituents on their sulfur atom could be obtained.

1 Introduction

2 Asymmetric Synthesis of Chiral Sulfoximines

3 Asymmetric Synthesis of Chiral Sulfimides

4 Conclusion
Current Patterns of Probiotic Use in U.S. Neonatal Intensive Care Units: A Multi-Institution Survey
Authors: Hanna Morcos , Ahmad Irfan , Yanowitz Toby , Kim Jae , Hunter Catherine , DiGeronimo Robert , Ahmad Kaashif A. , Sullivan Kevin , Markel Troy A. , Hair Amy B. , Chaaban Hala , Pammi Mohan , Huff Katie A. , Jasani Bonny , Fuchs Lynn , Cuna Alain , Garg Parvesh M. , Reber Kristina , Premkumar Muralidhar H. ,   On behalf of the Children's Hospital Neonatal Consortium Necrotizing Enterocolitis Focus Group
Published: July 2023

Objective Probiotic supplementation is associated with health benefits in preterm infants. The 2021 American Academy of Pediatrics (AAP) statement on probiotic use advised caution, citing heterogeneity and absence of federal regulation. We assessed the impact of the AAP statement and current institution-wide patterns of probiotic use across neonatal intensive care units (NICU) across the United States.

Study Design A cross-sectional web-based institutional survey using REDCap was emailed to 430 Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group institutions. The survey captured data on probiotic formulations, supplementation, initiation and cessation criteria, reasons for discontinuation, interest in initiating, and AAP statement's impact.

Results Ninety-five (22.1%) hospitals, including 42/46 (91%) CHNC and 53/384 (14%) Pediatrix institutions, completed the survey. Thirty-seven (39%) currently use probiotics. Fourteen different probiotic formulations were reported. The common criteria for initiation were birth weight <1,500 g and gestational age <32 weeks. Parental consent or assent was obtained at only 30% of institutions. Five hospitals (11%) with prior probiotic use discontinued solely due to the AAP statement. Overall, 23 (24%) of hospitals indicated that the AAP statement significantly influenced their decision regarding probiotic use. Nineteen of 51 nonusers (37%) are considering initiation.

Conclusion Probiotic use in preterm infants is likely increasing in NICUs across the United States, but significant variability exists. The 2021 AAP statement had variable impact on NICUs' decision regarding probiotic use. The growing interest in adopting probiotics and the significant interhospital variability highlight the need for better regulation and consensus guidelines to ensure standardized use.

Key Points
Niobium Pentachloride Mediated Direct Bradsher-Type Reaction: A Rapid and Efficient Strategy to Synthesize Novel Substituted 9-Anthraldehydes
Authors: Donate Paulo M. , Baviera Giovanni S.
Published: July 2023

Dichloromethyl methyl ether in the presence of niobium pentachloride and activated triarylmethanes leads to an efficient, mild, and rapid one-pot synthesis of several 9-anthraldehyde derivatives via a direct Bradsher-type reaction. This practical methodology offers several advantages, such as a broad substrate scope, simple workup process, and excellent yields.
Photo-Induced Glycosylations Using Organophotoacids: A New Environmentally Benign Carbohydrate Synthesis
Authors: Toshima Kazunobu , Takahashi Daisuke , Isozaki Yuka
Published: July 2023

This account reports the glycosylation reactions of glycosyl trichloroacetimidates and various alcohols using several organophotoacids as activators under photo-irradiation conditions. The reactions proceed smoothly to give the corresponding glycosides in high yields. The organophotoacids can be recovered and reused many times without any loss of efficiency, which demonstrates their environmentally benign features.

1 Introduction

2 Photo-Induced Glycosylation Using Naphthol Derivatives

3 Photo-Induced Glycosylation Using Aryl Thioureas

4 Photo-Induced Glycosylation Using Diaryldisulfides

5 Photo-Induced Glycosylation Using Diarylthiophenes

6 Conclusion
Lessons Learned from a National Initiative Promoting Publicly Available Standards-Based Clinical Decision Support
Authors: Dhopeshwarkar Rina V. , Freij Maysoun , Callaham Melissa , Desai Priyanka J. , I. Harrison Michael , Swiger James , A. Lomotan Edwin , Dymek Chris , Dullabh Prashila
Published: July 2023

Background Clinical decision support (CDS), which provides tools to assist clinical decision-making, can improve adherence to evidence-based practices, prevent medical errors, and support high-quality and patient-centered care delivery. Publicly available CDS that uses standards to express clinical logic (i.e., standards-based CDS) has the potential to reduce duplicative efforts of translating the same clinical evidence into CDS across multiple health care institutions. Yet development of such CDS is relatively new and its potential only partially explored.

Objectives This study aimed to describe lessons learned from a national initiative promoting publicly available, standards-based CDS resources, discuss challenges, and report suggestions for improvement.

Methods Findings were drawn from an evaluation of the Agency for Healthcare Research and Quality Patient-Centered Outcomes Research CDS Initiative, which aimed to advance evidence into practice through standards-based and publicly available CDS. Methods included literature and program material reviews, key informant interviews, and a web-based survey about a public repository of CDS artifacts and tools for authoring standards-based CDS.

Results The evaluation identified important lessons for developing and implementing standards-based CDS through publicly available repositories such as CDS Connect. Trust is a critical factor in uptake and can be bolstered through transparent information on underlying evidence, collaboration with experts, and feedback loops between users and developers to support continuous improvement. Additionally, while adoption of standards among electronic health record developers will make it easier to implement standards-based CDS, lower-resourced health systems will need extra support to ensure successful implementation and use. Finally, although we found the resources developed by the Initiative to offer valuable prototypes for the field, health systems desire more information about patient-centered, clinical, and cost-related outcomes to help them justify the investment required to implement standards-based, publicly available CDS.

Conclusion While the standards and technology to publicly share standards-based CDS have increased, broad dissemination and implementation remain challenging.
Mucinous Cystadenoma Arising in a Uterine Isthmocele: A Case Report
Authors: Carvalho Jesus Paula , Silva Alexandre Silva e , Kleine Rodolpho Truffa , Bertolazzi Marília Albanezi , Fernandes Rodrigo Pinto , Carvalho Filomena Marino
Published: July 2023

Isthmocele is a discontinuation of the myometrium at the uterine scar site in a patient with a previous cesarian section (CS). The cause of isthmocele appears to be multifactorial. Poor surgical technique, low incision location, uterine retroflection, obesity, smoking, inadequate healing of scars, and maternal age are possible related factors. Most patients with this condition are asymptomatic. However, women can present with postmenstrual bleeding, pelvic pain, subfertility, dysmenorrhea, infertility, and scar abscess. Brazil has one of the world's highest cesarean section rates. One of the consequences of the rising rate of CS is the isthmocele, an emerging female health problem. Here we report a case of mucinous cystadenoma arising in a uterine isthmocele, a complication, as far as we could investigate, not yet described in the literature.
COVID-19 and Preeclampsia: A Systematic Review of Pathophysiological Interactions
Authors: Nascimento Maria Isabel do , Cunha Alfredo de Almeida , Netto Nercélio Falcão Rangel , Santos Raphael Alves dos , Barroso Rodrigo Roberto , Alves Thiago Rodrigues de Carvalho , Soares Wender Emiliano
Published: July 2023

Objective: To review the literature and synthesize evidence on pathophysiological interactions attributed to the simultaneous occurrence of COVID-19 and preeclampsia.

Methods: A systematic review was conducted from November (2021) to January (2022) to retrieve observational studies published on the PubMed, LILACS, SciELO Brazil and Google Scholar databases. The search was based on the descriptors [(eclampsia OR preeclampsia) AND (COVID-19)]. Quantitative studies that pointed to pathophysiological interactions were included. Literature reviews, studies with HIV participants, or with clinical approach only were excluded. The selection of studies was standardized and the evaluation was performed by pairs of researchers.

Results: In this review, 155 publications were retrieved; 16 met the inclusion criteria. In summary, the physiological expression of angiotensin-converting enzyme-2 (ACE-2) receptors is physiologically increased in pregnant women, especially at the placental site. Studies suggest that the coronavirus binds to ACE-2 to enter the human cell, causing deregulation of the renin-angiotensin-aldosterone system and in the ratio between angiotensin-II and angiotensin-1-7, inducing manifestations suggestive of preeclampsia. Furthermore, the cytokine storm leads to endothelial dysfunction, vasculopathy and thrombus formation, also present in preeclampsia.

Conclusion: The studies retrieved in this review suggest that there is a possible overlap of pathophysiological interactions between COVID-19 and preeclampsia, which mainly involve ACE-2 and endothelial dysfunction. Given that preeclampsia courses with progressive clinical and laboratory alterations, a highly quality prenatal care may be able to detect specific clinical and laboratory parameters to differentiate a true preeclampsia superimposed by covid-19, as well as cases with hypertensive manifestations resulting from viral infection.
Efficacy of Embolization in Acquired Uterine Vascular Malformations: An Experience in Tertiary Care Centre in India
Authors: Inampudi Vineel , Nimmalapudi Sunanda
Published: July 2023

Objective: To determine the efficacy of Uterine Artery Embolization in patients with bleeding acquired uterine arteriovenous malformations (AVMs).

Methods: A prospective review of all patients who underwent Uterine Artery Embolization at our institution between July 2015 and April 2022 was performed. 225 patients were diagnosed with a uterine vascular malformation on doppler and corresponding MRI imaging. All patients underwent transcatheter embolization of the uterine arteries. Embolic agents in the 375 procedures included Histoacryl glue only (n = 326), polyvinyl alcohol (PVA) particles and Histoacryl glue (n = 29), PVA particles (n = 5), Gelfoam (n = 5), coils (n = 4), PVA particles and coils (n = 3), Histoacryl glue and Gelfoam (n = 2), and Histoacryl glue and coils (n = 1).

Results: A total of 375 embolization procedures were performed in 225 patients. 90 patients required repeat embolization for recurrence of bleeding. The technical success rate of embolization was 100%. The clinical success rate was 92%: bleeding was controlled in 222 of 225 patients and three patients underwent a hysterectomy. 60 of the 225 patients had uneventful intrauterine pregnancies carried to term. The 210 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up of 53 months (range, 5-122 months) after treatment. 15 patients were eventually lost to follow-up. One minor complication (0.4%) of non-flow-limiting dissection of the internal iliac artery occurred.

Conclusion: Uterine Artery Embolization is a safe, effective, minimally invasive method to treat uterine AVMs with long-term efficacy, which can provide the preservation of fertility.
Mirabegron and Anticholinergics in the Treatment of Overactive Bladder Syndrome: A Meta-analysis
Authors: Sartori Luisa Gracio Ferreira , Nunes Bruno Monteiro , Farah Daniela , Oliveira Leticia Maria de , Novoa Claudia Cristina Takano , Sartori Marair Gracio Ferreira , Fonseca Marcelo Cunio Machado
Published: July 2023

Objective To compare the use of mirabegron with anticholinergics drugs for the treatment of overactive bladder (OB).

Data Source Systematic searches were conducted in EMBASE, PUBMED, Cochrane, and LILACS databases from inception to September 2021. We included RCTs, women with clinically proven OB symptoms, studies that compared mirabegron to antimuscarinic drugs, and that evaluated the efficacy, safety or adherence.

Data Collection RevMan 5.4 was used to combine results across studies. We derived risk ratios (RRs) and mean differences with 95% CIs using a random-effects meta-analytic model. Cochrane Collaboration Tool and GRADE was applied for risk of bias and quality of the evidence.

Data Synthesis We included 14 studies with a total of 10,774 patients. Fewer total adverse events was reported in mirabegron group than in antimuscarinics group [RR 0.93 (0.89–0.98)]. The risk of gastrointestinal tract disorders and dry mouth were lower with mirabegron [RR 0,58 (0.48–0.68); 9375 patients; RR 0.44 (0.35–0.56), 9375 patients, respectively]. No difference was reported between mirabegron and antimuscarinics drugs for efficacy. The adherence to treatment was 87.7% in both groups [RR 0.99 (0.98–1.00)].

Conclusion Mirabegron and antimuscarinics have comparable efficacy and adherence rates; however, mirabegron showed fewer total and isolated adverse events.
VEXAS Syndrome—Review
Authors: Zhang Yue , Dong Xifeng , Wang Huaquan
Published: July 2023

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a newly defined refractory adult-onset autoinflammatory syndrome caused by somatic mutations in the ubiquitin-like modifier-activating enzyme 1 (UBA1) gene in hematopoietic stem and progenitor cells, resulting in a shift in UBA1 isoform expression. Thus, patients develop a spectrum of systemic inflammatory manifestations and hematologic symptoms. To date, patients respond poorly to immune suppressive drugs, except high-dose glucocorticoids, and no treatment guidelines have been established. Given the high mortality rate, VEXAS syndrome needs to be taken seriously by physicians in all specialties. This article aims to describe the key features, pathogenesis, and clinical manifestations of VEXAS syndrome to better understand the targeted treatment and improve the prognosis of VEXAS syndrome.
Contemporary Obstetric and Neonatal Outcomes in Sickle Cell Disease: A Retrospective Cohort Study
Authors: Hachey Sara M. , Joseph Sophie , Dolin Cara D. , Triebwasser Jourdan E. , Sayani Farzana , Hamm Rebecca F.
Published: July 2023

Objective Sickle cell disease is associated with adverse perinatal outcomes. Aspects of sickle cell disease in pregnancy, such as health care utilization and neonatal abstinence syndrome, are understudied. We aimed to describe contemporary sickle cell disease outcomes in a U.S. hospital system to improve perinatal counseling.

Study Design We conducted a retrospective cohort study of patients with sickle cell disease who delivered at >20 weeks' gestation at two sites within the University of Pennsylvania Health System from May 1, 2017 to August 30, 2020. Descriptive statistics were utilized.

Results Over the study period, 48 patients with sickle cell disease had 52 deliveries of 53 neonates. Sickle cell disease-related morbidity was prevalent prior to pregnancy; 27% had a history of avascular necrosis, and 58% had experienced acute chest syndrome. In the year prior to pregnancy, 52% used daily opioids. During pregnancy, more than half of patients were admitted at least once for sickle cell disease-related complications, spending a median 3 days admitted interquartile range (0–23); >10% spent >70 days of pregnancy admitted. New daily opioids were prescribed during pregnancy for 10% to manage pain crises. Acute chest syndrome was experienced by 23% of patients during pregnancy, and 8% required placement of long-term intravenous access. Preterm delivery <37 weeks occurred in 48%. The primary cesarean rate in nulliparas was 43%. Additionally, 50% experienced a hypertensive disorder of pregnancy, 35% underwent transfusion during delivery admission, and 10% had a perinatal venous thromboembolism. Finally, 53% of neonates were admitted to the intensive care unit. Low birth weight was noted in 34%, severe respiratory distress in 15% of infants, and neonatal abstinence syndrome in 21%.

Conclusion Sickle cell disease remains associated with significant perinatal morbidity and need for hospitalization. These data provide contemporary outcomes to target improvements in the care of patients with sickle cell disease.

Key Points
Neonatal Catheter and Tube Placement and Radiographic Assessment Statistics in Relation to Important Anatomic Landmarks
Authors: Henderson Robert D. E. , Padash Sirwa , Adams Scott J. , Augusta Carolyn , Yi Xin , Babyn Paul
Published: July 2023

Objective Neonatal catheters and tubes are commonly used for monitoring and support for intensive care and must be correctly positioned to avoid complications. Position assessment is routinely done by radiography. The objective of this study is to characterize neonatal catheter and tube placement in terms of the proportion of those devices that are malpositioned.

Study Design Using an institutional dataset of 723 chest/abdominal radiographs of neonatal intensive care unit (ICU) patients (all within 60 days of birth), we assessed the proportion of catheters that are malpositioned. Many radiographs contained multiple catheter types. Umbilical venous catheters (UVCs; 448 radiographs), umbilical arterial catheters (UACs; 259 radiographs), endotracheal tubes (ETTs; 451 radiographs), and nasogastric tubes (NGTs; 603 radiographs) were included in our analysis.

Results UVCs were malpositioned in 90% of radiographs, while UACs were malpositioned in 36%, ETTs in 30%, and NGTs in just 5%. The most common locations in which UVCs were malpositioned were in the right atrium (31%) and umbilical vein (21%), and for UACs the most common malpositioned tip location was the aortic arch (8%). For the remaining tubes, 5% of ETTs were found to be in the right main bronchus and 4% of NGTs were found in the esophagus.

Conclusion A substantial proportion of catheters and tubes are malpositioned, suggesting that optimizing methods of catheter placement and assessment ought to be areas of focus for future work.

Key Points
Current clinical and research practices on frontotemporal dementia in Brazil: a national survey
Authors: de Souza Leonardo Cruz , Brucki Sonia Maria Dozzi , Schilling Lucas Porcello , Silva Letícia Costa da , Takada Leonel Tadao , Bahia Valéria Santoro , Barbosa Breno José Alencar Pires , Balthazar Marcio Luiz Figueredo , Frota Norberto Anizio Ferreira , Nitrini Ricardo , Caramelli Paulo , Smid Jerusa
Published: July 2023

Background Frontotemporal dementia (FTD) is a frequent cause of young-onset dementia and represents a major challenge for the diagnosis and clinical management. It is essential to evaluate the difficulties faced by physicians on the diagnostic workup and on patient care.

Objective The aim of this study was to investigate the current practices and the local limits on the diagnosis and management of FTD in Brazil.

Methods We elaborated an online survey, composed of 29 questions and divided in four parts, comprising questions about existing health facilities, clinical practices related to FTD, and suggestions to increment the national research on FTD. The invitation to participate was sent by email to all neurologists affiliated to the Brazilian Academy of Neurology (n = 3658), and to all physicians who attended the XII Meeting of Researchers on Alzheimer's disease, in 2019 (n = 187). The invitation was also diffused through social media.

Results 256 Brazilian physicians answered the questionnaire. The three most relevant disorders for the differential diagnosis of FTD were Alzheimer's disease (AD) (n = 211), bipolar disorder (n = 117) and dementia with Lewy bodies (n = 92). Most respondents (125/256) reported the difficulty in performing genetic testing as the main limit in the diagnostic of FTD. 93% and 63% of participants considered that the assessment of social cognition and AD CSF biomarkers are useful for the diagnosis of FTD, respectively.

Conclusions The present study may provide valuable insights for the medical education and clinical training of physicians, and to foster future research on FTD in Brazil.
Examining the Relationship between Social Determinants of Health and Adverse Pregnancy Outcomes in Black Women
Authors: Walker Shannon L. , Walker Rebekah J. , Palatnik Anna , Dawson Aprill Z. , Williams Joni S. , Egede Leonard E.
Published: July 2023

Objective Our objective was to examine associations between social determinants of health (cultural, neighborhood, and psychosocial factors) and adverse pregnancy outcomes (gestational age at birth [GAB], preterm birth [PTB], and preeclampsia) in Black women.

Study Design Cross-sectional data (n = 204) comprised adult Black women aged ≥18 years who delivered between 2013 and 2022 in Milwaukee,Wisconsin. Sequential unadjusted linear and logistic regression models were run to evaluate associations between social determinants of health and pregnancy outcomes. Stepwise regressions with forward selection were run to test the contribution of the social determinants of health to adverse pregnancy outcomes, independent of the contribution of established risk factors.

Results Mean GAB was 37.9 weeks, 19.6% had a PTB and 17.7% had preeclampsia. In all fully adjusted models, education (β0.15, 95% confidence interval [CI]: 0.005, 0.29), nulliparity (β −1.26, 95%CI: −2.08, −0.44), multifetal gestation (β −2.67, 95% CI: −4.29, −1.05), and exposure to neighborhood violence (β −0.13, 95%CI: −0.25, −0.005) were associated with shortened GAB. Education (adjusted odds ratio [aOR]: 0.83, 95%CI: 0.69, 0.99), provider trust (aOR: 0.94, 95%CI: 0.88, 0.99), chance health locus of control (aOR: 0.88, 95%CI: 0.78, 0.99), and anxiety (aOR: 0.81, 95%CI: 0.69, 0.95) were associated with reduced odds of PTB. Powerful others health locus of control (aOR: 1.16, 95%CI: 1.03, 1.32), depression (aOR: 1.17, 95%CI: 1.01, 1.34), nulliparity (aOR: 4.73, 95%CI: 1.79, 12.55), multifetal gestation (aOR: 17.78, 95%CI: 3.49, 90.50), diabetes (aOR: 4.71, 95%CI: 1.17, 19.00), and obstructive sleep apnea (aOR: 44.28, 95%CI: 2.50, 783.12) were associated with increased odds of PTB. Internal health locus of control (aOR: 1.13, 95%CI: 1.01, 1.25), depression (aOR: 1.09, 95%CI: 1.01, 1.17), preeclampsia in a previous pregnancy (aOR: 5.96, 95% CI: 2.22, 16.01), and kidney disease (aOR: 34.27, 95% CI: 1.54, 763.75) were associated with preeclampsia.

Conclusion Provider trust, health locus of control, neighborhood violence, depression, and anxiety were associated with adverse pregnancy outcomes in Black women, independent of demographic and clinical risk factors.

Key Points
Endovascular Repair of Thoracoabdominal Aortic Aneurysm: A Brief Review
Authors: Tohme Scarlett , Newman Joshua , Yu Pey-Jen
Published: July 2023

Thoracoabdominal aortic aneurysms (TAAAs) are complex and if untreated have high mortality and morbidity rates. Open surgical repair is the historical treatment approach; however, postoperative complications remain high with spinal cord ischemia notably one of the more serious and common complications. The avoidance of thoracotomy or laparotomy with the advent of endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) have decreased the morbidity and mortality with TAAA repair, especially in patients with significant comorbidities such as a history of aortic surgery, underlying cardiac disease, and chronic obstructive pulmonary disease. Endovascular treatment options have grown to include fenestrated EVAR, multibranched EVAR, and physician-modified fenestration stent grafts. These techniques have achieved lower mortality rates than traditional open repair, but complications such as limb ischemia, spinal cord ischemia, and long-term durability must be considered. This review provides an overview of the most common endovascular techniques for TAAAs as well as short- and midterm outcomes.
Corruption revisited: the influence of national personality, culture, and wealth
Authors: Obschonka Martin , Stuetzer Michael , Newman Alexander , Gibson Cristina B. , Gosling Samuel D. , Rentfrow Peter J. , Potter Jeff
Published: July 2023

Corruption is often seen as one of the root causes of pressing national and global challenges. The persisting stark national differences in corruption levels and their potential causes have thus attracted growing interest from international business scholars. The objective of this study was to re-examine key factors that predict levels of national corruption. Drawing on comprehensive personality data from over 5 million respondents across 87 nations, and numerous dimensions of national culture, the study examines the relative importance of national personality versus national culture and wealth as predictors of national corruption. Regression analysis found that collectivism (particularly societal practices pertaining to collectivism) and wealth were robust predictors of corruption. In contrast, there was no consistent support for the effects of the Big Five personality traits aggregated to the national level, above and beyond the effects of national culture and wealth. These findings highlight and specify the important role played by national culture, and call into question previous research on national personality and corruption. More broadly, our study further highlights the need to exert caution when examining the influence of national-level personality, and the need for cross-national personality researchers to improve the validity, interpretability, and replicability of their work.