bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFICACY OF BETA-BLOCKERS ON BLOOD PRESSURE CONTROL, MORBIDITY AND MORTALITY ENDPOINTS IN HYPERTENSIVES OF AFRICAN ANCESTRY: AN INDIVIDUAL PATIENT DATA META-ANALYSIS
Authors: Tsabedze Nqoba , Naicker Darshni , Mrabeti Sanaa
Published: June 2023

Objective:

Beta-blockers have been reported to sub-optimally lower central aortic blood pressure and cause an increased stroke incidence. There is a paucity of data regarding beta-blocker efficacy in patients of African origin. We proposed that an individual patient data meta-analysis (IPD-MA) focusing on the efficacy of traditional and second or third-generation beta-blockers (STGBBs) in the whole and African hypertensive population may provide new insights.

Design and method:

A single-stage IPD-MA analysed the efficacy of STGBBs in the setting of other anti-hypertensives for lowering mean arterial pressure (MAP) and reducing the occurrence of composite outcome (total cardiovascular mortality, stroke and myocardial infarction).

Results:

A total of 11860 participants were included in the analysis, of which 3864 (32.5%) were on STGBB. STGBBs reduced the MAP by 1.75 mmHg (95% confidence interval (CI): 1.16 - 2.33; p<0.001) in the whole population and by 1.93 mmHg (95% CI: 0.86 - 3.00; p<0.001) in 3880 African hypertensives, outperforming angiotensin-converting enzyme inhibitors (ACE-I) in the whole population studied and ACE-I and calcium channel blockers in the African population. Confounding through beta-blocker use in established cardiovascular disease resulted in STGBBs being associated with an adjusted odds ratio of 1.33 (95 % CI: 1.06 - 1.65; p = 0.015) of the composite outcome while controlling for age, gender, race and smoking history. STGBBs were not associated with an increase in the odds of stroke in African hypertensives nor the whole population.

Conclusions:

STGBBs reduced the MAP comparably to other anti-hypertensives. No increase in the odds of stroke was found.
MEDICATION ADHERENCE AND GENDER DIFFERENCE IN HYPERTENSIVE PATIENTS
Authors: Radic Josipa , Dogas Hana , Vuckovic Marijana , Kolak Ela , Gelemanovic Andrea , Nenadic Dora Bucan , Radic Mislav
Published: June 2023

Objective:

One of the major clinical problems in the management of arterial hypertension (AH) is adherence to the medical regimen. Failure to adhere affects not only patients causing disease progression, reduced functional abilities as well as lower quality of life, but also the healthcare system due to medication waste and increased hospital visits and admissions. Data about hypertensive medication adherence in our region are lacking. Therefore, we aimed to assess medication adherence in our hypertensive patients in order to identify possible strategies to improve and enhance mentioned adherence.

Design and method:

This study included 324 participants with AH, of which 51.2 % were men, and with an overall median age of 64 years (IQR = 17). Along with the 24-hour ambulatory blood pressure measurement, each patient completed a medication adherence questionnaire, Morisky Medication Adherence Scale (MMAS-8). This self-reported questionnaire consists of 8 questions with a total score ranging from 0 to 8 and a lower score indicates lower adherence to the prescribed pharmacological antihypertensive therapy.

Results:

51 (15.7%) participants had low, 114 (35.2%) had moderate and 159 (49.1%) had high medication adherence. There was no significant difference in MMAS-8 score regarding age (p = 0.334), however, men were found to have -higher adherence to antihypertensive therapy than women (58.5% vs. 41.5% had high adherence, respectively, p = 0.018).

Conclusions:

The results of our study showed that more than half of our hypertensive patients (50.9%) are not completely adherent to antihypertensive medication. Among all of them women were found to have lower adherence compared to men. Low medication adherence could lead to substantial worsening of disease as well as increased health care costs in care of hypertensive patients. Therefore, the presented results highlight the need for patient education and support to increase patient adherence in order to reduce cardiovascular risk.
ADHERENCE TO TREATMENT IN HYPERTENSIVE ADULTS: RELATIONSHIP WITH SOCIAL SUPPORT, ANXIETY AND DEPRESSION
Authors: Martinez Vanessa Carolina Romero , Silva Eglé , Bermudez Greily , Bracho Mayela , Esis Carlos , Calmón Gustavo , Madueño Freddy
Published: June 2023

Objective:

This study examined the relationship between Social Support (SS) Anxiety (A) Depressión (D) with adherence to treatment (AT) in hypertensive adults.

Design and method:

There were 1582 hypertensive adults, males (n = 404) and females (n = 1178), age mean = 72 years, (SD = 12, 57). The Morisky–Green test evaluated compliant and non-compliant, DUKE test evaluated affective social support (ASS) and confidential social support (CSS), Zung Anxiety scale: Minimum anxiety (MiA), Moderate anxiety MoA) and Severe anxiety (SeA) and Zung Depression scale: Non depression (NoD) Minimum Depression (MiD) and Moderate- Severe Depression (MosD), all applied in one day doctor's visit.

Results:

The means and standard deviations for Systolic Blood Pressure of hypertensive adults was: 158,91 ± 29,82; for Diastolic Blood Pressure of hypertensive adults was 74,43 ± 12,79. Hypertensive adults compliant 20,3% and hypertensive adults non-compliant 79,7%. Good ASS support was 4.1%; bad ASS was 95.9%. Good CSS was 3.4% and 96.6% for bad CSS. MiA 35.6%; MoA 30% and SeA 34.4%. NoD 29.3%; MiD 63.7% and MosD 7%. The Rho Spearman correlation showed a significant correlation between AT and ASS (Rho Spearman: r = ,120**/ p = ,000); AT and CSS (Rho Spearman: r = ,113**/ p = ,000); AT and A (Rho Spearman: r = ,141**/ p = ,000); AT and D (Rho Spearman: r = ,132**/ p = ,000).

Conclusions:

The results provide evidence of a relationship between AT and ASS, CSS, A, D in hypertensive adults, indicating that social support and mood are important variables that must be evaluated when measuring adherence to treatment and seeking strategies to improve them.
THE EFFECT OF TEXT MESSAGES BY CELL PHONE IN THE CONTROL OF HYPERTENSION: A RANDOMIZED CLINICAL TRIAL
Authors: Coelho Juliana Chaves , Lee Renata Jae Won , Silva Giovanio Vieira , Drager Luciano Ferreira , Pierin Angela Maria Ger
Published: June 2023

Objective:

To compare the effects of texting by cell phone plus standard usual guidance for hypertension versus standard usual guidance alone, on blood pressure control, among hypertensive patients undergoing outpatient treatment.

Design and method:

Randomized controlled clinical trial, composed of two groups: Intervention Group, who received SMS text messages twice a week for 10 weeks; and Comparison Group, who received the usual care. Both groups received an educational pamphlet about the hypertension. The primary outcome was BP control by office blood pressure measurement (OBPM; <140/90 mmHg) or by daytime Ambulatory Blood Pressure Monitoring (ABPM; <135/85 mmHg). Adherence to treatment was assessed indirectly using the 4 item Morisky Medication Adherence Scale and, directly, by assessing antihypertensive drugs in the urine, using a high-performance liquid chromatography technique associated with mass spectrometry. The significance level was 5%.

Results:

In the study, 178 patients were randomized, (90 in the Intervention Group and 88 in the Comparison Group). The sample was 60 (10) years old, women (63.8%), non-white (58.9%) and married (54.6%). The hypertensive patients were classified as having high cardiovascular risk (77.3%). The result of the intervention effect showed that there was no difference between the Intervention Group and Comparison Group (RR = 1.05; 95%CI = 0.75-1.47, and RR = 1.23; 95%CI = 0.87-1.74, respectively) in the control of OBPM, or by the daytime ABPM. However, in the Intervention Group and Comparison Group, respectively, there was a mean reduction in BP (-8.6 and -7.3 mmHg in systolic OBPM and -2.19 mmHg and -2.09 mmHg in systolic daytime ABPM); and increase in the BP control by the OBPM (19.8% to 36.0% and 19.7% to 38.2%) and daytime ABPM (38.6% to 42.5% and 41.3% to 52.2%); and in the assessment of adherence indirectly (45.3% to 69.4% and 57.1% to 59.2%). In the assessment of adherence directly, there was little difference between the groups and the two moments evaluated.

Conclusions:

The effect of texting by cell phone was similar to usual treatment for hypertension on BP control. On the other hand, both groups improved BP control and increased adherence to treatment.
A SPECIFIC 3 MONTHS-PROGRAM TO IMPROVE NON-ADHERENCE IN UNCONTROLLED HYPERTENSION IMPROVES BLOOD PRESSURE CONTROL AND ASSOCIATED ORGAN DAMAGE (ATHAN CLINICAL TRIAL)
Authors: Oliveras Anna , Hernández Juanjo , Camps Carme , Fontdevila Laia , Vega Victoria , Vinyoles Ernest , Galceran Isabel , Crespo Marta , Vazquez Susana
Published: June 2023

Objective:

To evaluate whether a specific 3-month(m) action plan to improve therapeutic adherence in patients with uncontrolled hypertension on ◊ 2 drugs results in a decrease in BP and whether this is maintained at 12m. Secondly, to assess if this correlates with an improvement in subclinical organ damage.

Design and Method: Prospective, randomized clinical trial where patients attended consecutively in a Hypertension Unit with ambulatory 24h-BP ◊130/80 mmHg despite receiving at least 2 antihypertensive drugs and with therapeutic non-compliance confirmed by the determination of antihypertensive drugs in the urine, were randomized (1:1) to receive a specific 3-month program to improve adherence (INT = intervention) or routine follow-up (C = control). Antihypertensive treatment was not modified, but beyond 3m all patients received usual care. Before randomization, and at 3m and 12m, urinary screening for antihypertensive drugs and albuminuria, and 24h-ambulatory BP monitoring were determined.

Results:

Forty-six patients were randomized. At 3m, mean (95%CI) baseline-adjusted BP differences (INT vs. C) were -14.7 mmHg (-5.4 to -24.1), p = 0.001 and -10.0 mmHg (-3.9 to -16.2), p<0.001 for 24h-SBP and 24h-DBP, respectively. The INT group maintained the BP decrease at 12m. vs. baseline: mean(95%CI) variation of 24h-SBP = -16.1 mmHg (-22.8 to -9.4), p<0.001 and variation of 24h-DBP = -7.8 (-12.8 to -2.7), p = 0.002. In the INT group, the percentage of non-detected antihypertensive drugs decreased compared to baseline: median [IQR]: 40% [20-85.7], 0% [0-25], and 18.3 % [0-40] at baseline, 3m and 12m respectively; Z = -3.295 (p<0.001) and Z = -3.055 (p = 0.002) for changes at 3m and 12m, respectively. Albuminuria (median [IQR]) decreased in the INT group: 27.1 mg/g [11.2-116.2] and 22.4 mg/g [6.4-91.9] at baseline and 12m, respectively (Z = -2.207, p = 0.027). At 12m, variation of albuminuria correlated with variation of 24h-BP but not with variation of percentage of non-detected antihypertensive drugs.

Conclusions:

a 3-month specific nursing intervention to improve therapeutic adherence results in improved BP control in patients with inadequate therapeutic compliance. This improvement continues beyond the completion of this program. Decreased BP correlates with a regression of albuminuria.
PRESCRIPTION OF SINGLE-PILL ANTIHYPERTENSIVE COMBINATION THERAPY
Authors: Dogas Hana , Radic Josipa , Vuckovic Marijana , Gelemanovic Andrea , Kolak Ela , Nenadic Dora Bucan , Radic Mislav
Published: June 2023

Objective:

The need for polytherapy is common among people affected by arterial hypertension (AH). A single-pill combination is a response to decreased medication adherence, especially in elderly people often suffering from more than one disease, which tends to improve blood pressure control and cardiovascular outcomes. The aim of our study was to determine the frequency of use of a single-pill antihypertensive combination (SPC) therapy and possible differences in presence of comorbidities.

Design and method:

324 hypertensive participants on pharmacological treatment were included in this research, of which 51.2% were men, and with an overall median age of 64 years (IQR = 17). For each participant undergoing 24-hour ambulatory blood pressure measurement, data about pharmacological therapy, weight, height and comorbidities such as chronic kidney disease (CKD) and diabetes mellitus (DM) were obtained from their most recent medical records combined with self reports. Body mass index (BMI) was calculated.

Results:

148 (45.7%) participants were prescribed a SPC. Participants taking a SPC had lower presence of CKD (23.7% with CKD vs. 76.3% without CKD, p<0.001). No significant difference was found in the presence of DM (p = 0.496). Another interesting finding was more frequent use of SPC therapy among patients with higher BMI (p = 0.029).

Conclusions:

The results show that less than half of the participants in our study were prescribed an SPC. From this we can conclude that more attention should be paid to educating people about the options for antihypertensive treatment and simplifying therapy regimen. Another point we should highlight is the limited availability of SPCs in the treatment of hypertension in patients suffering from CKD.
USE OF COMBINATION TREATMENT IN HYPERTENSION MANAGEMENT AND ITS ASSOCIATION WITH HYPERTENSION CONTROL
Authors: Croce Alessandro , Bilo Grzegorz , Pengo Martino , Gorini Francesca , Amato Franca , Sucapuca Richard , Rosa Debora , Parati Gianfranco
Published: June 2023

Objective:

Achievement of blood pressure (BP) targets in hypertension is crucial for cardiovascular prevention and, in most cases, requires combined pharmacological treatment. Current ESC/ESH Guidelines for hypertension management recommend initiating treatment with combination therapy in most hypertensives, except low-risk individuals with mildly elevated BP. Our aim was to assess how this recommendation is applied in practice and whether it is associated with differences in hypertension control.

Design and method:

In the setting of an ongoing cardiovascular prevention trial (CV-PREVITAL) we prospectively recruited 278 hypertensive patients with no history of cardiovascular disease, among individuals who responded to the advertisement campaign in outpatient facilities of Istituto Auxologico Italiano. Physical examination, standard routine blood tests, office blood pressure recording and standard 24h ABPM has been performed at baseline. We analyzed the office and ambulatory BP control in relationship to the number of antihypertensive drugs and cardiovascular risk assessed by SCORE for low risk countries.

Results:

Median age of our sample was 61 years, with balanced gender distribution. Ninety-nine (36%) participants were not receiving any pharmacological treatment, 106 (41%) were on monotherapy and 73 (23%) on combined treatment. Comparison of principal characteristics among the three groups is shown in Table 1.

Among study participants 44 (16%) had low to moderate CV risk and 227 (84%) had high or very high estimated risk. The percentage of participants receiving combined treatment in these groups was 4.1% and 22.5%, respectively, and the percentage of patients with well controlled office/ambulatory BP was 50%/41% in low to moderate risk and 35%/65% in high to very high risk participants, respectively.

Conclusions:

In this sample of patients with known hypertension, a considerable proportion received substandard treatment (no treatment or monotherapy), even among those at high risk. This was associated with worse BP control in these individuals. Implementation of current hypertension guidelines in practice remains largely suboptimal.
ASSESSMENT OF TRADITIONAL HERBAL REMEDIES USE AND MEDICAL TREATMENT AMONG HYPERTENSIVE PATIENTS ATTENDING PRIMARY HEALTH CARE CENTERS IN KHARTOUM STATE 2022-2023
Authors: Alhaj Waleed Mohammed , Mohammed Hazim Hassan , Jaber Mohammed Hammad , Abdelgadir Hiba S
Published: June 2023

Objective:

Hypertension is the leading risk factor for cardiovascular disease mortality worldwide. It affects approximately 74.7 million people in Sub-Saharan Africa, and this figure is expected to increase to 125.5 million by 2025. Although antihypertensive drugs have been used to decrease blood pressure; traditional herbal remedies have been utilized within local or regional practices, in up to 80% of African populations.

The current study was carried out to assess adherence to medications and perception of Hypertensive patients regarding use of herbal treatment.

Design and method:

This was a descriptive cross-sectional facility centres-based study at 3 PHC centers. A total of 100 hypertensive patients were enrolled using multi-stage sampling. The data was collected by modified open and closed ended interview questionaries. Modified Morisky score system was used to assess adherence to medical treatment

Results:

The study population was 100 participants of which (57%) were females. Most of the participants (77%) were in the age group of 51 and above, (49%) had secondary and higher levels of education, (66%) were using Single type of drug and (77%) were in regular clinical checkup, (90%) were taking their medications as prescribed by their physicians, (58%) were diagnosed before ten years or more, (43%) had Diabetes as co-morbid. Fifty one percent of the participants had low adherence to medication. Forty nine percent of participants used herbal remedies with 67.3% of them had low adherence to their medications; Hibiscus was the most commonly used herb (31%). There was significant association between lack of adherence and the medication unavailability (p = .009).there was significant association between lack of adherence and taking more than one medication (p = 0.001);and between lack of adherence and lack of confidence in medical treatment (p = 0.012).

Conclusions:

A significant proportion of hypertensive patients are using herbal remedies which is negatively affects their adherence to the prescribed medications
In Utero Enzyme-Replacement Therapy for Infantile-Onset Pompe's Disease
Authors: Cohen Jennifer L. , Chakraborty Pranesh , Fung-Kee-Fung Karen , Schwab Marisa E. , Bali Deeksha , Young Sarah P. , Gelb Michael H. , Khaledi Hamid , DiBattista Alicia , Smallshaw Stacey , Moretti Felipe , Wong Derek , Lacroix Catherine , El Demellawy Dina , Strickland Kyle C. , Lougheed Jane , Moon-Grady Anita , Lianoglou Billie R. , Harmatz Paul , Kishnani Priya S. , MacKenzie Tippi C.
Published: June 2023

(Abstracted from N Engl J Med 2022;387:2150–2158

Some diseases, such as early-onset lysosomal storage diseases, are so destructive that organ damage begins before birth, in utero. For some of these conditions, therapies have been developed to reduce damage and increase the likelihood of a higher quality of life in affected patients.
Maternal and Neonatal Outcomes of Trial of Labor Compared With Elective Cesarean Delivery According to Predicted Likelihood of Vaginal Delivery
Authors: Downs Sarah , Mokhtari Neggin , Gold Stacey , Ghofranian Atoosa , Kawakita Tetsuya
Published: June 2023

(Abstracted from J Matern Fetal Neonatal Med 2022;35(26):10487–10493

In 2007, the Maternal-Fetal Medicine Unit (MFMU) Network developed the vaginal birth after cesarean (VBAC) calculator to help optimize the likelihood of a successful vaginal delivery. One study found that the risk of maternal and neonatal morbidity is no greater than that of elective repeat cesarean delivery (CD)—specifically when the likelihood of successful VBAC is >70%.
Buprenorphine Versus Methadone for Opioid Use Disorder in Pregnancy
Authors: Suarez Elizabeth A. , Huybrechts Krista F. , Straub Loreen , Hernández-Díaz Sonia , Jones Hendrée E. , Connery Hilary S. , Davis Jonathan M. , Gray Kathryn J. , Lester Barry , Terplan Mishka , Mogun Helen , Bateman Brian T.
Published: June 2023

(Abstracted from N Engl J Med 2022;387:2033–2044

Opioid use disorder (OUD) affects approximately 8.2 per 1000 deliveries in the United States. Among those insured by Medicaid, the disorder affects 14.6 per 1000 deliveries.
Efficacy and Safety of Mirvetuximab Soravtansine in Patients With Platinum-Resistant Ovarian Cancer With High Folate Receptor Alpha Expression: Results From the SORAYA Study
Authors: Matulonis Ursula A. , Lorusso Domenica , Oaknin Ana , Pignata Sandro , Dean Andrew , Denys Hannelore , Colombo Nicoletta , Van Gorp Toon , Konner Jason A. , Marin Margarita Romeo , Harter Philipp , Murphy Conleth G. , Wang Jiuzhou , Noble Elizabeth , Esteves Brooke , Method Michael , Coleman Robert L.
Published: June 2023

(Abstracted from J Clin Oncol 2023;41(13):2436–2445

Approximately 80% of patients with ovarian cancer experience recurrence after platinum-based chemotherapy, and unfortunately nearly all will eventually develop platinum-resistant ovarian cancer (PROC). Treatment in this setting consists of nonplatinum chemotherapy with or without bevacizumab; however, each successive line of therapy in PROC is associated with progressively lower response rates.
Transcription of MERVL Retrotransposons Is Required for Preimplantation Embryo Development
Authors: Sakashita Akihiko , Kitano Tomohiro , Ishizu Hirotsugu , Guo Youjia , Masuda Harumi , Ariura Masaru , Murano Kensaku , Siomi Haruhiko
Published: June 2023

(Abstracted from Nat Genet 2023;55(3):484–495

Zygotic genome activation (ZGA) is a critical developmental step that occurs after fertilization of the embryo and promotes totipotency, allowing different cell fates to emerge in the developing embryo. In mice, the expression of murine endogenous retrovirus with leucine transfer RNA primer binding site (MERVL), a known marker of totipotency, becomes specifically activated at the 2-cell stage concomitant with ZGA.
Decreasing Decision-to-Incision Times for Unscheduled, Urgent Cesarean Deliveries
Authors: Tibavinsky Bernal Lina , Yarrington Christina D. , Xuan Ziming , Zani Lisa , Friedman Scott , Schultz Michele , Chandra Phanirekha , Iverson Ronald E.
Published: June 2023

OBJECTIVE:

To standardize the preprocedure process for urgent, unscheduled cesarean deliveries to decrease the time from decision to skin incision to improve maternal and fetal outcomes.

METHODS:

In our quality-improvement project, we selected indications that require urgent cesarean deliveries, created a standard algorithm, then implemented a multidisciplinary process intended to reduce decision-to-incision time. This initiative was conducted from May 2019 to May 2021, with a preimplementation period from May 2019 to November 2019 (n=199), implementation period from December 2019 to September 2020 (n=283), and postimplementation period from October 2020 to May 2021 (n=160). An interrupted time series calculation was performed, with stratification by patient race and ethnicity. The primary process measure was mean decision-to-incision time. The secondary outcomes were neonatal status as measured by 5-minute Apgar score and quantitative blood loss during the cesarean delivery.

RESULTS:

We analyzed 642 urgent cesarean deliveries; 199 were preimplementation of the standard algorithm, and 160 were postimplementation. The mean decision-to-incision time improved from 88 minutes (95% CI 75–101 min) to 50 minutes (95% CI 47–53 min) from the preimplementation period to the postimplementation period. When stratified by race and ethnicity, the mean decision-to-incision time among Black non-Hispanic patients improved from 98 minutes (95% CI 73–123 min) to 50 minutes (95% CI 45–55 min) (t=3.27, P<.01); it improved from 84 minutes (95% CI 66–103 min) to 49 minutes (95% CI 44–55 min) among Hispanic patients (t=3.51, P<.001). There was no significant improvement in decision-to-incision time among patients in other racial and ethnic groups. When the cesarean delivery was performed for fetal indications, Apgar scores were significantly higher in the postimplementation period compared with the preimplementation period (8.5 vs 8.8 beta=0.29, P<.01).

CONCLUSION:

Development and implementation of a standard algorithm to expedite decision-to-incision time for unscheduled, urgent cesarean deliveries led to a significant decrease in decision-to-incision time.
Effects of Same-Day Discharge on 30-Day Readmission Rates in Women Aged 65 Years and Older Undergoing Minimally Invasive Pelvic Organ Prolapse Surgery
Authors: Berger Alexander A. , Bretschneider C. Emi , Gregory W. Thomas , Sung Vivian
Published: June 2023

OBJECTIVE:

To compare the effects of same-day discharge on 30-day readmission after minimally invasive pelvic organ prolapse (POP) surgery in older patients.

METHODS:

This retrospective cohort study examined all minimally invasive POP surgeries performed and included in the national Centers for Medicare & Medicaid Services 5% Limited Data Set (2011–2018). Our primary outcome was 30-day hospital readmission, and our secondary outcome was 30-day emergency department (ED) visits.

RESULTS:

Of the 7,278 patients undergoing surgery, patients who had same-day discharge were older (73.5 years vs 73.1 years, P=.04) and less likely to undergo concomitant hysterectomy (9.5% vs 34.9%, P<.01) or midurethral sling (36.8% vs 40.1%, P=.02). Same-day discharge increased over the study period from 15.7% in 2011 to 25.5% in 2018 (P<.01). On propensity score–matching multiple logistic regression, the adjusted difference was statistically significant, with same-day discharge increasing the odds of 30-day readmission compared with next-day discharge (adjusted odds ratio [OR] 1.57, 95% CI 1.19–2.08). There was no difference (OR 0.81, 95% CI 0.63–1.05) for 30-day ED visits on propensity score–matching multiple logistic regression.

CONCLUSION:

After minimally invasive POP surgery, older women have low rates of readmission and ED visits within 30 days. After propensity score matching and adjustment for perioperative factors, there may be increased odds in readmission and no difference in ED visits risk in those who had same-day discharge. When considering patient factors, same-day discharge after minimally invasive POP surgery may be effective for older patients.
Placenta Accreta Spectrum
Authors: Einerson Brett D. , Gilner Jennifer B. , Zuckerwise Lisa C.
Published: June 2023

Placenta accreta spectrum (PAS) is one of the most dangerous conditions in pregnancy and is increasing in frequency. The risk of life-threatening bleeding is present throughout pregnancy but is particularly high at the time of delivery. Although the exact cause is unknown, the result is clear: Severe PAS distorts the uterus and surrounding anatomy and transforms the pelvis into an extremely high-flow vascular state. Screening for risk factors and assessing placental location by antenatal ultrasonography are essential for timely diagnosis. Further evaluation and confirmation of PAS are best performed in referral centers with expertise in antenatal imaging and surgical management of PAS. In the United States, cesarean hysterectomy with the placenta left in situ after delivery of the fetus is the most common treatment for PAS, but even in experienced referral centers, this treatment is often morbid, resulting in prolonged surgery, intraoperative injury to the urinary tract, blood transfusion, and admission to the intensive care unit. Postsurgical complications include high rates of posttraumatic stress disorder, pelvic pain, decreased quality of life, and depression. Team-based, patient-centered, evidence-based care from diagnosis to full recovery is needed to optimally manage this potentially deadly disorder. In a field that has relied mainly on expert opinion, more research is needed to explore alternative treatments and adjunctive surgical approaches to reduce blood loss and postoperative complications.
Hemorrhoidal Artery Ligation for the Treatment of Grade II-III Hemorrhoids: Is it Worth the Use of Doppler Guide in Long-Term Follow-Up?: A Single-Center Cohort Study
Authors: Bonomo Luca Domenico , Falletto Ezio , Cuccomarino Salvatore , Nicotera Antonella , Jannaci Alberto
Published: June 2023

Background:

Hemorrhoidal artery ligation (HAL) may reduce postoperative pain and complications and shorten patients’ recovery when compared to standard hemorrhoidectomy. It is unclear if the Doppler guide (DG) is useful in reducing recurrence risk.

Objective:

To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients’ satisfaction grade.

Methods:

Between January 1, 2014 and January 31, 2021, 122 patients affected by grade II-III hemorrhoidal prolapse underwent DG-HAL or HAL at Chivasso Hospital, Italy. Mucopexy was routinely performed. After discharge, patients were subjected to 1-week, 1-, 3-, 6-, and 12-month clinical assessment. Thereafter, they were interviewed by telephone annually.

Results:

Seventy-six (62.3%) DG-HAL and 46 (37.7%) HAL procedures were performed. Median surgical time was 30 (15–45) minutes for DG-HAL versus 25 (15–40) minutes for HAL (P = 0.005). No intraoperative complications occurred. Postoperative bleeding needing surgery occurred in 2 (1.6%) patients in the DG-HAL group. During a median follow-up of 46 months (6–86), we registered 18 (23.7%) recurrences in the DG-HAL group and 13 (28.3%) in the HAL one (P = 0.574). No cases of incontinence or anal stenosis occurred. No significant difference was observed between the two groups in terms of patients’ satisfaction. At multivariate analysis, age ≥ 65 years resulted a protective factor for recurrence (odds ratio 0.31; 95% confidence interval 0.09–0.98; P = 0.047).

Conclusions:

In our study, the use of DG did not reduce recurrence risk. Operative time was significantly increased in the DG-HAL group.
Inhaled Prostacyclins for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis
Authors: Torbic Heather , Saini Aftabh , Harnegie Mary Pat , Sadana Divyajot , Duggal Abhijit
Published: June 2023

OBJECTIVES:

Studies evaluating inhaled prostacyclins for the management of acute respiratory distress syndrome (ARDS) have produced inconsistent results regarding their effect on oxygenation. The purpose of this systematic review and meta-analysis was to evaluate the change in the Pao
2/Fio
2 ratio after administration of an inhaled prostacyclin in patients with ARDS.

DATA SOURCES:

We searched Ovid Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane, Scopus, and Web of Science.

STUDY SELECTION:

We included abstracts and trials evaluating administration of inhaled prostacyclins in patients with ARDS.

DATA EXTRACTION:

Change in the Pao
2/Fio
2 ratio, Pao
2, and mean pulmonary artery pressure (mPAP) were extracted from included studies. Evidence certainty and risk of bias were evaluated using Grading of Recommendations Assessment, Development, and Evaluation and the Cochrane Risk of Bias tool.

DATA SYNTHESIS:

We included 23 studies (1,658 patients) from 6,339 abstracts identified by our search strategy. The use of inhaled prostacyclins improved oxygenation by increasing the Pao
2/Fio
2 ratio from baseline (mean difference [MD], 40.35; 95% CI, 26.14–54.56; p < 0.00001; I
2 = 95%; very low quality evidence). Of the eight studies to evaluate change in Pao
2, inhaled prostacyclins also increased Pao
2 from baseline (MD, 12.68; 95% CI, 2.89–22.48 mm Hg; p = 0.01; I
2 = 96%; very low quality evidence). Only three studies evaluated change in mPAP, but inhaled prostacyclins were found to improve mPAP from baseline (MD, –3.67; 95% CI, –5.04 to –2.31 mm Hg; p < 0.00001; I
2 = 68%; very low quality evidence).

CONCLUSIONS:

In patients with ARDS, use of inhaled prostacyclins improves oxygenation and reduces pulmonary artery pressures. Overall data are limited and there was high risk of bias and heterogeneity among included studies. Future studies evaluating inhaled prostacyclins for ARDS should evaluate their role in ARDS subphenotypes, including cardiopulmonary ARDS.
Xuanfeibaidu Granule Alleviates Coronavirus-Induced Pneumonia in Low Temperature and High Humidity Environments
Authors: Zhao Qianru , Zhao Ronghua , Geng Zihan , Bao Lei , Guo Shanshan , Wang Yu , Cui Xiaolan
Published: June 2023

Objective:

Our study aimed to investigate the action of Xuanfei Baidu granules (XFBD) and their mechanism of action in a model of coronavirus pneumonia under cold and damp conditions.

Methods:

A total of 60 Bagg Albino (BALB/c) mice were randomly assigned to different groups, including the control, model, low-dose XFBD (1.84 g/kg) medium-dose XFBD (3.67 g/kg) and high-dose XFBD (7.34 g/kg) groups. To simulate the model of coronavirus infection, a combination of cold and damp stimuli and coronavirus strain 229E (CoV 229E) was employed. Subsequently, XFBD was administered on the fifth day and lasted for 3 days. To evaluate the efficacy of XFBD in BALB/c mice, various parameters, including behavior, lung index, viral load, and pulmonary pathology, were observed. Levels of interleukin-6 (IL-6), IL-10, and tumor necrosis factor-α (TNF-α) were measured using enzyme-linked immunosorbent assay (ELISA). The fractions of CD4+T cells, CD8+T cells, and B cells were measured using flow cytometry.

Results:

The mice in the control group were active, in good condition, and exhibited shiny hair. After modeling, the mice demonstrated less activity, low energy levels, messy and less shiny hair, poor appetite, and soft stools. The symptoms of coronavirus pneumonia were all significantly improved after the administration of different doses of XFBD. At three dosage levels, XFBD effectively increased gastrin (GAS) content, whereas medium and high doses of XFBD reduced motilin (MTL) content. The high-dose XFBD group showed a significant reduction in pathological damage to lung tissue. Treatment with three doses of XFBD demonstrated significant downregulation of inflammatory factors and regulation of CD4+and CD8+T cell and B cell expression. The high-dose XFBD group exhibited enhanced efficacy compared to the other doses.

Conclusions:

XFBD showed a therapeutic effect on coronavirus pneumonia under cold and damp conditions, improved the behavioral characterization and gastrointestinal index, and reduced the lung virus titer and histopathology. This may be associated with the inhibition of inflammation and an increase in the number of lymphocytes.
In search of conditioned pain: an experimental analysis
Authors: Kang Sahaj , Van Ryckeghem Dimitri M.L. , Vlaeyen Johan W.S. , De Paepe Annick L. , Crombez Geert
Published: June 2023

There is an ongoing debate about whether pain can be classically conditioned, but surprisingly, evidence is scarce. Here, we report 3 experiments investigating this idea. In a virtual reality task, healthy participants were approached and touched near or on their hand with a coloured pen (blue or yellow). During acquisition, participants learned that one of the colours of the pen (CS+) was predictive of a painful electrocutaneous stimulus (ECS) whereas the other coloured pen (CS−) was not. During the test phase, more frequent reports of experiencing an US when none was delivered (“false alarm”) for the CS+ vs CS− qualified as evidence of conditioned pain. Notable differences between experiments were that the US was delivered when the pen touched a spot between the thumb and index finger (experiment 1; n = 23), when it virtually touched the hand (experiment 2; n = 28) and when participants were informed that the pen caused pain rather than simply predicting something (experiment 3; n = 21). The conditioning procedure proved successful in all 3 experiments: Self-reported fear, attention, pain, fear, and US expectancy were higher (P < 0.0005) for the CS+ than the CS−. There was no evidence for conditioned pain in experiment 1, but there was some evidence in experiments 2 and 3. Our findings indicate that conditioned pain may exist, albeit most likely in rare cases or under specific situations. More research is needed to understand the specific conditions under which conditioned pain exists and the underlying processes (eg, response bias).
Variation in the management of adhesive small bowel obstruction in the Netherlands: a prospective cross-sectional study
Authors: Krielen Pepijn , Kranenburg Lisa P.A. , Stommel Martijn W.J. , Bouvy Nicole D. , Tanis Pieter J. , Willemsen Jorn J. , Migchelbrink Jorne , de Ree Rick , Bormans Esther M.G. , van Goor Harry , ten Broek Richard P.G. ,   ASBO Snapshot Study Group
Published: June 2023

Background:

ASBO is a frequent abdominal surgical emergency and a leading cause of morbidity and mortality in emergency surgery. The aim of this study is to provide insight into the current management of adhesive small bowel obstruction (ASBO) and associated outcomes.

Methods and materials:

A nationwide prospective cross-sectional cohort study was conducted. All patients with clinical signs of ASBO admitted to participating Dutch hospitals were included during a 6 months inclusion period between April 2019 and December 2020. Ninety-day clinical outcomes were described and compared for nonoperative management (NOM) and laparoscopic and open surgery.

Results:

In 34 participating hospitals, 510 patients were included, of whom 382 (74.9%) had a definitive diagnosis of ASBO. Initial management consisted of emergency surgery in 71 (18.6%) patients and NOM in 311 (81.4%) patients, 119 (31.1%) of whom required delayed surgery after failure of NOM. Surgical interventions started laparoscopically in 51.1%, of which 36.1% were converted to laparotomy. Intentional laparoscopy resulted in shorter hospital stays compared with open surgery (median 8.0 vs. 11.0 days; P<0.001) and comparable hospital mortality (5.2 vs. 4.3%; P=1.000). Oral water-soluble contrast use was associated with a decreased length of stay (P=0.0001). Hospital stay for surgical patients was shorter in patients who were operated on within 72 h of admission (P<0.001).

Conclusion:

This nationwide cross-sectional study demonstrates shorter hospital stay in ASBO patients who received water-soluble contrast, were operated within 72 h of admission or were operated with minimally invasive techniques. Results may support the standardization of ASBO treatment.
Textbook outcomes in liver surgery for gallbladder cancer patients treated with curative-intent resection: a multicenter observational study
Authors: Liu Zhi-Peng , Guo Wei , Yin Da-Long , Chen Wei-Yue , Wang Jiao-Yang , Li Xue-Lei , Yue Ping , Yu Chao , Wu Zhao-Ping , Ding Rui , Zhu Yi , Huang Fan , Zhou Jin-Xue , Zhang Dong , Chen Wei , Jiang Yan , Bai Jie , Wang Jing-Jing , Zhang Yan-Qi , Dai Hai-Su , Lau Wan Yee , Chen Zhi-Yu
Published: June 2023

Background:

Cholecystectomy, hepatectomy, and lymphadenectomy are recommended as the curative treatment for resectable gallbladder cancer (GBC). Textbook outcomes in liver surgery (TOLS) is a novel composite measure that has been defined by expert consensus to represent the optimal postoperative course after hepatectomy. This study aimed to determine the incidence of TOLS and the independent predictors associated with TOLS after curative-intent resection in GBC patients.

Methods:

All consecutive GBC patients who underwent curative-intent resection between 2014 and 2020 were enrolled from a multicenter database from 11 hospitals as the training and the internal testing cohorts, and Southwest Hospital as the external testing cohort. TOLS was defined as no intraoperative grade greater than or equal to 2 incidents, no grade B/C postoperative bile leaks, no postoperative grade B/C liver failure, no 90-day postoperative major morbidity, no 90-day readmission, no 90-day mortality after hospital discharge, and R0 resection. Independent predictors of TOLS were identified using logistic regression and were used to construct the nomogram. The predictive performance was assessed using the area under the curve and calibration curves.

Results:

TOLS was achieved in 168 patients (54.4%) and 74 patients (57.8%) from the training and internal testing cohorts, and the external testing cohort, respectively. On multivariate analyses, age less than or equal to 70 years, absence of preoperative jaundice (total bilirubin≤3 mg/dl), T1 stage, N0 stage, wedge hepatectomy, and no neoadjuvant therapy were independently associated with TOLS. The nomogram that incorporated these predictors demonstrated excellent calibration and good performance in both the training and external testing cohorts (area under the curve: 0.741 and 0.726).

Conclusions:

TOLS was only achieved in approximately half of GBC patients treated with curative-intent resection, and the constructed nomogram predicted TOLS accurately.
Concomitant Introduction of New Robotic Systems (Hugo RAS and Versius) at a Single Center: Analysis of First Clinical Cases of Radical Prostatectomy by a Single Surgeon
Authors: Rocco Bernardo , Turri Filippo , Sangalli Mattia , Centanni Stefano , Stocco Matteo , Chiumello Davide , Assumma Simone , Coelho Rafael Ferreira , Sarchi Luca , Grasso Angelica , Piacentini Igor , Dell’Orto Paolo , Calcagnile Tommaso , Sighinolfi Maria Chiara
Published: June 2023

Introduction:

Radical prostatectomy is a standard option for clinically localized prostate cancer. The first robot-assisted radical prostatectomy (RARP) was performed in 2001 with the DaVinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA); after 2 decades from the first procedure and the expiry of the patents, new systems are entering the market to improve the existing technology and increase the whole accessibility to robotic surgery. Currently, a face-to-face comparison of systems is still unavailable. The aim of the study was to report the first case of concomitant introduction of new systems—Hugo robot-assisted surgery (RAS) and Versius surgical system—at a single center already equipped with a Da Vinci.

Methods:

This is a prospective study that analyzes the first cases performed with the Hugo RAS and Cambridge Medical Robotics Versius for RARP at a single center. Three patients with clinical organ-confined prostate cancer were selected to receive a Hugo RAS, a CMR Versius, or a DaVinci—as standard reference—radical prostatectomy. All procedures were recorded, and videos were reviewed by internal and external reviewers. RARP was evaluated according to the definition of metric errors and critical errors (Mottrie et al, BJU 2020) (See Supplemental Data, http://links.lww.com/JU9/A20). The primary end point is to evaluate the safety of novel systems; outcome measure is the absence of critical errors or intraoperative adverse events.

Results:

Surgical procedures were fully completed with all robotic systems. No intraoperative adverse events occurred, nor surgical errors classified as “critical” according to the European Association of Urology Robotic Urology Section metric system. None of the metric error nor technological issues were clinically significant to invoke a change in surgical strategy.

Conclusions:

This is the first analysis of concomitant introduction of new robotic systems at a single institution. Even if the shift from one model to another is expected to pose some challenges for surgeons, RARP is feasible with HugoRAS and Versius systems by an already experienced surgeon with the Da Vinci. A proper structured training is mandatory; the impact of prior console expertise is unknown and still unmeasured, but is expected to have significance. The current clinical experience supports the feasibility of the implementation of a new surgical system into surgical practice; however, further studies are required to evaluate outcomes in an unselected cohort.
The psychosocial impact of thyroid cancer
Authors: Haymart Parker , Levin Nina Jackson , Haymart Megan R.
Published: June 2023

Purpose of Review

This review discusses the psychosocial impact of thyroid cancer diagnosis and management. It summarizes recent findings, presents management options, and briefly discusses future directions.

Recent Findings

A thyroid cancer diagnosis and its downstream management can impact patients in a variety of ways, including contributing to distress, worry, worse quality of life, and in some cases, anxiety and depression. Racial/ethnic minorities, those with lower education, women, adolescents/young adults, and individuals with a prior mental health conditions are a few of the patient groups at greater risks for adverse psychosocial effects from their thyroid cancer diagnosis and management. Findings are mixed, but some studies suggest treatment, for example, more intensive treatment as opposed to less, may be associated with a greater psychosocial impact. Clinicians providing care to thyroid cancer patients use a variety of resources and techniques, some more effective than others, to provide support.

A thyroid cancer diagnosis and its subsequent treatment can greatly impact a patient's psychosocial wellbeing, particularly for at-risk groups. Clinicians can help their patients by informing them of the risks associated with treatments and by offering education and resources for psychosocial support.
Peripartum Pubic Symphysis Diastasis
Authors: Anastasio Mary Katherine , Anastasio Albert T. , Kuller Jeffrey A.
Published: June 2023

Importance

Peripartum separation of the pubic symphysis is a rare but potentially severe complication of childbirth, which may lead to prolonged immobilization. Thus, prompt diagnosis and treatment are paramount.

Objective

The purpose of this review is to define peripartum separation of the pubic symphysis and provide a thorough review of its etiology, clinical manifestations, diagnostic imaging techniques, management, and prognosis.

Evidence Acquisition

This was a literature review using PubMed and Google Scholar.

Results

Peripartum pubic symphysis separation is defined as disruption of the pubic symphysis joint and ligamentous structures with greater than 1 cm of separation during delivery. Risk factors include fetal macrosomia, nulliparity, and precipitous labor. Patients often present with a sensation of something “giving way” in the pubic symphysis area at the time of delivery, or with severe pain in the pubic symphysis region with attempted mobilization postpartum. In severe cases, associated hematomas, pelvic fractures, sacroiliac joint disruption, and urinary tract injury may be seen. Imaging such as x-ray or ultrasound may be used to confirm the diagnosis. Although most patients recover well with conservative management, orthopedic surgical intervention may be indicated in more severe or unresolved cases.

Conclusions and Relevance

Pubic symphysis separation is increasingly identified peripartum due enhanced accessibility and utilization of imaging modalities. It can be debilitating and lead to prolonged immobility postpartum. Therefore, early recognition and diagnosis are important, as this can guide decision-making for management. A multidisciplinary team approach, including coordination with obstetrics, orthopedic surgery, physical therapy, and occupational therapy should be used for early detection and treatment to ensure optimal patient outcomes.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, learners should be better able to define peripartum separation of the pubic symphysis and discuss the relevant anatomy involved; identify risk factors associated with peripartum separation of the pubic symphysis; describe the typical presentation of a patient with separation of the pubic symphysis and next steps in making the diagnosis; and explain both conservative and orthopedic surgical intervention methods for treatment of peripartum separation of the pubic symphysis.