bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Bowel Injury in Hysterectomy for Benign Indications
Authors: Zhu Cici R. , Mallick Ranjeeta , Singh Sukhbir S. , Auer Rebecca , Solnik Jonathon , Choudhry Abdul Jamil , Chen Innie
Published: January 2021

(Abstracted from Obstet Gynecol 2020;136:803–810)

The vast majority of hysterectomies are performed for benign indications. Visceral injuries are major intraoperative complications of hysterectomy.
Cost and Reimbursement of Providing Routine Vaccines in Outpatient Obstetrician/Gynecologist Settings
Authors: Dempsey Amanda F. , Pyrzanowski Jennifer , Campbell Jonathan , Brewer Sarah , Sevick Carter , O'Leary Sean T.
Published: January 2021

(Abstracted from Am J Obstet Gynecol 2020;223:562.e1–562.e8)

Both nationally and globally, immunization rates among adults are poor. Greater efforts are needed to improve vaccination rates.
Hemadsorption
Authors: Cutuli Salvatore Lucio , Grieco Domenico Luca , De Pascale Gennaro , Antonelli Massimo
Published: January 2021

Purpose of review

To review pathophysiological pathways of immune system response to infections, which may justify mediators removal by extracorporeal blood purification therapies (EBPTs) in critically ill septic patients. Moreover, we presented an overview of the EBPTs mostly used in clinical practice with the aim to modulate immune system dysfunction in sepsis.

Recent findings

Sepsis is a life-threatening disease and recent findings showed that its pathophysiology relies on dysregulated immune system response to pathogen invasion of the body. In the light of this view, EBPTs have been demonstrated effective to remove specific mediators and foster balance between pro- and anti-inflammatory pathways.

EBPTs have been widely used in clinical practice, with the aim to modulate immune system dysfunction by the removal of pathogens and inflammatory mediators in critically ill patients with sepsis. Such therapies are characterised by specific structural features, which allow selective and nonselective removal of mediators by adsorption. However, few evidences support their role in the management of critically ill patients with sepsis. Accordingly, an evidence-based and personalized approach to EBPTs in sepsis is strongly advocated, in order to solve controversies in this field and optimise the management of critically ill septic patients.
A narrative review on antimicrobial therapy in septic shock: updates and controversies
Authors: Ling Lowell , Joynt Gavin Matthew , Lipman Jeffrey
Published: January 2021

Purpose of review

Antibiotics are an essential treatment for septic shock. This review provides an overview of the key issues in antimicrobial therapy for septic shock. We include a summary of available evidence with an emphasis on data published in the last few years.

Recent findings

We examine apparently contradictory data supporting the importance of minimizing time to antimicrobial therapy in sepsis, discuss approaches to choosing appropriate antibiotics, and review the importance and challenges presented by antimicrobial dosing. Lastly, we evaluate the evolving concepts of de-escalation, and optimization of the duration of antimicrobials.

The topics discussed in this review provide background to key clinical decisions in antimicrobial therapy for septic shock: timing, antibiotic choice, dosage, de-escalation, and duration. Although acknowledging some controversy, antimicrobial therapy in septic shock should be delivered early, be of the adequate spectrum, appropriately and individually dosed, rationalized when possible, and of minimal effective duration.
Mechanical ventilation in septic shock
Authors: Maccagnan Pinheiro Besen Bruno Adler , Tomazini Bruno Martins , Pontes Azevedo Luciano Cesar
Published: January 2021

Purpose of review

The aim of this study was to review the most recent literature on mechanical ventilation strategies in patients with septic shock.

Recent findings

Indirect clinical trial evidence has refined the use of neuromuscular blocking agents, positive end-expiratory pressure (PEEP) and recruitment manoeuvres in septic shock patients with acute respiratory distress syndrome. Weaning strategies and devices have also been recently evaluated. The role of lung protective ventilation in patients with healthy lungs, while recognized, still needs to be further refined. The possible detrimental effects of spontaneous breathing in patients who develop acute respiratory distress syndrome is increasingly recognized, but clinical trial evidence is still lacking to confirm this hypothesis. A new concept of lung and diaphragm protective is emerging in the critical care literature, but its application will need a complex intervention implementation approach to allow adequate scrutiny of this concept and uptake by clinicians.

Many advances in the management of the mechanically ventilated patient with sepsis and septic shock have occurred in recent years, but clinical trial evidence is still necessary to translate new hypotheses to the bedside and find the right balance between benefits and risks of these new strategies.
Minimally Invasive Technique for Hallux Valgus Correction
Authors: Acevedo Jorge I. , Cedeno Andres A. , Doty Jesse , McWilliam James
Published: January 2021

The evolution of minimally invasive surgery has led to techniques that can achieve comparable results to that of traditional open methods of surgery. For hallux valgus correction of the foot, several studies have demonstrated the equivalency between open procedures and current minimally invasive procedures in terms of stability and final outcomes. The authors present a detailed technique for minimally invasive hallux valgus correction. Early clinical and radiographic outcomes are reported, including a comparison of chevron and transverse osteotomies.

Level of Evidence: Diagnostic level IV, case series. See Instructions for Authors for a complete description of levels of evidence.
Prospective Randomized Controlled Study on an Innovative Mini-open Technique Versus Standard Percutaneous Technique to Avoid Sural Nerve Injury During Acute Achilles Tendon Repair
Authors: Sharaby Mohamed M.F. , Abouheif Mohamed Mahmoud , El-Mowafi Hani
Published: January 2021

Percutaneous and mini-open repair of the tendo-Achilles have proved good results according to several authors. However, sural nerve injury is one of the most important complications that may be associated with this technique because of either entangling the nerve inside the suture laterally or piercing the nerve with the needle. The authors present a simple and reproducible technique to avoid injury of the sural nerve with the mini-open repair of the Achilles tendon. The patients were split into 2 groups, each consisted of 20 patients. They were randomly allocated using identical envelopes to either treatment by the new modified technique of surgical repair. The study group, and the conventional mini-open technique; the control group. The patients were assessed clinically at 1, 6, 12 months, and at the end of follow-up postoperatively. The outcome was assessed using the Weber Modification of Thermann score. The demographic data and the gap size were comparable between both groups with no statistical significance. The mean Weber Modification of Thermann score For the study group was 86 (range, 80 to 95; SD, 5.062). It was better than that for the control group (mean, 83.25; range, 75 to 90; SD, 4.375). This was statistically significant (P=0.036). None of the cases in group I developed sural nerve injury, whereas 7 cases (35%) in group II developed sural nerve injury, and this was statistically significant (P=0.003*). None of the patients in both groups developed rerupture, surgical site tenderness, or skin-related complications. Our innovative surgical technique permitted avoidance of injury of the sural nerve during mini-open Achilles tendon repair, meanwhile retained all the advantages of the mini-open repair.

Level of Evidence: Level I—a prospective randomized clinical trial.
Minimally Invasive All Arthroscopic Broström With InternalBrace Augmentation: A Technique Tip
Authors: Miller Christopher P. , McWilliam James R. , Broughton Kimberly K. , Acevedo Jorge
Published: January 2021

Minimally invasive and all-arthroscopic lateral ligament repairs are increasingly popular in the ankle. These techniques are biomechanically and clinically as successful as their equivalent open procedures. Open lateral ligament repairs have benefitted by the inclusion of a suture tape to augment the strength of the repair and allow for earlier, accelerated rehabilitation. We present an arthroscopic technique to incorporate the benefits of minimally invasive ligament repair with the inclusion of the suture tape augmentation. This allows for immediate postoperative weight bearing, accelerated rehabilitation, and rapid return to function while minimizing scarring and wound complications.

Level of Evidence: Diagnostic Level V, expert opinion. See Instructions for Authors for a complete description of levels of evidence.
Cricothyroidotomy competence and injuries using nonmedical equipment
Authors: Nabecker Sabine , Hornshaw Tobias Alexander , Greif Robert , Conrad Carl , Rohrer Mara , Theiler Lorenz , Riva Thomas
Published: January 2021

BACKGROUND

International guidelines recommend cricothyroidotomy as a life-saving procedure for ‘cannot intubate, cannot ventilate’ situations. Although commercially available sets facilitate surgical cricothyroidotomy, regular training seems to be the key to success.

OBJECTIVES

The goal was to investigate if trained anaesthetists are able to transfer their skill in one surgical cricothyroidotomy technique to another. The primary hypothesis postulated that trained anaesthetists could perform an emergency cricothyroidotomy equally fast and successfully with a pocketknife compared with a surgical cricothyroidotomy set.

DESIGN

Crossover noninferiority randomised controlled trial.

SETTING

After written informed consent and ethics committee approval, this single-centre study was performed at the University Hospital of Bern, Bern, Switzerland.

PARTICIPANTS

Altogether, 61 study participants already familiar with surgical cricothyroidotomy were included.

INTERVENTION

The use of a commercially available cricothyroidotomy set was compared with a short-bladed pocketknife and ballpoint pen barrel. A pig-larynx cadaver model including trachea, with pig skin overlaid, was used. Participants underwent additional training sessions in both procedures.

MAIN OUTCOME MEASURES

The primary outcome was the time necessary to position the tracheal tube or pen barrel in the trachea. Other outcome parameters were success rate, tracheal and laryngeal injuries and preferred device.

RESULTS

Cricothyroidotomy with the pocketknife was performed significantly faster and equally successfully as compared with the cricothyroidotomy sets. Tracheal and laryngeal injuries were similar in both groups. Paratracheal or submucosal placement of the pen barrel occurred in 32%, compared with 29% for the tracheal tube. Sixty-six per cent of participants preferred the cricothyroidotomy set.

CONCLUSION

Regularly trained anaesthetists are able to accomplish cricothyroidotomy irrespective of the equipment used. A pocketknife with a ballpoint pen barrel was just as effective as a commercially available surgical set.
Blood pressure control in Australian general practice: analysis using general practice records of 1.2 million patients from the MedicineInsight database
Authors: Roseleur Jacqueline , Gonzalez-Chica David A. , Bernardo Carla O. , Geisler Benjamin P. , Karnon Jonathan , Stocks Nigel P.
Published: January 2021

Introduction:

Hypertension is mostly managed in primary care. This study investigated the prevalence of diagnosed hypertension in Australian general practice and whether hypertension control is influenced by sociodemographic characteristics, duration since diagnosis or prescription of antihypertensive medications.

Methods:

Cross-sectional study using a large national database of electronic medical records of patients attending general practice in 2017 (MedicineInsight).

Results:

Of 1.2 million ‘regular’ patients (one or more consultations per year in every year from 2015 to 2017), 39.8% had a diagnosis of hypertension (95% confidence interval 38.7–40.9). Of these, 85.3% had their blood pressure (BP) recorded in 2017, and 54.9% (95% confidence interval 54.2–55.5) had controlled hypertension (<140/90 mmHg). BP control was lower in females (54.1%) compared with males (55.7%) and in the oldest age group (52.0%), with no differences by socioeconomic status. Hypertension control was lower among ‘regular’ patients recently diagnosed (6–12 months = 48.6% controlled) relative to those more than 12 months since diagnosis (1–2 years = 53.6%; 3–5 years 55.5%; >5 years = 55.0%). Among recently diagnosed ‘regular’ patients, 59.2% had no record of being prescribed antihypertensive therapy in the last 6 months of the study, of which 44.3% had controlled hypertension. For those diagnosed more than 5 years ago, 37.4% had no record of being prescribed antihypertensive patients, and 56% had normal BP levels.

Conclusion:

Although the prevalence of hypertension varied by socidemographics, there were no differences in BP assessment or control by socioeconomic status. Hypertension control remains a challenge in primary care, and electronic medical records provide an opportunity to assess hypertension management.
INTERMEDIATE AND DEEP CAPILLARY PLEXUSES IN MACHINE LEARNING SEGMENTATION OF HIGH-RESOLUTION OPTICAL COHERENCE TOMOGRAPHY IMAGING
Authors: Spaide Richard F. , Caujolle Sophie , Otto Tilman
Published: January 2021

Purpose:

To describe imaging produced by machine learning-based segmentation of high-resolution optical coherence tomography imaging of the intermediate capillary plexus and deep capillary plexus, layers of vessels not imaged well by dye-based angiography.

Methods:

Three healthy subjects with no ocular problems were imaged with spectral domain optical coherence tomography using an instrument with a scanning speed of 85,000 A-scans per second and 3 µm axial optical resolution. A random forest segmentation strategy was used to segment the intermediate capillary plexus and deep capillary plexus. The depth-resolved imaging data was visualized with the help of volume rendering.

Results:

The high-resolution optical coherence tomography showed the intermediate capillary plexus and deep capillary plexus at the outer borders of the inner nuclear layer. These vessels could be visualized with unprecedented detail in three dimensions. There were multiple bridging vessels connecting to the whorl-like patterns of capillary mesh of the deep capillary plexus, a feature only previously imaged in histologic evaluation of excised eyes.

Conclusion:

High-resolution optical coherence tomography, machine learning, and advanced image display techniques have wide relevancy in studying the retina in health and disease. Application of this approach has provided images of the deeper vascular layers of the eye that approximate histologic imaging, but noninvasively.
Precision in Cardiovascular Care Using Targeted Neonatal Echocardiography in Lethal Neonatal Disseminated Herpes Infection
Authors: Bhattacharya Soume , McNamara Patrick J. , Giesinger Regan E.
Published: January 2021

Neonates with disseminated neonatal herpes simplex virus infection often present with cardiorespiratory failure. The pathophysiological contributors to the disease phenotype, biologic mechanisms underlying the hemodynamic instability and optimal approach to cardiovascular treatment have not been well described. We describe clinical and echocardiography features of cardiovascular dysfunction, in a case series of neonates with disseminated herpes simplex virus, and response to physiology-based hemodynamic management. The biologic phenotype includes low systemic vascular resistance state, hypovolemia secondary to third space losses, myocardial dysfunction and pulmonary hypertension. Early targeted neonatal echocardiography provided hemodynamic insights on blood flow, shunt characterization, vascular resistance and cardiac function, that were difficult to gauge clinically (eg, differentiating parenchymal from pulmonary vascular disease) thereby positively impacted clinical care. All patients were stabilized hemodynamically without utilizing extracorporeal membrane oxygenation, although all patients died of multiorgan failure.
Study of Profile of Swine Flu Cases Admitted in Tertiary Care Hospital: Lessons Learned!
Authors: Kamath Sangita D. , Kumar Manish , Sunder Ashok
Published: January 2021

Introduction

Swine flu is caused by a novel strain of H1N1 influenza A virus that evolved by genetic assortment. The global pandemic affected India in May 2009. Sporadic cases continue to occur and cause significant morbidity and mortality.

Aim

To study the clinical profile, laboratory parameters, and outcome of the confirmed cases of swine flu.

Methods

This was a retrospective study involving confirmed swine flu cases admitted with category B2 and C symptoms from February to September 2019 in Tata Main Hospital. Their case records were analyzed for demographic characteristics, clinical features, treatment, and various outcomes. Reverse transcriptase polymerase chain reaction on the samples was used to confirm the infection.

Observation

Of the 12 cases, 33.7% were men and 66.7% were women. There were 66.7% in the age group 41 to 60 years. Case fatality ratio was 25%. Average duration of symptoms was 3.5 ± 2.4 days. Fever and breathlessness (100%) were the commonest symptoms followed by cough and weakness (83.3%). Comorbidities, like diabetes, hypertension and chronic kidney disease, were seen in 25% patients. Pneumonia was the commonest complication. Average length of hospital stay was 17.8 days. Twenty-five percent of the patients needed supplemental oxygen, whereas 25% required noninvasive ventilation and 50% needed mechanical ventilation. Male sex, older age, severity of hypoxemia, need for mechanical ventilation, and involvement of more than 3 radiological zones were the predictors of mortality (P < 0.0001).

Conclusions

H1N1 influenza can present with severe life-threatening illness. The most common cause of death is pneumonia. Mortality is higher in elderly, men, and those requiring invasive ventilation.
Evaluation of intraocular lens position and retinal shape in negative dysphotopsia using high-resolution magnetic resonance imaging
Authors: van Vught Luc , Dekker Cornelis E. , Stoel Berend C. , Luyten Gregorius P.M. , Beenakker Jan-Willem M.
Published: January 2021

Purpose:

To assess potential relationships of intraocular lens (IOL) position and retinal shape in negative dysphotopsia (ND).

Setting:

Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.

Design:

Case-control study.

Methods:

High-resolution ocular magnetic resonance imaging (MRI) scans were performed in patients with ND and pseudophakic controls, and subsequently used to determine the displacement and tilt of the in-the-bag IOL about the pupil and iris. In addition, anterior segment tomography was used to assess the iris–IOL distance. Furthermore, the retinal shape was quantified from the MRI scans by fitting an ellipse to the segmented inner boundary of the retina. Both the IOL position and retinal shape were compared between groups to assess their potential role in the etiology of ND.

Results:

In total, 37 patients with ND and 26 pseudophakic controls were included in the study. The mean displacement and tilt of the IOL were less than 0.1 mm and 0.5 degrees, respectively, in both groups and all directions. The corresponding mean iris–IOL distance was 1.1 mm in both groups. Neither of these values differed statistically significantly between groups (all P values >.6). The retinal shape showed large variations but was not statistically significantly different between the groups in both the left–right (P = .10) and the anterior–posterior (P = .56) directions.

Conclusions:

In this study, the in-the-bag IOL position and retinal shape did not statistically significantly differ between patients with ND and the general pseudophakic population. Given the large variation in retinal shape between subjects, however, it could still be an important factor in a multifactorial origin of ND.
Cost analysis of mydriasis strategies in cataract surgery care in the Netherlands
Authors: Simons Rob W.P. , Rondas Luigi U.E. , van den Biggelaar Frank J.H.M. , Berendschot Tos T.J.M. , Visser Nienke , de Crom Ronald M.P.C. , Nuijts Rudy M.M.A.
Published: January 2021

Purpose:

To investigate the economic impact of an intracameral mydriatics and anesthetic agent (ICMA), topical mydriatics, and a mydriatic ocular insert in cataract patients.

Setting:

One public hospital in the Netherlands.

Design:

Prospective cohort study.

Methods:

Resource use data were collected from a healthcare and societal perspective on the day of surgery. Other outcome parameters included pupil size, surgeon satisfaction, postoperative pain, and Catquest-9SF scores.

Results:

A total of 368 patients were included, the mean costs per patient were €506 in the ICMA group (n = 122), €474 in the ocular insert group (n = 115), and €451 in the topical group (n = 131). The acquisition cost of ICMA was highest and resulted in longer surgical time. After correction for an imbalance in the distribution of fast and slow surgeons, the mean costs in the ocular insert and topical groups were comparable (€450 vs €444). There was no statistically significant difference in the use of additional mydriatics intraoperatively (P = .521). The mean ratio of pupil size to white-to-white distance was lower in the ICMA group during all intraoperative measurements (P < .001) but similar between the topical and ocular insert groups (P range .11–.82).

Conclusions:

In the investigated setting in the Netherlands, ICMA was the most costly strategy. In addition, pupil size was lowest in the ICMA group but did not result in more additional mydriasis measures intraoperatively. The ocular insert was comparable with topical mydriatics in costs and pupil size. Implementation of ICMA could be considered when availability of nurses or physical space for perioperative care is limited.
Pain-related beliefs, cognitive processes, and electroencephalography band power as predictors and mediators of the effects of psychological chronic pain interventions
Authors: Jensen Mark P. , Hakimian Shahin , Ehde Dawn M. , Day Melissa A. , Pettet Mark W. , Yoshino Atsuo , Ciol Marcia A.
Published: January 2021

The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.
Interleukin-1 Receptor Antagonism as Adjunct Therapy for Heart Failure Patients with Left Ventricular Assist Devices
Authors: Healy Aaron H. , Bowen Megan , McKellar Stephen H. , Koliopoulou Antigone , Drakos Stavros G. , Selzman Craig H.
Published: January 2021

While left ventricular assist devices (LVAD) successfully unload the failing ventricle, most hearts do not regain sufficient function to allow for device explantation. Herein, we report a pilot series of LVAD patients treated with interleukin-1 receptor antagonism as a biologic adjuvant that safely and effectively treated inflammation so as to create a milieu whereby the heart could functionally improve. This pilot study sets the stage for a more rigorous, controlled trial of interleukin-1 receptor antagonism in treating heart failure and promoting myocardial recovery in patients supported by LVADs.
Heart Failure Severity Stratification Beyond INTERMACS Profiles: A Step Toward Optimal Left Ventricular Assist Device Timing
Authors: Cogswell Rebecca , Estep Jerry D. , Araujo-Gutierrez Raquel , Masotti Maria , Majaraj Valmiki , Teigen Levi , Schultz Jessica , John Ranjit , Martin Cindy M. , Trachtenberg Barry
Published: January 2021

The purpose of this analysis is to determine whether pectoralis muscle measures quantified on pre left ventricular assist device (LVAD) computerized tomography (CT) scans can identify subgroups of patients with differential disease severity within each Interagency Registry for Mechanical Circulatory Support (INTERMACS) profile. Patients with chest CTs performed ≤3 months before LVAD implantation at University of Minnesota (n = 143) and Houston Methodist Hospital (n = 133) were identified from the larger LVAD cohorts (University of Minnesota n = 353, Houston Methodist =278). Unilateral Pectoralis muscle mass indexed to body surface area and pectoralis muscle attenuation were measured on preoperative chest CT scans. Patients within each INTERMACS profile were separated into HIGH and LOW PEC muscle groups. Kaplan–Meier and multivariable cox regression analyses were performed to compare mortality among INTERMACS profiles by HIGH and LOW PEC muscle groups. INTERMACS 3 and 4 patients in the HIGH PEC groups had the highest survival on LVAD support (1 year survival 85% vs. 68%, log rank P = 0.0001). Being in this group was associated with a 60% reduction in the hazards rate (HR) of death after LVAD (adjusted HR 0.40, 95% confidence interval 0.25–0.62). Additionally, renal function deterioration in the year before LVAD was associated with lower INTERMACS profiles and lower measured pectoralis muscle tissue attenuation at the time of LVAD implantation. INTERMACS 3 and 4 patients with the highest pectoralis muscle measures had the best survival after LVAD. The association between renal function deterioration and sarcopenia suggests these muscle changes are progressive. Computerized tomography quantification of sarcopenia may help identify optimal LVAD implantation timing.
Effects of cycling bouts performed with different intensities and amounts of energy expended on central pressure and pulse wave reflection in normotensive and hypertensive men
Authors: de Paula Tainah , Cunha Felipe A. , Monteiro Walace , Farinatti Paulo , Oigman Wille , Midgley Adrian , Neves Mario Fritsch
Published: January 2021

Objective

This study investigated pulse wave analysis in normotensive and hypertensive men after cycling bouts with different intensities and amounts of energy expended.

Methods

Twenty-four men were assigned into normotensive (n = 14; age: 40.7 ± 2.8 years; 24-h ambulatory SBP/DBP:121 ± 2/74 ± 1 mmHg) and hypertensive (n = 10; age: 39.2 ± 2.3 years; 24-h ambulatory SBP/DBP:139 ± 3/86 ± 2 mmHg) groups. Participants undertook a maximal cardiopulmonary exercise test, a nonexercise control session (CTL) and three cycling bouts [two prolonged bouts expending 300 kcal at 50% (i.e. P-MOD) and 70% (i.e. P-VIG) oxygen uptake reserve (VO2R) and one short bout expending 150 kcal at 50% VO2R (i.e. S-MOD)] performed in a randomized order. Central SBP (cSBP), pulse pressure (cPP), augmentation pressure, augmentation index (AIx), heart rate (HR) and AIx adjusted for HR (AIx@75) were determined 10 min before, and 30- and 70-min postintervention.

Results:

Compared to CTL, only the P-VIG changed the cSBP [70-min (Δ −11.7 mmHg)], cPP [70-min (Δ:−7.4 mmHg)], augmentation pressure [30-min (Δ:−5.7 mmHg); 70-min (Δ:−7.3 mmHg)], AIx [30-min (Δ:−15.3 %); 70-min (Δ:−16.4 %)], AIx@75 [30-min (Δ:−12.8 %); 70-min (Δ:−13.9 %)] and HR [70-min (Δ: 9.9 bpm)] in the hypertensive group. However, all exercise bouts mitigated the increased cSBP responses post-CTL in the hypertensive group.

Conclusion:

The present study provides evidence that vigorous-intensity aerobic exercise reduces acute central pressure and pulse wave reflection in hypertensive men.
Cellular mechanisms and pathways in myocardial reperfusion injury
Authors: Valikeserlis Ioannis , Athanasiou Amaryllis-Aikaterini , Stakos Dimitrios
Published: January 2021

Despite the progress of cardiovascular medicine, ischemia-reperfusion injury can contribute to increased mortality and prolonged hospitalization after myocardial infarction. Ischemia-reperfusion injury pathophysiology encompasses many cells including cardiomyocytes, fibroblasts, mesenchymal stromal cells, vascular endothelial and smooth muscle cells, platelets, polymorphonuclear cells, macrophages, and T lymphocytes. However, specific mechanisms for all contributing cells and molecular pathways are still under investigation. What is definitely known is that endothelial dysfunction, immunity activation and inflammatory response are crucial events during ischemia-reperfusion injury while toll-like receptors, inflammasomes, reactive oxygen species, intracellular calcium overload and mitochondrial permeability transition pore opening consist of key molecular mediators. Indicatively, cardiac fibroblasts through inflammasome activation mediate the initial inflammatory response. Cardiac mesenchymal stromal cells can respond to myocardial injury by pro-inflammatory activation. Endothelial cell activation contributes to the impaired vasomotion, inflammation and thrombotic events and together with platelet activation leads to microcirculation dysfunction and polymorphonuclear cells recruitment promoting inflammation. Polymorphonuclear cells and monocytes/macrophages subsets are critically involved in the inflammation process by producing toxic proteolytic enzymes and reactive oxygen species. T cells subsets are also involved in several stages of ischemia-reperfusion injury. In this review, we summarize the specific contribution of each of the above cells and the related molecular pathways in the pathophysiology of ischemia-reperfusion injury.
Does gallbladder wall thickness measurement predict esophageal varices in cirrhotic patients with portal hypertension?
Authors: Elkerdawy Mahmoud A. , Ahmed Mohamed H. , Zaghloul Mariam S. , Haseeb Mona T. , Emara Mohamed H.
Published: January 2021

Background and study aim

Endoscopy is the gold standard investigation for diagnosis of gastroesophageal varices (GOVs), yet it is invasive, associated with complications. Many noninvasive parameters were investigated to predict the presence of GOVs. The current study investigated gallbladder wall thickening (GBWT) measurement as a noninvasive predictor of GOVs in posthepatitic cirrhotic patients with portal hypertension.

Patients and methods

In this cross-sectional study, 105 cirrhotic patients were divided into, group I and II according to the presence or absence of GOVs, respectively. Group I subdivided into, groups A and B according to the grade of GOVs either nonadvanced (grades I and II) or advanced (grades III and IV), respectively. Complete history taking, full clinical examination, full investigations, upper endoscopy and abdominal ultrasonography were performed to examine all patients.

Results

Both groups were comparable in their baseline characteristics except for AST to Platelet Ratio Index and Fibrosis-4 scores, which were significantly higher in group I. GBWT, portal vein diameter and spleen length were significantly associated not only with GOVs but also with its advanced grades. GBWT at a cutoff level >3.1 mm can predict the presence of GOVs with 54.29% sensitivity, 97.14% specificity, 97.4% positive predictive value (PPV), 51.5% negative predictive value (NPV) and 68.5% accuracy. GBWT can predict advanced grades of GOVs at a cutoff level >3.5 mm, with 45% sensitivity, 90% specificity, 64.3% PPV, 80.4% NPV and 77.1% accuracy.

Conclusion

GBWT was associated with the presence of GOVs, and with advanced GOVs in posthepatitis cirrhotic patients with portal hypertension.
Malnutrition and sarcopenia are prevalent among inflammatory bowel disease patients with clinical remission
Authors: Ünal Nalan Gülşen , Oruç Nevin , Tomey Okşan , Ömer Özütemiz Ahmet
Published: January 2021

Aim

The aim of this study was to evaluate nutritional status and sarcopenia in patients with inflammatory bowel disease (IBD) in clinical remission.

Methods

A total of 344 patients with IBD in clinical remission were included in this cross-sectional study. Patients with clinical activity (Harvey-Bradshaw index >5 for Crohn’s disease and partial Mayo scores ≥5 for ulcerative colitis) were excluded. Sociodemographic, clinical, and anthropometric data were recorded. BMI was categorized according to WHO criteria. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) questionnaire. Body composition included fat-free mass (FFM) analyzed with Tanita-330 ST. Muscle strength was measured with a Takei digital hand grip dynamometer using a standard protocol. Physical performance was measured as 4-m gait speed. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People 2 criteria.

Results

Overall, 5.5% of patients were underweight, 9.9% were malnourished, and 39.5% were at risk of malnutrition. Sarcopenia and probable sarcopenia were diagnosed in 41.3% of patients. Total number of flares requiring hospitalization (100%) was the most important predictor of sarcopenia, followed by total number of flares (80.1%), FFMI (46.5%), age (44.6%), BMI (31.8%), MNA score (27.7%), serum creatinine (23.6%), anti-tumor necrosis factor alpha use (23.3%), and gender (17.8%).

Conclusion

In conclusion, our findings revealed a considerable proportion of IBD patients in clinical remission to be malnourished or at risk of malnutrition along with a high rate of sarcopenia. This emphasizes the need for concomitant screening for nutritional status and body composition analysis in patients with IBD for provision of appropriate nutritional support, even during the remission period, and prevention of sarcopenia-related surgical and poor clinical outcomes.
The prognostic value of the neutrophil-to-lymphocyte ratio in critically ill cirrhotic patients
Authors: Giabicani Mikhael , Weiss Emmanuel , Chanques Gerald , Lemaitre Caroline , De Jong Audrey , Grangé Steven , Moreau Richard , Piton Gaël , Paugam-Burtz Catherine , Jaber Samir , Tamion Fabienne
Published: January 2021

Background

Hospital death rates following ICU admission of cirrhotic patients remain high. Identifying patients at high risk of mortality after few days of aggressive management is imperative for providing adequate interventions. Herein, we aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) combined with usual organ failure scores in the outcome prediction of cirrhotic patients hospitalized more than 3 days in ICU.

Methods

We conducted a retrospective bicentric study in two cohorts of cirrhotic patients hospitalized more than 3 days in French university hospital ICUs. At admission and day 3, we calculated several clinico-biological scores grading liver disease and organ failure severity and calculated the NLR. The primary outcome was 28-day mortality.

Results

The test cohort included 116 patients. At day 28, 43 (37.1%) patients had died. Variations of MELD score (ΔMELD), SOFA score (ΔSOFA), CLIF-SOFA score (ΔCLIF-SOFA) and NLR (ΔNRL) between admission and day 3 were significantly associated with 28-day mortality in univariate analysis. When included in bivariate analysis ΔNLR remained a significant predictor of 28-day mortality independently of these severity scores. Kaplan–Meier curves and statistics using reclassification methods showed a better 28-day mortality risk prediction using ΔNRL in association with ΔSOFA in comparison to ΔSOFA alone. These results were confirmed in an external validation cohort, including 101 critically ill cirrhotic patients.

Conclusions

ΔNLR is an independent predictor of mortality in the critically ill cirrhotic patients’ population who requires intensive care supportive treatment and should be used in association with ΔSOFA as a prognostic biomarker.
Association between Schatzki ring and eosinophilic esophagitis: a systematic review and meta-analysis
Authors: Sarbinowska Joanna , Wiatrak Benita , Waśko-Czopnik Dorota
Published: January 2021

Background/objective

The involvement of hydrochloric acid in the etiology of eosinophilic esophagitis and numerous reports on its coexistence and interaction with reflux disease, as well as the rings of the esophageal mucosa formed with the advancement of the disease, suggest a potential association of eosinophilic esophagitis with another disorder of esophageal morphology potentially caused by exposure to acid reflux–Schatzki ring. Therefore, it seems reasonable to check the relationship of eosinophilic esophagitis with the coexistence of the Schatzki ring as a potential effect of advanced esophageal trachealization, which is the subject of this systematic review with a meta-analysis.

Methods

The protocol of this meta-analysis was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A systematic search of the indexed literature in the MEDLINE and Scopus databases from early to December 2019 was performed to identify all original research articles on the association between the occurrence of the Schatzki ring and eosinophilic esophagitis in adults.

Results

Out of 68 searched studies, after the analysis and evaluation of the works, only 4 met the criteria set according to the protocol and were included in the meta-analysis. Based on the performed meta-analysis, no relationship was found between the occurrence of Schatzki ring and eosinophilic esophagitis.

Conclusion

The present study did not show a significant relationship between the occurrence of the Schatzki ring and eosinophilic esophagitis in the adult population, which suggests that these are two independent causes of dysphagia in this patient population.
Gastrointestinal symptoms are associated with severity of coronavirus disease 2019: a systematic review and meta-analysis
Authors: Zeng Weibiao , Qi Kai , Ye Miao , Zheng Li , Liu Xinliang , Hu Sheng , Zhang Wenxiong , Tang Wenjing , Xu Jianjun , Yu Dongliang , Wei Yiping
Published: January 2021

Objective

Studies have suggested that coronavirus disease 2019 (COVID-19) appears to be more serious in patients with gastrointestinal symptoms. This meta-analysis was conducted to explore the relationship between gastrointestinal symptoms and the severity of COVID-19.

Methods

We searched PubMed, Web of Science, Science Direct, Embase, and Google Scholar on 16 October 2020, to identify observational studies that provided data on gastrointestinal symptoms and severity of COVID-19. Gastrointestinal symptoms include diarrhea, abdominal pain, nausea, and vomiting. The severe rate and the odds ratio (OR) were pooled. Heterogeneity was assessed using the I
2 statistic.

Results

A total of 21 studies with 5285 patients were included in this meta-analysis. The severe rate of COVID-19 patients with diarrhea was 41.1% [95% confidence interval (CI): 31.0–51.5%], and the OR of association between diarrhea and severe COVID-19 was 1.41 (95% CI: 1.05–1.89); sensitivity analysis showed that the results for the OR and 95% CI were unstable. For abdominal pain, the severe rate and OR of association with severe COVID-19 were 59.3% (95% CI: 41.3–76.4%) and 2.76 (95% CI: 1.59–4.81), respectively; for nausea, 41.4% (95% CI: 23.2–60.7%) and 0.92 (95% CI: 0.59–1.43), respectively; for vomiting, 51.3% (95% CI: 36.8–65.8%) and 1.68 (95% CI: 0.97–2.92), respectively.

Conclusion

The severe rate was more than 40% in COVID-19 patients with gastrointestinal symptoms. Abdominal pain was associated with a near 2.8-fold increased risk of severe COVID-19; the relationship between diarrhea and the severity of COVID-19 was regionally different; nausea and vomiting were limited in association with an increased risk of severe COVID-19.
Association between mean arterial pressure and survival in patients after cardiac arrest with vasopressor support: a retrospective study
Authors: Li Zhimin , Zhou Dawei , Zhang Shaolan , Wu Lei , Shi Guangzhi
Published: January 2021

Background

Mortality among patients admitted to the ICU after cardiac arrest is high. Hemodynamic management in the phase of postresuscitation care is recommended by international guidelines, but the optimal mean arterial pressure (MAP) range in postcardiac arrest patients with vasopressor support is still unclear.

Objective

The purpose of the article is to investigate the association between the time spent in different MAP categories and ICU mortality in postcardiac arrest patients admitted to the ICU surviving ≥24 h with vasopressor support.

Design, settings and participants

This retrospective observational study analysis on the basis of the multicenter ICU database (eICU database, eicu-crd.mit.edu) with high granularity data for 200 859 admissions admitted between 2014 and 2015 to one of 335 units at 208 hospitals located across the USA. Postcardiac arrest patients surviving ≥24 h with vasopressor support during the first 24 h were included.

Exposure

The main exposure was time spent in different MAP categories during the first 24 h after ICU admission.

Outcome measures and analysis

The primary outcome was ICU mortality. Associations between time spent in different MAP categories and ICU mortality were evaluated using 10 MAP thresholds: ≤100, ≤95, ≤90, ≤85, ≤80, ≤75, ≤70, ≤65, ≤60 and ≤55 mmHg. Multivariable logistic regression analyses were used to test the association between time spent in different MAP categories and ICU mortality.

Main results

The study included 1018 eligible subjects in ICUs from 156 hospitals. The ICU mortality rate was 44.5%. After adjusting for confounders, MAP thresholds of ≤60 mmHg (OR, 1.13; 95% CI, 1.02–1.24; P = 0.014) and ≤55 mmHg (OR, 1.25; 95% CI, 1.09–1.45; P = 0.002) were significantly associated with increased ICU mortality. MAP thresholds of 65 mmHg or above were not associated with ICU mortality.

Conclusions

This study suggests that maintaining a mean arterial pressure of equal or greater than 65 mmHg may be a reasonable target in postcardiac arrest patients admitted to the ICU with vasopressor support. However, further prospective randomized trials are needed to determine the optimal mean arterial pressure targets in this patient population.
Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review
Authors: Kronenberg Peter , Hameed BM Zeeshan , Somani Bhaskar
Published: January 2021

Purpose of review

Lasers have become a fundamental aspect of stone treatment. Although Holmium:Yttrium-Aluminum-garnet (Ho:YAG) laser is the current gold-standard in endoscopic laser lithotripsy, there is a lot of buzz around the new thulium fibre laser (TFL). We decided to evaluate the latest data to help create an objective and evidence-based opinion about this new technology and associated clinical outcomes.

Recent findings

Sixty full-text articles and peer-reviewed abstract presentations were included in the qualitative synthesis of this systematic review performed over the last 2 years. Current super pulsed TFL machines are capable of achieving peak powers of 500W and emit very small pulse energies of 0.025 Joules going up to 6 Joules, and capable of frequency over 2000 Hz. This makes the TFL ablate twice as fast for fragmentation, 4 times as fast for dusting, more stone dust of finer size and less retropulsion compared to the Ho:YAG laser. Because of the smaller laser fibres with the TFL, future miniaturization of instruments is also possible.

Based on the review, the TFL is a potential game-changer for kidney stone disease and has a promising role in the future. However larger multicentric prospective clinical studies with long-term follow-up are needed to establish the safety and efficacy of the TFL in endourology.
Health and Financial Burdens Associated With Venous Thrombosis in Hospitalized Children With Inflammatory Bowel Disease
Authors: Chien Kimberley A. , Cooley Victoria , Prishtina Fisnik , Grinspan Zachary M. , Gerber Linda M. , Kucine Nicole
Published: January 2021

Venous thromboembolism (VTE) is a known complication in children with inflammatory bowel disease (IBD). Despite awareness of the increased thrombosis risk in this population, prophylaxis is not standardly used and there is limited published guidance for thrombosis prevention. To better appreciate the impact of thrombosis in this population, we compared children with IBD who did or did not have a VTE, using the Pediatric Health Information System inpatient database from 2009 to 2017. In hospitalized children with IBD, VTE was associated with longer median hospital stays (11 vs 5 days), need for intensive care unit admission (30.2% vs 4.8%), higher median adjusted costs ($32.8k vs $12.3k) and hospital charges ($96.6k vs $36k), and in-hospital death (1.5% vs 0.2%) (P 
< 0.001 in all comparisons). These findings highlight the need to determine and implement appropriate strategies to reduce VTE rates in children with IBD, given its association with high morbidity, mortality, and cost.
Uterine Dehiscence and Subsequent Pregnancy Management: A Review of the Literature
Authors: Whittington Julie R. , Slaton Kala B. , Rhomberg Mary E. , Ghahremani Taylor , Thomas Shelia L. , Magann Everett F.
Published: January 2021

Importance

Uterine dehiscence is a separation of the uterine musculature with intact uterine serosa. Uterine dehiscence can be encountered at the time of cesarean delivery, be suspected on obstetric ultrasound, or be diagnosed in between pregnancies. Management is a conundrum for obstetricians, regardless of timing of onset.

Evidence Acquisition

A literature search was undertaken by our research librarian using the search engines PubMed, CINAHL, and Web of Science. The search term used was “uterine dehiscence.” The search was limited to the English language, and there was no limit on the years searched.

Results

The search identified 152 articles, 32 of which are the basis for this review. Risk factors, treatment, and management in subsequent pregnancies are discussed. The number of prior cesarean deliveries is the greatest risk factor for uterine dehiscence. Unrepaired uterine dehiscence can cause symptoms outside of pregnancies and may require repair for alleviation of these symptoms. Dehiscence should also be repaired prior to subsequent pregnancies.

Conclusion and Relevance

Planned delivery prior to the onset of labor with careful monitoring of maternal symptoms is the preferred management strategy of women with prior uterine dehiscence. Careful attention should be paid to the lower uterine segment thickness when ultrasonography is performed in women with prior cesarean delivery.

Relevance Statement

An evidence-based review of uterine dehiscence in pregnancy and how to manage subsequent pregnancies following uterine dehiscence.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to identify the risks of pregnancy following uterine dehiscence; explain treatment of uterine dehiscence; and describe symptoms of unrepaired uterine dehiscence.