bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and efficacy of Jujadokseo-hwan for memory deficit (amnesia) in mild neurocognitive disorder
Authors: Jeong Jin-Hyung , Lee Ji-Yoon , Kim Ju-Yeon , Seo Young-Kyung , Kang Wee-Chang , Kang Hyung-Won , Park So-Jung , Jang Hye-Kyoung , Park Yang-Chun , Jung In Chul
Published: February 2020

Background:

Mild neurocognitive disorder (mNCD) is one of the degenerative diseases that results in memory deficit, and can progress to dementia. The effectiveness of drug therapy for mNCD is still debatable, but treatment of this disease has important implications for postponing or preventing dementia. Jujadokseo-hwan (JDH) is a traditional herbal medicine formulation that exhibits improvement in cognitive abilities and neuroprotective effects. In this study, we will evaluate the safety and efficacy of JDH compared to placebo in mNCD patients.

Methods and design:

This is a randomized, double-blind, placebo-controlled, parallel-group, multicenter clinical trial. After obtaining informed consent from all participants and performing the screening process, the participants will be equally divided into an experimental group and a control group. Each participant will visit the trial center 7 times during the 12 weeks of intervention. The follow up study will be conducted 12 weeks after the intervention ends. The primary outcome is the variance in Seoul verbal learning test-elderly's version (SVLT-E) score from baseline to 12 weeks. Secondary outcomes include scores/values for the following variables: SVLT-E, Rey complex figure test, Digit span test, Korean-Boston naming test, calculation ability, controlled oral word association test, Korean-color word stroop test, digit symbol coding, Korean-trail making test-elderly's version, Korean version of mini mental state examination for dementia screening, euro-qol-5 dimension, pattern identifications tool for cognitive disorders, Korean version of Montreal cognitive assessment, Korean quality of life-Alzheimer disease, computerized tongue image analysis system, blood pressure pulse analyzer, bioelectrical impedance analyzer, wearable electroencephalogram device, functional near-infrared spectroscopy system, and cost analysis.

Discussion:

This is the first trial evaluating the efficacy of JDH for mNCD. We expect this trial will provide strong support for wide use of JDH for mNCD and lead to further research on herbal medicine treatments for mNCD.

Trial registration number:

KCT0003570 (Registered in Clinical Research Information Service of the Republic of Korea, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=12669).
Clinicopathological characteristics and prognostic value of POLE mutations in endometrial cancer
Authors: He Ya , Wang Tian , Li Na , Yang Binkai , Hu Yuanjing
Published: February 2020

Background:

The aim of this meta-analysis was to assess the clinicopathological features and to confirm prognostic value of POLE exonuclease domain mutations (EDM) in endometrial carcinoma patients.

Methods:

The PubMed, Web of Science, the data of China National Knowledge Infrastructure, and Wan fang Medical Network were systematically searched for relevant articles without a cut-off date. The keywords for the search were “endometrial cancer,” “endometrial carcinoma,” “EC,” “POLE mutations,” “POLE exonuclease domain mutations,” “POLE-mutant,” “clinical characteristics” “prognostic.” Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by using Review manager 5.3 and Stata 14.0 statistical software.

Results:

Six cohort studies assessing 179 EC patients with POLE EDMs were included. The results indicated a favorable progression-free survival in POLE-mutant patients (HR = 0.32; 95% CI: = [0.09–1.18]). Furthermore, the overall survival was great in patients with POLE-mutant (HR = 0.68; 95% CI = [0.41–1.13]). It was shown that a significantly higher incidence of POLE mutations with Federation of International of Gynecologists and Obstetricians (FIGO) I group compared to FIGO II-IV group (pooled ORs: 0.34, 95% CI: [0.12–0.94], P = .04), POLE-mutant EC was not significantly associated with histology (OR = 0.56,95% CI: 0.29–1.23), tumor grade (OR = 1.22,95% CI:0.85–1.74), lymph-vascular space invasion (OR = 0.40,95% 0.06–2.42), depth of myometrial invasion (OR = 0.70,95% CI: 0.41–1.18), lymph node status (OR = 0.41, 95% 0.04–4.50), and European Society for Medical Oncology risk groups (OR = 0.68,95% CI: 0.37–1.26).

Conclusion:

This meta-analysis has confirmed POLE EDMs may serve as a predictive biomarker of favorable prognosis. Further studies are needed to explore the appropriate clinical utility of POLE EDMs in EC.
A retrospective cohort study comparing two treatments for active venous leg ulcers
Authors: Liu Xiaochun , Zheng Guofu , Ye Bo , Chen Weiqing , Xie Hailiang , Zhang Teng , Lin Jing
Published: February 2020

Endovenous laser ablation (EVLA) and ultrasound-guided foam sclerotherapy (UGFS) have largely replaced traditional surgery for treatment of varicose veins (VVs) with active venous leg ulcers (VLUs), and multiple combined modes have emerged. A retrospective cohort study was performed to compare the effect of traditional surgery (high ligation and stripping followed with compression [compression plus HL-S]) to high ligation-endovenous laser ablation-foam sclerotherapy followed with compression (compression plus HL-EVLA-FS) on the treatment of active VLUs.

Data of active VLUs treated in our center from 2008 to 2017 and followed up for 1 year were analyzed. The intervention measures in the first 5 years were compression plus HL-S, and in the following 5 years were compression plus HL-EVLA-FS. The primary outcome was ulcer healing time. The secondary outcomes were the VVs occlusion and clinical success as assessed by a change in venous clinical severity score (VCSS) and complications.

The study included 120 patients and 200 patients treated with HL-S and HL-EVLA-FS, respectively, during 2008 to 2017. The average ulcer healing time were 2.3 ± 2.4 and 1.7 ± 1.7 months, respectively. Significant difference was found in the cumulative ulcers healing rate between the two groups (Hazard ratio [HR] and 95% confidence interval [CI] was respectively 1.458 and 1.140–1.865, P = .0002), but no difference was found in the VVs occlusion (HR and 95% CI was respectively 1.005 and 0.774–1.3071, P = .967). Significant difference occurred in 6 months and 12 months post-operatively in the VCSS change and in the procedure data and some complications between the 2 groups.

In conclusion, the treatment of HL-EVLA-FS can accelerate the healing of VLUs, improve the VCSS and present superior procedure data. However, no advantage could be found in the VVs occlusion compared with control group.
Use of Infliximab in the Treatment of Macrophage Activation Syndrome Complicating Kawasaki Disease
Authors: Rivera-Rodriguez Leonardo , Pardo-Díaz Edwin , Moreno-Espinosa Sarbelio , Scheffler-Mendoza Selma , Ruiz-Ontiveros Marco A. , Garrido-García Luis Martin , Iglesias-Amaya Andrea , Yamazaki-Nakashimada Marco A.
Published: February 2020

Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. KD can be complicated with macrophage activation syndrome. The optimal treatment for this KD complication has not been established, and a variety of treatments have been used. Infliximab, a chimeric monoclonal antibody that binds tumor necrosis factor, has proved to be efficacious in IV gammaglobulin resistant KD. We present 2 cases of KD complicated with macrophage activation syndrome, including 1 patient with DiGeorge syndrome successfully treated with a combined treatment of IV gammaglobulin, corticosteroids, cyclosporine, and infliximab.
A Lean Approach to Improve Medication Administration Safety by Reducing Distractions and Interruptions
Authors: Kavanagh Adam , Donnelly Jennifer
Published: February 2020

Background:

Medication errors are potentially avoidable incidents that can lead to harm. Medications are often administered under challenging conditions, which creates opportunities for distractions and interruptions.

Purpose:

The aim of this study was to reduce the number of interruptions and distractions experienced by nurses during the medication administration process.

Methods:

A Lean approach was used to value stream map the process, devise solutions, and measure the impact of the change.

Results:

Sources of distraction and interruption were identified. Through collaboration the medication administration process was standardized, and a purpose-built medication administration room was developed. Frequency of interruptions and distractions from all sources was reduced.

Conclusions:

Value stream mapping the process enabled the identification of non–value-added activities that were threats to the integrity of the process. Standardizing the medication administration process and creating a safe space to facilitate the process successfully reduced interruptions and distractions from all sources.
Preeclampsia Among African American Pregnant Women: An Update on Prevalence, Complications, Etiology, and Biomarkers
Authors: Zhang Ming , Wan Philip , Ng Kenneth , Singh Kurnvir , Cheng Tzu Hsuan , Velickovic Ivan , Dalloul Mudar , Wlody David
Published: February 2020

Importance

Preeclampsia is a devastating disease of pregnancy associated with increased risk of fetal and maternal complications. African American pregnant women have a high prevalence of preeclampsia, but there is a need of systemic analyses of this high-risk group regarding complications, etiology, and biomarkers.

Objective

The aim of this study was to provide a synopsis of current research of preeclampsia specifically related to African American women.

Evidence Acquisition

A comprehensive search was performed in the bibliographic database PubMed with keywords “preeclampsia” and “African American.”

Results

African American women with preeclampsia were at an increased risk of preterm birth, which resulted in low-birth-weight infants. Intrauterine fetal death among African American preeclamptic patients occurs at twice the rate as in other races. On the maternal side, African American mothers with preeclampsia have more severe hypertension, antepartum hemorrhage, and increased mortality. Those who survive preeclampsia have a high risk of postpartum cardiometabolic disease. Preexisting conditions (eg, systemic lupus erythematosus) and genetic mutations (eg, sickle cell disease in the mother, FVL or APOL1 mutations in the fetus) may contribute to the higher prevalence and worse outcomes in African American women. Many blood factors, for example, the ratio of proteins sFlt/PlGF, hormones, and inflammatory factors, have been studied as potential biomarkers for preeclampsia, but their specificity needs further investigation.

Conclusions

Further studies of preeclampsia among African American women addressing underlying risk factors and etiologies, coupled with identification of preeclampsia-specific biomarkers allowing early detection and intervention, will significantly improve the clinical management of this devastating disease.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to describe the difference in prevalence of fetal and maternal complications among African American women with preeclampsia versus women of other races; explain updated genetic studies of preeclampsia specifically related to African American women; and analyze current research of biomarkers for prediction of status and progress of preeclampsia.
Ulipristal Acetate Before Hysteroscopic Myomectomy: A Systematic Review
Authors: Vitale Salvatore Giovanni , Ferrero Simone , Caruso Salvatore , Barra Fabio , Marín-Buck Alejandro , Vilos George Angelos , Vitagliano Amerigo , Török Péter , Ciebiera Michal , Cianci Antonio
Published: February 2020

Importance

Uterine leiomyomas, also referred to as myomas or fibroids, are the most common benign tumors of the reproductive tract. Ulipristal acetate (UPA) is an active selective progesterone receptor modulator used as preoperative treatment for uterine myomas.

Purpose

The aim of this review is to provide an overview of the literature about the effects of UPA administration before hysteroscopic myomectomy. The clinical question in “PICO” format was in patients affected by uterine myomas undergoing operative hysteroscopic management, “Does UPA impact the surgical outcomes?”

Evidence Acquisition

We performed a systematic literature search in PubMed/MEDLINE and Embase for original studies written in English (registered in PROSPERO CRD42018092201), using the terms “hysteroscopy” AND “ulipristal acetate” published up to March 2019. Original articles about UPA treatment before hysteroscopic myomectomy (randomized, observational, retrospective studies) were considered eligible.

Results

Our literature search produced 32 records. After exclusions, 4 studies were considered eligible for analysis. Results show that UPA does not worsen the overall technical difficulty of hysteroscopic myomectomy. Moreover, it may increase the chance of complete primary myomectomy in complex hysteroscopic procedures.

Conclusions and Relevance

Despite the positive results presented in this systematic review, low-quality evidence exists yet on the impact of UPA treatment before hysteroscopic myomectomy. High-quality prospective randomized controlled trials are required to establish the impact of UPA on surgical outcomes of patients treated for uterine myomas by hysteroscopy. Moreover, long-term outcomes of myomectomies after UPA treatment (such as frequency of myoma recurrence, recovery time, and quality of life) should be determined.

Target Audience

Obstetricians and gynecologists, family physicians, nurse practitioners.

Learning Objectives

After completing this activity, the learner should be better able to (1) identify the main characteristics of uterine myomas; (2) discuss the advantages and disadvantages of the use of UPA before hysteroscopic myomectomy; and (3) select the most appropriate therapeutic strategy based on the characteristics of the myoma(s) and the patient.
Monitoring of Respiratory Muscle Function in Critically Ill Children
Authors: Mortamet Guillaume , Crulli Benjamin , Fauroux Brigitte , Emeriaud Guillaume
Published: February 2020

Objectives:

This review discusses the different techniques used at the bedside to assess respiratory muscle function in critically ill children and their clinical applications.

Data Sources:

A scoping review of the medical literature on respiratory muscle function assessment in critically ill children was conducted using the PubMed search engine.

Study Selection:

We included all scientific, peer-reviewed studies about respiratory muscle function assessment in critically ill children, as well as some key adult studies.

Data Extraction:

Data extracted included findings or comments about techniques used to assess respiratory muscle function.

Data Synthesis:

Various promising physiologic techniques are available to assess respiratory muscle function at the bedside of critically ill children throughout the disease process. During the acute phase, this assessment allows a better understanding of the pathophysiological mechanisms of the disease and an optimization of the ventilatory support to increase its effectiveness and limit its potential complications. During the weaning process, these physiologic techniques may help predict extubation success and therefore optimize ventilator weaning.

Conclusions:

Physiologic techniques are useful to precisely assess respiratory muscle function and to individualize and optimize the management of mechanical ventilation in children. Among all the available techniques, the measurements of esophageal pressure and electrical activity of the diaphragm appear particularly helpful in the era of individualized ventilatory management.
Comparison of End-of-Life Care Practices Between Children With Complex Chronic Conditions and Neonates Dying in an ICU Versus Non-ICUs: A Substudy of the Pediatric End-of-LIfe CAre Needs in Switzerland (PELICAN) Project*
Authors: Ramelet Anne-Sylvie , Bergstraesser Eva , Grandjean Chantal , Dorsaz Anouk , Fahrni-Nater Patricia , Cignacco Eva , Zimmerman Karin
Published: February 2020

Objectives:

To describe and compare characteristics of care provided at the end of life for children with chronic complex conditions and neonates who died in an ICU with those who died outside an ICU.

Design:

Substudy of a nation-wide retrospective chart review.

Setting:

Thirteen hospitals, including 14 pediatric and neonatal ICUs, two long-term institutions, and 10 community-based organizations in the three language regions of Switzerland.

Patients:

One hundred forty-nine children (0–18 yr) who died in the years 2011 or 2012. Causes of death were related to cardiac, neurologic, oncological, or neonatal conditions.

Interventions:

None.

Measurements and Main Results:

Demographic and clinical characteristics, therapeutic procedures, circumstances of death, and patterns of decisional processes were extracted from the medical charts. Ninety-three (62%) neonates (median age, 4 d) and children (median age, 23 mo) died in ICU, and 56 (38%) with a median age of 63 months outside ICU. Generally, ICU patients had more therapeutic and invasive procedures, compared with non-ICU patients. Changes in treatment plan in the last 4 weeks of life, such as do-not-resuscitate orders occurred in 40% of ICU patients and 25% of non-ICU patients (p < 0.001). In the ICU, when decision to withdraw life-sustaining treatment was made, time to death in children and newborns was 4:25 and 3:00, respectively. In institutions where it was available, involvement of specialized pediatric palliative care services was recorded in 15 ICU patients (43%) and in 18 non-ICU patients (78%) (p = 0.008).

Conclusions:

This nation-wide study demonstrated that patients with a complex chronic condition who die in ICU, compared with those who die outside ICU, are characterized by fast changing care situations, including when to withdraw life-sustaining treatment. This highlights the importance of early effective communication and shared decision making among clinicians and families.
Brain Connectivity Modulation After Exoskeleton-Assisted Gait in Chronic Hemiplegic Stroke Survivors
Authors: Molteni Franco , Formaggio Emanuela , Bosco Anna , Guanziroli Eleonora , Piccione Francesco , Masiero Stefano , Del Felice Alessandra
Published: February 2020

Objective

The aim of this study was to investigate electroencephalographic (EEG) connectivity short-term changes, quantified by node strength and betweenness centrality, induced by a single trial of exoskeleton-assisted gait in chronic stroke survivors.

Design

Study design was randomized crossover. Electroencephalographic data (64-channel system) were recorded before gait (baseline) and after unassisted overground walking and overground exoskeleton-assisted walking. Coherence was estimated for alpha1, alpha2, and beta frequency ranges. Graph analysis assessed network model properties: node strength and betweenness centrality.

Results

Nine participants were included in the final analysis. In the group (four participants) with a left-hemisphere stroke lesion (dominant hemisphere), over the vertex, node strength increased in alpha1, alpha2, and beta bands, and betweenness centrality decreased in alpha2 both after unassisted overground walking and exoskeleton-assisted walking. In the group (five participants) with a right-hemisphere lesion (nondominant hemisphere), node strength increased in alpha1 and alpha2 over the contralesional sensorimotor area and ipsilesional prefrontal area after overground exoskeleton-assisted walking, compared with baseline and unassisted overground walking.

Conclusion

A single session of exoskeleton training provides short-term neuroplastic modulation in chronic stroke. In participants with a nondominant hemisphere lesion, exoskeleton training induces activations similar to those observed in able-bodied participants, suggesting a role of lesion lateralization in networks’ reorganization.
Utilizing Artificial Intelligence to Determine Bone Mineral Density Via Chest Computed Tomography
Authors: Savage Rock H. , van Assen Marly , Martin Simon S. , Sahbaee Pooyan , Griffith Lewis P. , Giovagnoli Dante , Sperl Jonathan I. , Hopfgartner Christian , Kärgel Rainer , Schoepf U. Joseph
Published: February 2020

Purpose:

The purpose of this study was to validate the accuracy of an artificial intelligence (AI) prototype application in determining bone mineral density (BMD) from chest computed tomography (CT), as compared with dual-energy x-ray absorptiometry (DEXA).

Materials and Methods:

In this Institutional Review Board–approved study, we analyzed the data of 65 patients (57 female, mean age: 67.4 y) who underwent both DEXA and chest CT (mean time between scans: 1.31 y). From the DEXA studies, T-scores for L1-L4 (lumbar vertebrae 1 to 4) were recorded. Patients were then divided on the basis of their T-scores into normal control, osteopenic, or osteoporotic groups. An AI algorithm based on wavelet features, AdaBoost, and local geometry constraints independently localized thoracic vertebrae from chest CT studies and automatically computed average Hounsfield Unit (HU) values with kVp-dependent spectral correction. The Pearson correlation evaluated the correlation between the T-scores and HU values. Mann-Whitney U test was implemented to compare the HU values of normal control versus osteoporotic patients.

Results:

Overall, the DEXA-determined T-scores and AI-derived HU values showed a moderate correlation (r=0.55; P<0.001). This 65-patient population was divided into 3 subgroups on the basis of their T-scores. The mean T-scores for the 3 subgroups (normal control, osteopenic, osteoporotic) were 0.77±1.50, −1.51±0.04, and −3.26±0.59, respectively. The mean DEXA-determined L1-L4 BMD measures were 1.13±0.16, 0.88±0.06, and 0.68±0.06 g/cm2, respectively. The mean AI-derived attenuation values were 145±42.5, 136±31.82, and 103±16.28 HU, respectively. Using these AI-derived HU values, a significant difference was found between the normal control patients and osteoporotic group (P=0.045).

Conclusion:

Our results show that this AI prototype can successfully determine BMD in moderate correlation with DEXA. Combined with other AI algorithms directed at evaluating cardiac and lung diseases, this prototype may contribute to future comprehensive preventative care based on a single chest CT.
Thoracic Wall Reconstruction
Authors: Groth Anne Karoline , Pazio André Luiz Bilieri , Kusano Larissa Dalla Costa , Lupion Fabiola , Itikawa William Massami , Legnani Bruno Cesar , Ono Maria Cecilia Closs , da Silva Alfredo Benjamin Duarte
Published: February 2020

Introduction

The reconstruction of defects in thoracic wall remains a challenge for plastic surgeons. Advances in surgical treatment of illnesses of thoracic wall have been fostering the treatment of lesions within more advanced levels. Consequently, larger and more complex defects are generated, demanding soft tissue covering and framework repair.

Objective

The aim of this study was to report the experience in chest wall reconstruction and demographics of a tertiary cancer center.

Methods

All patients submitted to thoracic wall reconstruction by the plastic surgery department from January 2012 to May 2018 in a tertiary cancer center were evaluated.

Results

Thirty-two patients have undergone thoracic wall reconstruction. The majority of patients in our series were submitted to surgical treatment of locally advanced breast cancer (84.3%). The most common defect location was the right anterolateral region (65.6%). The latissimus dorsi musculocutaneous flap was the most used in thoracic wall reconstructions. Three cases of thoracectomy with rib resection were reconstructed with methylmethacrylate and polypropylene surgical mesh associated with musculocutaneous flap. Four patients presented major complications, and 12 patients (37.5%) presented minor complications. There were no deaths related to procedures or instability of thoracic wall. Twenty-two patients presented progression of the disease, and 16 died due to the primary pathology.

Conclusions

Extended resection of the chest wall is associated in most cases with advanced disease, especially advanced breast cancer. Despite poor prognosis associated to locally advanced disease, it is imperative to perform chest wall reconstruction and allow the patient to continue adjuvant therapy (radiotherapy or chemotherapy) and improve quality of life.
Effect of Cross-Sex Hormone Therapy on Venous Thromboembolism Risk in Male-to-Female Gender-Affirming Surgery
Authors: Haveles Christos S. , Wang Maxwell M. , Arjun Arpana , Zaila Kassandra E. , Lee Justine C.
Published: February 2020

Individuals with gender dysphoria often seek medical interventions, such as hormone treatment and surgery, to live as their identified gender. Cross-sex hormone therapy typically consists of various estrogen formulations which confer varying risks of venous thromboembolism (VTE). Currently, there is no standard practice by surgeons regarding the preoperative gender-affirming surgery (GAS) hormone regimen of male-to-female (MTF) patients to minimize thromboembolic postoperative complications. The aim of this review is to examine the current literature on VTE occurring in MTF transgender patients on cross-sex hormone therapy (CSHT) when undergoing various gender-affirming surgeries—facial feminization surgery (FFS), top surgery (TS), and bottom surgery (BS)—to understand how evidence-based recommendations regarding perioperative hormone regimens can be established to improve clinical outcomes. Within the past 25 years, 7 published studies have examined the incidence of VTE in MTF patients undergoing GAS procedures. Two of these articles examined MTF patients undergoing FFS, 1 article reported a patient who had undergone BS and FFS during the same hospitalization, and the remaining 4 articles investigated VTE risk in BS. Our review supports that plastic surgeons who perform GAS are divided on their preferred CSHT protocols, with some requiring patients to suspend their CSHT weeks before surgery and others allowing patients to continue CSHT through the day of surgery. Three of the 7 studies detailed a CSHT perioperative regimen which instructed patients to suspend CSHT sometime before surgery; 1 study tapered CSHT to lower levels before surgery; the remaining 3 studies did not specify a CSHT perioperative regimen. This review highlights the paucity of data failing to support that continuing CSHT through GAS elevates VTE risk. We conclude that in the absence of definitive VTE risk factors (e.g., smoking, clotting disorders, or malignancy), surgeons may engage MTF patients in joint decision-making process to determine the most optimal perioperative CSHT management plan on a case-by-case basis. Future studies are warranted to evaluate VTE risk based on patient age, type of surgery, operating time, prophylactic measures, follow-up time, and CSHT perioperative regimens.
Experimental Approaches to Evaluate Leukocyte–Endothelial Cell Interactions in Sepsis and Inflammation
Authors: Kilpatrick Laurie E. , Kiani Mohammad F.
Published: February 2020

Sepsis is a life-threatening syndrome of organ dysfunction caused by a dysregulated host response to infection characterized by excessive neutrophil infiltration into vital organs. In sepsis, patients often die of organ failure and therapies directed against endothelial cell dysfunction and tissue damage are important targets for treatment of this disease. Novel approaches are required to understand the underlying pathophysiology of neutrophil dysregulation and neutrophil–endothelial cell interactions that play a critical role in the early course of organ damage and disruption of endothelial protective barrier. Here, we review methodologies that our laboratories have employed to study neutrophil–endothelial interaction and endothelial barrier function in in vivo and in vitro models of sepsis. We will focus on in vivo rodent models of sepsis and in vitro tools that use human cell culture models under static conditions and the more physiologically relevant biomimetic microfluidic assays. This Methods paper is based on our presentation in the Master Class Symposium at the 41st Annual Conference on Shock 2018.
Circulatory Trauma: A Paradigm for Understanding the Role of Endovascular Therapy in Hemorrhage Control
Authors: Duchesne Juan , Taghavi Sharven , Khan Mansoor , Perreira Bruno , Cotton Bryan , Brenner Megan , Ferrada Paula , Horer Tal , Kauvar David , Kirkpatrick Andrew , Ordoñez Carlos , Priouzram Artai , Roberts Derek
Published: February 2020

The pathophysiology of traumatic hemorrhage is a phenomenon of vascular disruption and the symptom of bleeding represents one or more vascular injuries. In the Circulatory Trauma paradigm traumatic hemorrhage is viewed as injury to the circulatory system and suggests the underlying basis for endovascular hemorrhage control techniques. The question “Where is the patient bleeding?” is replaced by “Which blood vessels are disrupted?” and stopping bleeding becomes a matter of selective vessel access and vascular flow control. Control of traumatic hemorrhage has traditionally been performed via external access to the end organ that is bleeding followed by the application of direct pressure, packing, or clamping and repair of directly affected blood vessels. In the circulatory trauma paradigm, bleeding is seen as disruption to vessels which may be accessed internally, from within the vascular system. A variety of endovascular treatments such as balloon occlusion, embolization, or stent grafting can be used to control hemorrhage throughout the body. This narrative review presents a brief overview of the current role of endovascular therapy in the management of circulatory trauma. The authors draw on their personal experience combined with the last decade of published experiences with the use of endovascular techniques in trauma and present general recommendations for their evolving use. The focus of the review is on the use of endovascular techniques as specific vascular treatments using the circulatory trauma paradigm.
Hemodynamic Impact of Cardiovascular Antihypertensive Medications in Patients With Sepsis-Related Acute Circulatory Failure
Authors: de Roquetaillade Charles , Jamme Matthieu , Charpentier Julien , Chiche Jean-Daniel , Cariou Alain , Mira Jean-Paul , Pène Frédéric , Llitjos Jean-François
Published: February 2020

Background:

Impact of prior cardiovascular antihypertensive medication during the initial phase of septic shock in terms of catecholamine requirements and mortality has been poorly investigated and remains unclear.

Objectives:

To investigate the association between chronic prescription of cardiovascular antihypertensive medication prior to intensive care unit (ICU) admission, catecholamine requirement, and mortality in patients with septic shock.

Methods:

We included all consecutive patients diagnosed with septic shock within the first 24 h of ICU admission, defined as a microbiologically proven or clinically suspected infection, associated with acute circulatory failure requiring vasopressors despite adequate fluid filling. Prior cardiovascular antihypertensive medication was defined as the chronic use of betablockers (BB), calcium channel blockers (CCB), angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blockers (ARB). ICU mortality was investigated using multivariate competitive risk analysis.

Results:

Among 735 patients admitted for septic shock between 2008 and 2016, 46.9% received prior cardiovascular antihypertensive medication. Prior cardiovascular antihypertensive therapy was not associated with increased norepinephrine requirements during the first 24 h (median = 0.28 μg/kg/min in patients previously treated vs. 0.26 μg/kg/min). Prior cardiovascular antihypertensive medication was not associated with a higher risk of ICU mortality after adjustment (cause-specific hazard = 1.28, 95% confidence interval [0.98–1.66], P = 0.06). Subgroups analyses for BB, CCB, and ACEi/ARB using propensity score analyses retrieved similar results.

Conclusion:

In patients admitted with septic shock, prior cardiovascular antihypertensive medication seems to have limited impact on initial hemodynamic failure and catecholamine requirement.
The Safety and Feasibility of Laparoscopic Technology in Right Posterior Sectionectomy
Authors: Luo Dilai , Xiong Xiaoli , Xiong Hu , Liu Hongliang , Huang Yong , Huang Mingwen
Published: February 2020

Background:

Laparoscopic hepatectomy has been accepted widely due to its advantages as a minimally invasive surgery, but laparoscopic right posterior sectionectomy (LRPS) has rarely been reported. We aimed to explore the safety and feasibility of LRPS by comparing it with open surgical approaches.

Materials and Methods:

Between January 2014 and July 2019, 51 patients who underwent right posterior sectionectomy were enrolled in this study. The patients’ characteristics, intraoperative details, and postoperative outcomes were compared between 2 groups.

Results:

There were no statistically significant differences in the preoperative data. LRPS showed significantly less blood loss (P=0.001) and shorter hospital stay (P=0.002) than open right posterior sectionectomy, but hospital expenses (P=0.382), operative time (P=0.196), surgical margin (P=0.311), the rate of other complications, and the postoperative white blood cell count, alanine aminotransferase, aspartate aminotransferase, and total bilirubin showed no statistically significant differences between the 2 groups (P>0.05). For hepatocellular carcinoma, the results showed there were no differences in both disease-free survival (P=0.220) and overall survival (P=0.417) between the 2 groups.

Conclusions:

Our research suggests that LRPS is a safe and feasible surgical procedure that is efficient from an oncological point of view. It may be the preferred choice for lesions in the right posterior hepatic lobe.
Characteristics and Impact of Librarian Co-authored Systematic Reviews: A Bibliometric Analysis
Authors: Saleh Ahlam A. , Huebner Frank
Published: February 2020

Background

Health sciences libraries have been providing services that support systematic reviews (SRs) for many years. In recent times the problem facing health sciences libraries is the management of the demand versus resources availability. There have been questions posed as to the value of this type of service in health sciences libraries. A valuable outcome of librarian collaboration on SR teams is co-authorship of the reported SRs. This study aimed to examine the characteristics and impact of librarian co-authored SRs.

Methods

A bibliometric analysis was conducted. Librarian co-authored SRs were identified in the Web of Science (WOS) Core Collection limited up to the year 2017. Librarian co-authored SRs with the librarian as first author were excluded from this analysis. Additional inclusion and exclusion criteria were applied in the selection process. The included records were analyzed using Perl programs and VOSviewer. To examine the dissemination of librarian co-authored SRs, citing articles to the included SR records were retrieved from the WOS Core Collection and then identified in MEDLINE for an analysis of the indexed publication types.

Results

The included results yielded 1,711 librarian co-authored SRs published between 1996 and 2017. The top three countries of the first author affiliation were USA, Canada, and Netherlands. Sources of publication were distributed among 730 journal titles. The number of MEDLINE citing articles to the included SRs was 28,868. The mean number of citations to a SR was 26.4. The top publication type descriptor of the citing articles representing the MEDLINE “Study Characteristic” category was “Randomized Controlled Trial”.

Conclusion

Outcomes of librarian contributions to supporting SRs include increasing scholarship opportunities that highlight librarian contributions to other disciplines. SRs are bodies of evidence, which can influence policy, patient care, and future research. In this study, we demonstrate that librarian co-authored SRs are disseminated into randomized controlled trials and other study types, meta-analyses, as well as guidelines, thus providing insight into knowledge transfer and the potential for clinical implementation.
Estimating the cure rate and case fatality rate of the ongoing epidemic COVID-19
Authors: Diao Ying , Liu Xiaoyun , Wang Tao , Zeng Xiaofei , Dong Chen , Zhang Yuanming , Zhou Changlong , She Xuan , Liu Dingfu , Hu Zhongli
Published: February 2020

The epidemic caused by the novel coronavirus COVID-19 in Wuhan at the end of 2019 has become an urgent public event of worldwide concern. However, due to the changing data of the epidemic, there is no scientific estimate of the cure rate and case fatality rate of the epidemic. This study proposes a method to estimate the cure rate and case fatality rate of COVID-19. The ratio of cumulative discharges on a given day to the sum of cumulative discharges on a given day and cumulative deaths before j days is used to estimate the cure rate. Moreover, the case fatality ratio can also be estimated. After simulation calculations, j is statistically appropriate when it is 8-10, and it is also clinically appropriate. When j is 9, based on the available data, it is inferred that the cure rate of this epidemic is about 93% and the case fatality rate is about 7%. This method of estimating the cure rate can be used to evaluate the effectiveness of treatment in different medical schemes and different regions, and has great value and significance for decision-making in the epidemic.
Overlapping Pathogenic Signalling Pathways and Biomarkers in Preeclampsia and Cardiovascular Disease
Authors: Suvakov Sonja , Bonner Emma , Nikolic Valentina , Jerotic Djurdja , Simic Tatjana P , Garovic Vesna D , Lopez-Campos Guillermo , McClements Lana
Published: February 2020

Objectives

Preeclampsia is a cardiovascular pregnancy complication which occurs in 5-10% of pregnancies that can lead to a number of pregnancy complications including maternal and foetal death. Long-term, preeclampsia is associated with up to 8-fold increased risk of cardiovascular disease (CVD) for both mothers and their offspring. The lack of mechanistic data in relation to the causes or consequences of preeclampsia has prevented the development of effective therapeutic or monitoring strategies.

Study design

This study investigates common underlying mechanisms of preeclampsia and CVD, specifically hypertension and heart failure with preserved ejection fraction (HFpEF) using “in silico”approach of publicly available datasets. Integrated techniques were designed to mine data repositories and identify relevant biomarkers associated with these three conditions.

Main outcomes measures

The knowledge base tools were employed that enabled the analysis of these biomarkers to discover potential molecular and biological links between these three conditions.

Results

Our bioinformatics “in silico” analyses of the publically available datasets identified 76 common biomarkers between preeclampsia, hypertension and HFpEF. These biomarkers were representative of 29 pathways commonly enriched across the three conditions which were largely related to inflammation, metabolism, angiogenesis, remodelling, haemostasis, apoptosis, endoplasmic reticulum (ER) stress signalling and the renin-angiotensin-aldosterone (RAAS) system.

Conclusions

This bioinformatics approach which uses the wealth of scientific data available in public repositories can be helpful to gain a deeper understanding of the overlapping pathogenic mechanisms of associated diseases, which could be explored as biomarkers or targets to prevent long-term cardiovascular complications such as hypertension and HFpEF following preeclampsia.

Highlights

Women with preeclampsia have increased risk of cardiovascular disease later in life but the mechanism is poorly understood.

“In silico” analyses of publically available datasets provided overlapping biomarkers and pathogenic pathways between preeclampsia, hypertension and heart failure with preserved ejection fraction (HFpEF).

These data could be utilised in the future studies that may lead to the development of better risk stratification strategies or preventative treatments for women post preeclampsia.
Visual predictions, neural oscillations and Newtonian physics
Authors: Saurels Blake W. , Hohaia Wiremu , Yarrow Kielan , Johnston Alan , Arnold Derek H.
Published: February 2020

Prediction is considered a core function of the human visual brain, but relating this suggestion to real life is problematic, as findings regarding the neural correlates of prediction rely on abstracted experiments, not reminiscent of a typical visual diet. We addressed this by having people view videos of basketball, and asking them to predict jump shot outcomes while we recorded eye movements and brain activity. We used the brain’s understanding of physics to manipulate predictive success, by inverting footage. People had enhanced alpha-band activity in occipital brain regions when watching upright videos, and this predicted both an increase in predictive success and enhanced ball tracking. Alpha-band activity in visual brain regions has been linked to inhibition, so we regard our results as evidence that inhibition of task irrelevant information is a core function of predictive processes in the visual brain, enacted as people complete visual tasks typical of daily life.
Oxidative Modifications of Parkin Underlie its Selective Neuroprotection in Adult Human Brain
Authors: Tokarew Jacqueline M. , El-Kodsi Daniel N. , Lengacher Nathalie A. , Fehr Travis K. , Nguyen Angela P. , O’Nuallain Brian , Jin Ming , Khan Jasmine M. , Ng Andy C. H. , Li Juan , Jiang Qiubo , Zhang Mei , Wang Liqun , Sengupta Rajib , Barber Kathryn R. , Tran An , Zandee Stephanie , Dong Xiajun , Scherzer Clemens R. , Prat Alexandre , Tsai Eve , Takanashi Masashi , Hattori Nobutaka , Chan Jennifer A. , West Andrew B. , Holmgren Arne , Puente Lawrence , Shaw Gary S. , Toth Gergely , Woulfe John M. , Taylor Peggy , Tomlinson Julianna J. , Schlossmacher Michael G.
Published: February 2020

The mechanisms by which Parkinson disease-linked parkin confers neuroprotection of human dopamine cells remain elusive. We hypothesized that its cysteines mediate multiple anti-oxidant effects in the midbrain. By studying >60 control specimens, we found that in adult human brain - but not in skeletal muscle- parkin is mostly aggregated and insoluble due to oxidative modifications, such as at C253.In vitro, parkin’s oxidation directly reduces hydrogen peroxide (H2O2) to water. In parkin-deficient human brain, H2O2concentrations are elevated. In dopamine toxicity studies, wild-type parkin -but not disease-associated mutants-prevents neural death by lowering H2O2and sequestering radicals within insoluble aggregates. Parkin conjugates dopamine metabolites at the human-specific residue C95 and augments melanin formationin vitro. Using epitope-mapped antibodies, we found that in adultSubstantia nigraneurons parkin localizes to neuromelanin within LAMP-3/CD63-positive lysosomes. We conclude that parkin’s own oxidation, previously considered a loss-of-function event, underlies three neuroprotective effects in adult midbrain: its cysteines participate in H2O2reduction, dopamine radical conjugation and the formation of neuromelanin.
Septins disruption controls tumor growth and enhances efficacy of Herceptin
Authors: Singh Rakesh K , Kim Kyu Kwang , Khazan Negar , Rowswell-Turner Rachael B. , Laggner Christian , Jones Aaron , Srivastava Priyanka , Hovanesian Virginia , Lamere Liz , Conley Thomas , Pandita Ravina , Baker Cameron , Myers Jason R , Pritchett Elizabeth , Ahmad Awada , Ruffolo Luis , Jackson Katherine , Gerber Scott A. , Ashton John , Milano Michael T. , Linehan David , Moore Richard G
Published: February 2020

Septin expressions are altered in cancer cells and exhibit poor prognoses in malignancies. As the first approach to develop a septin filament targeting agent, we optimized the structure of Forchlorfenuron (FCF), a known plant cytokinin to generate UR214-9, which contrary to FCF, causes septin-2/9 filamental structural catastrophe in cancer cells without altering cellular septin protein levels.In-silicodocking using septin-2/septin-2 dimer complex showed that UR214-9 displaced the guanine carbonyl oxygen from the GDP binding domain and showed increased binding energy than FCF(−8.59vs-7.21). UR214-9 reduced cancer cell growth, downregulated HER2/STAT-3 axis and controlled growth of HER2+ pancreatic, breast and ovarian cancer xenografts in NSG mice and enhanced response of Herceptin against HER2+breast cancer xenograft. Transcriptome analysis of UR214-9 exposed cells demonstrated significant perturbation of <20 genes compared to afatinib which impacted >1200 genes in JIMT-1 breast cancer cells indicating target specificity and non-transcriptional functions of UR214-9. In summary, disrupting septins via UR214-9 is a new approach to control the growth of HER2+ malignancies.
Distinct motivations to seek out information in healthy and addicted individuals
Authors: Dezza Irene Cogliati , Noel Xavier , Cleeremans Axel , Yu Angela J.
Published: February 2020

As massive amounts of information are becoming available to people understanding the mechanisms underlying information-seeking is more pertinent today than ever. In this study, we investigate the underlying motivations to seek out information in healthy and addicted individuals. We developed a novel decision-making task and a novel computational model which allow to dissociate the relative contribution of two motivating factors to seek out information: a desire for novelty and a desire to reduce uncertainty. To investigate whether/how the motivations to seek out information vary between healthy and addicted individuals, in addition to healthy controls we included a sample of individuals with gambling disorder- a form of addiction without the confound of substance consumption and characterized by compulsive gambling. Our results indicate that healthy subjects and problem gamblers adopt distinct information-seeking “modes”. Healthy information-seeking behavior was mostly motivated by a desire for novelty. Problem gamblers, on the contrary, displayed reduced novelty-seeking and an increased desire to reduce uncertainty (general information-seeking) compared to healthy controls. Our findings not only shed new light on the motivations driving healthy and addicted individuals to seek out information, but they also have important implications for treatment and diagnosis of behavioral addiction.