bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Clinical Value of Artery Umbilical Cord Blood Gas in Predicting Neonate Condition: A Prospective Cohort Study
Authors: Xin Xing , Lu Weixin , Ye Chunhua , Du Hongyan , Wang Shaoshuai , Feng Ling 
Published: October 2020

Abstract

Objective:
To evaluate the predictive ability of neonate condition through the traditional parameters and artery umbilical cord blood gas (aUCBG).

Methods:
A prospective cohort study was conducted in obstetrics and gynecology department between October 2017 and August 2018 at Tongji Hospital in Wuhan, China, and 360 aUCBG samples were collected. The average age of pregnant women was (29.50 ± 4.42) years, range from 19 to 48 years old. The gestational age range from 28+4 weeks to 41+3 weeks at admission. Logistic regression and area under the curve (AUC) from Receiver operating characteristic curves were used to identify risk factors, such as, premature rupture of membranes (PROM), high blood pressure, premature delivery (PD), low 1-minute Apgar scores (Apgar 1), low 5-minute Apgar scores (Apgar 5), pH, base excess, bicarbonate, neonatal blood sugar (NBS), and so on, to predict neonatal condition and evaluate the predictive ability of traditional and aUCBG parameters.

Results:
In all cases, PROM, PD, Apgar 1, Apgar 5, pH, base excess, bicarbonate, total carbon dioxide, and neonatal blood sugar were risk factors and were associated with poor condition of neonate. Apgar 1 were an independent risk factor. Combined traditional and aUCBG parameters had higher AUC of 0.895 (95% confidence interval (CI): 0.830–0.960, P < 0.001). In cesarean section subgroup, high blood pressure, PD, and Apgar 1 were risk factors and were associated with poor condition of neonate. Apgar 1 and low pH were the independent risk factors. Combined traditional and aUCBG parameters had highest AUC of 0.940 (95% CI: 0.886–0.993, P < 0.001). In vaginal delivery subgroup, maternal age above 35 years, PROM, PD, Apgar 1, Apgar 5, and male newborn were risk factors and were associated with poor condition of neonate. Maternal age above 35 years was an independent risk factor. Combined traditional and aUCBG parameters had highest AUC of 0.897 (95% CI: 0.828–0.965, P < 0.001). For pregnant women without comorbidities and complications of pregnancy, aUCBG may not be necessary.

Conclusion:
In high-risk pregnancies, especially lower Apgar scores, PD, and maternal age above 35-year old, aUCBG is recommended. Traditional parameters combined with aUCBG might increase the predicting ability of neonate condition.
Ambulatory blood pressure adaptations to high-intensity interval training: a randomized controlled study
Authors: Edwards Jamie J. , Taylor Katrina A. , Cottam Christian , Jalaludeen Navazh , Coleman Damian A. , Wiles Jonathan D. , Sharma Rajan , O’Driscoll Jamie M. 
Published: October 2020

Objective:
Hypertension remains the leading cause of cardiovascular disease and premature mortality globally. Although high-intensity interval training (HIIT) is an effective nonpharmacological intervention for the reduction of clinic blood pressure (BP), very little research exists regarding its effects on ambulatory BP. The aim of this study was to measure alterations in ambulatory and clinic BP following HIIT in physically inactive adults.

Methods:
Forty-one participants (22.8 ± 2.7 years) were randomly assigned to a 4-week HIIT intervention or control group. The HIIT protocol was performed on a cycle ergometer set against a resistance of 7.5% bodyweight and consisted of 3 × 30-s maximal sprints separated with 2-min active recovery. Clinic and ambulatory BP was recorded pre and post the control period and HIIT intervention.

Results:
Following the HIIT intervention, 24-h ambulatory BP significantly decreased by 5.1 mmHg in sBP and 2.3 mmHg in dBP (P = 0.011 and 0.012, respectively), compared with the control group. In addition, clinic sBP significantly decreased by 6.6 mmHg compared with the control group (P = 0.021), with no significant changes in dBP and mean BP (mBP). Finally, 24-h ambulatory diastolic, daytime sBP, mBP and dBP, and night-time sBP and mBP variability significantly decreased post-HIIT compared with the control group.

Conclusion:
HIIT remains an effective intervention for the management of BP. Our findings support enduring BP reduction and improved BP variability, which are important independent risk factors for cardiovascular disease.
Does higher SBP at discharge explain better outcomes in non-heart failure with reduced ejection fraction patients? Insights from Fuwai Hospital
Authors: Yao Younan , Zhang Rongcheng , Zhang Qi , Zhao Xinke , Zhang Jian 
Published: October 2020

Objective:
We hypothesized that discharge SBP had different associations with outcomes in non-HFrEF (left ventricular ejection fraction ≥40%) patients with or without high blood pressure (HBP) at admission.

Methods:
Non-HFrEF patients hospitalized for decompensated heart failure were consecutively recruited and were categorized into HBP (admission SBP ≥130 mmHg) group and non-HBP group. The primary outcome was a composite of cardiovascular death and heart transplantation. Multivariate Cox and penalized spline analyses were used to assess the relationships between discharge SBP and outcomes.

Results:
Nine hundred and sixty-four non-HFrEF patients were enrolled with a median follow-up of 71.8 months. Three hundred and sixty-five (37.9%) patients had HBP. In multivariate Cox analyses, non-HBP patients with higher discharge SBP were associated with a better outcome (per 10 mmHg increased, hazard ratio = 0.788, P = 0.001). However, an opposite relationship between discharge SBP and the primary outcome was observed in HBP group (per 10 mmHg increased, hazard ratio = 1.312, P = 0.002). Results of penalized spline regression models showed that there was a U-shaped association between discharge SBP and outcomes in the total cohort. Compared with 120 mmHg, the risk of the primary outcome increased when discharge SBP was below 99 mmHg in non-HBP group; in HBP group, a worse outcome was observed when discharged SBP was above 145 mmHg.

Conclusion:
Non-HFrEF had a U-shaped association between discharge SBP and adverse events. Such an association was modified by admission HBP. Higher discharge SBP correlated with a worse outcome in non-HFrEF patients with admission HBP, as opposed to patients admitted without HBP.
Comparative effects of intensive-blood pressure versus standard-blood pressure-lowering treatment in patients with severe ischemic stroke in the ENCHANTED trial
Authors: Minhas Jatinder S. , Wang Xia , Lindley Richard I. , Delcourt Candice , Song Lili , Woodward Mark , Lee Tsong-Hai , Broderick Joseph P. , Pontes-Neto Octavio M. , Kim Jong S. , Ricci Stefano , Lavados Pablo M. , Bath Philip M. , Durham Alice C. , Wang Ji-Guang , Sharma Vijay K. , Demchuk Andrew M. , Martins Sheila O. , Chalmers John , Anderson Craig S. , Robinson Thompson G. 
Published: October 2020

Objective:
Limited data exist on the optimum level of SBP in thrombolyzed patients with acute ischemic stroke (AIS). We aimed to determine the effects of intensive blood pressure (BP) lowering, specifically in patients with severe AIS who participated in the international, Enhanced Control of Hypertension and Thrombolysis Stroke Study.

Methods:
Prespecificed subgroup analyzes of the BP arm of Enhanced Control of Hypertension and Thrombolysis Stroke Study, a multicenter, partial–factorial, open, blinded outcome assessed trial, in which 2227 thrombolysis-eligible and treated AIS patients with elevated SBP (>150 mmHg) were randomized to intensive (target 130–140 mmHg) or guideline-recommended (<180 mmHg) BP management. Severe stroke was defined by computed tomography or magnetic resonance angiogram confirmation of large-vessel occlusion, receipt of endovascular therapy, final diagnosis of large artery atheromatous disease, or high (>10) baseline neurological scores on the National Institutes of Health Stroke Scale. The primary efficacy outcome was death or any disability (modified Rankin scale scores 2–6). The key safety outcome was intracranial hemorrhage (ICH). Treatment effects estimated in logistic regression models are reported as odds ratios (ORs) with 95% confidence intervals (CIs).

Results:
There were 1311 patients [mean age 67 years; 37% female; median baseline National Institutes of Health Stroke Scale of 11 (range 6.0–15.0)] with severe AIS. Overall, there was no significant difference in the primary outcome of death or disability. However, intensive BP lowering significantly increased mortality (OR 1.52, 95% CI 1.09–2.13; P = 0.014) compared with guideline BP lowering, despite significantly lowering clinician-reported ICH (OR 0.63, 95% CI 0.43–0.92; P = 0.016).

Conclusion:
Intensive BP lowering is associated with increased mortality in patients with severe AIS despite lowering the risk of ICH. Further randomized trials are required to provide reliable evidence over the optimum SBP target in the most serious type of AIS.

Trial registration:
ClinicalTrials.gov Identifier: NCT01422616.
Sympathetic nerve traffic overactivity in chronic kidney disease: a systematic review and meta-analysis
Authors: Grassi Guido , Biffi Annalisa , Seravalle Gino , Bertoli Silvio , Airoldi Flavio , Corrao Giovanni , Pisano Anna , Mallamaci Francesca , Mancia Giuseppe , Zoccali Carmine 
Published: October 2020

Background:
Studies based on microneurographic sympathetic nerve activity (MSNA) recordings have shown that the sympathetic system is overactivated in chronic kidney disease (CKD) patients but the relationship between MSNA and renal function and other risk factors has not been systematically reviewed in this population.

Design and measurements:
This meta-analysis compares MSNA in cardiovascular complications-free CKD patients (n = 638) and healthy individuals (n = 372) and assesses the relationship of MSNA with the eGFR, age, BMI and hemodynamic variables.

Results:
In a global analysis, MSNA was higher in CKD patients than in healthy control individuals (P < 0.001). The difference in MSNA between patients and healthy individuals was more marked in end-stage kidney diseases patients than in stage 3A 3B CKD patients (P < 0.001). In an analysis combining patients and healthy individuals, MSNA rose gradually across progressively lower eGFR categories (P < 0.01). In separate meta-regression analyses in CKD patients and in healthy individuals, MSNA associated directly with age (CKD: r = 0.57, P = 0.022; healthy individuals: r = 0.71, P = 0.031) and with the BMI (r = 0.75, P = 0.001 and r = 0.93, P = 0.003). In both groups, MSNA correlated with heart rate (r = 0.77, P = 0.02 and r = 0.66, P = 0.01) but was unrelated to plasma norepinephrine.

Conclusion:
Independently of comorbidities, MSNA is markedly increased in CKD patients as compared with healthy individuals and it is related to renal function, age, the BMI and heart rate. Sympathetic activation intensifies as CKD progresses toward kidney failure and such an intensification is paralleled by a progressive rise in heart rate but it is not reflected by plasma norepinephrine.
Ocular Sequelae of Stevens–Johnson Syndrome: A Comprehensive Approach
Authors: Iyer Geetha , Srinivasan Bhaskar , Agarwal Shweta 
Published: October 2020

Abstract:
The chronic sequelae of Stevens–Johnson syndrome cause severe ocular morbidity. Among the various manifestations, including dry eye, cicatrization causing forniceal shortening, adnexal disorders, lid margin keratinization, and limbal stem cell deficiency, keratinization of the lid margin leads to progressive ocular surface damage through constant blink-induced microtrauma. This damage induces corneal punctate keratopathy and neovascularization and can produce epithelial defects leading to corneal infection or perforation. Management strategies for chronic ocular sequelae are broadly categorized into ocular surface stabilization procedures, tectonic procedures, and visual rehabilitation procedures. Interventions in the acute stage of the disease include amniotic membrane grafting. Timely intervention helps to prevent deterioration of the ocular surface in these eyes.
Histologic Findings of Trabecular Meshwork and Schlemm’s Canal After Microhook Ab Interno Trabeculotomy
Authors: Tsutsui Aika , Hamanaka Teruhiko , Manabe Kaoru , Kaidzu Sachiko , Kumasaka Toshio , Tanito Masaki 
Published: October 2020

Introduction:
Trabeculotomy (LOT) and related goniotomy surgeries are classified based on excision or incision of the trabecular meshwork (TM); however, histologic evidence of the incision/excision pattern is insufficient.

Case Presentations:
Two cases of glaucomatous eyes in which trabeculectomy specimens previously “incised” during LOT were assessed histologically. A 39-year-old man with juvenile open-angle glaucoma (case 1) and a 70-year-old man with exfoliation glaucoma (case 2) underwent trabeculectomy for insufficient intraocular pressure reduction or visual field progression after initial microhook ab interno trabeculotomy (μLOT). In case 1, Schlemm’s canal (SC) opened into the anterior chamber due to extensive absence of the inner wall of SC and TM. In case 2, SC endothelium (SCE)-marker CD34 staining showed the slit-like entry site of a previous LOT, the SC lumen was sealed partially by scleral tissue, and CD34-positive and CD34-negative areas in the SC wall suggested SCE dropout and partial conversion of SC into ghost vessels. Active aqueous outflow-marker podoplanin (D2-40) staining showed intense immunolabeling in the sclera between the entry site and collector channels, indicating aqueous outflow.

Discussion:
The μLOT cleft can appear as both incisional and excisional patterns. In addition to incremental conventional outflow with reduced TM resistance, another unconventional outflow may be a mechanism of IOP reduction after LOT procedures.
Effect of Toric Intraocular Lens Implantation on Visual Acuity and Astigmatism Status in Eyes Treated With Microhook Ab Interno Trabeculotomy
Authors: Ichioka Sho , Manabe Kaoru , Tsutsui Aika , Takai Yasuyuki , Tanito Masaki 
Published: October 2020

Précis:
Use of toric intraocular lenses is a reasonable option for better visual outcomes when a combined minimally invasive glaucoma surgery (MIGS) and cataract surgery is performed in eyes with corneal astigmatism.

Purpose:
To assess the efficacy of toric intraocular lenses (IOLs) in combined cataract and MIGS, visual and refractive outcomes were compared between eyes implanted with nontoric and toric IOLs during microhook ab interno trabeculotomy triple procedures.

Methods:
Glaucomatous eyes with preexisting corneal astigmatism exceeding −1.5 D implanted with nontoric (n=10) or toric (n=10) IOLs were evaluated retrospectively. The uncorrected visual acuity (UCVA) and refractive astigmatism preoperatively and 3 months postoperatively were compared.

Results:
Preoperatively, the groups had similar logarithm of the minimum angle of resolution (logMAR) UCVAs and refractive astigmatism. Postoperatively, the logMAR UCVA (toric, 0.07±0.07; nontoric, 0.33±0.30; P=0.0020) was significantly better and the refractive astigmatism (toric, −0.63±0.56 D; nontoric, −1.53±0.74 D; P=0.0110) significantly less in the toric group. The toric group had postoperative improvements in the logMAR UCVA (−0.58, P=0.0039) and refractive astigmatism (+1.45 D, P=0.0195). Vector analyses showed the postoperative centroid magnitude of refractive astigmatism was less in the toric group (0.23 D at 83 degrees) than the nontoric group (1.03 D at 178 degrees). Postoperatively, 70% of eyes in the toric group had 1.0 D or less refractive astigmatism compared with 10% in the nontoric group. Surgically induced astigmatism (nontoric group, 0.62 D at 10 degrees; toric group, 0.50 D at 113 degrees) and intraocular pressure reduction (22% in both groups) did not differ between groups.

Conclusions:
Better visual outcomes may be achieved with toric IOLs when a combined MIGS/cataract surgery is performed in eyes with corneal astigmatism.
Xylazine, a Veterinary Tranquilizer, Detected in 42 Accidental Fentanyl Intoxication Deaths
Authors: Nunez Jacqueline , DeJoseph Maura E. , Gill James R. 
Published: October 2020

Abstract
Xylazine is an emerging adulterant with fentanyl in fatal drug intoxications, which has public health, safety, and criminal investigative implications. Xylazine is a nonnarcotic sedative used for analgesia and muscle relaxation exclusively in veterinary medicine. Its chemical structure is similar to clonidine and acts as a central α-2 agonist which may cause bradycardia and transient hypertension followed by hypotension. We report the detection of xylazine in 42 deaths in Connecticut from March to August 2019. Xylazine combined with an opioid or stimulant may affect the toxicity of these drugs. Detection of xylazine may help the forensic pathologist distinguish illicit from prescribed fentanyl, and law enforcement agents track the illicit drugs to a specific drug supplier. Because of its lack of response to naloxone, emergency medicine physicians need to be aware of its potential presence as it may affect therapy.
18F-Fluciclovine–Avid Mediastinal Lymph Node Metastasis of Cutaneous Malignant Melanoma
Authors: Shariftabrizi Ahmad , Pillenahalli Maheshwarappa Ravishankar , Kahn Daniel , Pollard Janet 
Published: October 2020

Abstract
A 63-year-old man with recent diagnosis of high-risk prostate adenocarcinoma was referred to our Nuclear Medicine Department for 18F-fluciclovine PET/CT to rule out metastasis in the setting of elevated serum prostate-specific antigen levels. The patient had previous history of nodular melanoma of the right cheek treated 6 years back with surgery and adjuvant radiation. Surveillance 18F-FDG PET/CT for melanoma 1 month back had revealed enlarged FDG-avid mediastinal para-aortic lymph nodes, which on endoscopic biopsy had revealed melanoma metastasis. On current fluciclovine PET/CT, the same enlarged para-aortic lymph nodes showed fluciclovine uptake, suggesting false-positive uptake.
An Unusual Case of Maxillary Sinus Cholesterol Granuloma Showing FDG Uptake on PET/CT
Authors: Umeda Naoki , Hayama Masaki , Nakamura Akiko , Maeda Yohei , Inohara Hidenori 
Published: October 2020

Abstract
Cholesterol granuloma (CG) occurs primarily in the middle ear and rarely in the paranasal sinus. We report an unusual case of paranasal sinus CG with 18F-FDG uptake. A 76-year-old man presented with right refractory epistaxis. PET/CT showed FDG uptake in the maxillary sinus. CT findings are typically uncharacteristic, whereas MRI scans are characterized by a high signal on both T1-weighted and T2-weighted images. Nasal endoscopy from the ostium revealed a granulomatous lesion with hemorrhage at the base of the maxillary sinus. After pathological examination by endoscopic sinus surgery, the patient was diagnosed with CG.
Clinicopathologic Characteristics of Late Acute Antibody-mediated Rejection in Pediatric Liver Transplantation
Authors: Zhou Shengmei , Mitsinikos Tania , Emamaullee Juliet , Weaver Carly , Wang Larry , Shillingford Nick , Warren Mikako , Bawab Julie Huss , Tiwari Nishant , Genyk Yuri , Thomas Danny , Parham David M. 
Published: October 2020

Background.
An early and accurate diagnosis of liver antibody-mediated rejection (AMR) followed by timely intervention is important for clinical management but remains challenging. The aim of this study was to assess the clinicopathologic characteristics and outcomes of late acute AMR in pediatric liver transplantation recipients.

Methods.
We performed a retrospective review of 739 ABO-identical/compatible allograft liver biopsies from 199 pediatric transplantation recipients.

Results.
Based on Banff 2016 AMR criteria, 3 recipients fulfilled the criteria for definite for late acute AMR, 2 met the criteria for suspicious for AMR, and 2 were indeterminate for AMR. We further assessed the clinicopathologic characteristics of these 7 patients. All 7 patients had at least 1 biopsy with a histopathologic pattern compatible with acute AMR. Additionally, we observed accompanied moderately to markedly dilated portal/central veins and endothelialitis disproportionate to the degree of bile duct injury in all 7 patients; periportal/perivenular hepatocyte necrosis was seen in 6 of 7 patients; and arteritis was seen in 3 of 7 patients. In each case, microvascular C4d deposition was present in at least 1 biopsy. Posttransplant donor specific anti-HLA antibodies were detected in 5 patients. Two of 7 patients were retransplanted, and 2 died after developing refractory AMR. The remaining 5 patients were alive with stable graft function at a median follow-up of 4.1 years.

Conclusions.
Our data suggest that acute AMR in pediatric liver grafts is rare, can develop late, and may be associated with graft loss or patient death. The recurrent histopathologic findings of moderately to markedly dilated portal/central veins and endothelialitis disproportionate to the degree of bile duct injury are features that appear unique to pediatric acute AMR of liver grafts.
Long-term Outcomes of Sequential Hematopoietic Stem Cell Transplantation and Kidney Transplantation: Single-center Experience
Authors: Moreira Carla Leal , Hasib Sidiqi M. , Buadi Francis K. , Litzow Mark R. , Gertz Morie A. , Dispenzieri Angela , Russell Stephen J. , Ansell Stephen M. , Stegall Mark D. , Prieto Mikel , Dean Patrick G. , Nyberg Scott L. , El Ters Mireille , Hogan William J. , Amer Hatem , Cosio Fernando G. , Leung Nelson 
Published: October 2020

Background.
Experience with sequential hematopoietic stem cell transplant (HSCT) and kidney transplant (KT) is limited.

Methods.
We conducted a retrospective observational study of adult patients who underwent both HSCT and KT at our center, with a median follow-up of 11 y.

Results.
In our 54 patients cohort (94% autologous HSCT), 36 (67%) patients received HSCT first followed by KT, while 18 (33%) received KT before HSCT. In both groups, AL amyloidosis represented 50% of hematologic diagnosis. Only 4 patients expired due to hematologic disease relapse (2 patients in each group) and only 3 allografts were lost due to hematologic disease recurrence (HSCT first n = 1 and KT first n = 2). Overall 1, 5, and 10 y death-censored graft survival rates were 94%, 94%, and 94%, respectively, for the HSCT first group and 89%, 89%, and 75%, respectively, for the KT first group. Overall 1, 5, and 10 y patients survival rates were 100%, 97% and 90%, respectively, for the HSCT first group and 100%, 76%, and 63%, respectively, for the KT first group.

Conclusions.
Our study supports safety of sequential KT and HSCT, with improved overall patient survival compared to recipients of HSCT remaining on dialysis and good long-term kidney allograft outcome.