bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postpartum urinary retention in women undergoing instrumental delivery: A cross‐sectional analytical study
Authors: Gupta Avantika , Pampapati Veena , Khare Chetan , Murugesan Rajeswari , Nayak Deepthi , Keepanasseril Anish 
Published: July 2020

AbstractIntroductionWomen undergoing instrumental delivery are known to be at higher risk of urinary retention, which can lead to long‐term complications such as voiding dysfunction. Nulliparous women undergo a pronounced and sudden change in the perineum due to stretching during delivery, which may add to the perineal trauma from an episiotomy, increasing the risk of urinary retention. We aim to study the incidence and risk factors associated with postpartum urinary retention in women undergoing instrumental delivery.Material and methodsPregnant women who had an instrumental delivery after 37 weeks of gestation at JIPMER, Puducherry, India, between January 2017 and June 2017 were included in the study. Postpartum urinary retention was defined as the inability to void spontaneously or ultrasonographic documentation of post‐void residual volume of >150 mL, 6 hours after delivery. Demographic factors, clinical profile and follow‐up of these patients were noted. Multivariate logistic regression analysis was performed to assess the risk factors associated with urinary retention and was presented as adjusted odds ratios (OR) with 95% confidence intervals (CI).ResultsPostpartum urinary retention was noted in 124 (20.6%) women undergoing instrumental delivery. Overt and covert urinary retention occurred in 2.3% and 18.3%, respectively. After adjusting for other risk factors, nulliparity (adjusted OR = 4.05, 95% CI 2.02‐8.12 compared with multiparity) and prolonged second stage (OR = 3.96, 95% CI 1.53‐10.25) compared with suspected fetal compromise as an indication for instrumental delivery was associated with increased risk of postpartum urinary retention. Interaction was noted between parity and episiotomy on the occurrence of postpartum urinary retention (P = .010). Among nulliparous women, those with episiotomy (adjusted OR = 6.10, 95% CI 2.65‐14.04) have higher odds of developing postpartum urinary retention compared with those without episiotomy.ConclusionsApproximately one of five (20.6%) women undergoing instrumental delivery developed postpartum urinary retention. Among women undergoing instrumental delivery, episiotomy increased the chances of developing postpartum retention in nulliparous but not multiparous women. Prolonged second stage as an indication for instrumental delivery also increased the chances of retention. Future studies are needed to define the cutoff for diagnosis and to evaluate the long‐term effects of covert postpartum urinary retention, as well to study the effect of episiotomy on development of postpartum urinary retention in women undergoing instrumental delivery.
Role of prenatal magnetic resonance imaging in fetuses with isolated agenesis of corpus callosum in the era of fetal neurosonography: A systematic review and meta‐analysis
Authors: Sileo Filomena Giulia , Di Mascio Daniele , Rizzo Giuseppe , Caulo Massimo , Manganaro Lucia , Bertucci Emma , Masmejan Sophie , Liberati Marco , D’Amico Alice , Nappi Luigi , Buca Danilo , Van Mieghem Tim , Khalil Asma , D’Antonio Francesco 
Published: July 2020

AbstractIntroductionCorpus callosum agenesis (ACC) is frequently diagnosed during fetal life; its prognosis depends also on additional anomalies. The additional value of fetal magnetic resonance imaging (MRI) in fetuses with “isolated” complete (cACC) and partial (pACC) agenesis of the corpus callosum on ultrasound is still debated.Material and methodsWe performed a systematic literature review and meta‐analysis including fetuses with a prenatal diagnosis of cACC and pACC without associated structural anomalies on ultrasound, undergoing fetal MRI. The primary outcome was the rate of additional anomalies detected at fetal MRI. Further analyses assessed the effect of type of ultrasound assessment (neurosonography vs standard axial assessment), gestational age at fetal MRI and rate of postnatally detected brain anomalies. Random‐effect meta‐analyses of proportions were used to analyze the data.ResultsFourteen studies (798 fetuses) were included. In cases with isolated cACC, 10.9% (95% CI 4.1‐20.6) and 4.3% (95% CI 1.4‐8.8) additional anomalies were detected by fetal MRI and postnatally, respectively. Stratifying according to the type of ultrasound assessment, the rate of associated anomalies detected only on fetal MRI was 5.7% (95% CI 0.5‐16.0) with dedicated neurosonography and 18.5% (95% CI 7.8‐32.4) with a standard axial assessment. In fetuses with isolated pACC, 13.4% (95% CI 4.0‐27.0) and 16.2% (95% CI 5.9‐30.3) additional anomalies were detected by fetal MRI or postnatally, respectively. Stratifying according to the type of ultrasound assessment, the rate of associated anomalies detected only on fetal MRI was 11.4% (95% CI 2.7‐25.0) when dedicated neurosonography was performed. Cortical and posterior fossa anomalies represented the most common anomalies missed at ultrasound with both cACC and pACC. Due to the very small number of included cases, stratification according to early (<24 weeks of gestation) and late (>24 weeks) fetal MRI could not be done for either cACC or pACC.ConclusionsThe rate of associated anomalies detected exclusively at fetal MRI in isolated ACC undergoing neurosonography is lower than previously reported. Cortical and posterior fossa anomalies are among the most common anomalies detected exclusively at MRI, thus confirming the crucial role of fetal MRI in determining the prognosis of these fetuses. However, some anomalies still go undetected prenatally and this should be stressed during parental counseling.
A case report and literature review of vaginal bleeding in prepubertal girl
Authors: Wang Xinyan , Zeng Wenjie , Xu Sheng , Huang Lu , Lai Yucheng , Yu Yan 
Published: July 2020

AbstractVaginal bleeding in the prepubertal girl is an uncommon condition with complex aetiological factors. We report a case of a 6‐year‐old girl brought to hospital when vaginal bleeding was noticed after defecation. Various common causes were excluded by genital and auxiliary examinations. Serial vaginoscopy revealed increasing petechiae within the non‐oestrogenised cervix and vaginal wall. The aetiology of these petechiae was considered to result from ruptured small blood vessels or submucosal capillaries due to an increase in abdominal pressure.ConclusionThis case report and review of literature has shed new light on the aetiology of prepubertal bleeding, which details challenging clinical characteristics of use to gynaecologists in the evaluation of related conditions and formulation of appropriate treatment regimens.
An integrated PK‐PD model for cortisol and the 17‐hydroxyprogesterone and androstenedione biomarkers in children with congenital adrenal hyperplasia
Authors: Al‐Kofahi Mahmoud , Ahmed Mariam A. , Jaber Mutaz M. , Tran Thang N. , Willis Brian A. , Zimmerman Cheryl L. , Gonzalez‐Bolanos Maria T. , Brundage Richard C. , Sarafoglou Kyriakie 
Published: July 2020

AimsThe aim of this study was to characterize the pharmacokinetic/pharmacodynamic relationships of cortisol and the adrenal biomarkers 17‐hydroxyprogesterone and androstenedione in children with congenital adrenal hyperplasia (CAH).MethodsA nonlinear mixed‐effect modelling approach was used to analyse cortisol, 17‐hydroxyprogesterone and androstenedione concentrations obtained over 6 hours from children with CAH (n = 50). A circadian rhythm was evident and the model leveraged literature information on circadian rhythm in untreated children with CAH. Indirect response models were applied in which cortisol inhibited the production rate of all three compounds using an Imax model.ResultsCortisol was characterized by a one‐compartment model with apparent clearance and volume of distribution estimated at 22.9 L/h/70 kg and 41.1 L/70 kg, respectively. The IC50 values of cortisol concentrations for cortisol, 17‐hydroxyprogesterone and androstenedione were estimated to be 1.36, 0.45 and 0.75 μg/dL, respectively. The inhibitory effect was found to be more potent on 17OHP than D4A, and the IC50 values were higher in salt‐wasting subjects than simple virilizers. Production rates of cortisol, 17‐hydroxyprogesterone and androstenedione were higher in simple‐virilizer subjects. Half‐lives of cortisol, 17‐hydroxyprogesterone and androstenedione were 60, 47 and 77 minutes, respectively.ConclusionRapidly changing biomarker responses to cortisol concentrations highlight that single measurements provide volatile information about a child's disease control. Our model closely captured observed cortisol, 17‐hydroxyprogesterone and androstenedione concentrations. It can be used to predict concentrations over 24 hours and allows many novel exposure metrics to be calculated, e.g., AUC, AUC‐above‐threshold, time‐within‐range, etc. Our long‐range goal is to uncover dose–exposure–outcome relationships that clinicians can use in adjusting hydrocortisone dose and timing.
The health sphere beyond borders: Coverage portability and justice in a global space
Authors: Webb Adam K. 
Published: July 2020

AbstractMedical coverage often stops at borders, for both travellers and long‐term migrants. Such patchiness imposes a de facto limit on free movement. This article considers this phenomenon not as a mere policy choice or technical matter, but as a form of territorial discrimination that is incoherent and even unjust. This legacy of nationally bounded social citizenship rests on a mistaken version of solidarity. Moreover, with growing mobility and rising expectations of medical coverage around the world, the fragmenting of safety nets by the political honeycomb of statehood will become a vexing problem in coming decades. A proper understanding of the health sphere not only can justify incremental reforms that lessen territorial discrimination, without impairing either solidarity or sustainability. It also foreshadows a radically different vision of how social provision might work in a future global space beyond the nation‐state.
Lenalidomide‐associated progressive multifocal leukoencephalopathy
Authors: Nishimura Kazutaka , Iwai Yuta , Yabuki Mariko , Fuse Hiroe , Nakamichi Kazuo , Takahashi Kenta , Suzuki Tadaki , Saijo Masayuki , Fukushima Takeshi , Kuwabara Satoshi 
Published: July 2020

AbstractBackgroundLenalidomide, an analogue of thalidomide, is frequently used to treat multiple myeloma (MM). Progressive multifocal leukoencephalopathy (PML) is an infectious disease of the central nervous system caused by the reactivation of the JC polyomavirus. Only a few reports have described PML in patients receiving lenalidomide therapy.Case presentationA 76‐year‐old man with MM presented progressive visual and cognitive impairment during lenalidomide administration. Magnetic resonance imaging showed a lesion in the right parietal lobe. Brain biopsy confirmed the diagnosis of PML. Lenalidomide therapy was discontinued, and oral mefloquine was commenced. He was alive more than 1 year later with mild neurologic decline.ConclusionsAlthough rare, lenalidomide‐induced PML should be considered in myeloma patients treated with lenalidomide.
Steroid‐sparing maintenance immunosuppression is safe and effective after simultaneous liver‐kidney transplantation
Authors: Weeks Sharon R. , Luo Xun , Toman Lindsey , Gurakar Ahmet O. , Naqvi Fizza F. , Alqahtani Saleh A. , Philosophe Benjamin , Cameron Andrew M. , Desai Niraj M. , Ottmann Shane E. , Segev Dorry L. , Garonzik‐Wang Jacqueline 
Published: July 2020

AbstractOptimization of maintenance immunosuppression (mIS) regimens in the transplant recipient requires a balance between sufficient potency to prevent rejection and avoidance of excessive immunosuppression to prevent toxicities and complications. The optimal regimen after simultaneous liver‐kidney (SLK) transplantation remains unclear, but small single‐center reports have shown success with steroid‐sparing regimens. We studied 4184 adult SLK recipients using the Scientific Registry of Transplant Recipients, from March 1, 2002, to February 28, 2017, on tacrolimus‐based regimens at 1 year post‐transplant. We determined the association between mIS regimen and mortality and graft failure using Cox proportional hazard models. The use of steroid‐sparing regimens increased post‐transplant, from 16.1% at discharge to 88.0% at 5 years. Using multi‐level logistic regression modeling, we found center‐level variation to be the major contributor to choice of mIS regimen (ICC 44.5%; 95% CI: 36.2%‐53.0%). In multivariate analysis, use of a steroid‐sparing regimen at 1 year was associated with a 21% decreased risk of mortality compared to steroid‐containing regimens (aHR 0.79, P = .01) and 20% decreased risk of liver graft failure (aHR 0.80, P = .01), without differences in kidney graft loss risk (aHR 0.92, P = .6). Among SLK recipients, the use of a steroid‐sparing regimen appears to be safe and effective without adverse effects on patient or graft survival.
Fasting Status and Circadian Variation Must be Considered When Performing AUC‐based Therapeutic Drug Monitoring of Tacrolimus in Renal Transplant Recipients
Authors: Gustavsen Marte Theie , Midtvedt Karsten , Robertsen Ida , Woillard Jean‐Baptiste , Debord Jean , Klaasen Rolf Anton , Vethe Nils Tore , Bergan Stein , Åsberg Anders 
Published: July 2020

Therapeutic drug monitoring (TDM) is mandatory for the immunosuppressive drug tacrolimus (Tac). For clinical applicability, TDM is performed using morning trough concentrations. With recent developments making tacrolimus concentration determination possible in capillary microsamples and Bayesian estimator predicted area under the concentration curve (AUC), AUC‐guided TDM may now be clinically applicable. Tac circadian variation has, however, been reported, with lower systemic exposure following the evening dose. The aim of the present study was to investigate tacrolimus pharmacokinetic (PK) after morning and evening administrations of twice‐daily tacrolimus in a real‐life setting without restrictions regarding food and concomitant drug timing. Two 12 hour tacrolimus investigations were performed; after the morning dose and the following evening dose, respectively, in 31 renal transplant recipients early after transplantation both in a fasting‐state and under real‐life nonfasting conditions (14 patients repeated the investigation). We observed circadian variation under fasting‐conditions: 45% higher peak‐concentration and 20% higher AUC following the morning dose. In the real‐life nonfasting setting, the PK‐profiles were flat but comparable after the morning and evening doses, showing slower absorption rate and lower AUC compared with the fasting‐state. Limited sampling strategies using concentrations at 0, 1, and 3 hours predicted AUC after fasting morning administration, and samples obtained at 1, 3, and 6 hours predicted AUC for the other conditions (evening and real‐life nonfasting). In conclusion, circadian variation of tacrolimus is present when performed in patients who are in the fasting‐state, whereas flatter PK‐profiles and no circadian variation was present in a real‐life, nonfasting setting.
Left‐sided congenitally unguarded tricuspid valve with congenitally corrected transposition of the great arteries: A rare diagnosis confirmed by three‐dimensional echocardiography
Authors: Williams Jason L. , Lockhart John L. , Miller Stephen G. , Barker Piers C. A. , Campbell M. Jay 
Published: July 2020

AbstractLeft‐sided unguarded tricuspid valve disease with congenitally corrected transposition of the great arteries (ccTGA) is a rare cardiac malformation, only reported a few times in the literature. Two‐dimensional echocardiography (2DE) uses standard views to diagnose tricuspid valve disease. Advanced imaging techniques, such as three‐dimensional echocardiography, allow for simultaneous visualization of the tricuspid valve annulus and all leaflets. Three‐dimensional echocardiography (3DE) may be useful in distinguishing unguarded tricuspid valve orifice from other forms of tricuspid valve disease.
Unexpected mechanism of mitral regurgitation in a patient post ALCAPA repair: Added value of three‐dimensional echocardiography
Authors: Danylenko Oleksandr , Surkova Elena , Senior Roxy , Li Wei 
Published: July 2020

AbstractAccurate assessment of etiology of mitral regurgitation (MR) is one of the key steps in the decision‐making process and further clinical management of patients with severe MR. Our clinical case illustrates the added value of three‐dimensional echocardiography (3DE) in assessment of mitral valve morphology and identification of an unexpected mechanism of MR which was not previously diagnosed using conventional echocardiography. 3DE helped to choose appropriate management strategy in this patient.
A time‐efficient method to determine parameters for measurement of short‐interval intracortical inhibition for quadriceps
Authors: Ruas Cassio V. , Taylor Janet L. , Nosaka Kazunori , Haff G. Gregory , Latella Christopher 
Published: July 2020

AbstractShort‐interval intracortical inhibition (SICI) is often assessed to investigate inhibitory responses in the primary motor cortex representation of the quadriceps. However, determining appropriate paired‐pulse transcranial magnetic stimulation (TMS) parameters to optimise SICI measurement can be impractical and time‐consuming. This study investigated the intensity required to elicit maximal and 50% of maximum inhibition, and the test‐retest reliability of a time‐efficient approach for SICI measurement in quadriceps. Nine men and six women (26.6 ± 4.4 years) underwent single and paired‐pulse (3‐ms interval) TMS during 10% maximal voluntary isometric contraction on two days. Responses were recorded from vastus lateralis (VL), rectus femoris (RF) and vastus medialis (VM). Test stimulus intensity was 140% of active motor threshold (AMT), and conditioning stimulus intensities (CSIs) ranged from 55% to 90% (eight intensities) of AMT (five test and five paired responses for each intensity). With CSI of 55% AMT, SICI was minimal (conditioned:test motor evoked potential [MEP]; 1.00, 0.96 and 0.95 for VL, RF and VM, respectively, <1.00 indicates inhibition). Inhibition was greater at 70%–90% AMT for VL (0.67–0.85), at 75%–90% AMT for RF (0.70–0.78) and at 80%–90% AMT for VM (0.59–0.68) when compared to 55% AMT. The CSIs that elicited maximal and 50% maximal inhibition were ~84% and ~75% AMT, respectively. Reliability for individual CSIs ranged from “poor‐to‐good” for all muscles. SICI averaged across all CSIs demonstrated “moderate” reliability for VL and VM, but “poor” reliability for RF. This method may offer a practical approach to individualise and select CSIs to investigate quadriceps inhibitory networks in neurophysiological studies.
Photoplethysmographic evaluation of generalized tonic‐clonic seizures
Authors: Mohammadpour Touserkani Fatemeh , Tamilia Eleonora , Coughlin Francesca , Hammond Sarah , El Atrache Rima , Jackson Michele , Bendsen‐Jensen Megan , Kim Boram , Connolly Jack , Manganaro Sheryl , Papadelis Christos , Kapur Kush , Loddenkemper Tobias 
Published: July 2020

AbstractObjectivePhotoplethysmography (PPG) is an optical technique measuring variations of blood perfusion in peripheral tissues. We evaluated alterations in PPG signals in relationship to the occurrence of generalized tonic‐clonic seizures (GTCSs) in patients with epilepsy to evaluate the feasibility of seizure detection.MethodsDuring electroencephalographic (EEG) long‐term monitoring, patients wore portable wristband sensor(s) on their wrists or ankles recording PPG signals. We analyzed PPG signals during three time periods, which were defined with respect to seizures detected on EEG: (1) baseline (>30 minutes prior to seizure), (2) preseizure period, and (3) postseizure period. Furthermore, we selected five random control segments during seizure‐free periods. PPG features, including frequency, amplitude, duration, slope, smoothness, and area under the curve, were automatically calculated. We used a linear mixed‐effect model to evaluate changes in PPG features between different time periods in an attempt to identify signal changes that detect seizures.ResultsWe prospectively enrolled 174 patients from the epilepsy monitoring unit at Boston Children's Hospital. Twenty‐five GTCSs were recorded from 13 patients. Data from the first recorded GTCS of each patient were included in the analysis. We observed an increase in PPG frequency during pre‐ and postseizure periods that was higher than the changes during seizure‐free periods (frequency increase: preseizure = 0.22 Hz, postseizure = 0.58 Hz vs changes during seizure‐free period = 0.05 Hz). The PPG slope decreased significantly by 56.71 nW/s during preseizure periods compared to seizure‐free periods. Additionally, the smoothness increased significantly by 0.22 nW/s during the postseizure period compared to seizure‐free periods.SignificanceMonitoring of PPG signals may assist in the detection of GTCSs in patients with epilepsy. PPG may serve as a promising biomarker for future seizure detection systems and may contribute to future seizure prediction systems.
Functional and behavioral signatures of Kv7 activator drug subtypes
Authors: Kanyo Richard , Wang Caroline K. , Locskai Laszlo F. , Li Jingru , Allison W. Ted , Kurata Harley T. 
Published: July 2020

AbstractObjectiveVoltage‐gated potassium channels of the KCNQ (Kv7) family are targeted by a variety of activator compounds with therapeutic potential for treatment of epilepsy. Exploration of this drug class has revealed a variety of effective compounds with diverse mechanisms. In this study, we aimed to clarify functional criteria for categorization of Kv7 activator compounds, and to compare the effects of prototypical drugs in a zebrafish larvae model.MethodsIn vitro electrophysiological approaches with recombinant ion channels were used to highlight functional properties important for classification of drug mechanisms. We also benchmarked the effects of representative antiepileptic Kv7 activator drugs using behavioral seizure assays of zebrafish larvae and in vivo Ca2+ imaging with the ratiometric Ca2+ sensor CaMPARI.ResultsDrug effects on channel gating kinetics, and drug sensitivity profiles to diagnostic channel mutations, were used to highlight properties for categorization of Kv7 activator drugs into voltage sensor‐targeted or pore‐targeted subtypes. Quantifying seizures and ratiometric Ca2+ imaging in freely swimming zebrafish larvae demonstrated that while all Kv7 activators tested lead to suppression of neuronal excitability, pore‐targeted activators (like ML213 and retigabine) strongly suppress seizure behavior, whereas ICA‐069673 triggers a seizure‐like hypermotile behavior.SignificanceThis study suggests criteria to categorize antiepileptic Kv7 activator drugs based on their underlying mechanism. We also establish the use of in vivo CaMPARI as a tool for screening effects of anticonvulsant drugs on neuronal excitability in zebrafish. In summary, despite a shared ability to suppress neuronal excitability, our findings illustrate how mechanistic differences between Kv7 activator subtypes influence their effects on heteromeric channels and lead to vastly different in vivo outcomes.