bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Preload on Right Ventricular Hemodynamics in Acute Pulmonary Embolism
Authors: Mortensen Christian S. , Kramer Anders , Schultz Jacob , Lyhne Mads D. , Nielsen-Kudsk Jens Erik , Andersen Asger 
Published: October 2020

Objectives:
To compare the hemodynamic effects of increased versus decreased preload in a porcine model of acute intermediate-risk pulmonary embolism.

Design:
Randomized, controlled animal study.

Setting:
Tertiary medical center, animal research laboratory.

Subjects:
Female, Danish slaughter pigs (n = 22, ~ 60 kg).

Interventions:
Acute pulmonary embolism was induced by large emboli made from clotting of autologous blood. Sixteen animals were randomized to either fluid loading (n = 8, isotonic saline, 1 L/hr for 2 hr) or diuretic treatment (n = 8, furosemide, 40 mg every 30 min, total 160 mg) and compared with a vehicle group (n = 6, no treatment).

Measurements and Main Results:
Hemodynamics were evaluated at baseline, after pulmonary embolism and after each dose by biventricular pressure-volume loops, invasive pressures, diuretic output, respiratory variables, and blood analysis. Pulmonary embolism increased mean pulmonary arterial pressure (p < 0.0001), pulmonary vascular resistance (p = 0.008), right ventricular arterial elastance (p = 0.003), and right ventricular end-systolic volume (p = 0.020) while right ventricular stroke volume and right ventricular ejection fraction were decreased (p = 0.047 and p = 0.0003, respectively) compared with baseline. Fluid loading increased right ventricular end-diastolic volume (+31 ± 13 mL; p = 0.004), right ventricular stroke volume (+23 ± 10 mL; p = 0.009), cardiac output (+2,021 ± 956 mL; p = 0.002), and right ventricular ejection fraction (+7.6% ± 1.5%; p = 0.032), whereas pulmonary vascular resistance decreased (–202 ± 65 dynes; p = 0.020) compared with vehicle. Diuretic treatment decreased right ventricular end-diastolic volume (–84 ± 11 mL; p < 0.001), right ventricular stroke volume (–40 ± 6 mL; p = 0.001), cardiac output (–3,327 ± 451 mL; p = 0.005), and mean pulmonary arterial pressure (–7 ± 1 mm Hg; p < 0.001) and increased right ventricular end-systolic elastance (+0.72 ± 0.2 mm Hg/mL; p < 0.001) and systemic vascular resistance (+1,812 ± 767 dynes; p < 0.001) with no effects on mean arterial pressure.

Conclusions:
In a porcine model of acute intermediate-risk pulmonary embolism, fluid loading increased right ventricular preload and right ventricular stroke volume, whereas diuretics decreased right ventricular preload and right ventricular stroke volume without affecting mean arterial pressure.
Prediction Models for Physical, Cognitive, and Mental Health Impairments After Critical Illness: A Systematic Review and Critical Appraisal
Authors: Haines Kimberley J. , Hibbert Elizabeth , McPeake Joanne , Anderson Brian J. , Bienvenu Oscar Joseph , Andrews Adair , Brummel Nathan E. , Ferrante Lauren E. , Hopkins Ramona O. , Hough Catherine L. , Jackson James , Mikkelsen Mark E. , Leggett Nina , Montgomery-Yates Ashley , Needham Dale M. , Sevin Carla M. , Skidmore Becky , Still Mary , van Smeden Maarten , Collins Gary S. , Harhay Michael O. 
Published: October 2020

Objectives:
Improved ability to predict impairments after critical illness could guide clinical decision-making, inform trial enrollment, and facilitate comprehensive patient recovery. A systematic review of the literature was conducted to investigate whether physical, cognitive, and mental health impairments could be predicted in adult survivors of critical illness.

Data Sources:
A systematic search of PubMed and the Cochrane Library (Prospective Register of Systematic Reviews ID: CRD42018117255) was undertaken on December 8, 2018, and the final searches updated on January 20, 2019.

Study Selection:
Four independent reviewers assessed titles and abstracts against study eligibility criteria. Studies were eligible if a prediction model was developed, validated, or updated for impairments after critical illness in adult patients. Discrepancies were resolved by consensus or an independent adjudicator.

Data Extraction:
Data on study characteristics, timing of outcome measurement, candidate predictors, and analytic strategies used were extracted. Risk of bias was assessed using the Prediction model Risk Of Bias Assessment Tool.

Data Synthesis:
Of 8,549 screened studies, three studies met inclusion. All three studies focused on the development of a prediction model to predict (1) a mental health composite outcome at 3 months post discharge, (2) return-to-pre-ICU functioning and residence at 6 months post discharge, and (3) physical function 2 months post discharge. Only one model had been externally validated. All studies had a high risk of bias, primarily due to the sample size, and statistical methods used to develop and select the predictors for the prediction published model.

Conclusions:
We only found three studies that developed a prediction model of any post-ICU impairment. There are several opportunities for improvement for future prediction model development, including the use of standardized outcomes and time horizons, and improved study design and statistical methodology.
Long-Term Sustainability and Acceptance of Antimicrobial Stewardship in Intensive Care: A Retrospective Cohort Study*
Authors: Sehgal Prateek , Elligsen Marion , Lo Jennifer , Lam Philip W. , Leis Jerome A. , Fowler Rob , Pinto Ruxandra , Daneman Nick 
Published: October 2020

OBJECTIVES:
To evaluate long-term uptake of an antimicrobial stewardship audit-and-feedback program along with potential predictors of stewardship suggestions and acceptance across a diverse ICU population.

DESIGN:
A retrospective cohort study.

SETTING:
An urban, academic medical institution.

PATIENTS:
Patients admitted to an ICU who received an antimicrobial stewardship program suggestion between June 2010 and September 2019.

INTERVENTION:
None.

MEASUREMENTS AND MAIN RESULTS:
The antimicrobial stewardship program provided 7,749 antibiotic assessments over the study period and made a suggestion to alter therapy in 2,826 (36%). Factors associated with a higher likelihood of receiving a suggestion to alter therapy included shorter hospital length of stay prior to antimicrobial stewardship program review (odds ratio 1.15 for ≤ 5 d; 95% CI 1.00–1.32), admission to cardiovascular (1.37; 1.06–1.76) or burn surgery (1.88; 1.50–2.36) versus general medicine, and preceding duration of antibiotic use greater than 5 days (1.33; 1.10–1.60). Assessment of aminoglycosides (2.91; 1.85–4.89), carbapenems (1.93; 1.54–2.41), and vancomycin (2.71; 2.19–3.36) versus ceftriaxone was more likely to result in suggestions to alter therapy. The suggestion acceptance rate was 67% (1,895/2,826), which was stable throughout the study period. Admission to a level 3 ICU was associated with higher likelihood of acceptance of suggestions (1.50; 1.14–1.97). Factors associated with lower acceptance rates were admission to burn surgery (0.64; 0.45–0.91), treatment of pneumonia (0.64; 0.42–0.97 for community-acquired and 0.65; 0.44–0.94 for ventilator-acquired), unknown source of infection (0.66; 0.48–0.92), and suggestion types of “narrow spectrum” (0.65; 0.45–0.94), “change formulation of antibiotic” (0.42; 0.27–0.64), or “change agent of therapy” (0.63; 0.40–0.97) versus “change of dose”.

CONCLUSIONS:
An antimicrobial stewardship program implemented over a decade resulted in sustained suggestion and acceptance rates. These findings support the need for a persistent presence of audit-and-feedback over time with more frequent suggestions to alter potentially nephrotoxic agents, increased efforts toward specialized care units, and further work approaching infectious sources that are typically treated without pathogen confirmation and identification.
A multi-center investigation of breast-conserving surgery based on data from the Chinese Society of Breast Surgery (CSBrS-005)
Authors: Yu Li-Xiang , Shi Peng , Tian Xing-Song , Yu Zhi-Gang 
Published: October 2020

AbstractBackground:Although breast-conserving surgery is one of the standard treatments for breast cancer, few studies have assessed its recent implementation in China. We aimed to clarify the current real-world status of breast-conserving surgery in China.Methods:This cross-sectional survey relied on data collected by the Chinese Society of Breast Surgery (CSBrS) to examine patients who underwent this surgery between January 2018 and December 2018. The survey was conducted using a uniform electronic questionnaire to collect information, including clinical and pathological data on these patients.Results:Overall, 4459 breast-conserving surgeries were performed in 34 member units of CSBrS, accounting for 14.6% of all breast cancer surgeries performed in these units during the study period. In patients who underwent breast-conserving surgery with information on tumor size available, more than half (61.2%) of the tumors were smaller than 2 cm in diameter, and only 87 (3.2%) tumors were larger than 4 cm in diameter. Among patients who underwent breast-conserving surgeries, 457 (10.2%) patients received neoadjuvant therapy before the surgery. Among patients with a reported margin width, 34 (2.0%) patients had a margin of ≤2 mm, and 1530 (88.2%) of them had a margin of >5 mm.Conclusions:This study demonstrated the rates of breast-conserving surgery in member units of the CSBrS, and introduced the characteristics and surgical margins of patients who underwent this surgery. This information helps describe the real-world status of breast-conserving surgery in China.Trial registrationchictr.org.cn, ChiCTR1900026841; http://www.chictr.org.cn/showproj.aspx?proj=42783
Health anxiety among adults with congenital heart disease
Authors: Roseman Alexandra , Morton Liza , Kovacs Adrienne H. 
Published: October 2020

Purpose of review
Adults with congenital heart disease (CHD) may experience anxiety specifically related to their medical condition. This review introduces the concepts of health anxiety and heart-focused anxiety, summarizes what is currently known about heart-focused anxiety among adults with CHD and offers suggestions to help adult CHD providers address heart-focused anxiety in their patients.

Recent findings
Although minimal research has been conducted specific to this outcome, health anxiety may occur at any point across the lifespan of individuals with CHD. A recent study found that children and adolescents with CHD reported greater health anxiety than community peers. Health anxiety was commonly reported among adults with CHD presenting for psychological assessment. It was linked with older age, trait anxiety, perceived parental overprotection and greater CHD complexity in one study.

Summary
Adults with CHD face many potential health-related stressors, including cardiac symptoms, treatments and interventions throughout the lifespan (including surgeries and other invasive procedures), the impact of CHD on daily lives and longer-term health expectations. Providers should be aware that heart-focused anxiety among patients is understandable and perhaps common. Patient-centred education and psychological intervention should be integrated within a comprehensive approach to long-term disease management.
Evaluation of Emotional Adverse Effects of Antidepressants
Authors: Aşçibaşi Kadir , Çökmüş Fikret Poyraz , Dikici Didem Sücüllüoğlu , Özkan Hüseyin Murat , Alçi Deniz , Altunsoy Neslihan , Kuru Erkan , Yüzeren Serra , Aydemir Ömer 
Published: October 2020

Abstract

Purpose/Background
Emotional adverse effects due to antidepressant use may cause difficulties for the clinician in the treatment of depression. In this prospective study, the emotional adverse effects of antidepressants were evaluated in various aspects.

Methods/Procedures
Ninety eight patients diagnosed with major depressive disorder were included in the study. At 2nd, 4th, 8th, 12th, and 16th weeks, patients were assessed with Montgomery-Asberg Depression Rating Scale (MADRS), and the antidepressant dose was increased in patients with less than a 50% reduction at each visit compared with the initial MADRS score. The Oxford Questionnaire on the Emotional Side-effects of Antidepressants (OQESA) was used at the 8th-week and 16th-week visits.

Findings/Results
A significant difference is found in the OQESA score at the 8th-week visit compared with the 16th-week assessment (P < 0.001, t = 5.73). There were significant correlations between MADRS scores and OQESA scores both at the 8th (r = 0.346, P = 0.05) and the 16th (r = 0.490, P < 0.001) weeks. In regression analyses, at eighth-week assessment, MADRS score (B = 1.487, P = 0.002) and selective serotonin reuptake inhibitor use (B = 14.014, P = 0.023) had a significantly predicted OQESA score.

Implications/Conclusions
In this study, it is found that, as the rate of remitted patients is increased, OQESA scores get decreased, and furthermore, the OQESA score of the remitted group is statistically low when compared with that of the nonremitted group at the 8th- and 16th-week visits. Oxford Questionnaire on the Emotional Side-effects of Antidepressants and MADRS scores are significantly correlated in all assessments. These results suggest that the score obtained from OQESA may be related not only to the emotional adverse effects of antidepressants but also to the residual symptoms of depression.
Alternate Light Source Findings of Common Topical Cosmetics and Three Removal Methods
Authors: Anderson Jocelyn C. , Pollitt Erin N. , Schildbach Caroline , MacDonald Ryan , Rose Lauren , Sheridan Daniel J. 
Published: October 2020

ABSTRACT

Introduction
Alternate light sources (ALSs) are a tool used by forensic nurses to aid in the physical examination of patients. Prior research has shown some topical makeup products absorb alternate light similar to the absorption noted in bruises. Therefore, the purposes of this study were (a) to further examine the ALS findings of multiple brands and types of makeup products and (b) to compare the efficacy of three methods of makeup removal.

Methods
Fourteen makeup products were applied to the forearms of 100 healthy adult volunteers with varying skin tones and then assessed under white light, six alternate light wavelengths, and three color filters, producing 19 total wavelength-and-filter combinations. The results were recorded before and after removal procedures by forensic nurse examiners who were blinded to the removal method. A three-arm randomized controlled trial of makeup removal methods (soap and water, isopropyl alcohol swab, makeup removal wipe) was conducted with the participants.

Results
All 14 makeup products produced absorption in at least 10% of the observations. Fluorescence was observed in more than 10% of the observations for only two products. After product removal, four products continued to produce statistically significant absorption findings when viewed under an ALS. One product produced significant fluorescence after removal procedures. There were no statistically significant differences between the removal methods noted in any of these analyses.

Conclusion
Our findings support the importance of using alternate light as one component of a comprehensive forensic examination, including history taking and physical examination.
The association of diabetes mellitus with neointimal formation following deployment of second-generation drug-eluting stents: an optical coherence tomographic study
Authors: Cai Jin-Zan , Lu Wen-Qi , Xu Chen , Gu Jue , You Wei , Xu Tian , Gogas Bill D. , Jia Hai-Bo , Ye Fei 
Published: October 2020

Objectives
The purpose of this study was to evaluate the association of diabetes mellitus (DM) with neointimal formation after implantation of second-generation drug-eluting stent (DES) visualized by optical coherence tomography (OCT).

Methods
Patients with single de novo coronary artery disease treated with second-generation DES between June 2014 and June 2017 in our department underwent OCT examination at 1-year follow-up and were enrolled in this retrospective study. The primary end point was in-stent mean neointimal thickness (MNT), and secondary end points included uncovered stent strut, minimal lumen area (MLA), neointimal burden, neointimal hyperplasia (NIH) patterns and stent thrombosis (ST) after 1 year of OCT follow-up.

Results
A total of 68 patents with DM (DM group) and 216 patients without DM (non-DM group) were enrolled. At 1-year follow-up, the DM group compared with the non-DM group, showed: MNT [160 (85–245) μm vs. 120 (60–220) μm, P = 0.038] and neointimal burden [21.4 (8.3–30.1)% vs. 14.0 (5.7–26.1)%, P = 0.023] to be significantly increased. Concurrently, MLA [4.60 (3.53–6.06) mm vs. 5.76 (4.28–7.20) mm2, P = 0. 0.002] was significantly reduced. Interestingly, the degree of uncovered struts (7.3 ± 7.1% vs. 7.7 ± 6.7%, P = 0.704), NIH patterns (P = 0.984), and ST (7.9% vs. 7.4%, P = 0.88) were comparable between the two groups. After propensity score matching, the MNT [160 (90–240) μm vs. 110 (60–220) μm, P = 0.048] and neointimal burden [21.4 (8.3–30.1)% vs. 15.4 (5.6–26.3)%, P = 0.044] remained significantly different in the DM compared to the non-DM group.

Conclusion
DM leads to significant increase in MNT and neointimal burden even with second-generation DES, nevertheless stent strut coverage, ST and NIH characteristics remained comparable among the cohorts at 1-year.
Avoiding the emergence of contrast-induced acute kidney injury in acute coronary syndrome: routine hydration treatment
Authors: Arslan Sukru , Yildiz Ahmet , Dalgic Yalcin , Batit Servet , Kilicarslan Onur , Ser Ozgur Selim , Dalgic Sadiye Nur , Kocas Cuneyt , Abaci Okay 
Published: October 2020

Background:
Patients with acute coronary syndrome (ACS) have about a three-fold risk for developing contrast-induced acute kidney injury(CI-AKI). Investigating studies on routine hydration therapy have frequently included patients with stable coronary artery disease and high risk of CI-AKI [estimated glomerular filtration rate (eGFR) < 60 ml/min]. However, data on routine hydration treatment in non-ST segment elevation myocardial infarction (NSTEMI) patients with eGFR ≥60 ml/min are insufficient. We aimed to investigate the association between routine hydration therapy and CI-AKI development in NSTEMI patients at low risk for nephropathy.

Methods and results:
We randomly assigned a total of 401 NSTEMI patients to two groups: the routine hydration group (198 patients) and the nonhydration group (control group) (203 patients). Intravenous hydration with isotonic saline (1 ml/kg/h, 0.9% sodium chloride) was given for 3–12 h before and 24 h after contrast exposure to the hydration group. CI-AKI was defined as the increase in serum creatinine values 0.5 mg/dl or 25% between 48 and 72 h after the invasive procedures. In our study, the incidence of CI-AKI development in the routine hydration group (7.1%) was significantly lower than in the nonhydration group (14.1%) (P: 0.02). This study revealed that older age, amount of contrast media, and routine hydration were independent risk factors for developing CI-AKI (P < 0.01, P: 0.04, P < 0.01, respectively).

Conclusion:
We found that preprocedural and postprocedural intravenous hydration therapy reduces the development of CI-AKI in patients with NSTEMI at low risk for CI-AKI. We suggest administering routine hydration therapy in all ACS patients regardless of eGFR values.
Acute cardiorenal anemia syndrome among ST-elevation myocardial infarction patients treated by primary percutaneous intervention
Authors: Merdler Ilan , Loewenstein Itamar , Zahler David , Levit Dana , Hochstadt Aviram , Banai Shmuel , Gal-Oz Amir , Shacham Yacov 
Published: October 2020

Background
Acute kidney injury (AKI) and anemia have been extensively studied in ST-elevation myocardial infarction (STEMI), yet the precise nature of their reciprocal relationship has not been elucidated in STEMI patients.

Methods
We performed a retrospective analysis of 2096 consecutive patients admitted for STEMI between January 2008 and December 2018 and treated with primary coronary intervention. Patients were stratified into four groups according to the presence of baseline anemia and occurrence of AKI: without anemia or AKI, baseline anemia without AKI, AKI without baseline anemia and acute cardiorenal anemia syndrome (CRAS), defined as the occurrence of AKI in patients with baseline anemia. Patients’ medical records were reviewed for in-hospital complications, 30-day and long-term mortality.

Results
The mean age was 61 ± 13 years and 1682 patients (80%) were men. Ten percent of patients had baseline anemia without AKI, 7% had AKI without baseline anemia and 3% were classified as CRAS. We found increments between the four groups for occurrence of new onset atrial fibrillation and heart failure rates, presence of a critical state, and both 30-day and long-term mortality (P < 0.001 for all). Logistic regression models demonstrated that as compared to AKI alone, CRAS was associated with a higher risk for long-term mortality (HR 10.49; 95% CI 6.5–17.1) as compared to anemia (HR 3.32, 95% CI 2.1–5.2) and AKI (HR 7.71, 95% CI 5.1–11.7) alone (P < 0.001 for all).

Conclusions
Among STEMI patients, the interaction between anemia and AKI is associated with worse short and long-term outcomes and reflects the reciprocity of cardiac and renal exacerbations.
Correlation between aortic root dimension and coronary ectasia
Authors: Ghetti Gabriele , Taglieri Nevio , Donati Francesco , Minnucci Matteo , Bruno Antonio Giulio , Palmerini Tullio , Saia Francesco , Marrozzini Cinzia , Galié Nazzareno 
Published: October 2020

Background
Aortic aneurysms are associated with coronary artery ectasia (CAE). However, the relation between the extent of CAE and the severity of aortic dilatation is not understood. This study was undertaken to investigate the relationship between angiographic extension of CAE and aortic dimension.

Patients and methods
We retrospectively include 135 patients with angiographic diagnosis of CAE defined as dilatation of coronary segment more than 1.5 times than an adjacent healthy one. Study population was divided in four groups according to the maximum diameter of ascending aorta beyond sinus of Valsalva obtained in the parasternal long-axis view (group 1: <40 mm; group 2: 40–45 mm; group 3: 45–55 mm; group 4: >55 mm or previous surgery because of aortic aneurysm/dissection). The relationship between aortic dimension and the extension of CAE was investigated by means of multivariable linear regression, including variables selected at univariable analysis (P < 0.1). The total estimated ectatic area (EEA total) was used as dependent variable.

Results
Baseline characteristics of study groups were well balanced. Patients in group 4 were more likely to have both higher neutrophil count and neutrophil to lymphocyte ratio. On univariable analysis ascending aorta diameter [Coef. = 0.075; 95% confidence interval (CI) 0.052–0.103, P < 0.01] and c-reactive protein (CRP) values [Coef. = 0.033, 95% CI 0.003–0.174, P = 0.04] showed a linear association with total EEA. After adjustment for CRP values only the ascending aorta diameter was still associated with the extent of CAE (95% CI 0.025–0.063, P < 0.01).

Conclusion
In patients with diagnosis of CAE, a strong linear association between aortic dimension and coronary ectasia extent exists.