bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular function during and after thoracic surgery
Authors: Gelzinis Theresa , Assaad Sherif , Perrino Albert C. 
Published: November 2019

Purpose of review
Right ventricular (RV) dysfunction following thoracotomy and pulmonary resection is a known phenomenon but questions remain about its mechanism, risk factors, and clinical significance. Acute RV dysfunction can present intraoperatively and postoperatively, persisting for 2 months after surgery.

Recent findings
Recently, the pulmonology literature has emphasized pulmonary arterial capacitance, rather than pulmonary vascular resistance, as a marker to predict disease progression and outcome in patients with pulmonary hypertension and heart failure. Diagnostic focus has emerged on the use of cardiac MRI and new echocardiographic parameters to better quantify the presence of RV dysfunction and the role of pulmonary capacitance in its development.

Summary
In this review, we examine the most recent literature on RV dysfunction following lung resection, including possible mechanisms, time span of RV dysfunction, and available diagnostic modalities. The clinical relevance of these factors on preoperative assessment and risk stratification are presented.
Understanding osteoarthritis pathogenesis: a multiomics system-based approach
Authors: Ratneswaran Anusha , Rockel Jason S. , Kapoor Mohit 
Published: November 2019

Purpose of review
Osteoarthritis is a heterogeneous, multifactorial condition regulated by complex biological interactions at multiple levels. Comprehensive understanding of these regulatory interactions is required to develop feasible advances to improve patient outcomes. Improvements in technology have made extensive genomic, transcriptomic, epigenomic, proteomic, and metabolomic profiling possible. This review summarizes findings over the past 20 months related to omics technologies in osteoarthritis and examines how using a multiomics approach is necessary for advancing our understanding of osteoarthritis as a disease to improve precision osteoarthritis treatments.

Recent findings
Using the search terms ‘genomics’ or ‘transcriptomics’ or ‘epigenomics’ or ‘proteomics’ or ‘metabolomics’ and ‘osteoarthritis’ from January 1, 2018 to August 31, 2019, we identified advances in omics approaches applied to osteoarthritis. Trends include untargeted whole genome, transcriptome, proteome, and metabolome analyses leading to identification of novel molecular signatures, cell subpopulations and multiomics validation approaches.

Summary
To address the complexity of osteoarthritis, integration of multitissue analyses by multiomics approaches with the inclusion of longitudinal clinical data is necessary for a comprehensive understanding of the disease process, and for appropriate development of efficacious diagnostics, prognostics, and biotherapeutics.
Clinical Considerations to Reduce Saphenous Neurovascular Bundle Injury During Suture Button Fixation of Syndesmosis Injuries
Authors: Page Brian J. , de la Fuente Guadalupe , Stahl Daniel L. , Brennan Michael L. 
Published: November 2019

Objective:
To document angles, from 2 difference starting points, or danger zones that should be avoided to minimize risk of injury or irritation to the saphenous neurovascular bundle (SNVB) during suture button (SB) fixation for distal tibiofibular syndesmosis injuries.

Design:
Retrospective imaging study.

Setting:
Academic Level 1 trauma center.

Patients:
Forty-eight randomly selected patients with healthy ankles and computed tomography scans for nonankle diagnoses.

Main Outcome Measures:
Computed tomography scans and 3D reconstructed images were used to define the angle between the SNVB and 2 different fibular starting points, using the direct lateral (DL) and the posterolateral (PL) starting points. Descriptive analyses were performed to identify angles that should be avoided during suture button fixation. Distances from the SNVB using preset angles of 0, 10, 20, and 30 degrees were analyzed. In addition, the width of the SNVB, the midsubstance angle of the SNVB, and the distance from the 30-degree point to the tibialis anterior were recorded.

Results:
The mean angle between the SNVB and the standard DL starting point was 13.7 ± 5.0 degrees (P < 0.05), whereas the mean angle using the alternate PL starting point was 17.2 ± 5.3 degrees (P < 0.05). The SNVB width was 5.2 mm [range, 2.6–9.1 mm] (P < 0.05). The distances from the SNVB were greatest for the DL 30-degree group and the PL 0-degree group.

Conclusions:
The results document angles that should be avoided when using suture button fixation for syndesmosis injuries. Device characteristics and surgery-related variables may require intraoperative modifications, and knowledge of this anatomical relationship may reduce SNVB injury during those situations. Considering our results, we recommend that surgeons place suture buttons from the DL starting point with a 30-degree trajectory to avoid injuries to the SNVB.
Infraspinatus Tenotomy Improves Glenoid Visualization With the Modified Judet Approach
Authors: Garlich John M. , Samuel Katherine , Nelson Trevor J. , Monfiston Carl , Kremen Thomas , Metzger Melodie F. , Little Milton T. M. 
Published: November 2019

Objectives:
To determine if the addition of an infraspinatus tenotomy to the modified Judet approach (MJA) improves glenoid visualization.

Methods:
We performed an MJA on 14 human cadaveric shoulders. After exposing the glenoid, the boundary of the visualized glenoid surface was marked with a 1.8- and 2.0-mm drill bit before and after performing an infraspinatus tenotomy, respectively. The humerus was disarticulated, and the pre- and post-tenotomy drill marks were verified. The area of the entire glenoid, and each of the 4 quadrants [anterior-superior (AS), anterior-inferior (AI), posterior-superior (PS), and posterior-inferior (PI)] were analyzed using a custom image-processing program. The amount of glenoid exposure and percentage of area visualized before and after the tenotomy were compared.

Results:
Adding an infraspinatus tenotomy to the MJA significantly increased total glenoid area (cm2) exposure by 33%, P < 0.0001. Three of 4 glenoid quadrants (PS, AS, and AI) had a significant increase in glenoid visualization, with the AS quadrant having the most substantial improvement after the tenotomy (+67%), P < 0.0001.

Conclusions:
The results provide the percentage of glenoid fossa that can be seen using an MJA and demonstrate that visualization significantly improves after adding an infraspinatus tenotomy.
A 10-Year Longitudinal Analysis of Protocol-Based Sepsis Management in a Philippine Tertiary ICU
Authors: Bumanglag Niña M. , San Juan Mari Des J. , Palo Jose Emmanuel M. 
Published: November 2019

Objectives:
To compare the outcomes of sepsis management using protocol-based therapy versus non-protocolized care, assessed over 10 years.

Design:
Retrospective cohort study, analyzed longitudinally with risk-adjusted control charts, referenced against hospital- and unit-level programs or interventions.

Setting:
Private, tertiary teaching hospital ICU in the Philippines.

Patients:
Nine-hundred fifty adult patients (19 yr old or older) diagnosed with severe sepsis or septic shock, using 2001 consensus definitions, admitted to the ICU from September 2007 to August 2017.

Interventions:
Three iterations of a standard clinical pathway (including early antibiotics, prescribed fluid resuscitation, and hemodynamic management) versus concurrent non-protocolized care.

Measurements and Main Results:
Seven-hundred sixty patients were in the protocol-based care group versus 190 in the non-protocolized care group. Protocol-based management was associated with lower hospital mortality (28.4% vs 44.7%; p = 0.00) and ICU mortality (24.2% vs 31.6%; p = 0.038). There were no differences in ICU or hospital length-of-stay, mechanical ventilator days, or vasoactive days. Risk-Adjusted Cumulative Sum and Risk-Adjusted Exponentially Weighted Moving Average control charts showed that a survival advantage was achieved after 1 year and was sustained over the duration of the study.

Conclusions:
Protocol-based management was associated with sustained improvements in the survival of sepsis patients over 10 years in this hospital setting, after a run-in period of 1 year. Hospital- and unit-level interventions may have measurable impacts on the efficacy of sepsis clinical pathways.
Sepsis Immunometabolism: From Defining Sepsis to Understanding How Energy Production Affects Immune Response
Authors: Koutroulis Ioannis , Batabyal Rachael , McNamara Brittany , Ledda Matthew , Hoptay Claire , Freishtat Robert J. 
Published: November 2019

Objectives:
This review will examine current definitions and trends in sepsis management as well pathophysiologic mechanisms in animal and ex vivo studies that correlate decreased energy production with deranged inflammatory response during the septic process.

Data Sources:
The latest articles in the literature that focus on the role of immunometabolism and associated mechanisms in sepsis were selected.

Study Selection:
The most relevant, original articles were included in the review.

Data Extraction:
All pertinent data for sepsis definitions as well as changes in immunometabolic pathways during the septic process was reviewed and assessed for inclusion in this article.

Data Synthesis:
Sepsis is a major cause of multiple organ dysfunction. It is the principal cause of death resulting from infection and one of the most expensive conditions treated in the United States. Despite current efforts to accurately define sepsis, novel treatments and highly trained providers, mortality rates for sepsis remain high, prompting a need for further investigation of underlying immunometabolic mechanisms to identify potential treatment targets. The definition of sepsis has shifted and changed in the past few decades due to poorly defined criteria, as well as unclear guidelines for providers with regards to management of severe sepsis and septic shock. The early identification of patients with a systemic inflammatory response that will progress to septic shock is critical since recent traditional therapeutic approaches, such as early goal-directed therapy, IV immunoglobulin, and anti–tumor necrosis factor-α antibodies have failed.

Conclusions:
There are no effective anti-sepsis drug therapies due to complex inflammatory and metabolic interactions. Further studies regarding the interface between innate immunity and metabolism should be investigated to effectively address septic patient mortality rates.
Family patterns of arterial stiffness across three generations in the Malmö Offspring Study
Authors: Rosberg Erik P. , Nilsson Peter M. 
Published: November 2019

Background:
Central haemodynamics have in recent years emerged as a promising predictor of cardiovascular health and risk of cardiovascular disease (CVD). Central haemodynamics are affected early in the development of vascular aging and contributes to target organ damage. Carotid–femoral pulse wave velocity (c-f PWV), augmentation index (Aix) and central SBP (cSBP) are variables that reflect arterial stiffness and central haemodynamics.

Aim:
To study the association between patterns of central haemodynamics across three related generations focusing on c-f PWV.

Methods:
In all, 1131 participants from the Malmö Diet Cancer Study (MDCS) and Malmö Offspring Study (MOS) were included. c-f PWV was measured (Sphygmocor) in grandparents and in all offsprings. Correlation analyses of c-f PWV between offspring and c-f PWV in parents and grandparents were conducted. Parents and grandparents were stratified into quartiles by c-f PWV. Offspring c-f PWV means were compared with one-way ANOVA analyses. Multiple regression analyses were adjusted for age, sex, BMI, SBP and fasting glucose. Bonferroni corrections were used.

Results:
c-f PWV in offsprings was positively correlated with c-f PWV in parents (r = 0.26, P < 0.001) and in grandparents (r = 0.29, P < 0.001). Parents with high c-f PWV had offspring with significantly higher means of c-f PWV.

Conclusion:
A measure of aortic stiffness (c-f PWV) is positively correlated across three related generations in this population-based study.
Association of increased arterial stiffness with diastolic dysfunction in ischemic stroke patients: the Norwegian Stroke in the Young Study
Authors: Einarsen Eigir , Gerdts Eva , Waje-Andreassen Ulrike , Naess Halvor , Fromm Annette , Saeed Sahrai 
Published: November 2019

Background:
Young and middle-aged ischemic stroke survivors have a high prevalence of hypertension, increased arterial stiffness and abnormal left ventricular (LV) geometry, which all are associated with the presence of LV diastolic dysfunction. However, the prevalence and covariates of diastolic dysfunction in these patients have not been reported.

Objectives:
To explore diastolic dysfunction in ischemic stroke patients aged 15–60 years included in the Norwegian Stroke in the Young Study.

Methods:
Data from 260 patients with acute ischemic stroke was analyzed. Diastolic dysfunction was assessed by combining transmitral peak early flow (E), early diastolic mitral annular velocity (e′), E/e′ ratio, left atrial volume index and peak tricuspid regurgitant jet velocity, following current European guidelines. Carotid–femoral pulse wave velocity at least 10 m/s by aplanation tonometry was defined as increased arterial stiffness.

Results:
Prevalent diastolic dysfunction was found in 20% of patients (13% with diastolic dysfunction grade 1 and 7% with diastolic dysfunction grades 2–3). Patients with diastolic dysfunction were older and more likely to have hypertension, overweight, increased arterial stiffness, higher LV mass and less percentage nightly reduction in mean blood pressure (BP) (all P < 0.001). In a multivariable logistic regression analysis, diastolic dysfunction was associated with increased arterial stiffness [odds ratio 2.86 (95% confidence interval 1.05–7.79), P < 0.05] independent of age more than 45 years, overweight, hypertension, night-time BP reduction and LV mass.

Conclusion:
Among young and middle-aged ischemic stroke survivors, diastolic dysfunction was found in 20%. The presence of diastolic dysfunction was associated with increased arterial stiffness independent of higher age, overweight, hypertension, night-time BP reduction and LV mass.
The role of insomnia in the association between posttraumatic stress disorder and hypertension
Authors: Gaffey Allison E. , Redeker Nancy S. , Rosman Lindsey , Mullington Janet M. , Brandt Cynthia A. , Haskell. Sally G. , Burg Matthew M. 
Published: November 2019

Objective:
Posttraumatic stress disorder (PTSD) is associated with incident hypertension. Although this relationship is poorly understood, PTSD is also associated with insomnia symptoms, which increases the risk for hypertension. Whether insomnia contributes to PTSD-associated risk for hypertension is unknown.

Methods:
We examined self-report survey and electronic health record data from 1109 participants in the Women Veterans Cohort Study (mean age: 43.8 ± 10.9 years; 52% women, 81% White) to assess the cross-sectional associations between PTSD symptom severity, recent symptoms of insomnia, and hypertension, defined as self-reported treatment for high blood pressure in the last year. Structural equation modeling was used to examine whether insomnia symptoms mediate the association between PTSD and hypertension.

Results:
PTSD symptom severity was associated with hypertension (r = 0.09, P < 0.001). PTSD symptom severity and hypertension were each associated with the insomnia symptoms difficulty falling asleep, difficulty staying asleep, and worry/distress about sleep problems (PTSD: rs = 0.58--0.62, P <  0.001; hypertension: rs = 0.07--0.10, P <  0.001). A latent variable derived from those symptoms mediated 9% of the association between PTSD symptom severity and hypertension (P = 0.02).

Conclusion:
In this study of young and middle-aged Veterans, insomnia symptoms mediated the association between PTSD and hypertension. Difficulties falling asleep and maintaining sleep and related distress may be particularly deleterious for cardiovascular health in Veterans. Longitudinal data is required to further investigate the associations between PTSD, insomnia, and hypertension.
Subclinical Inflammation of the Ocular Surface in Soft Contact Lens Wear
Authors: Saliman Noor Haziq , Morgan Philip B. , MacDonald Andrew S. , Maldonado-Codina Carole 
Published: November 2019

Purpose:
To investigate the inflammatory response of the ocular surface with different soft contact lens (CL) replacement frequencies and materials.

Methods:
Twenty soft CL wearers were required to wear 3 lens types: reusable Acuvue 2 (A2), reusable Acuvue Oasys (AO), and daily disposable Acuvue Oasys (AODD), for 1 week in random sequence in 1 eye with the nonlens-wearing eye acting as a control. Three methods were used to assess the subclinical response: tear cytokine evaluation, in vivo confocal microscopy (IVCM), and impression cytology.

Results:
Of 13 cytokines investigated, differences were observed only for IL-12p70, which was present in greater concentrations for A2 (interocular difference 8.8 pg/mL, 95% confidence interval 5.5–12.1) and AO (8.9 [5.7–12.1]) compared with AODD (3.7 [0.6–6.8]). For IVCM, corneal presumed dendritic cell density was lower for AODD (interocular difference 1.9 [−0.1 to 3.9] cells/mm2) than for both A2 (9.3 [7.2–11.4]) and AO (10.6 [8.6–12.6]). This trend was the same for the other 5 IVCM measures evaluated. The proportion of CD45+ cells in the bulbar conjunctiva was lower for AODD (0.6 [−0.3 to 1.5]%) compared with A2 (4.6 [3.7–5.6]) and AO (4.8 [3.9–5.8]). Similar findings were observed for cells in the upper lid margin.

Conclusions:
This work has demonstrated for the first time that daily disposable CL wear produces a minimal subclinical inflammatory response compared with no lens wear over 1 week. By contrast, this inflammatory response is upregulated with reusable lenses but appears to be similar between hydrogel and silicone hydrogel materials over this short time frame.
Descemet Stripping Only for a Chronic Descemet Detachment After Cataract Surgery
Authors: Hirabayashi Kristin E. , Mark David , Lau Jackson , Lin Charles C. 
Published: November 2019

Purpose:
To describe a case of postsurgical corneal decompensation in a patient with Fuchs endothelial dystrophy with a sectoral Descemet detachment and corneal edema that was successfully managed with a targeted Descemet stripping only (DSO) procedure.

Methods:
This is a case report and review of the literature.

Results:
A female patient with Fuchs endothelial dystrophy presented with a 6-month history of a persistent sectoral Descemet membrane detachment after cataract surgery with overlying corneal edema. Specular microscopy demonstrated moderate cell dropout with a cell density of 929 cells/mm2 in the affected eye. Intracameral air injection was attempted without improvement, and a sectoral DSO procedure was performed. Netarsudil and prednisolone were used postoperatively, and she demonstrated gradual improvement with resolution of the edema by postoperative week 10 and a central endothelial cell density of 675 cells/mm2 by postoperative month 8.

Conclusions:
DSO is a viable therapy in certain cases of postsurgical corneal decompensation.
Quadrivalent Influenza Vaccine Prevents Illness and Reduces Healthcare Utilization Across Diverse Geographic Regions During Five Influenza Seasons
Authors: Dbaibo Ghassan , Amanullah Arshad , Claeys Carine , Izu Allen , Jain Varsha K. , Kosalaraksa Pope , Rivera Luis , Soni Jyoti , Yanni Emad , Zaman Khalequ , Acosta Beatriz , Ariza Miguel , Arroba Basanta Maria L. , Bavdekar Ashish , Carmona Alfonso , Cousin Luis , Danier Jasur , Diaz Adolfo , Diez-Domingo Javier , Dinleyici Ener C. , Faust Saul N. , Garcia-Sicilia Jose , Gomez-Go Grace D. , Gonzales Maria L. A. , Hacimustafaoglu Mustafa , Hughes Stephen M. , Jackowska Teresa , Kant Shashi , Lucero Marilla , Mares Bermudez Josep , Martinón-Torres Federico , Montellano May , Prymula Roman , Puthanakit Thanyawee , Ruzkova Renata , Sadowska-Krawczenko Iwona , Szymanski Henryk , Ulied Angels , Woo Wayne , Schuind Anne , Innis Bruce L. 
Published: November 2019

Background:
We evaluated an inactivated quadrivalent influenza vaccine (IIV4) in children 6–35 months of age in a phase III, observer-blind trial.

Methods:
The aim of this analysis was to estimate vaccine efficacy (VE) in preventing laboratory-confirmed influenza in each of 5 independent seasonal cohorts (2011−2014), as well as vaccine impact on healthcare utilization in 3 study regions (Europe/Mediterranean, Asia-Pacific and Central America). Healthy children were randomized 1:1 to IIV4 or control vaccines. VE was estimated against influenza confirmed by reverse transcription polymerase chain reaction on nasal swabs. Cultured isolates were characterized as antigenically matched/mismatched to vaccine strains.

Results:
The total vaccinated cohort included 12,018 children (N = 1777, 2526, 1564, 1501 and 4650 in cohorts 1−5, respectively). For reverse transcription polymerase chain reaction confirmed influenza of any severity (all strains combined), VE in cohorts 1−5 was 57.8%, 52.9%, 73.4%, 30.3% and 41.4%, respectively, with the lower limit of the 95% confidence interval >0 for all estimates. The proportion of vaccine match for all strains combined in each cohort was 0.9%, 79.3%, 72.5%, 24.1% and 28.6%, respectively. Antibiotic use associated with influenza illness was reduced with IIV4 by 71% in Europe, 36% in Asia Pacific and 59% in Central America.

Conclusions:
IIV4 prevented influenza in children 6−35 months of age in each of 5 separate influenza seasons in diverse geographical regions. A possible interaction between VE, degree of vaccine match and socioeconomic status was observed. The IIV4 attenuated the severity of breakthrough influenza illness and reduced healthcare utilization, particularly antibiotic use.
Earlier Antiretroviral Therapy Initiation and Decreasing Mortality Among HIV-infected Infants Initiating Antiretroviral Therapy Within 3 Months of Age in South Africa, 2006–2017
Authors: Iyun Victoria , Technau Karl-Gunter , Eley Brian , Rabie Helena , Boulle Andrew , Fatti Geoffrey , Egger Matthias , Tanser Frank , Wood Robin , Fairlie Lee , Cotton Mark F. , Davies Mary-Ann 
Published: November 2019

Background:
Early infant diagnosis of HIV and antiretroviral therapy (ART) has been rapidly scaled-up. We aimed to examine the effect of expanded access to early ART on the characteristics and outcomes of infants initiating ART.

Methods:
From 9 cohorts within the International epidemiologic Databases to Evaluate AIDS-Southern Africa collaboration, we included infants with HIV initiating ART ≤3 months of age between 2006 and 2017. We described ART initiation characteristics and the probability of mortality, loss to follow-up (LTFU) and transfer out after 6 months on ART and assessed factors associated with mortality and LTFU.

Results:
A total of 1847 infants started ART at a median age of 60 days [interquartile range: 29–77] and CD4 percentage (%) of 27% (18%–38%). Across ART initiation calendar periods 2006–2009 to 2013–2017, ART initiation age decreased from 68 (53–81) to 45 days (7–71) (P < 0.001), median CD4% improved from 22% (15%–34%) to 32% (22–43) (P < 0.001) and the proportion with World Health Organization clinical disease stage 3 or 4 declined from 81.6% to 32.7% (P < 0.001). Overall, the 6-month mortality probability was 5.0% and LTFU was 20.4%. Mortality was 10.6% (95% confidence interval: 7.8%–14.4%) in 2006–2009 and 4.6% (3.1%–6.7%) in 2013–2017 (P < 0.001), with similar LTFU across calendar periods (P = 0.274). Pretreatment weight-for-age Z score <−2 was associated with higher mortality.

Conclusions:
Infants with HIV are starting ART younger and healthier with associated declines in mortality. However, the risk of mortality remained undesirably high in recent years. Focused interventions are needed to optimize the benefits of earlier diagnosis and treatment.