bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of Modifiable and Non-Modifiable Factors Associated With Mid-Urethral Sling Revision Surgery [40S]
Authors: Keslar Melissa Marie , Katz Justin , Margossian Haroutyoun , Lakhi Nisha 
Published: October 2020

INTRODUCTION:
The objective of this study was to identify modifiable factors and urodynamic parameters predictive of mid-urethral sling (MUS) revision surgery that can be used for counseling patients and individualizing risk prediction.

METHODS:
Retrospective analysis of 56 sling revisions performed during the 12-year study period. Those with complete medical records (n=40) were matched to 123 control cases that did not require revision, randomly selected from a total of 946 procedures to obtain a 3:1 control: case ratio. Demographic, history, patient reported symptoms, urodynamic study results, intraoperative data, and post-operative data were collected.

RESULTS:
Significant demographic findings predictive of sling revision included younger age (52.95 vs. 64.48 years, p<0.001) and greater than two previous cesarean deliveries (OR 13.556, 95% CI 1.468-125.137, p=0.013). Presence of posterior pelvic organ prolapse (OR 0.302, 95% CI 0.163-0.803, p=0.011), retropubic sling (OR 2.685, 95% CI 1.037, 6.955, p=0.037) and concomitant apical prolapse repair procedure (OR 3.086, 95% CI 1.299-7.332, p=0.009) was significantly associated with the revision group. Urodynamic factors were not predictive, except a maximum urethral closure pressure less 40 cm H2O was found to be protective (OR 0.0394, 95% CI 0.159-0.978). After multiple regression analysis, younger age, increasing number of cesarean deliveries, and concomitant apical prolapse repair retained statistical significance.

CONCLUSION:
Urodynamic studies were not useful in determining revision risk as compared to patient age, previous surgical history, and concomitant procedures.
Prevalence of Shoulder Dystocia by Maternal Height and Diabetes Status [5T]
Authors: Thayer Sydney Marie , Owens Sarah N. , Skeith Ashley , Valent Amy , Caughey Aaron B. 
Published: October 2020

INTRODUCTION:
Our objective was to investigate the association between maternal height and shoulder dystocia in women with and without diabetes.

METHODS:
This is a retrospective cohort study of singleton, non-anomalous, term pregnancies between 2007 and 2011 using linked vital statistics and ICD-9 data. Chi-square tests were used to compare rates of shoulder dystocia by maternal height and diabetes status. Height was stratified in 2 inch increments from 56 inches (4' 8") to 72 inches (6' 0"). Multivariable logistic regression was used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI) of shoulder dystocia by height and diabetes status. Regression analysis controlled for maternal BMI, race/ethnicity, age, education, insurance status, and prenatal care.

RESULTS:
In a cohort of 2,069,817 pregnant women, we found that increasing maternal height was associated with decreasing prevalence of shoulder dystocia, independent of diabetes status. After controlling for confounders of interest, there remained a statistically significant decrease in the odds of shoulder dystocia as height increased (aOR 0.97, 95% CI 0.97-0.98). When compared to women without diabetes, those with diabetes had significantly increased odds of shoulder dystocia (aOR 1.61, 95% CI 1.54-1.68), independent of maternal height.

CONCLUSION:
While height is not a modifiable risk factor for shoulder dystocia, odds of this adverse obstetrical outcome should be addressed in patient education and counseling. Particular consideration for shoulder dystocia risk should be given to pregnant women with diabetes and short stature.
Applying Skin Barrier Film for Skin Tear Management in Patients with Central Venous Catheterization
Authors: Chen Ya-Hui , Hsieh Hui-Ling , Shih Whei-Mei 
Published: October 2020

ABSTRACT

OBJECTIVE
To examine and compare different methods of dressing change on skin tears at the periductal wound for ICU patients with central venous catheterization (CVC).

METHODS
This research used a quasi-experimental design. Participants included 98 patients from the ICU of a medical center in Taiwan using a convenience sampling technique from April 1, 2017 to March 31, 2018.

RESULTS
Applying skin barrier film at the CVC insertion site effectively protected the skin and significantly reduced the risk of skin tears among ICU patients (P < .01).

CONCLUSIONS
This study showed that use of skin barrier film at the site of CVC insertion can increase skin strength, maintain skin integrity, and decrease the incidence of skin tears. Skin barrier film is thus recommended for routine use in peripheral skin care for patients receiving CVC.
Failure of Healing in Chronic Diabetic Wounds: A Case Report
Authors: Stiehl James B. 
Published: October 2020

ABSTRACT
Stalled healing in chronic wounds is a challenging problem for providers and remains multifactorial in etiology. Older adults with insulin-dependent diabetes are at very high risk. In this case report, two patients with large nonhealing wounds were considered for treatment with daily jet lavage irrigation in an attempt to remove the inflammatory products of their respective chronic wounds and eliminate the persisting biofilm bacteria. Several attempts were made to reduce treatments to two to three times per week, and negative-pressure wound therapy was initiated in both cases only to see the return of inflammation and necrosis of the wound bed. In both cases, the daily jet lavage irrigation was successful in creating a granulating wound bed that slowly healed over many months. One patient died with an open sacral pressure injury, and the other patient died 4 months after complete healing of a large heel pressure injury. The interesting observation is the necessity of daily high-intensity wound irrigation to correct the chronic infectious process. Diabetic chronic wounds in high-risk older adults are recalcitrant to standard wound treatments, and providers should consider daily jet lavage wound irrigation to deal with this problem.
Creating a Program to Support Registering and Reporting Clinical Trials at Johns Hopkins University
Authors: Keyes Anthony , Mayo-Wilson Evan , Nuamah Prince , Lalji Aliya , Tetteh Oswald , Ford Daniel E. 
Published: October 2020

Problem
The Food and Drug Administration Amendments Act of 2007 (FDAAA) and the National Institutes of Health (NIH) require that many clinical trials register and report results on ClinicalTrials.gov. Noncompliance with these policies denies research participants and scientists access to potentially relevant findings and could lead to monetary penalties or loss of funding. After discovering hundreds of potentially noncompliant trials affiliated with the institution, the Johns Hopkins University School of Medicine (JHUSOM) sought to develop a program to support research teams with registration and reporting requirements.

Approach
JHUSOM conducted a baseline assessment of institutional compliance in 2015, launched the ClinicalTrials.gov Program in June 2016, and expanded the program to the Sidney Kimmel Comprehensive Cancer Center in April 2018. The program is innovative in its comprehensive approach, and it was among the first to bring a large number of trials into compliance.

Outcomes
From September 2015 to September 2020, JHUSOM brought completed and ongoing trials into compliance with FDAAA and NIH policies and maintained almost perfect compliance for new trials. During this period, the proportion of trials potentially noncompliant with the FDAAA decreased from 44% (339/774) to 2% (32/1,304).

Next Steps
JHUSOM continues to develop and evaluate tools and procedures that facilitate trial registration and results reporting. In collaboration with other academic medical centers, JHUSOM plans to share resources and to identify and disseminate best practices. This report identifies practical lessons for institutions that might develop similar programs.
Emergency Airway Management During Awake Craniotomy: Comparison of 5 Techniques in a Cadaveric Model
Authors: Gruenbaum Shaun E. , Bilotta Federico , Bertasi Tais G.O. , Bertasi Raphael A.O. , Clifton William E. , Gruenbaum Benjamin F. , De Biase Gaetano , Garcia Diogo M. , Bojaxhi Elird , Torp Klaus D. , Quinones-Hinojosa Alfredo 
Published: October 2020

Background:
During awake craniotomy, securing the patient’s airway might be necessary electively or emergently. The objective of this study was to compare the feasibility of airway management using a laryngeal mask airway (LMA) and 4 alternative airway management techniques in an awake craniotomy simulation.

Methods:
After completing a questionnaire, 9 anesthesia providers attempted airway management in a cadaver positioned to simulate awake craniotomy conditions. Following the simulation, participants rated and ranked the devices in their order of preference.

Results:
Only 3 approaches resulted in the successful securement of an airway device for 100% of participants: LMA (median; interquartile range time to secure the airway 6 s, 5 to 10 s), fiberoptic bronchoscopy through an LMA (41 s; 23 to 51 s), and video laryngoscopy (49 s; 43 to 127 s). In contrast, the oral and nasal fiberoptic approaches demonstrated only 44.4% (154.5 s; 134.25 to 182 s) and 55.6% (75 s; 50 to 117 s) success rates, respectively. The LMA was the fastest and most reliable primary method to secure the airway (P=0.001). After the simulation, 100% of participants reported that an LMA would be their first choice for emergency airway management, followed by fiberoptic intubation through the LMA (7 of 9 participants) if the LMA failed to properly seat.

Conclusions:
We demonstrated that an LMA was the fastest and most reliable primary method to secure an airway in a laterally positioned cadaver with 3-pin skull fixation. Fiberoptic and video laryngoscope airway equipment should be readily available during awake craniotomy procedures, and an attempt to visualize the vocal cords through the LMA should be attempted before removing it for alternative techniques.
Modulatory effect of aquaporin 5 on estrogen-induced epithelial-mesenchymal transition in prostate epithelial cells
Authors: Fan Yu , Song Tu-Run , Wei Qiang , Yang Lu , Lin Tao , Feng Xiao-Bing , Wang Xian-Ding , Huang Zhong-Li , Feng Shi-Jian 
Published: October 2020

Abstract

Background
Estrogen is involved in the pathophysiological process of benign prostatic hyperplasia (BPH), in which epithelial-mesenchymal transition (EMT) plays an important role. Upregulation of aquaporin (AQP) 5, which is directly activated by estrogen, has been reported to promote EMT in multiple cells. This study aimed to examine the effects of AQP5 on estrogen-induced EMT in the prostate.

Methods
Normal prostate (NP) tissue samples without any histopathological changes and BPH tissue samples with pathologically confirmed hyperplasia were obtained. An EMT cell model was subsequently established by adding estradiol (E2) to RWPE-1 cells, after which AQP5 knockdown was performed. Tissue morphological and immunohistochemical features were examined using hematoxylin-eosin and immunohistochemical staining. Western blot analysis was performed to determine the expression of AQPs, estrogen receptors, and EMT-related proteins. Cell proliferation was assessed and supernatants were collected for enzyme-linked immunosorbent assay to determine transforming growth factor-β1 (TGF-β1) concentrations. Immunofluorescence staining was performed to assess protein expressions in RWPE-1 cells.

Results
BPH tissues exhibited greater EMT (TGF-β1: 1.362 ± 0.196 vs. 0.107 ± 0.067, P = 0.003; vimentin: 1.581 ± 0.508 vs. 0.221 ± 0.047, P < 0.001; E-cadherin: 0.197 ± 0.188 vs. 1.344 ± 0.088, P < 0.001), higher AQP5 (1.268 ± 0.136 vs. 0.227 ± 0.055, P < 0.001) and estrogen receptor (ER) α (1.250 ± 0.117 vs. 0.329 ± 0.134, P < 0.001) expression but lower ERβ (0.271 ± 0.184 vs. 1.564 ± 0.130, P < 0.001) expression than NP tissues. E2-stimulated cells had higher AQP5 expression (1.298 ± 0.058 vs. 1.085 ± 0.104, P = 0.049), increased cell proliferation (1.510 ± 0.089 vs.1.000 ± 0.038, P < 0.001), and EMT (TGF-β1 concentration: 0.352 ± 0.021 ng/mL vs. 0.125 ± 0.014 ng/mL, P < 0.001; vimentin: 1.641 ± 0.120 vs. 0.188 ± 0.020, P = 0.002; E-cadherin: 0.075 ± 0.030 vs. 0.843 ± 0.046, P < 0.001) than controls. E2-stimulated cells with AQP5 knockdown exhibited decreased EMT (TGF-β1 concentration: 0.223 ± 0.041 ng/mL vs. 0.352 ± 0.021 ng/mL, P = 0.016; vimentin: 0.675 ± 0.056 vs. 1.641 ± 0.120, P = 0.001; E-cadherin: 0.159 ± 0.037 vs. 0.075 ± 0.030, P = 0.040) than E2-stimulated cells with non-related small interfering RNA (siRNA).

Conclusion
Our findings suggest that estrogen induces BPH possibly by promoting AQP5 expression. Hence, AQP5 might be a novel target for modulating EMT in prostate epithelial cells.
MicroRNAs of bone marrow mesenchymal stem cell-derived exosomes regulate acute myeloid leukemia cell proliferation and apoptosis
Authors: Xu Yi-Chuan , Lin Yan-Si , Zhang Ling , Lu Ying , Sun Yan-Ling , Fang Zhi-Gang , Li Zi-Yu , Fan Rui-Fang 
Published: October 2020

Abstract

Background:
Acute myeloid leukemia (AML) is a malignant hematological disease, originating from hematopoiesis stem cell differentiation obstruction and clonal proliferation. New reagents or biologicals for the treatment of AML are urgently needed, and exosomes have been identified as candidate biomarkers for disease diagnosis and prognosis. This study aimed to investigate the effects of exosomes from bone marrow mesenchymal stem cells (BMSCs) on AML cells as well as the underlying microRNA (miRNA)-mediated mechanisms.

Methods:
Exosomes were isolated using a precipitation method, followed by validation using marker protein expression and nanoparticle tracking analysis. Differentially expressed miRNAs were identified by deep RNA sequencing and confirmed by quantitative real-time polymerase chain reaction (qPCR). Cell proliferation was assessed by the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium inner salt method, and cell cycle progression and apoptosis were detected by flow cytometry. Functional gene expression was analyzed by qPCR and Western blotting (WB). Significant differences were determined using Student's t test or analysis of variance.

Results:
BMSCs-derived exosomes effectively suppressed cell proliferation (both P < 0.0001 at 10 and 20 μg/mL) and cell cycle progression (P < 0.01 at G0–G1 stage), and also significantly enhanced cell apoptosis (P < 0.001) in KG-1a cells. There were 1167 differentially expressed miRNAs obtained from BMSCs-derived exosomes compared with KG-1a cell-derived exosomes (P < 0.05). Knockdown of hsa-miR-124-5p in BMSCs abrogated the effects of BMSCs-derived exosomes in regulating KG-1a such as the change in cell proliferation (both P < 0.0001 vs. normal KG-1a cell [NC] at 48 and 72 h). KG-1a cells treated with BMSCs-derived exosomes suppressed expression of structural maintenance of chromosomes 4 (P < 0.001 vs. NC by qPCR and P < 0.0001 vs. NC by WB), which is associated with the progression of various cancers. This BMSCs-derived exosomes effect was significantly reversed with knockdown of hsa-miR-124-5p (P < 0.0001 vs. NC by WB).

Conclusions:
BMSCs-derived exosomes suppress cell proliferation and cycle progression and promote cell apoptosis in KG-1a cells, likely acting through hsa-miR-124-5p. Our study establishes a basis for a BMSCs-derived exosomes-based AML treatment.
Artificial intelligence in cardiovascular medicine
Authors: Ranka Sagar , Reddy Madhu , Noheria Amit 
Published: October 2020

Purpose of review
Artificial intelligence is a broad set of sophisticated computer-based statistical tools that have become widely available. Cardiovascular medicine with its large data repositories, need for operational efficiency and growing focus on precision care is set to be transformed by artificial intelligence. Applications range from new pathophysiologic discoveries to decision support for individual patient care to optimization of system-wide logistical processes.

Recent findings
Machine learning is the dominant form of artificial intelligence wherein complex statistical algorithms ‘learn’ by deducing patterns in datasets. Supervised machine learning uses classified large data to train an algorithm to accurately predict the outcome, whereas in unsupervised machine learning, the algorithm uncovers mathematical relationships within unclassified data. Artificial multilayered neural networks or deep learning is one of the most successful tools. Artificial intelligence has demonstrated superior efficacy in disease phenomapping, early warning systems, risk prediction, automated processing and interpretation of imaging, and increasing operational efficiency.

Summary
Artificial intelligence demonstrates the ability to learn through assimilation of large datasets to unravel complex relationships, discover prior unfound pathophysiological states and develop predictive models. Artificial intelligence needs widespread exploration and adoption for large-scale implementation in cardiovascular practice.
Effects of a Mediterranean diet on blood pressure: a systematic review and meta-analysis of randomized controlled trials and observational studies
Authors: Cowell Owen R. , Mistry Nathan , Deighton Kevin , Matu Jamie , Griffiths Alex , Minihane Anne Marie , Mathers John C. , Shannon Oliver M. , Siervo Mario 
Published: October 2020

Objective:
To conduct a systematic review and meta-analysis investigating effects of MedDiet on blood pressure in randomized controlled trials (RCTs) and associations of MedDiet with risk of hypertension in observational studies.

Methods:
PubMed, The Cochrane Library and EBSCOhost were searched from inception until January 2020 for studies that met the following criteria: participants aged at least 18 years, RCTs investigating effects of a MedDiet versus control on BP, observational studies exploring associations between MedDiet adherence and risk of hypertension. Random-effects meta-analyses were conducted. Meta-regression and subgroup analyses were performed for RCTs to identify potential effect moderators.

Results:
Nineteen RCTs reporting data on 4137 participants and 16 observational studies reporting data on 59 001 participants were included in the meta-analysis. MedDiet interventions reduced SBP and DBP by a mean −1.4 mmHg (95% CI: −2.40 to −0.39 mmHg, P = 0.007, I
2 = 53.5%, Q = 44.7, τ
2 = 1.65, df = 19) and −1.5 mmHg (95% CI: −2.74 to −0.32 mmHg, P = 0.013, I
2 = 71.5%, Q = 51.6, τ
2 = 4.72, df = 19) versus control, respectively. Meta-regression revealed that longer study duration and higher baseline SBP was associated with a greater decrease in BP, in response to a MedDiet (P < 0.05). In observational studies, odds of developing hypertension were 13% lower with higher versus lower MedDiet adherence (95% CI: 0.78--0.98, P = 0.017, I
2 = 69.6%, Q = 41.1, τ
2 = 0.03, df = 17).

Conclusion:
Data suggest that MedDiet is an effective dietary strategy to aid BP control, which may contribute towards the lower risk of CVD reported with this dietary pattern. This study was registered with PROSPERO: CRD42019125073.
On or Off: Life-Changing Decisions Made by Vibrio cholerae Under Stress
Authors: Zhou Yitian , Lee Zachariah L. , Zhu Jun 
Published: October 2020

Abstract

Vibrio cholerae, the causative agent of the infectious disease, cholera, is commonly found in brackish waters and infects human hosts via the fecal-oral route. V. cholerae is a master of stress resistance as V. cholerae's dynamic lifestyle across different physical environments constantly exposes it to diverse stressful circumstances. Specifically, V. cholerae has dedicated genetic regulatory networks to sense different environmental cues and respond to these signals. With frequent outbreaks costing a tremendous amount of lives and increased global water temperatures providing more suitable aquatic habitats for V. cholerae, cholera pandemics remain a probable catastrophic threat to humanity. Understanding how V. cholerae copes with different environmental stresses broadens our repertoire of measures against infectious diseases and expands our general knowledge of prokaryotic stress responses. In this review, we summarize the regulatory mechanisms of how V. cholerae fights against stresses in vivo and in vitro.
Cost Study of a Cluster Randomized Trial on a Clinical Decision Rule Guiding Antibiotic Treatment in Children With Suspected Lower Respiratory Tract Infections in the Emergency Department
Authors: van de Maat Josephine , van der Ven Michaël , Driessen Gertjan , van Wermeskerken Anne-Marie , Smit Frank , Noordzij Jeroen , Tramper-Stranders Gerdien , Obihara Charlie , Punt Jeanine , Moll Henriette , Polinder Suzanne , Oostenbrink Rianne 
Published: October 2020

Background:
Children with fever and respiratory symptoms represent a large patient group at the emergency department (ED). A decision rule-based treatment strategy improved targeting of antibiotics in these children in a recent clinical trial. This study aims to evaluate the impact of the decision rule on healthcare and societal costs, and to describe costs of children with suspected lower respiratory tract infections (RTIs) in the ED in general.

Methods:
In a stepped-wedge, cluster randomized trial, we collected cost data of children 1 month to 5 years of age with fever and cough/dyspnea in 8 EDs in The Netherlands (2016–2018). We calculated medical costs and societal costs per patient, during usual care (n = 597), and when antibiotic prescription was guided by the decision rule (n = 402). We calculated cost-of-illness of this patient group and estimated their annual costs at national level.

Results:
The cost-of-illness of children under 5 years with suspected lower RTIs in the ED was on average €2130 per patient. At population level this is €15 million per year in The Netherlands (€1.7 million/100,000 children under 5). Mean costs per patient in usual care (€2300) were reduced to €1870 in the intervention phase (P = 0.01). Main cost drivers were hospitalization and lost parental workdays.

Conclusions:
Implementation of a decision rule-based treatment strategy in children with suspected lower RTI was cost-saving, due to a reduction in hospitalization and parental absenteeism. Given the high frequency of this disease in children, the decision rule has the potential to result in a considerable cost reduction at population level.