bluuebunny/crossref_metadata_2025_split huggingface dataset:
End-tidal to Arterial Gradients and Alveolar Deadspace for Anesthetic Agents
Authors: Peyton Philip J. , Hendrickx Jan , Grouls Rene J. E. , Van Zundert Andre , De Wolf Andre 
Published: August 2020

Background
According to the “three-compartment” model of ventilation-perfusion (

JOURNAL/anet/04.03/00000542-202009000-00015/inline-graphic1/v/2024-12-04T190757Z/r/image-png

) inequality, increased

JOURNAL/anet/04.03/00000542-202009000-00015/inline-graphic2/v/2024-12-04T190757Z/r/image-png

scatter in the lung under general anesthesia is reflected in increased alveolar deadspace fraction (Vda/Va) customarily measured using end-tidal to arterial (a-a) partial pressure gradients for carbon dioxide. a-a gradients for anesthetic agents such as isoflurane are also significant but have been shown to be inconsistent with those for carbon dioxide under the three-compartment theory. The authors hypothesized that three-compartment Vda/Va calculated using partial pressures of four inhalational agents (Vda/Va

g
) is different from that calculated using carbon dioxide (Vda/Vaco
2) measurements, but similar to predictions from multicompartment models of physiologically realistic “log-normal”

JOURNAL/anet/04.03/00000542-202009000-00015/inline-graphic3/v/2024-12-04T190757Z/r/image-png

distributions.

Methods
In an observational study, inspired, end-tidal, arterial, and mixed venous partial pressures of halothane, isoflurane, sevoflurane, or desflurane were measured simultaneously with carbon dioxide in 52 cardiac surgery patients at two centers. Vda/Va was calculated from three-compartment model theory and compared for all gases. Ideal alveolar (Pag
) and end-capillary partial pressure (Pc’
g
) of each agent, theoretically identical, were also calculated from end-tidal and arterial partial pressures adjusted for deadspace and venous admixture.

Results
Calculated Vda/Va

g
was larger (mean ± SD) for halothane (0.47 ± 0.08), isoflurane (0.55 ± 0.09), sevoflurane (0.61 ± 0.10), and desflurane (0.65 ± 0.07) than Vda/Va
co
2 (0.23 ± 0.07 overall), increasing with lower blood solubility (slope [Cis], –0.096 [–0.133 to –0.059], P < 0.001). There was a significant difference between calculated ideal Pag
and Pc’
g
median [interquartile range], Pa

g
5.1 [3.7, 8.9] versus Pc’
g
4.0[2.5, 6.2], P = 0.011, for all agents combined. The slope of the relationship to solubility was predicted by the log-normal lung model, but with a lower magnitude relative to calculated Vda/Vag
.

Conclusions
Alveolar deadspace for anesthetic agents is much larger than for carbon dioxide and related to blood solubility. Unlike the three-compartment model, multicompartment

JOURNAL/anet/04.03/00000542-202009000-00015/inline-graphic4/v/2024-12-04T190757Z/r/image-png

scatter models explain this from physiologically realistic gas uptake distributions, but suggest a residual factor other than solubility, potentially diffusion limitation, contributes to deadspace.

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What We Already Know about This Topic

What This Article Tells Us That Is New
Mitochondrial Complex I Mutations Predispose Drosophila to Isoflurane Neurotoxicity
Authors: Olufs Zachariah P. G. , Ganetzky Barry , Wassarman David A. , Perouansky Misha 
Published: August 2020

Background
General anesthetics influence mitochondrial homeostasis, placing individuals with mitochondrial disorders and possibly carriers of recessive mitochondrial mutations at increased risk of perioperative complications. In Drosophila, mutations in the ND23 subunit of complex I of the mitochondrial electron transport chain–analogous to mammalian NDUFS8–replicate key characteristics of Leigh syndrome, an inherited mitochondrial disorder. The authors used the ND23 mutant for testing the hypothesis that anesthetics have toxic potential in carriers of mitochondrial mutations.

Methods
The authors exposed wild-type flies and ND23 mutant flies to behaviorally equivalent doses of isoflurane or sevoflurane in 5%, 21%, or 75% oxygen. The authors used percent mortality (mean ± SD, n ≥ 3) at 24 h after exposure as a readout of toxicity and changes in gene expression to investigate toxicity mechanisms.

Results
Exposure of 10- to 13-day-old male ND23 flies to isoflurane in 5%, 21%, or 75% oxygen resulted in 16.0 ± 14.9% (n = 10), 48.2 ± 16.1% (n = 9), and 99.2 ± 2.0% (n = 10) mortality, respectively. Comparable mortality was observed in females. In contrast, under the same conditions, mortality was less than 5% for all male and female groups exposed to sevoflurane, except 10- to 13-day-old male ND23 flies with 9.6 ± 8.9% (n = 16) mortality. The mortality of 10- to 13-day-old ND23 flies exposed to isoflurane was rescued by neuron- or glia-specific expression of wild-type ND23. Isoflurane and sevoflurane differentially affected expression of antioxidant genes in 10- to 13-day-old ND23 flies. ND23 flies had elevated mortality from paraquat-induced oxidative stress compared with wild-type flies. The mortality of heterozygous ND23 flies exposed to isoflurane in 75% oxygen increased with age, resulting in 54.0 ± 19.6% (n = 4) mortality at 33 to 39 days old, and the percent mortality varied in different genetic backgrounds.

Conclusions
Mutations in the mitochondrial complex I subunit ND23 increase susceptibility to isoflurane-induced toxicity and to oxidative stress in Drosophila. Asymptomatic flies that carry ND23 mutations are sensitized to hyperoxic isoflurane toxicity by age and genetic background.

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Differences in patient and physician perspectives on pharmaceutical therapy and renal denervation for the management of hypertension
Authors: Schmieder Roland E. , Kandzari David E. , Wang Tzung-Dau , Lee Ying-Hsiang , Lazarus Gabriel , Pathak Atul 
Published: August 2020

Objective:
To study patient and physician attitudes to pharmaceutical therapy and renal denervation for the management of hypertension.

Methods:
Data were analyzed from 19 market research studies in Western Europe and the United States conducted between 2010 and 2019 to obtain quantitative and qualitative perspectives. The analysis incorporated insights from 2768 patients and the experiences of 1902 physicians either actively performing or interested to perform device procedures, or hypertension specialists who would refer patients for a device-based intervention.

Results:
Referring cardiologists and proceduralists were more likely to recommend the renal denervation procedure to patients with higher BP levels and a greater number of antihypertensive medications. Physicians perceived patient reluctance towards a procedure as an important obstacle to recommending renal denervation as a treatment option for uncontrolled hypertension. Patient interest in the renal denervation procedure did not correlate with BP severity (P = NS), and the highest preference for the procedure was in patients diagnosed with hypertension but not receiving treatment (P < 0.001). Patients who perceived high BP as a major problem (P = 0.029) and those who experienced side effects attributed to their BP medications (P = 0.006) had a higher preference for renal denervation.

Conclusion:
Patients with hypertension often regard the choice of renal denervation to lower BP differently from physicians. A considerable proportion of hypertensive patients, especially those not taking medications, may prefer a device-based approach to reduce their BP.
Impact of Nutritional Status on the Severity of Dengue Infection Among Pediatric Patients in Southern Thailand
Authors: Maneerattanasak Sarunya , Suwanbamrung Charuai 
Published: August 2020

Background:
Given the lack of specific antiviral drugs and effective vaccine for dengue infection, factors such as host nutritional status that may alter disease progression require investigation. This study examined the relationship between baseline nutritional status and severity of dengue infection in pediatric patients.

Methods:
Data from dengue patients 1–14 years of age treated at four hospitals in southern Thailand (2017–2018) were reviewed. Dengue infection was classified as dengue fever, dengue hemorrhagic fever and dengue shock syndrome. Children’s nutritional status was assessed based on international and national growth charts. Binary logistic regression was used to identify factors associated with dengue severity and malnutrition.

Results:
Overall, 248, 281 and 43 patients had dengue fever, dengue hemorrhagic fever and dengue shock syndrome, respectively. Overweight was associated with increased risk of dengue severity [odds ratio (OR) = 1.76, 95% confidence interval (CI): 1.13–2.75, P = 0.012; OR = 1.84, 95% CI: 1.09–3.09, P = 0.022, per international and national growth criteria, respectively). Stunting was associated with decreased risk of dengue severity (OR = 0.54, 95% CI: 0.33–0.88, P = 0.013; OR = 0.61, 95% CI: 0.39–0.95, P = 0.030, per international and national growth criteria, respectively). Being overweight was significantly and positively associated with levels of hemoglobin >14 g/dL, hematocrit >42%, hemoconcentration ≥20% and platelet count ≤50,000/mm3, whereas being stunted was significantly and negatively associated with levels of hemoglobin >14 g/dL and hematocrit >42%.

Conclusions:
These findings support a hypothesis that malnutrition might influence the severity of dengue infection through host immune response. Overweight children with dengue infections should be closely observed for early signs of severe dengue infection.
Trends of Pediatric Bloodstream Infections in Stockholm, Sweden: A 20-year Retrospective Study
Authors: Luthander Joachim , Bennet Rutger , Giske Christian G. , Eriksson Margareta , Nilsson Anna 
Published: August 2020

Background:
The etiology of bloodstream infections (BSIs) changes over time due to updated immunization programs, new antibiotic-use strategies, changes in patient mix and travel. Continuous surveillance can guide empiric therapy and identify targets for prevention.

Method:
We conducted a descriptive retrospective analysis among children <18 years of age who were detected with BSI between July 1998 and June 2018 for changes in the incidence, risk factors, and etiology of BSI in a Swedish tertiary hospital (Karolinska University Hospital).

Results:
We evaluated 2079 episodes of BSI. During the study period, the incidence of BSI in children 0–17 years of age decreased (τ = −0.45, P = 0.016), which was most evident among children 3 months to 2 years of age (τ = −0.59, P = 0.0006) and in early neonatal period (0–7 days; τ = −0.44, P = 0.0069). These were explained by the reduced occurrence of Streptococcus pneumoniae in children 3 months to 2 years of age and Streptococcus agalactiae and Candida spp. in neonates. Staphylococcus aureus was the commonest pathogen, accounting for 31.6% of episodes. The proportion of hospital-acquired infection was higher in patients with underlying risk factors (47.6% vs. 2.6%). The etiology of hospital-acquired infection BSI was more diverse than that of community-acquired infections and was related to underlying risk factors. The crude mortality rate was 5.7%. For children admitted to the neonatal ward, the mortality was 17.6%, but declined (τ = −0.469, P = 0.004) over the study period.

Conclusions:
There was a decreasing trend of pediatric BSI and mortality over last 20 years, which was associated with pneumococcal immunization and antimicrobial prophylaxis for high-risk patients.
Assessment of Tactile Sensitivity Threshold Using Cochet-Bonnet Esthesiometer and Semmes-Weinstein Monofilaments and Their Use in Corneal Neurotization
Authors: Vinee Frédéric , Grobnicu Oana , Errera Charlotte , Gomart Gabrielle , Tuzin Nicolas , Heitz Antoine , Liverneaux Philippe , Bourcier Tristan 
Published: August 2020

Purpose:
Although the Cochet-Bonnet esthesiometer (CBE) measures corneal sensitivity, it has heretofore only been tested on the index pulp. Tactile skin sensitivity thresholds are measured with Semmes-Weinstein monofilaments (SWM). This study measured skin sensitivity thresholds in healthy individuals using CBE and SWM, and compared both instruments in territories involved in corneal neurotization.

Methods:
Overall, 27 healthy individuals were tested by a single examiner at 9 territories on the face, neck, forearm, and leg, using 20-thread SWM and CBE with a diameter of 0.12 mm. Both sides were tested. Thresholds were compared for both instruments and between the different territories using Bayesian methods.

Results:
Mean sensitivity levels for SWM ranged from 0.010 to 1.128 g, while mean sensitivity levels for CBE ranged from 0.006 to 0.122 g. Thresholds measured with SWM were significantly higher than with CBE. Both instruments demonstrated higher thresholds in the leg territory than the forearm. However, the forearm presented higher thresholds than the head territories. No significant differences were found between the head territories themselves. Overall, right-side territories exhibited lower thresholds than left-side territories.

Conclusions:
We have reported the first mapping of skin sensitivity thresholds using CBE. Thresholds measured with CBE and SWM were coherent. The use of CBE on the skin is particularly relevant to the field of corneal neurotization.
Using multiple-steps bioinformatic analysis to predict the potential microRNA targets by cardiogenic HoxA11
Authors: Wang Chien-Ying , Liu Szu-Yuan , Kuo Fu-Hsuan , Lin Heng-Fu , Liu Chao-Yu , Yang Yi-Ping , Tsai Fu-Ting , Huang Wei-Chun , Tarng Yih-Wen , Lin Hsin-Chi , Lu Kai-Hsi , Yu Wen-Chung , Yang Meng-Yin 
Published: August 2020

Background:
In this study, our major aim is to using multiple-steps bioinformatic analysis to predict cardiogenic genes with targeting mRNA profiling for predicting cardiogenic HoxA11 gene.

Methods:
We first analyzed the microarray data with bioinformatic measurement, including combining with panel module 1 (mouse embryonic stem cells), panel module 2 (mouse induced pluripotent stem cells), and panel module 3 (gene list form literature of heart development). A literature-based comparison of the two microarrays and a software-based (Targetscan program, www.targetscan.org) comparative analysis of the two datasets. Furthermore, we select the common central pathways and potential candidate genes involved in the cardiomyocyte-lineaged differentiation and development.

Results:
Schematic presentation of a putative miR181a target site in Hox-A11 3′UTR. The bioinformatic result showed that potential interacted cardiogenic targets of Tbx5, Tbx20, Mal2c, Nkx2.5, cTNT, Cx43, MHC, and MCK in different treatment groups of pluripotent stem cells by using a literature-based comparison of the two microarrays and a software-based gene-lineage system.

Conclusion:
Our findings support that mir181a is an up-stream regulating microRNA to target the 3′UTR of HoxA11 mRNA during the process of cardiomyocyte differentiation.
The effect of aspirin on preeclampsia, intrauterine growth restriction and preterm delivery among healthy pregnancies with a history of preeclampsia
Authors: Abdi Nazanin , Rozrokh Afsane , Alavi Azin , Zare Shahram , Vafaei Homeira , Asadi Nasrin , Kasraeian Maryam , Hessami Kamran 
Published: August 2020

Background:
Due to the significance of preeclampsia (PE) and its adverse outcomes in the health of both mother and newborn, the present study was carried out to investigate the effect of aspirin on preventing the occurrence of PE, intrauterine growth restriction (IUGR), and preterm delivery in women with a previous history of PE.

Methods:
The present clinical trial was conducted on 90 pregnant women with a previous history of PE referred to the Khalij Fars Hospital in Bandar Abbas, Hormozgan Province Iran from April 2017 to August 2018. The subjects of the study were randomly assigned into two groups of intervention and control to receive either 80 mg of aspirin or placebo daily during the pregnancy. Patients’ information was obtained and recorded upon entering the study, follow-up visits, and childbirth.

Results:
Among participants who entered the clinical trial, 86 patients (95.6%) completed the study. During the pregnancy, systolic blood pressure increased by 8.25 ± 14.83 and 19.06 ± 18.33 mmHg in aspirin and placebo groups, respectively (p = 0.001). Also, the same happened with diastolic blood pressure (6.12 ± 11.46 vs 13.48 ± 13.95 mmHg, p = 0.010). The rate of PE was equal to 27 (62.8%) and 38 (88.4%) in the aspirin and placebo groups, respectively (aOR = 0.23, p = 0.013). In the aspirin group, the rate of IUGR was equal to 27.9% compared with 25.6% of newborns in the control group (aOR = 1.18, p = 0.750). Similarly, there was no significant difference in the rate of preterm delivery between the two groups (p = 0.061).

Conclusion:
The findings of the present study conducted exclusively on women with previous documented PE revealed that taking aspirin may have a preventive effect on PE in the current pregnancy.
Relationship between platelet/lymphocyte ratio and prognosis of patients with septic acute kidney injury: A pilot study
Authors: Chen Yu , Feng Fang , Li Min , Yuan Jiao-Jiao , Chang Xue-Ni , Wei Bao-Hua , Du Hang , Dong Chen-Ming 
Published: August 2020

Background:
To explore the potential role of the platelet/lymphocyte ratio (PLR) as a prognostic marker in septic patients with acute kidney injury (AKI) and to provide theoretical evidence for the epidemiological study of the prognosis of patients with septic AKI in its early stage.

Methods:
A pilot study was conducted. A logistic regression analysis was conducted to screen the risk factors, and the selected factors were performed using multiple logistic regression analysis; a Receiver Operating Characteristic curve was used to determine the optimal cutoff value of the PLR and then to calculate the sensitivity and specificity of the PLR ratio.

Results:
Mechanical ventilation, platelet count, PLR, and arterial blood lactate concentration have a correlation with sepsis (p < 0.05). An elevated PLR is significantly associated with a worse prognosis of sepsis-induced AKI (higher mortality).

Conclusion:
The PLR might be an effective factor in predicting a worse prognosis of septic AKI patients.
Long-term imaging follow-up to evaluate restenosis in patients with carotid stenosis after angioplasty and stenting
Authors: Chen Jung-Hsuan , Wu Mei-Han , Luo Chao-Bao , Lirng Jiing-Feng , Chen Shu-Ting , Wu Chia-Hung , Guo Wan-Yuo , Chang Feng-Chi 
Published: August 2020

Background:
Stent patency after carotid angioplasty and stenting (CAS) correlates not only with stroke prevention but also with improvements in cognition and quality of life by positively influencing cerebral perfusion. The long-term outcomes of CAS after more than 5 years have still not been well described. This retrospective study was designed to evaluate the stent patency and significant restenosis (SR) after CAS with more than 5 years of follow-up.

Methods:
Between 2006 and 2012, 118 patients with carotid stenosis who underwent 131 CAS procedures with regular annual imaging follow-up for more than 5 years were enrolled. We evaluated their demographic characteristics and the risk factors related to stent restenosis. Patients with SR (restenosis ≥ 50%) were compared with those with no significant restenosis (NSR, patency or restenosis < 50%) to identify the restenosis predictors and restenosis-free survival.

Results:
Of the 131 CAS procedures, 16.0% (21/131) had SR. A history of head and neck radiotherapy (HNRT) was a predictor for SR (HR, 6.352; 95% CI, 2.504–16.112; p < 0.001) and was associated with shorter restenosis-free survival (log-rank test p value < 0.001, median time of restenosis-free survival was 38 months). Left-sided stenting was an associated factor for SR (HR, 3.007; 95% CI, 1.068–8.467; p = 0.037) with a trend of less restenosis-free survival (log-rank test p value 0.067).

Conclusion:
Both HNRT and left-sided carotid stenosis were predictors of SR after CAS in more than 5 years of long-term follow-up. Restenosis-free survival was significantly shorter in patients with prior HNRT than in patients without previous irradiation treatment. We suggest close follow-up and aggressive medical treatment for patients with prior HNRT and left-sided carotid stenosis undergoing CAS.
Nonintubated video-assisted thoracic surgery with high-flow oxygen therapy shorten hospital stay
Authors: Ke Hui-Hsuan , Hsu Po-Kuei , Tsou Mei-Yung , Ting Chien-Kun 
Published: August 2020

Background:
Nonintubated video-assisted thoracic surgery (VATS) is widely used due to its acceptable postoperative outcomes. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) has been successfully applied in cases of prolonged difficult intubation and intensive respiratory care in patients receiving VATS lobectomy. Thopaz Digital Chest Drainage System (THOPAZ) provides regulated negative pressure close to the patient’s chest, optimizing drainage of the pleural and mediastinum. We explored the surgical outcomes of nonintubated VATS lung wedge resection and traditional wedge resection with a double-lumen endotracheal tube.

Methods:
Patients who received nonintubated VATS lung wedge resection (group A, n = 81) and traditional wedge resection with double-lumen endotracheal tube (group B, n = 79) during the period of November 2015 to April 2018 were enrolled in the study. Demographic data and operation outcomes were obtained and analyzed from review of patient medical charts.

Results:
Group B had significantly longer mean induction and operative times than group A. Similarly, group B suffered greater intraoperative blood loss, longer postoperative hospital stays, and increased chest tube retention times than group A. Group A had higher partial pressure of carbon dioxide levels in both the pre-one-lung and during one-lung ventilation periods than group B. Furthermore, group A showed lower serum pH levels during one-lung ventilation period. However; group A had significantly higher partial pressure of oxygen levels during one-lung ventilation than group B, although the differences in peripheral oxygen saturation were not statistically significant.

Conclusion:
Our study demonstrated that nonintubated VATS using THRIVE and THOPAZ in lung wedge resection provides measurable benefits to patients.
Efficacy of endoscopic triage during the Covid-19 outbreak and infective risk
Authors: Elli Luca , Tontini Gian Eugenio , Filippi Elisabetta , Scaramella Lucia , Cantù Paolo , Vecchi Maurizio , Bertè Roberto , Baldassarri Annarita , Penagini Roberto 
Published: August 2020

Objective
SARS-CoV-2 outbreak is spreading worldwide. As a consequence of the new circumstances, almost all endoscopic units underwent in-depth reorganization involving patients’ selection. We analyzed the efficacy of the newly adopted endoscopic triage.

Methods
In March 2020, we monitored endoscopies to evaluate the effects of the novel selective triage aimed to reduce the number of investigations and viral spread/contagions. Clinical-demographic data of the patients, indications, type of endoscopy, endoscopic findings (subtyped in major and minor), finding rates (major and minor) and diagnostic yields (major findings) have been analyzed and compared to the endoscopic procedures performed in March 2019. Furthermore, patients were called at least 21 days after the endoscopy to evaluate the possibility of a Covid-19 onset.

Results
Accordingly to the novel triage, the number of procedures dropped from 530 to 91 (−84%). The finding rates and diagnostic yields were 83% (74–89) vs 71% (66–73) (P 0.015) and 56% (46–65) vs 43% (38–47) (P 0.03) on March 2020 and March 2019, respectively. A significant increase of operative procedures has been reported in 2020, 34% vs 22% in March 2019. All the patients were recalled and neither cases of onset of Covid-19 like symptoms nor positive nasopharyngeal swabs PCR have been evidenced.

Conclusion
The novel endoscopic triage significantly reduced the number of procedures and increased finding rates and diagnostic yields. However, a careful schedule of canceled procedures should be applied to avoid to miss relevant pathologies. No Covid-19 onset or infection has been noted after endoscopies.