bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining an Intraoperative Hypotension Threshold in Association with De Novo Renal Replacement Therapy after Cardiac Surgery
Authors: Ngu Janet M. C. , Jabagi Habib , Chung Amy M. , Boodhwani Munir , Ruel Marc , Bourke Michael , Sun Louise Y. 
Published: March 2020

Abstract

Background
Acute kidney injury (AKI) is a frequent and deadly complication after cardiac surgery. In the absence of effective therapies, a focus on risk factor identification and modification has been the mainstay of management. The authors sought to determine the impact of intraoperative hypotension on de novo postoperative renal replacement therapy in patients undergoing cardiac surgery, hypothesizing that prolonged periods of hypotension during and after cardiopulmonary bypass (CPB) were associated with an increased risk of renal replacement therapy.

Methods
Included in this single-center retrospective cohort study were adult patients who underwent cardiac surgery requiring CPB between November 2009 and April 2015. Excluded were patients who were dialysis dependent, underwent thoracic aorta or off-pump procedures, or died before receiving renal replacement therapy. Degrees of hypotension were defined by mean arterial pressure (MAP) as less than 55, 55 to 64, and 65 to 74 mmHg before, during, and after CPB. The primary outcome was de novo renal replacement therapy.

Results
Of 6,523 patient records, 336 (5.2%) required new postoperative renal replacement therapy. Each 10-min epoch of MAP less than 55 mmHg post-CPB was associated with an adjusted odds ratio of 1.13 (95% CI, 1.05 to 1.23; P = 0.002), and each 10-min epoch of MAP between 55 and 64 mmHg post-CPB was associated with an adjusted odds ratio of 1.12 (95% CI, 1.06 to 1.18; P = 0.0001) for renal replacement therapy. The authors did not observe an association between hypotension before and during CPB with renal replacement therapy.

Conclusions
MAP less than 65 mmHg for 10 min or more post-CPB is associated with an increased risk of de novo postoperative renal replacement therapy. The association between intraoperative hypotension and AKI was weaker in comparison to factors such as renal insufficiency, heart failure, obesity, anemia, complex or emergent surgery, and new-onset postoperative atrial fibrillation. Nonetheless, post-CPB hypotension is a potentially easier modifiable risk factor that warrants further investigation.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
COVID-19 Infection
Authors: Greenland John R. , Michelow Marilyn D. , Wang Linlin , London Martin J. 
Published: March 2020

Abstract
Healthcare systems worldwide are responding to Coronavirus Disease 2019 (COVID-19), an emerging infectious syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure or multisystem organ failure, necessitating intubation and intensive care management. Healthcare providers, and particularly anesthesiologists, are at the frontline of this epidemic, and they need to be aware of the best available evidence to guide therapeutic management of patients with COVID-19 and to keep themselves safe while doing so. Here, the authors review COVID-19 pathogenesis, presentation, diagnosis, and potential therapeutics, with a focus on management of COVID-19–associated respiratory failure. The authors draw on literature from other viral epidemics, treatment of acute respiratory distress syndrome, and recent publications on COVID-19, as well as guidelines from major health organizations. This review provides a comprehensive summary of the evidence currently available to guide management of critically ill patients with COVID-19.
Inhibition of GPR35 Preserves Mitochondrial Function After Myocardial Infarction by Targeting Calpain 1/2
Authors: Chen Ken , He Lei , Li Yong , Li Xiuchuan , Qiu Chenming , Pei Haifeng , Yang Dachun 
Published: March 2020

Abstract:
Ischemia and anoxia-induced mitochondrial impairment may be a key factor leading to heart injury during myocardial infarction (MI). Calpain 1 and 2 are involved in the MI-induced mitochondria injury. G protein-coupled receptor 35 (GPR35) could be triggered by hypoxia. Whether or not GPR35 regulates calpain 1/2 in the pathogenesis of MI is still unclear. In this study, we determined that MI increases GPR35 expression in myocardial tissue. Suppression of GPR35 protects heart from MI injury in mice through reduction of reactive oxygen species activity and mitochondria-dependent apoptosis. Further studies show that GPR35 regulates calpain 1/2. Suppression of GPR35 reduces the expression and activity of calpain 1/2, and alleviates calpain 1/2-associated mitochondrial injury to preserve cardiac function. Based on these data, we conclude that a functional inhibition of GPR35 downregulates calpain 1/2 and contributes to maintenance of cardiac function under pathologic conditions with mitochondrial disorder. In conclusion, our study showed that the identified regulation by GPR35 of calpain 1/2 has important implications for the pathogenesis of MI. Targeting the action of GPR35 and calpain 1/2 in mitochondria presents a potential therapeutic intervention for MI.
Aging and the Indian Face: An Analytical Study of Aging in the Asian Indian Face
Authors: Shome Debraj , Vadera Sapna , Khare Stuti , Ram M. Shiva , Ayyar Anuradha , Kapoor Rinky , Desai Niharika 
Published: March 2020

Background:
Asian Indians make up almost one-sixth of the world’s population. Although some aspects of facial beauty are universal, anthropometric morphology and age-related changes differ in all ethnic groups. Currently, there are hardly any published studies highlighting the process of aging in Asian Indians. We wanted to understand the aging patterns in different ethnic subgroups within Asian Indians and also compare the aging patterns with Caucasians.

Method:
300 participants, above 30 years of age, were selected from different Indian ethnic groups (North, South, East, West). Recent good-quality photographs as well as those from the preceding decades (20 years and beyond) were studied. A validated grading score of 1–5 was used for assessing various aging parameters.

Results:
Significant differences exist in the process of aging between Asian Indians and Caucasians. Maximum signs of aging were reported in the age group of >70 years. Earlier signs of aging (in 30–40 years) were more visible in North and East Indian ethnic groups followed by West and South Indians in decreasing order. Also, South Indians showed the least signs of aging (early as well as overall) compared to the other 3 ethnic groups in any given age range.

Conclusions:
This study attempts to understand in greater detail the aging process of the Asian Indian population. This study could open up specific treatment protocols to treat this population in the fields of facial esthetics and facial cosmetic surgery.
Fundamentals of Extracellular Matrix Biomaterial Assimilation: Effect of Suture Type on Attachment Strength and Cell Repopulation
Authors: Adelman David M. , Cornwell Kevin G. 
Published: March 2020

Background:
The clinical results with extracellular matrix biomaterials are confounded by expectations of material response based on years of experience with permanent or degradable synthetic polymers. However, the remodeling or assimilation of extracellular matrix biomaterials is dictated by cell-mediated processes rather than fibrous encapsulation or hydrolytic degradation. Previously, we found that tissue adherence and revascularization were dictated by proximity with de-epithelialized host tissue. We now investigate the effects of polymer and fixation type on attachment strength and rate of cell repopulation in an intra-abdominal implant model.

Methods:
An intra-abdominal implant model in rats was used to probe assimilation properties at 4 weeks and 12 weeks with permanent and degradable suture types as well a combination of suture and biologic attachment (mesothelial abrasion). The mechanical strength of the attachment was measured by peel testing and the repopulation by automated cell counting of histologic sections.

Results:
The intensity of the biologic response was greater with degradable polymers than permanent polypropylene. Tissue attachment strength ranged from 2 to 15 N but changed in elasticity with time. The magnitude and distribution of cell repopulation was highly variable by suture type but ultimately did not affect the long-term strength of the soft tissue attachment.

Conclusions:
The tissue approximating polymer sutures were stretchy and of similar strength regardless of degradation rate or polymer type. The strongest attachment, most rapid repopulation of the deep matrix regions, and most uniform distribution of cells were found with the addition of biologic attachment.
Building a Multidisciplinary Comprehensive Academic Lymphedema Program
Authors: Schaverien Mark V. , Baumann Donald P. , Selber Jesse C. , Chang Edward I. , Hanasono Matthew M. , Chu Carrie , Hanson Summer E. , Butler Charles E. 
Published: March 2020

Background:
Lymphedema is a debilitating clinical condition predominantly affecting survivors of cancer. It adversely affects patients' quality of life and results in substantial cost burdens to both patients and the healthcare system. Specialist lymphedema care is optimally provided within integrated clinical programs that align the necessary specialties to provide patient-focused, multidisciplinary, structured, and coordinated care. This article examines our experience building a specialist lymphedema academic program.

Methods:
We describe the critical components necessary for constructing a multidisciplinary comprehensive academic lymphedema program. Furthermore, lessons learned from our experience building a successful lymphedema program are discussed.

Results:
Building a comprehensive academic lymphedema program requires institutional support and engagement of stakeholders to establish the necessary infrastructure for comprehensive patient care. This includes the infrastructure for outpatient clinical assessment, diagnostic investigations, radiological imaging, collection of outcomes metrics, non-surgical treatment delivered by lymphedema-specialist therapists, surgical procedures using specialized equipment, and integration of an outpatient framework for comprehensive patient evaluation during follow-up at standardized time intervals.

Conclusions:
This article examines our experience building a multidisciplinary comprehensive academic lymphedema program and provides a structured roadmap to benefit others that are embarking on this mission.
Carpal Tunnel Syndrome Surgery: What You Should Know
Authors: Tulipan Jacob E. , Ilyas Asif M. 
Published: March 2020

Summary:
Carpal tunnel release (CTR) surgery continues to evolve. Carpal tunnel syndrome remains a primarily clinical diagnosis, although ultrasound has supplemented electrodiagnostic testing as a confirmatory tool. Magnetic resonance imaging of the carpal tunnel has also showed some promise as an alternative method for the examination of the median nerve. Open CTR surgery remains the traditional, and most popular, method of CTR. Wide-Awake, with Local Anesthesia only, and No Tourniquet CTR has emerged as a means to decrease cost and improve pain control and convenience for patients. Endoscopic CTR is increasing in popularity due to its more rapid recovery. The safety profile of endoscopic CTR has improved, and recent studies show similar rates of major complications between open and endoscopic techniques. Nonsurgeon operated ultrasound-guided techniques for release of the transverse carpal ligament have emerged. While promising in early studies, the current evidence in their favor is limited in terms of patient numbers and direct comparison with other techniques. The outcomes of CTR continue to be excellent. Recent research has demonstrated that nerve conduction continues to recover postoperatively over a longer period of time than previously believed. Patient psychological factors play a significant role in outcomes after surgery but do not appear to limit the improvement provided by intervention.
Sex differences in arterial wave reflection and the role of exogenous and endogenous sex hormones: results of the Berlin Aging Study II
Authors: Seeland Ute , Demuth Ilja , Regitz-Zagrosek Vera , Steinhagen-Thiessen Elisabeth , König Maximilian 
Published: March 2020

Background:
Arterial stiffness is tightly linked to hypertension. Sex differences in hypertension and arterial stiffness have already been established, yet the role of sex hormones is not precisely defined. This study examined age and sex differences of arterial wave reflection and associations with endogenous and exogenous sex hormones in women.

Methods:
Pulse wave analysis was performed with an oscillometric device in 590 male and 400 female participants of the Berlin Aging Study II. Participants have been recruited from two age-strata, 22–35 years and 60–82 years. Data on exposures and potential confounders, including medication, have been collected at baseline visit.

Results:
Aumentation index (AIx) and pulse wave velocity increased with age. Mean AIx was higher in women than in men. Multivariable regression analysis showed a positive association between use of oral contraceptive pills (OCPs) and AIx controlling for confounders (age, BMI, current smoking, central blood pressure), with a significantly higher mean AIx in OCP-users compared with nonusers (mean group difference: 4.41; 95% confidence interval 1.61–7.22). Per quartile decrease in estradiol level AIx increased by 1.72 (95% confidence interval 0.43–3.00). In OCP users endogenous estradiol was largely suppressed.

Conclusion:
The findings suggest important sex differences in measures of arterial wave reflection, with a higher mean AIx observed in women compared with men. OCPs may promote the development of hypertension by increasing AIx. Suppressed endogenous estradiol levels may be responsible for this increased wave reflection due to increased vasotonus of the small and medium arteries.
The association of outdoor temperature with blood pressure, and its influence on future cardio-cerebrovascular disease risk in cold areas
Authors: Yu Bo , Jin Shanshan , Wang Chi , Yan Shichun , Zhou Xue , Cui Xiaoming , Tang Zhen , Luan Qing , Guo Yu , Bian Zheng , Li Liming , Chen Zhengming , Na Lixin 
Published: March 2020

Objectives:
To explore whether lower outdoor temperature increases cardio-cerebrovascular disease risk through regulating blood pressure and whether indoor heating in winter is beneficial to prevent cardio-cerebrovascular disease in cold areas.

Methods:
We analyzed the data of 38 589 participants in Harbin from the China Kadoorie Biobank (CKB) during 2004–2008, with an average of 7.14-year follow-up. Linear regression analysis was performed to estimate the relationship between outdoor temperature and blood pressure. Cox regression analysis and logistic regression analysis were used to analyze the association of blood pressure with cardio-cerebrovascular event risk. Mediation analysis was performed to explore the role of blood pressure in the association between outdoor temperature and cardio-cerebrovascular events risk.

Results:
There was an increase of 6.7 mmHg in SBP and 2.1 mmHg in DBP for each 10 °C decrease in outdoor temperature when outdoor temperature was higher than 5 °C. There was an inverse association between outdoor temperature and cardio-cerebrovascular event morbidity. The increases in blood pressure and cardio-cerebrovascular event morbidity were attenuated in months when central heating was fully provided. Participants with hypertension have higher risks of cardio-cerebrovascular disease (hazard ratio 1.347; 95% CI 1.281--1.415), CVD (hazard ratio 1.347; 95% CI 1.282--1.416), MACE (hazard ratio 1.670; 95% CI 1.560--1.788) and stroke (hazard ratio 1.683; 95% CI 1.571--1.803). Mediation analysis demonstrated that the association between outdoor temperature and cardio-cerebrovascular events risk was potentially mediated by blood pressure.

Conclusion:
Temperature-driven blood pressure potentially mediates the association between outdoor temperature and cardio-cerebrovascular events risk. Indoor heating in winter is probably beneficial to cardio-cerebrovascular disease prevention by inhibition of blood pressure increase.
Repeatability and reproducibility of pulse wave velocity in relation to hemodynamics and sodium excretion in stable patients with hypertension
Authors: Kubalski Piotr , Hering Dagmara 
Published: March 2020

Objective:
Pulse wave velocity (PWV) is a useful marker for determining subclinical vascular damage and patient risk stratification. Repeatability and reproducibility of PWV in relation to influencing factors have not yet been determined. This study examined the repeatability and reproducibility of PWV, and whether hemodynamics and sodium excretion impact on PWV in hypertensive patients remaining on stable medication.

Methods:
Office blood pressure (BP), heart rate (HR), carotid--femoral PWV and central BP (SphygmoCor device), impedance cardiography (HOTMAN device) and 24-h urinary sodium excretion (UNa) were measured at baseline and after 4 weeks in 74 hypertensive patients (age 56.8 ± 11.5 years, mean ± SD). Two PWV measurements were performed at each visit.

Results:
Intraclass correlation coefficient (ICC) and 95% confidence interval (95% CI) between the two PWV measurements were 0.981 (0.970--0.988) at baseline, 0.975 (0.960--0.984) after 4 weeks and 0.851 (0.773--0.903) between both visits. There were no significant changes in BP, HR, thoracic fluid content, stroke volume and UNa between visits. Despite excellent ICC, reproducibility of PWV was related to BP (P < 0.001) and HR (P = 0.07) changes between visits. Nineteen out of 74 patients had a difference in PWV greater than ±1 m/s between both visits.

Conclusion:
In the medium-term observation, changes in BP and HR seem to affect PWV values. Our findings suggest that the assessment of PWV should be performed under stabilized BP and HR values, particularly in patients with newly diagnosed hypertension and/or low--moderate cardiovascular risk in whom the detection of asymptomatic hypertension-mediated organ damage impact on patient risk stratification.
QUANTITATIVE ASSESSMENT OF THE FOVEAL AVASCULAR ZONE USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BEFORE AND AFTER SURGERY FOR IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Ersoz M. Giray , Hocaoglu Mumin , Sayman Muslubas Isil , Arf Serra , Karacorlu Murat 
Published: March 2020

Purpose:
To investigate, using optical coherence tomography angiography, the foveal avascular zone (FAZar), the FAZ perimeter (FAZp), the acircularity index of the FAZ (FAZai), and the density of vessels surrounding the FAZ (FAZvd) before and after idiopathic epiretinal membrane surgery, and associations of these parameters with postoperative best-corrected visual acuity, letter score gain, and central foveal thickness.

Methods:
We retrospectively reviewed preoperative and postoperative (sixth month) medical records of 28 eyes of 28 patients who undergone epiretinal membrane surgery and had an intact ellipsoid zone.

Results:
There were significant increases in best-corrected visual acuity, FAZar, and FAZp and decreases in central foveal thickness and FAZai (all P < 0.05). Postoperative best-corrected visual acuity was not significantly correlated with any preoperative parameters. Postoperative letter score gain and central foveal thickness correlated negatively with preoperative FAZar and preoperative FAZp (all P < 0.05). Multivariable linear regression analysis revealed that preoperative FAZp was independently associated with postoperative letter score gain (P < 0.05).

Conclusion:
The FAZ enlarges and becomes more circular after epiretinal membrane surgery. Postoperative best-corrected visual acuity is not associated with any FAZ parameters. In eyes with an intact foveal ellipsoid zone, especially a smaller preoperative FAZp is associated with more postoperative letter score gain.
OCULAR MANIFESTATIONS OF PORETTI-BOLTSHAUSER SYNDROME: FINDINGS FROM MULTIMODAL IMAGING AND ELECTROPHYSIOLOGY
Authors: Cai Cindy X. , Go Michelle , Kelly Michael P. , Holgado Sandra , Toth Cynthia A. 
Published: March 2020

Background/Purpose:
Poretti-Boltshauser syndrome is a rare, nonprogressive neurologic syndrome with characteristic cerebellar cysts on neuroimaging due to mutations in LAMA1. The ophthalmic findings in Poretti-Boltshauser syndrome are not well described. Here, we report the ophthalmic findings from multimodal imaging and electrophysiology of a patient with genetically confirmed Poretti-Boltshauser syndrome.

Methods:
A 3-year-old boy with confirmed mutations in LAMA1 underwent examination under anesthesia with electroretinography and multimodal imaging including fundus photography, fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography.

Results:
Dilated fundus examination was notable for retinal vascular anomalies, including a large area of nonperfusion in the temporal macula with corresponding retinal thinning on optical coherence tomography. There was an absence of a distinct foveal avascular zone and decreased density of both the superficial and deep vascular plexuses in the macula on optical coherence tomography angiography. There was diffuse loss of choriocapillaris architecture and decreased choroidal thickness.

Conclusion:
Patients with Poretti-Boltshauser syndrome may possess chorioretinal thinning and retinal vascular abnormalities appreciable on examination and multimodal imaging. These findings suggest a role for LAMA1 in retinal and choroidal vascular development.
Are weather conditions associated with chronic musculoskeletal pain? Review of results and methodologies
Authors: Beukenhorst Anna L. , Schultz David M. , McBeth John , Sergeant Jamie C. , Dixon William G. 
Published: March 2020

Abstract
Many people believe that weather influences chronic musculoskeletal pain. Previous studies on this association are narratively reviewed, with particular focus on comparing methodologies and summarising study findings in light of study quality. We searched 5 databases (Medline, Embase, Web of Science, PsycINFO, and Scopus) for observational studies on the association between weather variables and self-reported musculoskeletal pain severity. Of 4707 located articles, 43 were eligible for inclusion. The majority (67%) found some association between pain and a weather variable. Temperature, atmospheric pressure, relative humidity, and precipitation were most often investigated. For each weather variable, some studies found an association with pain (in either direction), and others did not. Most studies (86%) had a longitudinal study design, usually collecting outcome data for less than a month, from fewer than 100 participants. Most studies blinded participants to study aims but were at a high risk of misclassification of exposure and did not meet reporting requirements. Pain severity was most often self-reported (84%) on a numeric rating scale or visual analog scale. Weather data were collected from local weather stations, usually on the assumption that participants stayed in their home city. Analysis methods, preparation of weather data, and adjustment for covariates varied widely between studies. The association between weather and pain has been difficult to characterise. To obtain more clarity, future studies should address 3 main limitations of the previous literature: small sample sizes and short study durations, misclassification of exposure, and approach to statistical analysis (specifically, multiple comparisons and adjusting for covariates).