bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Risk of Aortic Dissection Associated With Pregnancy in Women With Turner Syndrome: A Systematic Review
Authors: Hynes Jenna S. , Kuller Jeffrey A. , Goldstein Sarah A. , Ward Cary C. , Muasher Suheil J. 
Published: September 2020

Importance
Turner syndrome (TS) is one of the most common chromosomal abnormalities in women. The condition is characterized by gonadal dysgenesis and is associated with structural cardiac abnormalities. Assisted reproductive technology with oocyte donation may be successful but places women with TS at increased risk of aortic dissection and death.

Objective
To summarize all cases of aortic dissection associated with pregnancy in women with TS and provide guidance regarding the safety of pregnancy.

Evidence Acquisition
Systematic review of PubMed for reports of women with TS, aortic dissection, and pregnancy.

Results
There are 14 total reported cases of aortic dissection associated with pregnancy in women with TS. Ten of these cases occurred during pregnancy or in the first month postpartum. The majority of affected pregnancies resulted from oocyte donation, 2 of which were multiple gestations. Two women had a documented history of hypertension, and 3 pregnancies were complicated by preeclampsia. Bicuspid aortic valve and coarctation of the aorta were the most common associated cardiac anomalies. More than half of women had some degree of aortic dilatation. Two women had no identifiable risk factors.

Conclusions and Relevance
Women with TS who desire pregnancy must be thoroughly counseled regarding the increased risk of aortic dissection during pregnancy and postpartum. Preconception consultation with maternal-fetal medicine, reproductive endocrinology, and cardiology is necessary along with a comprehensive physical evaluation. If women with TS choose to pursue pregnancy, they require rigorous cardiac monitoring each trimester during pregnancy and postpartum.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be able to describe the presentation of Turner syndrome, including the associated cardiovascular anomalies; identify the increased risk of aortic dissection associated with pregnancy in women with Turner syndrome; and recommend appropriate preconception consultation and optimal cardiac monitoring.
Intraoperative Tranexamic Acid to Decrease Blood Loss During Myomectomy: A Randomized, Double-blind, Placebo-Controlled Trial
Authors: Opoku-Anane Jessica , Vargas Maria V. , Marfori Cherie Q. , Moawad Gaby , Maasen Marloes S. , Robinson James K. 
Published: September 2020

(Abstracted from Am J Obstet Gynecol 2020;223:413.e1–413.e7)
Worldwide, more than 70% of women will develop uterine leiomyomas in their lifetime. Although most myomas are asymptomatic, 25% of women develop symptoms requiring treatment.
Confirmatory Trial for Drug to Prevent Preterm Birth Finds No Benefit, So Why Is it Still Prescribed?
Authors: Rubin Rita 
Published: September 2020

(Abstracted from JAMA 2020;323(13):1229–1232)
In 2011, the US Food and Drug Administration (FDA) approved Makena (hydroxyprogesterone caproate) for the prevention of preterm birth (PTB) in pregnant women with a history of spontaneous preterm delivery. The drug received accelerated approval based on one study demonstrating a benefit in reducing the risk of delivery before 37 weeks, on the condition that additional studies would be conducted to confirm the clinical benefit.
Nongenetic Factors Associated with Dupuytren’s Disease: A Systematic Review
Authors: Alser Osaid H. , Kuo Rachel Y. L. , Furniss Dominic 
Published: September 2020

Background:
Dupuytren’s disease is a common complex disease caused by genetic and nongenetic factors. The role of many nongenetic risk factors is still unclear and debatable. This study aimed to systematically review the association between Dupuytren’s disease and nongenetic risk factors.

Methods:
A search strategy was developed based on the Population, Exposure, Comparison, Outcomes and Study framework. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses–compliant literature search was conducted in MEDLINE, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception to November of 2018. Title and abstract and then full-text screening against eligibility criteria was performed independently by two reviewers, and consensus was achieved by a third reviewer. The Effective Public Health Practice Project and the Oxford Centre for Evidence Based Medicine tools were used to assess study quality and to evaluate the level of evidence of included studies, respectively.

Results:
Reviewers identified 4434 studies, of which 54 were included in the analysis. There was strong evidence for the association between Dupuytren’s disease and advanced age, male sex, family history of Dupuytren’s disease, and diabetes mellitus. Furthermore, heavy alcohol drinking, cigarette smoking, and manual work exposure showed a significant dose-response relationship. The quality of the included studies was mainly low or moderate, and most studies were level 3 or 4 on the Oxford Centre for Evidence Based Medicine scale.

Conclusions:
The study results show a strong association between Dupuytren’s disease and advanced age, male sex, family history of Dupuytren’s disease, diabetes mellitus, heavy alcohol drinking, cigarette smoking, and manual work exposure. Further studies are required to explain the causal relationship of these associations.
Avoiding Inferior Alveolar Nerve Injury during Osseous Genioplasty: A Guide for the Safe Zone by Three-Dimensional Virtual Imaging
Authors: Lin Hsiu-Hsia , Denadai Rafael , Sato Nobuhiro , Hung Yi-Tan , Pai Betty C. J. , Lo Lun-Jou 
Published: September 2020

Background:
No consensus exists about the safest position for performing the osseous genioplasty, with 5 to 6 mm below the mental foramen being the most frequently recommended position. This study intends to generate a safe distance guide to minimize the risk of inferior alveolar nerve injury during osteotomy.

Methods:
Pretreatment cone-beam computed tomography–derived three-dimensional models from adult patients with skeletal class I to III patterns and cleft lip/palate deformity who underwent orthodontic-surgical interventions (n = 317) were analyzed. A three-dimensional vertical distance between the inferior margin of the mental foramen and the lowest point of the inferior alveolar nerve canal was measured in each three-dimensional hemimandible (n = 634). Statistical analysis was performed to generate the safe distance guide in a stepwise fashion at 95, 99, and 99.99 percent confidence levels.

Results:
Class III (4.35 ± 1.42 mm) and cleft lip/palate (4.42 ± 1.53 mm) groups presented significantly (p < 0.001) larger three-dimensional distances than class I (3.44 ± 1.54 mm) and class II (3.66 ± 1.51 mm) groups. By considering the 5- to 6-mm safe distance parameter, 6.4, 5.0, 10.6, 16, and 9.9 percent of hemimandibles were at risk of osteotomy-induced nerve injury in the class I, class II, class III, cleft lip/palate, and overall cohorts, respectively. Overall, the safe distance zone to perform the osteotomy was set at 7.06, 8.01, and 9.12 mm below the mental foramen, with risk probabilities of 2.5, 0.5, and 0.0005 percent, respectively.

Conclusion:
This study contributes to patient safety and surgeon practice by proving a safe distance guide for genioplasty.
Practical Strategies for Identifying and Managing Burnout in Plastic Surgeons
Authors: Santos Pauline Joy F. , Evans Gregory R. D. 
Published: September 2020

Background:
Physician burnout is a well-known problem and widespread issue in the field of medicine. Recently, more attention has been given to the significance of burnout among plastic surgeons. The cause of burnout is multifactorial, with emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment all playing a role. The objective of this article is to provide practical measures to help plastic surgeons in identifying the signs of burnout, thereby mitigating its consequences.

Methods:
A literature review was performed to determine the comprehensive findings of previous research conducted on burnout among plastic surgeons. Particular interest was given to successful tactics used in managing work-related stress. Wellness strategies and resources from both academic and private medical settings were also obtained to further review methods for burnout management.

Results:
There is a wide range of causes and risk factors for burnout among plastic surgeons. The majority of cases correlate with increased workload, loss of physician autonomy, and, in the context of trainees, lack of mentorship. Managing burnout can be supported by identification through survey tools. Establishing a wellness committee is also useful to develop institution-specific interventions. Equally as important, individuals must take steps to manage and minimize their burnout.

Conclusions:
This article provides practical strategies for institutions to identify and manage burnout among plastic surgeons. It is obvious that causes of burnout vary in different settings such as academic and community hospitals; therefore, it is critical for institutions to individualize their approach to burnout.
The Effect of Absorbent Pad Design on Skin Wetness, Skin/Pad Microclimate, and Skin Barrier Function
Authors: Koudounas Sofoklis , Abbas Shabira , Voegeli David 
Published: September 2020

PURPOSE:
The main aims of this study were to describe the effects of incontinence pad composition on skin wetness, the skin/pad microclimate, and skin barrier function. We also evaluated the potential utility of our methods for future clinical investigation of absorbent pad design.

DESIGN:
Single-blind, quasi-experimental, open cohort design.

SUBJECTS AND SETTING:
Twenty healthy older volunteers (mean age = 72.8 years, SD = 5.8 years; 8 male and 12 female) tested 2 absorbent pad types, with acquisition layers of different compositions (A and B) applied to different sites on the volar aspect of the forearms. One type A pad served as control (A dry) versus 3 pad samples wetted with 3 volumes of saline (A 15 mL, A 35 mL, and B 15 mL). The study was conducted within the clinical laboratory of a university nursing research group in the United Kingdom.

METHODS:
Skin barrier function was assessed by measuring transepidermal water loss (TEWL), stratum corneum (SC) hydration by corneometry, and skin surface pH using a standard skin pH electrode. Skin water loading (excess water penetration into the skin) was quantified by measuring TEWL and creating a desorption curve of the water vapor flux density. Calculating the area under the curve of the desorption curve to give skin surface water loss reflected excess water penetration into the skin. In a subgroup of the sample, the temperature and relative humidity (microclimate) at the interface between the skin and test pads were measured using a wafer-thin sensor placed between the skin and pad sample. Proinflammatory cytokine release from the SC was assessed using a noninvasive lipophilic film. The main outcome measures in this study were the differences in biophysical measurements of skin barrier function (TEWL, corneometer, and pH) before and after the application of the different pads.

RESULTS:
Mean ± SD baseline TEWL across all test sites was 10.4 ± 4.4 g/h/m2. This increased to 10.6 ± 3.8 g/h/m2 at the control site, 15.3 ± 6.3 g/h/m2 for the A 15-mL pad, 15.3 ± 3.9 g/h/m2 for the A 35-mL pad, and 15.6 ± 3.2 g/h/m2 for the B 15-mL pad. The mean baseline skin surface pH was 5.9 ± 0.04; cutaneous pH increased to a mean of 6.1 ± 0.06 following all pad applications (P = .16). Mean SC hydration remained unchanged at the control site (A dry). In contrast, SC hydration increased following the application of all wetted pads. Target cytokines were detected in all samples we analyzed. The IL-1RA/IL-1α ratio increased following pad application, except for the wettest pad.

CONCLUSION:
Study findings suggest that absorbent pad design and composition, particularly the acquisition layer, affect performance and may influence skin health. Based on our experience with this study, we believe the methods we used provide a simple and objective means to evaluate product performance that could be used to guide the future development of products and applied to clinical settings.
Healing Rates of Venous Leg Ulcers Managed With Compression Therapy
Authors: Rajhathy Erin M. , Murray Heather D. , Roberge Veronica A. , Woo Kevin Y. 
Published: September 2020

PURPOSE:
The purpose of this study was to explore average time to heal for patients with venous leg ulcers (VLUs) receiving standard of care that included compression and advanced wound dressings.

DESIGN:
Secondary analysis of an existing electronic database.

SUBJECT AND SETTINGS:
A convenience sample consisting of 1323 patients with VLUs from various community care sectors (homecare and clinics) across Canada.

METHODS:
The Wound Studies database used in the analysis consisted of data from 6 studies conducted prospectively between 1999 and 2009 in which the treatment and delivery of care for all lower leg ulcers (venous, arterial, and mixed) in Canada was examined. From these studies, only patients with VLUs, with an ankle-brachial pressure index of greater than 0.8, and surface area measurements of the ulcers at baseline, 3 months, and 6 months were included. Descriptive statistics were used to determine the proportion of patients who achieved closure at 3 and 6 months and explore the weekly and monthly healing rates for those who did and did not achieve closure. Logistic regression analysis was performed to identify predictive factors for healing.

RESULTS:
A total of 777 patients (mean age 69 years) met inclusion criteria. The proportion of patients who achieved closure at 3 and 6 months was 42.2% and 48.6%, respectively. Of the participants who achieved wound closure, monthly mean healing rate, measured by percentage of reduction in surface area, was 33.4% (0.56 cm2, SD 1.4 [median 0.15 cm2]) through month 3, and 31.0% (0.70 cm2, SD 1.6 [median 0.08 cm2]) through month 6. The overall monthly surface area reduction was 30%.

CONCLUSION:
Study findings suggest a monthly surface area reduction of 30% provides a baseline healing rate for VLUs managed with compression therapy and advanced dressings. Findings also suggest standard of care is not sufficient for healing in over 50% of the population, as the proportion of those who achieved closure at 3 and 6 months was 42.2% and 48.6%, respectively.
Broadening Our Bandwidth
Authors: Engels Dawn , Austin Melody , Doty Sherry , Sanders Karen , McNichol Laurie 
Published: September 2020

BACKGROUND:
Managing patients during the coronavirus disease-2019 (COVID-19) pandemic, and the associated severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) in particular, required the nimble responsiveness for which WOC nurses are known. Problem-solving skills were needed to continue the level of WOC nursing services expected by patients, families, and professional colleagues, while reducing the hours we were physically present at our clinical facility. In order to respond to these demands, our team realized it must create an innovative approach to provide efficient, cost-effective consultations during this global crisis. This Challenges in Practice article summarizes our experience with use of telemedicine technologies to perform remote consultations within the acute care setting.

CASES:
Case 1 was a 52-year-old woman with a history of paraplegia. She had several pressure injuries but had not received topical care for these wounds prior to admission. A consultation for the WOC nurse was requested and performed via telehealth services on a day our team was working off-site. This case illustrates the process our team used to perform a virtual consultation and demonstrates how the use of images placed in the electronic medical record aided in developing an effective plan of care. Case 2 was a 48-year-old man who tested positive for COVID-19. He developed bilateral unstageable pressure injuries on his cheeks after being placed in the prone position for a prolonged period while critically ill. This case describes multiple technologic platforms used for telemedicine consults in a patient with COVID-19 requiring isolation.

CONCLUSIONS:
Remote consultation by WOC nurses was possible in our healthcare system because of previous experience using telemedicine technology and well-established collaborative relationships with providers and bedside nurses. By expanding our use of telemedicine technology, we were able to provide ongoing care to a patient without COVID-19 who had WOC consultation needs, and a patient with strict isolation demands due to COVID-19.
Vent-Lock: A 3D Printed Ventilator Multiplexer to Enhance the Capacity of Treating Patients with COVID-19
Authors: Xun Helen , Shallal Christopher , Unger Justin , Tao Runhan , Torres Alberto , Vladimirov Michael , Frye Jenna , Singhala Mohit , Horne Brockett , Yesantharao Pooja , Kim Bo Soo , Burke Broc , Montana Michael , Talcott Michael , Winters Bradford , Frisella Margaret , Kushner Bradley , Sacks Justin M. , Guest James K. , Kang Sung Hoon , Caffrey Julie 
Published: September 2020

ABSTRACTMechanical ventilators are essential to patients who become critically ill from acute respiratory distress syndrome (ARDS), and shortages have been reported due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We utilized cost-effective, on-demand 3D printing (3DP) technology to produce critical components for a novel ventilator multiplexer system, Vent-Lock, to split one ventilator or anesthesia gas machine between two patients. FloRest, a novel 3DP flow restrictor, provides clinicians control of tidal volumes and positive end expiratory pressure (PEEP), using the 3DP manometer adaptor to monitor pressures. We tested the ventilator splitter circuit in simulation centers between artificial lungs and used an anesthesia gas machine to successfully ventilate two swines. As one of the first studies to demonstrate splitting one anesthesia gas machine between two swines, we present proof-of-concept of a de novo, closed, multiplexing system, with flow restriction for individualized patient therapy. Our studies underscore that while possible, ventilator multiplexing is a complicated synergy between machine settings, circuit modification, and patient monitoring. Consequently, ventilator multiplexing is reserved only as a last emergency resource, by trained clinicians and respiratory therapists with ventilator operative experience.
Nasopharyngeal SARS-CoV2 viral loads in young children do not differ significantly from those in older children and adults
Authors: Madera Sharline , Crawford Emily , Langelier Charles , Tran Nam K , Thornborrow Ed , Miller Steve , DeRisi Joseph L 
Published: September 2020

AbstractThe role of children in the spread of the SARS-CoV2 coronavirus has become a matter of urgent debate as societies in the US and abroad consider how to safely reopen schools. Small studies have suggested higher viral loads in young children. Here we present a multicenter investigation on over five thousand SARS-CoV-2 cases confirmed by real-time reverse transcription (RT) PCR assay. Notably, we found no discernable difference in amount of viral nucleic acid among young children and adults.
DNA methylation patterns and disease activity in a longitudinal cohort of lupus patients
Authors: Coit Patrick , Ortiz-Fernandez Lourdes , Lewis Emily E. , McCune W. Joseph , Maksimowicz-McKinnon Kathleen , Sawalha Amr H. 
Published: September 2020

AbstractEpigenetic dysregulation is implicated in the pathogenesis of lupus. We performed a longitudinal analysis to assess changes in DNA methylation in lupus granulocytes over 4 years of follow up and across disease activity levels using 229 patient samples. We demonstrate that DNA methylation profiles in lupus are influenced by ancestry-specific genetic variants and are highly stable over time. DNA methylation levels in two CpG sites correlated significantly with changes in lupus disease activity. Progressive demethylation inSNX18was observed with increasing disease activity in African-American patients. Importantly, demethylation of a CpG site located withinGALNT18was associated with the development of active lupus nephritis. Differentially methylated genes between African-American and European-American lupus patients include type I interferon-response genes such asIRF7andIFI44, and genes related to the NFkB pathway.TREML4, which plays a vital role in toll-like receptor signaling, was hypomethylated in African-American patients and demonstrated a strongcis-meQTL association.
Improved symptoms following bumetanide treatment in children aged 3 to 6 years with autism spectrum disorder via GABAergic mechanisms: a randomized, double-blind, placebo-controlled trial
Authors: Dai Yuan , Zhang Lingli , Yu Juehua , Zhou Xin , Ji Yiting , Wang Kai , Du Xiujuan , Liu Xin , Tang Yun , Deng Shining , Langley Christelle , Li Weiguang , Zhang Jun , Feng Jianfeng , Sahakian Barbara J , Luo Qiang , Li Fei 
Published: September 2020

AbstractWith the drug therapy for the core symptoms of autism spectrum disorder (ASD) currently limited, here we reported a randomised, double-blind, placebo-controlled trial to investigate the efficacy, safety, and potential neural mechanism of bumetanide in children with ASD aged 3 to 6 years old. In this trial, 120 children with ASD were 1:1 randomly assigned to receive 0.5 mg bumetanide or placebo orally twice daily for 3 months. The primary outcome was the score reduction of Childhood Autism Rating Scale (CARS) and the secondary outcomes were the score of Clinical Global Impressions (CGI) Improvement scale (CGI-I) at 3 months and the change from baseline to 3-month in Autism Diagnostic Observation Schedule (ADOS). Magnetic resonance spectroscopy (MRS) was used to measure γ-aminobutyric acid (GABA) and glutamate neurotransmitter concentrations in the insular cortex (IC) before and after the treatment. As compared with the placebo, bumetanide treatment was significantly better in reducing severity. No patient withdrew from the trial due to adverse events. The superiority of bumetanide to placebo in reducing insular GABA, measured using MRS, was demonstrated. The clinical improvement was associated with the decrease in insular GABA in the bumetanide group. In children with predominantly moderate and severe ASD, the treatment of bumetanide at a dose of 0.5 mg twice daily attenuated the core symptoms, as compared with placebo, with few adverse events. The neuroimaging data demonstrated that bumetanide decreased GABA levels in insular cortex, which was associated with symptom reduction.